Inspection on 26/01/06 for Aldbourne Nursing Home

This inspection was carried out on 26th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Aldbourne Nursing Home 20/02/07

Aldbourne Nursing Home 07/09/05

Aldbourne Nursing Home 03/03/05

Aldbourne Nursing Home 16/11/04

Aldbourne Nursing Home 26/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Aldbourne Nursing Home South Street Aldbourne Marlborough Wiltshire SN8 2DW Lead Inspector Steve Cousins Unannounced Inspection 26th January 2006 09:45 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 Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 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. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Aldbourne Nursing Home Address South Street Aldbourne Marlborough Wiltshire SN8 2DW 01672 540919 01672 540997 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) Aldbourne Nursing Home Limited Mr Robert Gaetan Montezuma Care Home 40 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (40), of places Physical disability (2), Terminally ill (2), Terminally ill over 65 years of age (2) Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users who may be accommodated in the home at any one time is 40 No more than a total of 2 service users with a terminal illness may be accommodated at any one time and these must not be less than 50 years of age No more than 2 physically disabled users between the ages of 18 and 64 years may be accommodated at any one time. The only service user who may be accommodated in the category DE(E) is the female service user named in the application dated 1st July 2004. Records, including care plans and risk assessments, must demonstrate that the care home is able to meet this service users mental health needs. In addition, the wellbeing of other service users must not be compromised. Only rooms 2, 3, 4, 7, 9, 10, 11, 17 and 19 may be used for double occupancy and no more than 2 double rooms may be occupied at any one time That the registered manager is on duty in the home in a managerial capacity for a minimum of 21 hours per week, over 3 days, That the deputy matron is on duty in the home in a managerial capacity for a minimum of 14 hours per week, over 2 days That these conditions of registration are formally reviewed on 1st March 2006 The minimum staffing levels set out in the notice of decision dated 18th April 2005 must be met at all times. 7th September 2005 5. 6. 7. 8. 9. Date of last inspection Brief Description of the Service: Aldbourne Nursing Home provides care with nursing for up to 40 people. The majority of these will be aged over 65. The home is also registered to care for some younger adults. At any time, there could be 2 people with physical disability, or 2 who are terminally ill. Some short-term care places are offered. The home is privately operated. The owners, Mr and Mrs Adey live nearby and have regular contact with the service. The registered manager is Mr Guy Montezuma. Registered nurses are on duty at all times, supported by care assistants. Catering, domestic, laundry, maintenance and administration services are also available. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 5 The home was purpose built in 1988 and has since been further extended. It is set in its own grounds in the village of Aldbourne, which offers various local amenities and is an attractive location. The large town of Swindon is only 10 miles away. Market towns such as Marlborough, Hungerford, Newbury and Wantage are all within driving distance and there are also easy connections to the M4 motorway. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Service users are known as residents in this home and will be referred to as such throughout this report. This unannounced inspection took place between 9.45am and 3.30pm on the 26th January 2006. There were 39 residents in the home. The findings from this inspection are based on a tour of the premises, speaking to residents, staff and relatives; and visiting frail residents. A number of records were inspected, including care plans and staff files. The findings were discussed with Mrs K Porter, the registered nurse on duty, at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Although care plans have improved overall, care needs to be taken to ensure that they fully reflect residents’ needs and wishes. The use of a wound assessment tool may enhance current wound care practice. Complaints need to be recorded more thoroughly and a meeting with relatives may be useful to discuss their views on staffing levels in the home. Staff recruitment procedures are generally satisfactory, however the recording of verbal references needs to improve. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 7 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. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 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 Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 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 the following standard(s): None reviewed. EVIDENCE: Standards 1,3 and 5 were reviewed at the homes previous inspection held on the 7th and 8th of September 2005 and found to be met. Standard 6 does not apply to this home. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 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 and 10. The standard of personal and health care delivered meets residents’ needs and they are treated with respect and their right to privacy is upheld. Some improvement is required to care planning to ensure that plans fully reflect residents’ needs and wishes. EVIDENCE: Care plans reviewed were generally a good reflection of residents assessed needs and had been updated regularly; however the use of a wound assessment tool may help staff to monitor wound care more effectively. Nutritional assessments are undertaken, which is an improvement on the findings of the previous inspection. A resident with diabetes did not have a care plan in place to direct care, or to monitor and review their condition and this was discussed with Mrs Porter for action. Clearer information needs to be recorded with regard to ‘end of life’ decisions for those residents whose health is deteriorating. Visits to residents confirmed that appropriate action was being taken to meet their needs and pressure relief equipment was in place as required. Frail residents appeared well looked after and they were having their personal hygiene needs met. Records indicated prompt response by staff to residents’ Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 11 health care needs. It was reported that a GP visits weekly and also sees all new residents on admission. Records indicated that other health care professionals had visited the home in order to address residents’ health needs. Residents spoken with were complimentary about the care they received. Comments included, ‘the staff are very nice to me’ and ‘I’m able to see the doctor when I want and the staff look after me’. Two relatives were also complementary about the care given to their relatives. Staff were indirectly observed respecting residents wishes and speaking to them in a friendly but appropriate manner. Privacy was respected, doors were closed whilst personal care was delivered and a staff member was seen to knock on a closed bedroom door and wait for an answer before entering. Twenty comment cards were received by the Commission, five from residents and fifteen from relatives. Residents comment cards indicated that they felt well cared for and that their privacy was respected. Relatives comment cards indicated an overall satisfaction with the care provided, and comments included ‘the staff are excellent’ ‘superb’ and ‘ a good home with friendly staff’. One relative however, felt that they were not always kept informed of matters affecting the resident. Some relatives comment cards indicated dissatisfaction with staffing levels and the handling of complaints and these issues are dealt with in the relevant sections of this report. Standard 9 was not fully assessed, however since the last inspection, records indicated that there had been an improvement in the recording of administered medications. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 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): 13 and 15. Residents are able to maintain contact with friends, relatives and the local community. The choice and variety of meals ensures residents receive a nutritious and balanced diet in pleasant surroundings. EVIDENCE: It was stated that there are no restrictions to visiting. Residents spoken to confirmed that they received visitors. Comment cards received indicated that relatives were able to visit in private and that they were welcomed into the home at any time. Links with the local community were in place via the Friends of Aldbourne Nursing Home group, who provide in-house and external activities. Residents also have access to religious services if they so wish. The food served at lunchtime appeared well cooked and nutritious and there was a choice available. The cook was aware of any residents who had special dietary needs. Residents were generally complimentary about the meals available and they are asked to choose from the menu in advance. The home has a large dining room and tables are attractively laid. Residents can eat in their own rooms if they wish. A staff member was indirectly observed supporting a resident to eat. They ensured that they were at the same level as the resident, did not rush them and gave them their full attention ensuring that they received adequate nutrition. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Systems are in place to ensure that complaints are dealt with however some improvement is required regarding how they are recorded. EVIDENCE: A complaints procedure is in place. Comments received indicated that not all relatives were aware of it. In a telephone conversation with Mr Montezuma, the registered manager, he reported that he was aware of this and had ensured that a recent newsletter had contained information regarding the complaints procedure. Comments from some relatives indicated that they felt their complaints and concerns were not always being recorded and this issue was also discussed with Mr Montezuma. One complaint had been received by CSCI and was investigated by the homes manager. The complaint had been dealt with promptly and to the satisfaction of the complainant. Residents spoken to said that they would either talk to the manager, matron or one of the staff if they had any problems. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,21,22,24,25 and 26 The home is clean, safe, comfortable and suitable for the needs of the residents. Specialist equipment is available where required. EVIDENCE: All residents’ accommodation and communal rooms are on the ground floor. The environment is pleasant and homely and furniture, fixtures and fittings are of a good standard. There are well kept grounds including an enclosed courtyard garden, which is wheelchair accessible. There is a large communal area in the central part of the building. This offers both lounge and dining room facilities. Also on the ground floor are a separate quiet lounge, and a conservatory. The home was purpose built as a nursing home. The corridors and rooms are accessible and mobility equipment and aids available. Toilets and bathrooms contain grab rails and manual-handling equipment is available. A call bell system is installed and was working at the time of the inspection. All residents’ rooms have an en suite toilet, along with either a bath or shower. An assisted bathroom is also available, if required. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 15 Further toilets for general use are provided close to the main communal area. There are separate sluice facilities. The bedrooms provide a comfortable amount of space, and full en-suite facilities. Telephone points are available in each. Those seen were decorated to a satisfactory standard and carpeted. Occupants were able to personalise their rooms as they wish. Adjustable beds were available. Guarded radiators heated rooms and hot water supplies were controlled. Those rooms seen had a mix of natural and artificial lighting and windows provided ventilation if required. The home was found to be generally clean and free from unpleasant odour, apart from one bedroom that was brought to Mrs Porter’s attention. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Residents needs appear to be met by the numbers and skill mix of staff but some relatives do not share this view. The homes recruitment practice protects the residents, however verbal references need to be fully recorded. EVIDENCE: Residents spoken to felt that there were enough care staff available and reported minimal delays in answering call bells. Staff were observed responding promptly to call bells. The care staffing levels on the day of this unannounced inspection appeared appropriate. A review of duty rotas indicated that the home was meeting the minimum staffing notice and that registered nurses were on duty at all times. Of the fifteen comment cards received from residents’ relatives, eight indicated that they did not think that there was always sufficient staff on duty. The inspector was unable to evidence this, however a meeting with relatives to discuss staffing levels may enable the manager to decide whether any changes are required. The records of staff recruited since the previous inspection were reviewed and included all the required documentation. Staff had not commenced work prior to a POVA check being obtained and all had undergone a CRB check. In one case references had not been obtained until one month after a person had commenced work, in this case verbal references had been obtained but not fully recorded. This is recommended in order to evidence recruitment practice. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 The registered manager is fit to run the home and is supported to do so effectively. EVIDENCE: The homes registered manager is Mr Guy Montezuma. Mr Montezuma’ was only available for a short period of time during this inspection. His previous role was as the homes general manager and he had also undertaken the registered managers role in the past. He is a registered general nurse who has a district nursing certificate, and a degree in business administration. Mrs Wendy Sheen, who is also registered nurse and the homes deputy matron, supports Mr Montezuma in his role. Although standard 38 was not fully assessed, fire safety arrangements were satisfactory. A tour of the home indicated that it was free from hazards to safety. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 19 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 OP7 Regulation 15 (1) Requirement The registered manager is required to ensure that a care plan is in place relating to the management of diabetes for the resident indicated during the inspection. The registered manager is required to ensure that a record is kept of all complaints made that include details of any investigation and action taken. Timescale for action 26/01/06 2 OP16 17 (2) Sch 4 (11) 15/02/06 Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP8 OP27 OP29 Good Practice Recommendations It is recommended that a wound assessment tool be used in order enhance current practice. It is recommended that clearer information be recorded with regard to ‘end of life’ decisions. It is recommended that a meeting with relatives be held to discuss staffing levels, in order for the manager to decide whether changes are required. It is recommended that when a verbal reference is obtained for a new staff member, full details be recorded. Aldbourne Nursing Home DS0000015884.V275057.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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