CARE HOMES FOR OLDER PEOPLE
Albion Park House 7 Albion Hill Loughton Essex IG10 4RA Lead Inspector
Sharon Thomas Unannounced 19th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Albion Park House Address 7 Albion Hill, Loughton, Essex, IG10 4RA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 508 4172 0208 508 4172 Mr Mark Bowman Mrs Joanne Tier Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (OP) 19 Both of places Dementia - over 65 years of age (DE(E)) 10 Both Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age (not to exceed 19 persons) 2. Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 10 persons) 3. The total number of service users accommodated must not exceed 19 persons 4. No more than three persons may attend the home on a daily basis in addition to those 19 accommodated 5. The registered provider must consult with the existing service users and staff every three months on the daily attendance at the home of non-resident persons. The registered provider must respond according to the wishes and feelings of service users in respect of non-resident persons attending the home daily. Copies of the minutes of these meetings must be forwarded to the Commission. Date of last inspection 3rd November 2004 Brief Description of the Service: Albion Park House is a detached, two story, older style property, situated in a residential area near to Loughton town centre in Essex. The home is registered to provide residential care for 19 Older People (over the age of 65, 10 beds for residents with dementia).The home does not provide nursing care. The reisdents live in one double and seventeen single bedrooms. The communal rooms include two dining areas, and two lounge areas. The grounds around the property have been developed to provide additional access and facilities for residents. The home has wheelchair access via the extension. Due to the location of the house: on a steep hill, only the front garden is accessible to residents at present. The home provides 24 hour personal care and support to service users with varying levels of need. The home is well decorated and offers a homely atmosphere to the service users living there. The home is well designed to meet the needs of the current service users. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 19th April 2005, and took place over 6 hours. Thirteen of the thirty eight National Minimum Standards were inspected: Seven were met, four were nearly met and three were not met. For the purpose of this report the individuals living in the home spoken with on the day stated that they would prefer to be referred to as residents. During the course of the inspection four residents, three staff members, and a district nurse were spoken with. It was difficult to gain information from many of the other residents, however, there was an opportunity to spend a considerable period of time observing the care being given A tour of the premises was completed, care and staff records, and documentation relating to Health & Safety, were inspected on the day. The acting manager was available for the inspection. On the day of the inspection, the home was seen to be homely and domestic in appearance, there was no evidence of any unpleasant odours. The residents made positive comments throughout the day on the care that they receive in the home. What the service does well:
The service works well at ensuring that the home is decorated to a good level and is homely in nature. Residents healthcare needs are closely monitored and speedy referral is made to appropriate healthcare professionals as required. The district nurse spoken with reported that the staff were able to follow advice, and that the staff regularly contacted the GP and district nurses to refer for treatment. The food provided by the home (as evidenced by the menus) is varied and nutritious. Residents confirmed that the food is “good” “appetising” and “more than enough”.
Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 6 The residents living in Albion Park House benefited from an established and knowledgeable staff group who gave sensitive and professional care. The staff have an in-depth knowledge regarding the needs of the individual residents, particularly with the issue of dementia. The routines in the home are as flexible as possible and are changed to the meet the varying needs of the residents. Relatives and visitors are welcomed into the home and residents felt that the home done everything possible to make sure that their relationships were maintained. The environment in the home was considered safe and well maintained. The home had a warm and homely feeling. The residents spoken with on the day reported that they felt “warm and comfortable” and “at home”. What has improved since the last inspection? What they could do better:
The information held on files about residents and assessments regarding risk needs to clearly document the care being given by staff so that all care is appropriate and is given safely. The individual information needs to include all aspects of the care that is needed by the resident, and the information must be clear to staff so they are provided with detailed guidance. The home and staff would benefit from a formal staff training and development programme. A record of the training that is provided would enable the manager to identify gaps in training and develop the staff team to their full potential.
Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 7 The home’s policies and procedures regarding the Protection of Vulnerable Adults are to be developed to ensure the ongoing protection and safety of the residents. The policies and procedures need to give staff clear information of what steps to take if an allegation of abuse is made. The home’s policies and procedures are be developed to provide updated and appropriate information to residents and staff. This would enable staff to take the correct course of action in any given situation. The registered manager has been on maternity leave and it is not clear whether the manager will return to the home. The manager is offering telephone support to the acting manager. The home will need to ensure that a full time manager is in the home to oversee the care that is given and to ensure that the home is meeting the National Minimum Standards. 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. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, & 9. The home did not receive all of the appropriate information required prior to admission. The lack of information may result in the inappropriate admission of a resident. The home is able to meet the needs of all of the residents, including those with dementia. EVIDENCE: The care plan sampled was that of the newest admission into the home. It contained a social services assessment. On further examination of the care plan it was noted that the assessment was created for the care provided in the community and was not relevant to residential care. There was evidence that the resident and their family were involved in the care planning process. The home provides specific care for residents with dementia and there are close links with specialist services that support the needs of residents with dementia. Albion Park House provides social activity that is tailored to the needs of residents with dementia. Albion Park House does not provide intermediate care.
Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 10 Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8. Overall the health care needs of the residents are being promoted and maintained in the home. Evidence examined indicated that the home’s care planning systems remains insufficient. The residents care needs were not fully identified, planned for, or monitored in an appropriate manner. The shortfalls identified have the potential of placing resident at risk. EVIDENCE: Three care plans were examined and lacked detailed and appropriate information. One care plan did not provide information regarding the full range of care needs as set out in the Social Services assessment. While one care plan did not record the changing healthcare needs of the resident. Care plans were reviewed on a regular basis, but contained no evidence that residents or representatives were involved in the care planning process. In the three files sampled individual care plans contained clear detail and instruction for the delivery of personal care for residents. Oral healthcare was not detailed in any of the care plans. Routine health checks offered such as optician, dentist, and podiatrist were documented. The home provided residents with access to aids and equipment to address their healthcare needs and issues.
Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 12 As previously noted, the District Nurse available for comment, stated that the standard of care provided at Albion Park House was good, that the staff were experienced and responsive to instruction from healthcare professionals and they would recommend the home. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &15. Residents lifestyle within the home addressed their social, spiritiual and recreational needs. Residents experience of living in Albion Park House matched their expectations and preferences. Residents received a varied, nutritional and balanced diet that also addressed specific individual need. EVIDENCE: The residents spoken with confirmed that the routines in the home were flexible and took account of the needs of individuals. The home provided the residents with a programme of daily activity. The residents confirmed that the activities provided in the home were suitable and one resident reported that “the entertainment is enjoyable”. Evidence examined indicated that the home provides specific, appropriate activity for residents with dementia. From discussion with residents and staff and examination of the menu’s it was clear that the home provided a wholesome and well-balanced diet. Care plans indicated that special dietary needs were provided for. Resident comments were positive with regard to the quality and quantity of meals and snacks provided. Residents were observed eating in the dining room, communal areas and in their rooms if preferred. Assistance was provided if required. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 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 standard(s) 16 & 18 The home did not have a fully effective complaint system in operation. The home did not have a clear or robust system in place that ensured the protection of residents in the event of an allegation of abuse. EVIDENCE: Albion Park house had a clear and informative Complaint Procedure that was on display in the foyer of the home. The complaint log was examined and one new complaint had been recorded since the last inspection. The issue regarding this complaint was recorded, however the action taken and the outcome of the complaint was not recorded. Evidence of the action and the outcome of this complaint was found on the individual care plan but the information had not been transferred to the log. Residents reported that they were not aware of a Complaint procedure but were very clear and confident regarding who to report a complaint to. The home had a clear and comprehensive Protection of Vulnerable Adult (POVA) policy available to staff. The home did not have any formal guidelines to advise staff on the procedure to take in the event of an allegation of abuse being made. Albion Park House did not have a Whistle blowing policy available to staff. The home had no allegations of abuse to date. Evidence seen on the day confirmed that the home had a planned programme of training for staff on the issue of the Protection of Vulnerable Adults, the first training date was planned for late April. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19. The residents in Albion Park House live in a safe, well - maintained, clean and comfortable environment. EVIDENCE: The home employed ancilliary workers Monday to Friday with some minor domestic duties being carried out by carers over the weekend. There were no offensive odours present in the main body of the house, though one service user’s bedroom carpet was in need of cleaning and this had already been identified by the home. The residents spoken with reported that the home was “warm and clean” and “usually smelled very nice”. Most staff members had received training in Infection Control and the inspector recommended that this knowledge should be cascaded through the remainder of the care staff. The laundry area in the home is located away from the communal areas and residents bedrooms. Although small it contained appropriate equipment and washing facilities. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30. Albion Park house employed a sound base of experienced staff. The home benefits from a good rate of staff retention resulting in a cohesive and experienced care staff team. The staff in the home are provided with a comprehensive training programme. EVIDENCE: The staff rota indicated that the previously agreed staffing levels were being maintained. The home has a high number of highly dependent residents and an assessment of need and a calculation of staffing numbers would ensure that the staffing levels are appropriate. The home’s manager was on maturnity leave and the acting manager has been providing care hours as well as hours for management duties. The acting manager has not been supported to undertake her managerial duties that has resulted in the increase in the number of requirements raised on this inspection. The staff spoken with had a sound knowledge of the needs of the residents in their care. They were committed and motivated to providing quality care but their comments suggested that they did not appreciate the degree of paperwork involved in their role. One member of staff stated that they “would rather care for the staff than to have to fill out so much paperwork, while another commented that “doing the paperwork took up too much time”. The majority of comments made by residents regarding staff were positive and complimentary. The residents spoke warmly about the “patience of the staff” and reported that “the staff always have time for me, even when they are busy”. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 17 Albion Park House did not have a formal written staff training programme. Other evidence seen indicated that appropriate training was being provided on a regular basis. The staff spoken to stated that they were enjoying the range of training now being provided by the home. The staff were both willing and committed to undertaking any training provision. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35. The home has a clear system for measuring if it is meeting the needs of individual residents. The residents financial interests are safeguarded in the home. The staff in the home are not appropriately supervised. EVIDENCE: Evidence examined indicated that the home has a comprehensive process for measuring the quality of the service provision. Anonymous surveys are given to residents and relatives, the results are analysed, and changes are made as required. The personal allowances of four residents were examined and found to be accurate and well - maintained. The home does not act as appointee for any resident. All monies held in the home were held in secure facilities. The acting manager confirmed that the home did not provide any form of formal supervision for staff.
Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 19 The residents commented on the acting manager and three stated that the acting manager was “kind” and “friendly”. They stated that they missed the registered manager and were looking forward to her return. Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 x x 2 x 3 x x x Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) (a) (b) Requirement Timescale for action 31.05.05 2. OP7 13 (4) 15 (1) & (2) 3. 4. 5. OP8 OP16 OP18 12 (1) 17 (2) Schedule 4 12 (1), 13 (6) The registered person must ensure that pre-admission assessments contain appropriate information that is relevant to the residential care setting. 31.05.05 The registered person must ensure that resident care plans contain information on all aspects of care. The care plans must include a completed risk assesment. Care plans must be reviewed on a regular basis with the involment of the resident and/or representative. This is a repeat requirement.(03.11.04) The resident care plans must 31.05.05 include information with regard to oral care and hygiene. The registered person must 31.05.05 ensure that all complaints received are accurately recorded. 31.05.05 The registered person must ensure that the home has a robust system and guidance for staff, regarding the Protection of Vulnerable Adults. The registered person must ensure that all senior staff have the approriate training to deal effectively with this issue.
Version 1.30 Page 22 Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc 6. OP30 18 (1) (a) (i) 7. OP33 24 (1) (2) 8. OP36 18 (2) The regsitered person must ensure that the home has a formal staff training and development programme. Records of individual staff training must be held in the home. This is a repeat requirement. (31.12.04). The regsitered person must ensure that results of the Quality Assurance programme are published and a copy sent to the CSCI. The registered person must ensure that all members of staff are provided with formal supervision. 31.05.05 31.05.05 31.05.05 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 Good Practice Recommendations Albion Park House I56-I05 s17746 Albion Park House v222805 190405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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