Inspection on 03/10/06 for Alde House

This inspection was carried out on 3rd October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alde House 30/04/09

Alde House 02/05/07

Alde House 08/02/06

Alde House 22/06/05

Alde House 17/12/04

Alde House 06/07/04

Alde House 16/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Alde House Alde House Church Lane Penn High Wycombe Buckinghamshire HP10 8NX Lead Inspector Mrs Maureen Richards Unannounced Inspection 10:20 3 & 4 October 2006 rd th 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 Alde House DS0000022950.V307296.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. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alde House Address Alde House Church Lane Penn High Wycombe Buckinghamshire HP10 8NX 01494 813365 01494 814154 None available 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) Stumpwell Housing Association Limited Mrs Violet Bassam Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Alde House is a care home for older people situated in Penn, Buckinghamshire. It has fifteen places. The home was opened in 1972 and is managed by Stumpwell Housing Association Limited. The home has been adapted for its present use and comprises the original house and an extension. There is a large and pleasant garden to the rear with views over the surrounding countryside. The home is on two floors and there is a passenger lift to the first floor for service users with impairment of mobility. The home is mindful of its origins in Penn and priority is given to people who either live in the village, have lived there in the past, or still have family or friends in the area. The home endeavours to meet a range of needs and draws on the resources of health and social care professionals and other services in the local community as required. The fees range from £392 to £453 per week. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over two days. The key National Minimum Standards for older people were inspected. The inspection involved discussion with the manager, individual discussion with two service users and an informal discussion with a group of service users, brief discussions with two relatives and individual discussions with two staff, a tour of the communal areas of the home and four bedrooms, examination of some of the required records and observation of practices and staff interactions with service users. Two comment cards were received from relatives, none were received from the service users or professionals involved with the home. Two out of the three requirements from the last inspection have not been complied with and have been repeated at this inspection. What the service does well: What has improved since the last inspection? Some improvements have been made to medication practices. The complaints procedure has been updated. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 6 What they could do better: Service users care plans must be developed to ensure that service users needs are identified and met in a safe and consistent way. Health care records should be put in place to ensure that service users health needs are met and followed up on. Further improvements are required to medication practices to ensure the safety of service users. Planned activities should be displayed and made known to service users and records should be maintained of the activities that have taken place. The adult protection policy must be developed in line with interagency procedures and adult protection training must be made available to staff to promote this. The registered manager must liaise with the Fire Authority on the use of appropriate devices to keep doors open to allow service users safe access. The registered manager must ensure that safe staffing levels are maintained to meet service users needs and to allow for planned activities to take place. The rota should reflect the actual staff on duty. Recruitment practices must be improved to safeguard service users. Mandatory training must be made available to staff and records must be maintained to support this. The registered manager must ensure that requirements are met and the required records must be maintained, organised and accessible for future inspections. Monthly monitoring of the home must take place to ensure standards are being met and maintained and the quality audit should be developed and carried out annually. Formal one to one supervision of staff should be put in place, which covers discussion on all aspects of their role. Some improvements are required to health and safety practices to promote the health and safety of service users. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 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. Alde House DS0000022950.V307296.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 Alde House DS0000022950.V307296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessment documentation indicate that prospective service users are assessed prior to admission which ensures that the home is able to meet their assessed needs. EVIDENCE: At the time of the inspection the home had one vacancy and was considering referrals to fill that vacancy. The manager confirmed that prospective service users and or their families are invited to have a look around the home. The brochure of the home is either sent to prospective service users prior to the visit or given to them during their initial visit to the home. If the service user is interested in the vacancy they are asked to complete an initial enquiry and application form. On receipt of the completed application the manager carries out an assessment of the individual. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 10 A completed assessment document was seen which outlines personal details on the individual, the assistance required or not required in relation to personal care needs, mobility, communication and physical and mental heath needs. The assessment includes the date of admission, weight, dietary needs, any known allergies and reference to leisure interests. The manager confirmed that prospective service users are invited to the home for tea to meet other service users prior to moving in. All service users are admitted on a trial basis and the home does not accept emergency admissions. Alde House DS0000022950.V307296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service user plans must be developed to ensure service users assessed needs are met in a safe and consistent way. Service user healthcare needs are met but accurate records needs to be put in place to support this to safeguard service users. Further improvements are required to medication practices to promote the safety of service users. Service users privacy and dignity is promoted which benefits service users. EVIDENCE: Three service user plans were viewed at this inspection. The service user plans seen include a photograph and outline the key information for each individual. Service users plans outline individuals’ routines on waking, breakfast, routine on retiring to bed, daily routines and interests, social needs and relationships. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 12 However care plans lacked specific detail on how staff support service users to meet their personal care needs and how staff manage and support service users medical conditions. Issues identified on the assessment documentation particularly in relation to mental health needs was not referred to within the plan of care and where it was it did not outline how staff support individuals or manage the situation. Care plans did not include evaluation dates, evidence of written reviews or any indication of service users involvement. One service users daily progress sheets indicated a change in that individuals medical needs however the care plans was not updated to reflect that change. Service users plans included a moving and handling assessment and a separate risk assessment in relation to falls. However the moving and handling assessment indicated that staff assistance was required but was not specific as to what this assistance was. Risk assessments did not show evidence of review and in some instances did not include review dates. Risk assessments were not in place to address other risks posed by individuals in relation to their medical or mental health needs. A requirement was made at the inspection in February 2006 that the registered manager is required to address weaknesses in the home’s present system of care planning and care plan records. One of the files seen included a new care format that was to be introduced however this care plan lacked specific guidance for staff on meeting service users needs and did not include a care plan to address all of the key issues and needs identified in the assessment document. This requirement must be addressed. The manager confirmed that service users have access to a wide range of healthcare professionals. Service users are registered with local GP’s and a GP visits the home on a regular basis. The home is able to access the district nurse and Psychiatric input when required through the GP’s. The home has a visiting dental and chiropody service and service users attend audiology appointments and are supplied with the appropriate aids as required. At the time of the inspection the home had no service user with pressure sores. Any change in a service users health and the outcome of healthcare appointments is recorded in the service users daily progress notes. It was difficult to track from those records if service users healthcare needs were met and on occasions changes in health needs were identified but then did not appear to have been followed up or medical advice sought. Separate health care records should be put in place to ensure that service users healthcare needs are met and that changes in health needs are addressed and medical intervention sought if required. None of the current service users are self medicating. Named staff are responsible for the administration of medication and those individuals are indicated at the front of the medication administration records. The registered manager is responsible for the ordering, receipt and disposal of medication. The manager confirmed that all staff responsible for the administration of medication have completed a distance learning medication course. She confirmed that new staff would be supervised and assessed by her prior to Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 13 administering medication. A record would need to be maintained to confirm this assessment has taken place for new staff. The medication administration records showed no gaps in administration and changes to medications or handwritten medication was signed by two staff. In one service users medication administration chart the medication was prescribed to be taken daily. This medication was not being administered. The manager advised it was to be administered when required therefore the medication administration record need to indicate that. The home has a controlled drug which is stored and recorded appropriately. During the inspection it was noted that the staff member administering medication was dispensing medication for two service users at the same time. This is unsafe practice that puts service users at risk. It was addressed with the staff member during the inspection and this must be followed up and monitored by the registered manager. The home has a policy on privacy and dignity. Service users spoken with confirmed that staff respect their privacy and dignity and provide personal care in private. Service users wear their own clothes and are called by their preferred name. Service users plans outline the name the service users likes to be know as. The home does not have shared bedrooms. The home stores GP records for individuals. Those are stored in a box in the medication cupboard. This cupboard is accessible to staff responsible for medication administration. This should be discussed with the GP to ensure that records are stored in accordance, with data protection. Alde House DS0000022950.V307296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users have opportunities for activities but this needs to be developed to ensure that service users have a choice of activities made available to them. Family involvement is supported and encouraged to enable service users to develop and maintain family links and appropriate relationships. Service users are supported to make choices which promotes their self esteem and enable them to have some control over their lives. Service users are provided with varied, nutritionally balanced and good quality food which promotes their health and well being. EVIDENCE: Service users confirmed that they have the choice to join in activities, choose activities and choose meals, daily routines, relationships and particapte in religious services. Some service users plans identified service users leisure interests and hobbies. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 15 Service users confirmed that they felt there was a range of activities on offer and they can choose whether to take part in those activities or not. On day one of the inspection a group of service users went on a trip out in the local area and on day two of the inspection a group pf service users joined in scrabble. The home has input from an art student and evidence of this was displayed around the home. A comment card received from one visitor commented “that more could be done to provide greater intellectual stimulation for the service users”. The home does not have a record of what activities have taken place and who particapted and do not have up to date information displayed on what activities and events are forthcoming. Therefore it was difficult to assess if a range of activities is provided. This should be addressed. The manager confirmed that she has appointed a volunteer who will take on the role of activities organiser and it is hoped that this will promote more opportunities and different activities for service users. Service users and visitors confirmed that they are able to visit at any time. Service users have the option of seeing service users in their bedroom or in communal areas of the home and can choose whom they see and do not see. Visitors have the option of having a meal with their relative if they choose to. Service users are supported to make choices in relation to all aspects of life at the home. Service users are able to handle their own financial affairs or have the choice to involve family members with support on this. The home has information on advocates but at this inspection the home had no advocacy involvement for any individual. Service users are able to bring personal possessions into the home and service users bedrooms reflect this. Service users have three meals a day with tea, biscuits or cake provided in the morning, in the afternoon and late evening. The cook plans the menu taking into account service users likes, dislikes, specials diets and seasons. Service users are provided with a range of fresh vegetables and fruit daily. The menu seen indicate a varied and well balanced diet. Service users can have an alternative to what is on the menu if they wish and this was evident during the inspection. Service users and relatives commented that the food provided was excellent. The food was well presented in sufficient quantities and the meal time was relaxed. Alde House DS0000022950.V307296.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has a complaints policy and procedure in place, which ensures that complaints are acknowledged, investigated and concluded. The homes adult protection policy is not in line with interagency procedures and staff do not have up to date training in abuse awareness which potentially puts service users at risk. EVIDENCE: The pre inspection questionnaire indicated that the home has had no complaints since the last inspection and no complaints have been received by the Commission. During the inspection one service user raised an issue of concern to the inspector and the manager. The manager commenced the process of addressing this issue and the outcome of this will need to be recorded. Service users confirmed that they knew who to talk to if they had any concerns or complaints. A recommendation was made at previous inspections for the complaints procedure to be reviewed to ensure compliance with the standard. The complaints procedure has now being updated to take account of this recommendation. The home has a log of compliments on file which indicates relatives thanks for the care given and individual’s satisfaction with the quality of care. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 17 The home has a whistle blowing and adult protection policy in place. The adult protection policy indicates that all reports of abuse should be immediately investigated and acted on by the person in charge. It outlines that if the suspected victim do not want the incident taken further then their wishes should be respected and social service will only be informed if the service users consent has been received. This is not in line with interagency safeguarding adults procedures and must be addressed as a priority. The home does have a copy of the interagency adult protection procedures available and the manager was not aware of who the adult protection manager is. The manager confirmed that she facilitates adult protection training for the staff team however she has not recently attended adult protection training and is not clear of interagency procedures. The training records indicate that some staff had adult protection training in February 2005. The manager confirmed that this training is scheduled to take place in November and this must be facilitated by a person trained to deliver this training. Staff spoken with confirmed that they would report any allegation of abuse and poor practice. The home has had no protection of vulnerable adults investigations in the last twelve months. Alde House DS0000022950.V307296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is well maintained, clean and homely to benefit service users. Areas of the home are difficult to access for service users with walking aids and a safe system for propping doors open must be put in place to ensure the safety of service users. EVIDENCE: The home is accessible and generally well maintained. The home has a maintenance man on site three days a week and maintenance issues are addressed as they arise. The home has a large garden to the rear, which is well maintained. Bedrooms are decorated as they become vacant and in some instances new carpets are fitted. Four bedrooms were viewed at this inspection and the bedrooms seen were found to be nicely presented, clean and personable. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 19 During the tour of the environment one service user was looking for a wedge which, she indicated she usually has to wedge her bedroom open to make access to and from her bedroom with a frame easier. This bedroom was adjacent to a fire door in the corridor, which opened back onto the bedroom door and made access even more difficult. The door into the lounge opens inwards and people entering the lounge are unable to see if anyone is approaching the door. During the inspection one service user was walking towards the lounge door with a walking frame when the lounge door opened towards her which potentially put her at risk of falling. Those issues must be addressed as a priority and advice must be sought from the fire authority on the use of any door holding devices. A requirement was made at the previous inspection that the registered manager is required to obtain the opinion of the fire authority with regard to holding bedroom doors open. The manager confirmed she had done this but the service user who’s door was wedged open at the previous inspection had since died and this was no longer an issue. During the tour of the environment, a wedge was found in the kitchen and in an empty bedroom. A service user also advised that the door from the dining room to the corridor leading to the kitchen is usually wedged open but was not wedged open during this inspection. The manager must ensure that wedges are not used in the home to prop doors open. The home has a separate laundry and systems are in place to deal with clinical waste. The home has two domestic staff and the home is cleaned to a high standard. Service users and relatives were very complementary of this. Alde House DS0000022950.V307296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Adequate staffing levels are not provided to meet service users needs, resulting in staff not employed in care role taking on this role, which could affect the well being of service users. Some staff have obtained a care qualification however staff files do not indicate that staff have the required mandatory training to meet service users needs which could affect the safety and well being of service users. Recruitment practices are unsafe which potentially puts service users at risk. EVIDENCE: The rota indicates that there is generally two staff on each day time shift with the occasional shift where there is three staff on duty. The home has one waking night staff member and one sleep in staff member. The manager covers shift as and when required but she is not included on the rota to indicate the actual shifts she is scheduled to work or has worked. The rota seen did not always indicate two staff were on duty and did not include names of some of the agency staff that were used. The home has no care staff vacancies but is using agency to cover maternity leave and sickness. The home has a deputy manager’s vacancy and continues to make attempts to recruit into this vacancy. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 21 The home has separate domestic and catering staff and the manager get some administration support on a part time basis. The home has no staff under 21 years of age. Staff spoken with felt the staffing levels were sufficient to meet service users needs. Some service users commented that there has been more different staff on shift but felt that staff were available when required to assist them. During the inspection the service users went out for a drive with staff. The maintenance man was sent as the staff escort. This is not part of his role and is not outlined within his contract of employment. The manager advised she had made the decision to send the maintenance man as she had intended to go but due to the inspection felt unable to do this and the alternative would have been to cancel the trip. The manager must ensure that sufficient care staff are rostered on duty to meet service users needs and planned activities. The home has three out of nine carers with an National Vocational Qualification level 2 and other staff have been identified to go on this training. Five staff files were viewed at this inspection and a further staff file for the driver was requested but was not available. This must be made available. The five files seen included an application form, terms and conditions and confirmation of criminal records disclosure check. Three of the files contained two written references and the other two files only had one reference on file. None of the staff files included proof of identity as outlined in schedule 2. The home uses agency staff to cover vacancies and have obtained a profile from the agency on each staff member supplied, however on day one of the inspection the home had used a different agency to cover a shift and no information had been obtained from the agency on that individual. This is unsafe practice that puts service users at risk. A requirement was made at the inspection in February that the registered manager is required to ensure that staff files contain the information listed in schedule 2. This has not been complied with. The home has a training programme in place, which includes dates for mandatory training courses. The manager confirmed that new staff receive in house induction training and are expected to work through the social skills council workbook. The newest staff member had not yet commenced this workbook and had covered some aspects of the in house induction. All new staff are not included on the staff rota and as part of their induction shadow and work alongside experienced staff. The staff member confirmed this. The training records of the staff files seen indicate that only one staff member have up to date mandatory training. The manager disputed this but the certificates of training and individual training records were not available and updated to indicate otherwise. The training records were generally disorganised, information not filed and not kept up to date. The home uses agency staff to cover vacancies. One agency has included training certificates for each staff member. The manager must establish with Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 22 the agency if the health and safety training covers first aid and fire training as this would be required for agency staff working on waking night shifts within this service. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staff and service users feel the home is well managed however the required records are not adequately maintained and available to support this to ensure that all aspects of the home is well managed to benefit service users. Effective quality monitoring is not taking place to ensure that the home is meeting standards and to ensure that a high standard of care is maintained for service users. Systems are in place to ensure that service users financial interests are safeguarded. Formal supervision of care staff should be developed to ensure that staff are appropriately supervised to promote good practice, promote the philosophy of the care in the home and are adequately trained to benefit service users. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 24 Some improvements are necessary to health and safety practices to ensure the health and safety of service users. EVIDENCE: Staff confirmed that they feel the home is well managed and that the manager is available to offer support as required. The home does not have a deputy manager and the manager confirmed that she had difficulty in being able to find the time to update the required records and keep on top of the administration tasks, whilst supporting care staff and working on shift. Tasks are not delegated to care staff and they are not involved as keyworkers or in care planning. The manager has not complied with all of the requirements from the previous inspection and those requirements have been highlighted within the report. The required records as outlined within the report are not up to standard or in some cases were not available and some were disorganised and difficult to access. The manager confirmed that the Registered Provider carries out monthly Regulation 26 monitoring visits, however he has recently being unwell and this has not taken place. The last Regulation 26 report on file is dated 1st April 2004. This is unacceptable and the Registered Provider must ensure that monthly monitoring visits take place and copies of the reports must be maintained at the home. The registered manager confirmed that the home carries out a quality audit, which includes feedback from service users, visitors, family members and staff. The quality audit was completed in August 2006 and included feedback from three service users, one visitor, one family member and one staff member. This needs to be developed on. The home look after service users money as requested or required by service users and their families. The financial records for two service users were viewed. The home keeps a record of money in and money out and keeps receipts for all expenditure. The records seen were found to be accurate. The money and records are kept secure in the office and only the registered manager and the administrator have access to it. The pre inspection questionnaire indicates that the home does not act as an appointee for any service user. Standard 36 is not a key standard however a recommendation was made at the previous inspection that the registered manager establish a programme of personal supervision for care staff. Care staff files include a brief monthly record of supervision which identifies individuals training needs. This needs to be developed to cover aspects of practice, philosophy of care in the home and Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 25 career and development needs and to indicate that a formal one to one supervision session has taken place. Staff files were not updated to indicate if all staff had the required mandatory training as outlined under standard 30. The home has first aid boxes available but there was no log of contents and no record to confirm that the contents were checked on a regular basis. The home has two cooks who are responsible for the correct storage and preparation of food. This was well managed. The home has a maintenance man who is responsible for maintaining health and safety checks within the home and he carries out a visual monthly health and safety check with records maintained of checks. The records seen indicate that fire alarm tests and emergency lighting is checked and that fire drills take place regularly. The portable appliance equipment is tested and the lift, hoists and fire equipment services are up to date. The home has COSHH data sheets in place and risk assessments in relation to dealing with laundry and other up to date generic risk assessments are in place. The water at the home is thermostatically controlled and a check of water temperatures at the tank is carried out three monthly and the water temperature at the tap is checked annually. The home has accident records in place and accident records relating to service users are filed separately from staff accident records. One service user’s daily record indicated that she had recently had a near miss resulting in staff assisting her to the floor and using a hoist to lift her up. This was not recorded as an accident. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 26 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 1 8 2 9 2 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 1 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 2 x 2 Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement The registered manager is required to address weaknesses in the home’s present system of care planning and care plan records. (Previous timescale of the 30/06/06 not met) Medication must be administered in line with prescribed instructions. Staff must administer medication in line with procedures and training to safeguard service users. The adult protection policy must be developed in line with interagency procedures. All staff must have up to date adult protection training and this must be facilitated by an individual competent to deliver this training. The registered manager must liaise with the fire authority on suitable door holding devices to make access to areas of the home safer for service users. The registered manager must DS0000022950.V307296.R01.S.doc Timescale for action 31/01/07 2 3 OP9 OP9 13 13 30/11/06 30/11/06 4 5 OP18 OP18 13 13 31/12/06 31/12/06 6 OP19 23 30/11/06 7 OP19 13 & 23 30/11/06 Page 28 Alde House Version 5.2 8 OP27 18 9 OP29 19 10 OP30 18 11 OP33 26 12 OP38 13 ensure that door wedges are not used to prop doors open. The registered manager must ensure that sufficient care staff are rostered on duty to meet service users needs and planned activities. The registered manager is required to ensure that staff files contain the information listed in schedule 2. (Previous timescale of 08/02/06 not met) The registered manager must ensure that all staff have up to date mandatory training and training records must be updated and maintained to support this. The registered provider must carry out monthly monitoring visits of the home and make a copy of the report available to the home. Accident records must be completed for all service user accidents. 30/11/06 30/11/06 31/12/06 31/12/06 30/11/06 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 OP8 Good Practice Recommendations Separate health care records should be put in place to ensure that service users healthcare needs are met and that changes in health needs are addressed and medical intervention sought if required. A record should be maintained to confirm that new staff are assessed and deemed competent to administer medication. A record should be set up to record what activities have taken place and a programme of forthcoming events should be displayed and made available to service users. DS0000022950.V307296.R01.S.doc Version 5.2 Page 29 2. 3. OP9 OP12 Alde House 4. 5. 6. 7. OP18 OP27 OP33 OP36 8. OP38 The manager should access a copy of the interagency adult protection procedures and familirise herself with the procedure and key people to be informed. The rota should reflect the actual staff on duty and include the shifts and hours worked by the manager. The quality audit should be developed and carried out at least annually to include feedback from a larger sample of service users, staff, visitors, family and other professionals Supervision of care staff needs to be developed to cover aspects of practice, philosophy of care in the home and career and development needs and to indicate that a formal one to one supervision session has taken place. The manager should set up a system for checking the contents of the first aid boxes. Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Alde House DS0000022950.V307296.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!