Inspection on 15/01/07 for Alderson Resource Centre

This inspection was carried out on 15th January 2007.

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

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

Other inspections for this house

Alderson Resource Centre 17/03/08

Alderson Resource Centre 31/01/06

Alderson Resource Centre 16/08/05

Alderson Resource Centre 17/11/04

Alderson Resource Centre 17/06/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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

CARE HOMES FOR OLDER PEOPLE Alderson Resource Centre Linnaeus Street Kingston Upon Hull East Yorkshire HU3 2PD Lead Inspector Angela Sizer Unannounced Inspection 15th January 2007 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000034408.V325769.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. DS0000034408.V325769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alderson Resource Centre Address Linnaeus Street Kingston Upon Hull East Yorkshire HU3 2PD 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) 01482 585166 judith.lawtey@hullcc.gov.uk Kingston upon Hull City Council Thetis Eastwood Care Home 26 Category(ies) of Dementia - over 65 years of age (17), Physical registration, with number disability (9), Physical disability over 65 years of of places age (9) DS0000034408.V325769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Alderson Resource Centre is a Local Authority provision with Hull City Council’s Social Services Department. It is a purpose-built establishment in a busy area of Anlaby Road, opposite the Hull Royal Infirmary. There is a bus route into and out of the city centre and further if necessary. The home is registered for up to 26 residents, 17 permanent beds are for Older People with dementia and there is a Stroke Unit situated upstairs offering support for up to 9 people who are subject to a physical disability. The home is on 2 floors, serviced by a passenger lift, and provides permanent accommodation and care for up to 17 service users and rehabilitation and care to a further 9 service users who are victims of a stroke and require intermediate care. The home has a dedicated stroke unit. There are 4 lounge/dining rooms, 4 bathing/showering facilities, and 8 WCs. There are internal garden areas, which are secure and provide seating and potted plants. The stroke rehabilitation unit, located upstairs has a treatment/therapy room, which contains specialist hoists and electronic moving beds and couches. The unit also has a rehabilitation kitchen. The home is equipped with the necessary and appropriate furniture, equipment and fittings. The home has GP and hospital services close by, as well as local pubs and some shops. The Local Authority own and run the home with some assistance from the Primary Care Trust. All new residents are given a service user guide explaining what the home will provide. The weekly fees are £672.00, this information was provided by the registered manager before the inspection visit. Additional charges are made for hairdressing, toiletries, transport and chiropody when private. DS0000034408.V325769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was part of the key inspection process and took place over one day and took a total of 7.5 hours. Prior to the visit surveys were posted out to; 13 residents and 4 were returned, 20 were sent to staff members and 9 were returned, 16 of the sent to health and social care professionals 4 were returned and 1 was sent to a care manager, this was not returned. The registered provider returned the pre-inspection questionnaire and this gave some details about the service including staffing levels and some information about the level of need the residents’ have. From this information the decision was made about which staff and resident files would be looked at. The previous requirements were discussed with the manager and a large number have now been met. During the visit several of the residents, two staff members and one relative were spoken to this was to find out what it was like for people who live here. A tour of the building was undertaken; some of the records looked at included the medication, complaints, accident/incidents, 3 resident files, 3 staff files and other paperwork relating to the maintenance of the home and the care of the residents. A discussion with the manager occurred regarding diverse needs and in particular how the residents are currently supported to follow their religion of choice and practise their faith. Training courses have being undertaken to ensure that all residents are treated equally and not excluded because of a diverse need. The registered manager was present throughout the inspection and was told how the inspection had gone at the end of the day. A meeting took place at the CSCI Hessle Office on 26.3.07 in order to discuss the draft report and comments from this have been included. The inspector would like to thank the residents, manager and staff for welcoming her into the home and contributing to the content of this report. DS0000034408.V325769.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home’s statement of purpose and service user guide has been updated ensuring that residents are fully informed about what they can expect when living in the home. Regular reviews are held with residents ensuring that any change in need is looked at. Some other documentation has improved including the care planning system, this is now clear and directive to staff. The residents who are on the Stroke DS0000034408.V325769.R01.S.doc Version 5.2 Page 7 Unit now have a daily living assessment undertaken with them to ascertain what their needs are and how the home can help them with personal care. The environment has improved in relation to the new radiators being fitted to the upstairs of the building, these are individually controlled. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000034408.V325769.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 DS0000034408.V325769.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are fully informed about what facilities and support are available within the home. The home’s statement of purpose does not reflect the range of needs residents’ may have and the lack of knowledge and training in relation to learning disabilities could prevent needs from being met. EVIDENCE: A discussion with the registered manager confirmed that the statement of purpose had been updated since the last inspection visit and this now includes details about the support offered by the Stroke Unit. It now describes what DS0000034408.V325769.R01.S.doc Version 5.2 Page 10 facilities, support, whether they may have to move rooms’ part way through their stay or how they can complain if necessary. From discussion with the residents in the stroke unit it was evident that they are now fully informed about the service user guide and it’s content. One person said, “My wife has read it and knows what to do if I had a complaint”. There is a complaints leaflet included in the service user guide and this gives clear details about how to complain if necessary. During the previous inspection visit several of the residents in the Stroke Unit expressed their views and concerns that they had come straight from hospital for rehabilitation having suffered a stroke, all of the residents could not praise the staff and home enough, but had been unsure about what to expect prior to coming. The registered manager stated that the home was trying to implement a new system where by a member of staff would go across to the hospital and introduce themselves to the prospective resident and talk to the person about any worries they may have, unfortunately this has not been fully implemented as yet. All permanent residents or their representative are given a copy of the service user guide upon admission. Permanent residents receive a statement of terms and conditions, and this describes what facilities, support, room to be occupied, food and fees payable. One paragraph stated “in some cases it may be necessary to allocate another room to you during your stay. The Registered Manager reserves the right to carry out this action as and when necessary”. This paragraph has been reworded to ensure that this procedure is only carried out in extreme circumstances. From speaking to the staff and manager about residents moving rooms it is apparent that this is usually undertaken with residents on the Stroke Unit, this has been made clear in the statement of purpose and service user guide. The manager stated, “Usually a resident is only moved if this is in their best interests, it may be that their needs have changed and this move would be part of their rehabilitation programme”. Permanent residents are subject to a full community care assessment and then the homes daily living assessment following admission. In addition to this the care staff also undertakes a daily living assessment, evidence was seen when looking at individual files. In relation to the Stroke Unit residents there is a good range of professionals located within the building and the medical support is very good, but there is a lack of multi-disciplinary working in relation to assessment and care planning documentation. From speaking to the staff members it was evident that they had a good understanding of the general needs of the residents and some had undertaken in relation to memory impairment, diabetes and mental health. During the inspection visit it was noted that two residents also have learning disabilities and one person had previously lived in a small cluster home for people with learning disabilities run by the Local Authority. The home is not registered to take people who have a learning disability and will need to apply for this category retrospectively. Although the statement of purpose did not contain DS0000034408.V325769.R01.S.doc Version 5.2 Page 11 information about how the home could meet these needs, the staff and manager had obtained some information about social interaction from other professionals involved. None of the staff had undertaken training in relation to learning disabilities and therefore had limited or no knowledge in this area. The home has a designated Stroke Unit, which is situated on the first floor of the building, and the aim of this unit is to offer rehabilitation and enable the residents’ to return home. Residents are only admitted for intermediate care, there is separate accommodation, facilities and staff to support the unit. The residents on the stroke unit undergo a medical assessment whilst in the hospital and then on the day of admission undergo further assessment from the Physiotherapist and the Occupational Therapist. DS0000034408.V325769.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health care and social needs are not always met. Errors were found in the recording of medication. Care plans are in place for all permanent residents, but not for the residents in the Stroke Unit, which may pose a risk that some care tasks are not undertaken. EVIDENCE: The registered manager with regard to the care planning system gave an update and she confirmed that a new system had been implemented. From looking at three of the residents’ files it was clear that there is a care plan in DS0000034408.V325769.R01.S.doc Version 5.2 Page 13 place for each permanent resident an that this identifies what their needs are and how these needs should be met. The permanent resident’s files now contain a bathing record, the manager explained that this had been implemented and staff are aware that they need to record when prompting and encouragement has been given and when a resident declines to take a bath/shower. Evidence to confirm that this had been carried out was found on the residents’ files. For the residents in the stroke unit the care plan is drawn up by the health team and instruction given to the care staff about how to assist the person, any rehabilitation techniques are carried out under the guidance of the Occupational Therapist or Physiotherapist. The residents on the Stroke Unit have a daily living assessment undertaken with them and this was confirmed by speaking to three residents. This information is not transferred into the form of a care plan, so there is little direction to staff with regard to care tasks. Risk assessments have been developed for lots of areas including smoking, aggressive behaviour, going missing, falling and many more, these are clear, descriptive and give direction to staff. Evidence was seen confirming that the residents receive regular healthcare checks for optical, chiropody, dental, nutritional screening is undertaken at the point of admission and residents’ are weighed on a monthly basis. The registered manager explained that this would be increased if a problem had been identified and appropriate professional advice would be sought. Charts for bowel movement, activities, bathing, sleeping, fluid intake have been developed. The home operates a key worker and evidence was seen confirming that regular monthly reviews take place. Some comments made by residents on the Stroke Unit included; “the staff are lovely”, “my wife can visit whenever she wants to”. The home has a new medication policy and procedure. A discussion with the registered manager occurred and she explained how the new system had been implemented. Upon inspection of the medication administration records (MAR) the recording was of a good standard with no gaps on the MAR sheets. The home is now carrying forward the amount of medication left at the end of the month, but unfortunately from the four records checked, three of them did not tally with what medication stock was in the building. There is a controlled drugs cabinet and a controlled drugs register, two staff always sign when administering the controlled medication. There is a refrigerator in the medication room and the temperature is recorded on a regular basis. The shift leaders administer the medication and two have attended the new accredited course run by the Local Authority, the remainder of the shift leaders are awaiting dates to undertake this training. The home does undertake a risk assessment with each resident with regard to self-administration; currently none of the permanent residents are able to self-medicate due to their level of DS0000034408.V325769.R01.S.doc Version 5.2 Page 14 memory impairment. Several of the residents on the Stroke Unit are selfadministering and have a locked metal medication cabinet situated in their bedrooms. It was clear from speaking to residents in the stroke unit that they felt their privacy was respected, one resident stated “the staff always knock before coming into my room”, “if I buzz they come quickly”, other comments included “it’s a great place and the staff couldn’t be any better, I have come here to recover after having a stroke and they couldn’t have been better”. The permanent residents who endure memory impairment were less able to verbalise how they felt, but from observation their non-verbal behaviour suggested that they were content in their surroundings. Interaction between staff and residents was observed and staff carried out their duties in a professional and caring way. DS0000034408.V325769.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of recreational and rehabilitative activities are provided in the home and daily choice for residents is supported, but this is not always on a regular or consistent basis and is dependent upon staffing levels. Residents are encouraged to maintain outside links and contact with friends, local community is encouraged. Residents are offered a varied and nutritious menu. EVIDENCE: During the inspection visit several of the residents were spoken to, those who were able to verbally communicate stated that the care they received was of a good standard. Some comments included; “I cannot praise the staff enough, this is a lovely home”, “the food is great, you get too much really”, “I have got everything I need in my room, television, comfy chair and my radio”. DS0000034408.V325769.R01.S.doc Version 5.2 Page 16 There was written evidence to confirm that regular activities occur including bingo, soft bowls, tai chi, quizzes and games and sing-a-longs with the staff. The permanent residents who endure memory impairment are offered activities, but these tend to be individual and for short time periods. During the visit some activities were observed including 1-1 time with residents. Four staff surveys and two resident surveys stated that activities occur, but not as often as they would like. From speaking to staff members during the visit and also from information received before the inspection took place it would appear that overall activities are offered and vary depending upon the need of the individual, but that these are not always offered on a regular basis due to staffing levels being insufficient. At this current time the activities are being offered on a regular and consistent basis. Visitors are welcomed at any reasonable time and this was confirmed by speaking to residents and a relative. Some comments included; “I visit my husband everyday, the staff always make me welcome and offer me a cup of tea or my dinner”, “my relatives can come and see me whenever they want to”. There are small meeting rooms available to use or residents can receive visitors in the privacy of their own room. Comments were received from a visiting healthcare professional stating that they can see their patient in private and that the staff respect this. The home operates a six-week rotating menu and this is written in large print on a white board. Lunch was observed and consisted of minced meat pie, mashed potato, carrots, green beans and gravy or pork stew. There was a very good choice from the sweets trolley including crème caramel, Victoria sponge cake, Viennese whirls, jam tarts, sugar free jelly with cream, fruit salad or cheese and biscuits. It was very well presented and plentiful. From speaking to one of the cooks and the Registered Manager it was stated that fresh produce is used and the menu is varied, nutritious and wholesome. One resident said, “The food is great, you get too much really”. The cook displayed a good knowledge of diverse needs of the residents in relation to their diet and confirmed that if she didn’t understand something that she would find out what was appropriate. The home has one person who follows a Jewish diet and several who are diabetic; information is recorded about what is acceptable for the residents to have. The home has a catering team all of which have their food hygiene certificates. The home has achieved the Heartbeat Award for the seventh year is succession. DS0000034408.V325769.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which meets the needs of residents who feel their views are listened to. A vulnerable adults procedure and policy is available and staff are trained in order to protect residents from abuse. Resident’s safety has been compromised as incidents of verbal and physical aggression have not been reported to the appropriate agencies. EVIDENCE: The home has a good complaints policy and procedure, it is included in the statement of purpose. Therefore information is available to residents and their representatives informing them of what they need to do if they had a complaint. From speaking to several residents and a relative it was evident that they knew how to complain and who to. One resident said, “I would speak to the staff or the manager”. A relative confirmed; “I have read the booklet and have seen the complaints procedure”. There have been four complaints since the last inspection visit, all of which have been recorded and action taken if necessary. DS0000034408.V325769.R01.S.doc Version 5.2 Page 18 The home has a multi-agency policy and procedure for the prevention of abuse, from speaking to staff it was evident that they have a good understanding of what constitutes abuse and what they would need to do, training in this area is mandatory. The registered manager stated that since the last inspection the home has developed risk assessments for the use of bedrails and that this had been agreed within a multi-agency setting. Most of the time the residents’ are safeguarded from abuse, there have been several incidents involving the same resident and the registered manager stated that she had recorded all incidents on accident sheets, but confirmed that they have not been recorded as a vulnerable adult referral nor has the CSCI been made aware that these incidents had taken place. These incidents should have been reported to the appropriate agencies and therefore the safety of the residents was compromised. The home has a policy in relation to safeguarding resident’s monies. DS0000034408.V325769.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is homely and comfortable; some areas require attention in order to ensure that cleanliness and safety standards are maintained. A malodour was detected in the main entrance, hallway and two of the resident’s bedrooms. EVIDENCE: A tour of the building was undertaken and on the whole the environment is very well kept, it is homely and comfortable. Individual bedrooms were decorated nicely and personalised with pictures, ornaments and other personal DS0000034408.V325769.R01.S.doc Version 5.2 Page 20 items. The main entrance area, hallway and stairs carpet is stained and there was a malodour present, this requires replacement. There was a strong odour in bedrooms 1 and 6 and 25. This was a requirement from the previous inspection and continues to be a problem. The manager did explain that, “this has been a longstanding problem and the domestic team work very hard and shampoo the carpets on a regular basis. We just cannot seem to get rid of the odour”. A discussion occurred with regard to appropriate flooring and the replacement of carpet for non-slip flooring that would be more effective in maintaining an odour free environment. It was pointed out to the manager that as stated under Standard 24.4 the residents bedrooms’ must be carpeted or equivalent, therefore providing that the floor covering is homely and in keeping with the rest of the home it does not necessarily have to be carpet. The home has a separate laundry room and there are good infection control procedures in place, all staff have received infection control training. During a walk around the building several residents were spoken to confirming that they were happy with their room, some comments included, “my room is very nice”, “I have everything I need in here”. One resident was observed being escorted through the laundry room to the outside area, when discussed with Manager it was explained that this was to undertake an activity in the garden. Surveys received from residents all indicated that the home was clean. All of the water outlets have regulators fitted ensuring that the hot water distributes at a safe temperature. Several of the outlets were checked during the visit and found to be distributing between 41.6 and 42 degrees centigrade. The home has sufficient toilets and bathrooms in order to meet residents’ needs. All toilets and bathrooms are clearly signed in both written and picture format. Since the last inspection new radiators have been fitted upstairs, these can be individually controlled. DS0000034408.V325769.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is staffed to provide a good level of basic care for a group of persons with problems associated with aging requiring long term care. However this staffing level and the training staff receive must be critically examined in order to ensure that all the needs of persons of multiple categories and high dependency levels can be met in the variety of forms of care that are on offer at the home. Issues related to this matter are commented on in all areas of this report directly related to residents care. The home’s recruitment and selection procedure does protect the residents. Although the local authority offers a wide range of both mandatory and more specialised training to it’s staff group, the training records show that this has not been undertaken training and therefore the health and safety of the residents may be at risk. EVIDENCE: DS0000034408.V325769.R01.S.doc Version 5.2 Page 22 The registered manager stated that the staffing levels remained the same as at the previous inspection visit. From speaking to the manager and staff it would appear that the current staffing levels have not been sufficient recently due to the challenging behaviour of one resident in particular, therefore the health and safety of all residents has not always been maintained. There have been numerous incidents of verbal and physical aggression towards other residents, staff and visitors. The registered manager has discussed this problem with the locality manager and there has been an agreement to fund extra staffing on a 1-1 basis for this resident until a review meeting. The manager explained that since the additional support has been in place the number of physical and verbal assaults have decreased. From speaking to the staff it was also evident that this had been a problem for them. One person said, “due to the increased physical assaults and the unpredictability we have to monitor this person constantly, it affects the time that we can spend with other residents too”. The previous requirement regarding the night shift and only having 3 people on duty has not been addressed. Although the actual care hours meet the minimum standard consideration should be given to the allocation of care hours through the night. All residents are of high level need and more than 5 permanent residents require 2 staff to move and assist, in addition some of the stroke unit residents require intensive support when first arriving in the home. The service provider needs to critically examine the staffing level to ensure that all the needs of residents can be met and provide evidence confirming this. 36 out of the 38 care staff have now achieved or are working towards NVQ 2, the Local Authority offers a wide range of training courses to all staff. Three of the staff files were looked at confirming that the home’s recruitment and selection procedure is robust and ensures that staff have a CRB, two references, application and health declaration in place prior to commencing work. The majority of the personnel records are held at Brunswick House, the Local Authority’s head quarters and this agreement has been made with CSCI. From speaking to the staff members it was clear that they had a good understanding of the residents’ needs and could describe what care tasks were undertaken. It was clear that the ethos of the home is to offer a high standard of care in a sensitive way that would maintain the residents’ dignity and choice. The home has a training plan and keeps records on individual staff files and on a database. All of the mandatory training is offered to the staff including moving and handling, fire safety, first aid, health and safety, the protection of vulnerable adults and infection control, but unfortunately not all staff have undertaken the training as regular as it should be. The local authority has an induction and foundation training package that meets the specification of the Skills for Care targets. One staff member who is employed as a domestic was DS0000034408.V325769.R01.S.doc Version 5.2 Page 23 spoken to about her role and training offered. It was apparent that some domestic staff “help out at lunchtime” in assisting those residents who require help with feeding. The staff member stated, “I have done lots of training including basic food hygiene, health and safety”. None of the domestic staff undertake the basic induction training that would cover the feeding needs of individual residents. During a meeting held on 26.3.07 it was agreed that the registered manager must demonstrate the competence of domestic staff with regard to assisting with feeding and offering minimal personal care. A discussion occurred with the registered manager about two residents who in addition to memory impairment also have a learning disability. The manager explained that she had sought advice from other professionals involved in the residents’ care and had obtained some appropriate toys and games to maintain activities and occupation. Although this is positive in attempting to meet individual’s needs, there was a lack of planning and discussion about whether this would be an appropriate placement. None of the staff at Alderson Resource Centre have undertaken training in relation to learning disabilities. DS0000034408.V325769.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is carried out with leadership and appropriate guidance; ensuring residents receive a quality of care and a resident centred ethos is promoted within the home. Resident’s financial affairs are safeguarded by the homes policy. Supervision is offered, but is not always as regular as it needs to be and therefore the resident’s health and safety could be compromised. Training in relation to fire safety, moving and handling, first aid and infection control is not always up to date and this could put residents’ at risk of receiving support from untrained staff. DS0000034408.V325769.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has been in post since June 2005 and is registered with the CSCI, she has many years experience in the care industry. She has completed NVQ level 4 in Management and has commenced NVQ level 4 in Care and two components of the Registered Managers Award, she is aiming to complete by February 07. From speaking to both residents’ and staff it was evident that the manager operates an open door policy offering support whenever necessary. Staff stated that the manager is approachable and offers support whenever required. Throughout the inspection the manager was observed interacting with both residents and staff in a caring and sensitive manner and has developed a very good understanding of the needs of the client group catered for in the home. There are clear lines of accountability within the home and with external management. The home has developed a good quality assurance system, this incorporates regular liaison with residents, family/friends, other professionals, the completion of surveys and the correlation of this information throughout the year. The manager stated that she is in the process of producing an annual report highlighting both positive and corrective action, a copy of which must be made available within the home and a copy forwarded to the CSCI. The home takes care of residents’ personal allowance, written records are kept of all transactions. All monies and valuables are held in suitable secure facilities. Staff confirmed that they receive supervision, but that this is not always regular and from inspection of records this was confirmed. Staff stated, “the manager is always available, she is supportive”, “I get supervision on a regular basis most of the time”. Nine surveys that were completed by staff stated that they were offered supervision. The health and safety of the residents and staff is not always promoted, but there are systems for safe working practices in place. Documentation in relation to the maintenance of the building was in place to evidence that regular checks have been carried out. These included gas, electrical wiring certificate. The hoists and lifts were all up to date and evidence was seen confirming this. All care staff receive a thorough induction and foundation training within 6 months and on-going training as and when required. Records confirmed that training in relation to fire, infection control, food hygiene, protection of vulnerable adults and moving and handling are all offered, but they were not up to date for all staff and therefore the residents receive support from a staff DS0000034408.V325769.R01.S.doc Version 5.2 Page 26 group that could be better trained. During a meeting held on 26.3.07 it was agreed that in general the training offered by the local authority is of a very good standard, but unfortunately the records kept were not always up to date. The Locality Manager stated that this would be addressed immediately within all of the council run homes. As mentioned earlier in the report the safety of the residents is not always maintained. Several incidents involving one resident displaying both verbal and physical aggression towards other residents, staff and visitors have not been reported to the CSCI or via the correct channels in relation to protecting vulnerable adults. A discussion with the manager took place with regard to the diverse needs of residents and how the home is able to meet those needs. The manager stated that currently there is one person who is Jewish and the home has been in consultation with relatives to ascertain if there any particular needs the home needs to be aware of. The cook was also spoken to about a Jewish diet and she confirmed what alternative menus are offered. Also that equality and diversity training is mandatory and therefore all staff have been trained appropriately and should be aware of differing needs the residents’ may have. The home offers support to the over 65-age group and has appropriate aids and adaptations that would maintain independence. Some staff have also undertaken training in relation to Dementia, Care Mapping, Mental Health, Strokes and Diabetes. The home currently has two residents who have a learning disability and although it would appear that some effort has been made in obtaining age appropriate toys or activities, none of the staff have undertaken specific training nor has the home applied to vary it’s registration and therefore not fully looking at the diverse needs of these individuals. DS0000034408.V325769.R01.S.doc Version 5.2 Page 27 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 2 3 3 2 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X X 3 3 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 4 X 3 2 2 2 DS0000034408.V325769.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4,5 Sch 1 Requirement The registered person must provide information in the statement of purpose/service user guide regarding how the needs’ of residents who have a learning disability will be met. An application must be submitted to request this variation to registration retrospectively. Timescale for action 15/03/07 2 OP4 12,13,16, 17,18,23 3 OP7 14,15,17 The registered person must be 15/05/07 able to demonstrate that the diverse needs of residents’ can be met, in particular those with learning disabilities. Staff must individually and collectively have the skills and experience to deliver the care, which the home offers to provide. 15/05/07 Care plans for the Stroke Unit residents must be implemented and all care tasks undertaken recorded clearly. Regular weekly reviews by the Key Worker must take place and be recorded. (Previous timescale – 31/04/06 not met) DS0000034408.V325769.R01.S.doc Version 5.2 Page 29 4 5 OP9 OP18 12,13,16, 17 12,13,16, 17,37 Medication must be recorded accurately. Any incidents that adversely affects the well-being or safety of any service user; verbal or physical aggression towards other residents, staff or visitors must be reported to the appropriate agencies including notification to the CSCI under Regulation 37 and protection of vulnerable adult referrals to the local Care Management team. The main entrance area, hallway and stairs carpet is stained and there was a malodour present, this requires replacement. The home must be free from offensive odour. (Previous timescale 31/04/06 – not met) Staffing levels must be critically reviewed in relation to the actual number of staff on duty; evidence confirming that current staffing levels are appropriate. Domestic staff who undertake personal care tasks including assistance with feeding must undertake relevant induction training and there must be evidence confirming their competence. Other mandatory training must be kept up to date including fire safety, protection of vulnerable adults and moving and handling. The manager to complete NVQ level 4 in Care. All staff including the manager must receive supervision at least 6 times per year or more frequently if required. DS0000034408.V325769.R01.S.doc 15/05/07 15/01/07 6 OP19 16,23 15/01/08 7 OP26 16,23 15/05/07 8 OP27 12,13,18 15/05/07 9 OP30 12,13,17, 18 15/05/07 10 11 OP31 OP36 9 17,18 15/05/07 15/05/07 Version 5.2 Page 30 (Previous timescale 31/04/06 – not met) 12 13 OP38 OP38 12,13,17, 18,37 12,13,17, 18 See standard 18. See standard 30. All staff must undertake and keep up to date training in relation to maintaining the health and safety of the residents including; fire safety, first aid, protection of vulnerable adults and moving and handling with records kept confirming this. 15/01/07 15/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000034408.V325769.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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