Inspection on 06/04/08 for Aldington House

This inspection was carried out on 6th April 2008.

CSCI found this care home to be providing an Adequate service.

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

Aldington House 24/04/06

Aldington House 21/11/05

Aldington House 06/12/04

Aldington House 01/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Aldington House 107a Blackheath Park Blackheath London SE3 0EX Lead Inspector Maria Kinson Key Unannounced Inspection 6th April 2008 08:35 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 Aldington House DS0000006853.V361354.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. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldington House Address 107a Blackheath Park Blackheath London SE3 0EX 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) 020 8463 0641 020 8297 8985 Aldingtonhouse@new-meronden.co.uk www.newcenturycare.co.uk New Century Care Limited Mr D Seyler Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 31 Date of last inspection Brief Description of the Service: Aldington House is a care home registered to provide accommodation and personal care for thirty-one older people. The home is part of a group of care homes managed by New Century Limited. The home is situated in a quiet residential road on a private estate in Blackheath. It is approximately 15 minutes walk to the shops, local facilities and public transport connections in Blackheath Village. Accommodation in the home is provided on three floors. The home has twenty-nine single and one shared bedroom. There are pleasant and wellmaintained gardens to the front of the home and a small patio area accessible from the lounge on the lower ground floor. There are no parking facilities at the property but you can park in the road subject to parking restrictions. At the time of this inspection the fees ranged from £420 - £675 per week. The fees do not include newspapers, personal telephone calls, hairdressing, outings and private medical services. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over three days and was unannounced. On Sunday 06th April 2008 two inspectors spent one and a half hours in the home. During this period staffing levels were assessed and staff were observed serving breakfast and administering medicines. The inspectors spoke with eight residents and one member of staff. On Tuesday 8th April 2008 one inspector toured the building and spoke with three residents, five members of staff and a visiting health care professional. Care, medication and activity records were sampled. Comment cards were left beside the visitor’s book for relatives to complete and return to CSCI. Three cards were returned to the commission. Staff recruitment, health and safety records, personal money and quality assurance records were examined on Thursday 10th April 2008. Two immediate requirement notices were issued on 06/04/08 as the front door was wedged open with a bean bag and the medicine room and cupboard doors were left unlocked. The Registered Person was asked to advise the commission in writing by 16/04/08 about the action they were taking to address these issues. The area manager provided a written response on 14/04/08. There were thirty- one people living in the home at the time of this inspection. What the service does well: Staff obtained information about peoples care needs and used this information to formulate a care plan for the person. Mealtimes were well organised and people were given adequate time and support to eat. People said they could choose what they wanted to eat and usually enjoyed their meals. One relative said the home had a “flexible” approach to mealtimes. People said that their relatives and friends could visit at anytime. Relatives said that staff kept them informed them about important events such as accidents and hospital appointments. Arrangements were made for people to see their GP or other care professionals. Relatives said that the care provided in the home was “good overall” and people were made “comfortable”. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 6 People said they were able to make choices about how and where they spent their time in the home and their decisions to not take part in group activities or to spend time alone were respected. All of the communal areas and bedrooms were pleasantly decorated, clean and welcoming. Training was provided and staff were supported to obtain care qualifications. Equipment was serviced regularly and fire safety arrangements were good. What has improved since the last inspection? What they could do better: The Registered Person should update the Statement of Purpose to make it clear to the reader that the home does not provide nursing care (page 2) and to provide accurate information about the number of clients that the home can accommodate (page 3). The Service User Guide and terms and conditions should be reviewed to ensure that information is current and up to date. Care plans provided information about the support that people required on admission to the home, but were not always reviewed and updated to show what additional help or monitoring the person required when their health declined. Medicines were not stored at a suitable temperature, were not kept securely and were not properly managed. Records were not always properly Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 7 maintained. This made it difficult to assess if people were getting some of their prescribed medicines and to account for the use of some medicines. Disposal records for medicines that required special storage arrangements were incomplete. People were supported to undertake activities and outings but the programme lacked interest and did not take into account peoples individual needs. The home safeguarding procedure was good overall. To avoid any confusion the procedure should be amended to state that all allegations or suspicions of abuse must be referred to the local authority. Staff did not investigate or keep accurate records about unexplained injuries. Money records were maintained but the procedure followed by staff did not provide a complete audit trail. Complaints were recorded but one recent investigation was not thoroughly investigated. The area manager had agreed to provide additional support for staff that investigate complaints. Parts of the main kitchen and the food storage areas were stained and dusty. Staff recruitment records had improved but further work was required to safeguard residents. References must be checked and information provided by the applicant must be thoroughly assessed. Staffing levels had improved but we are concerned that the home may not have adequate arrangements in place to cover staff sickness or absence. The home had systems in place for checking that staff were following company procedures but audits were not always effective. The front door was left partially open and cleaning fluids were not stored securely. This could affect people’s health and safety. Moving and handling training was provided but some members of staff used practices that were old and could harm people. A number of people had difficulty moving. The home should consider purchasing a standing hoist. 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. Aldington House DS0000006853.V361354.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 Aldington House DS0000006853.V361354.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 and 3. This home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The services and facilities provided in the home were laid out in the homes ‘Statement of Purpose’, ‘Service User Guide’ and terms and conditions. Some amendments were required to these documents to ensure that people had access to accurate information about the service. Staff carried out a care needs assessment before confirming if the home could meet people’s needs. EVIDENCE: The registration certificate and public liability certificate were displayed in the hallway. A copy of the Statement of Purpose and Service User Guide were supplied to the commission. The Statement of Purpose states that the service provides nursing care for 30 people. The manager must ensure that people have access Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 10 to accurate and up to date information about the service. Some additional information should be included in the Service User Guide such as the telephone number for the commission, details about the location of inspection reports and information about the arrangements for paying for services that are not included in the fees such as hairdressing. The area manager said that a copy of the Statement of Purpose and Service User Guide was supplied to all residents. See recommendation1. Records showed that people’s needs were assessed before they moved into the home and information was obtained from other professionals such as care managers, where possible. We examined the pre-admission assessment for one person that had moved into the home in recent months. The assessment provided basic information about the person’s physical needs and their medication regime. We were shown a new pre-admission assessment form that had recently been developed for use in the company’s homes. The form will prompt staff to assess particular areas of need and to obtain specific information. We examined the terms and conditions for two residents, one of whom had recently moved into the home. One document was agreed and signed by the resident’s relative; the second document was not signed. The terms and conditions of occupancy indicated that the home provided nursing care. This home is not registered to provide nursing care. Information about the period of notice was clearly laid out and the reasons why people might be given notice to leave was included in the Statement of Purpose. See recommendation 2. Aldington House DS0000006853.V361354.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provided useful information about people’s needs on admission to the home but were not always updated when the person’s needs or circumstances changed. The management of medicines was poor. This could compromise people’s health, safety and wellbeing. People said staff were helpful and understanding and treated them with respect. EVIDENCE: We examined three sets of care records. The files included an assessment of the persons care needs, information about the person’s interests and lifestyle and details of any relevant medical issues. Separate care plans were developed for each area of need. Most of the plans that we examined provided adequate information about the support the person required but two plans did not address changes in people’s circumstances or health needs. This could Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 12 result in people receiving inadequate support or care. For instance the care records for one person indicated that they had lost a significant amount of weight in February 2008. The GP was not made aware of this issue for some weeks and there was no evidence that staff amended the persons care plan or carried out any additional monitoring during this period. Staff said there was a medical explanation for the weight loss but this was not evident in the person’s notes. The same resident who was known to be unsteady and at risk of falls, had tried to walk down the stairs independently. There was no evidence in the records that the persons care plan or risk assessment was amended as a result of this incident or that the frequency of checks were increased. See requirement 1. We spoke with some people who spent time in their rooms. Personal possessions and the call bell were positioned where people could reach them and people said staff responded quickly if they required help. Fresh drinking water was supplied and hot drinks were offered regularly. Communication between staff and residents was good overall. The atmosphere in the home was relaxed and calm. Staff addressed people by their preferred name which was recorded in the notes and spent time talking to people. One person that was not feeling well was reassured by staff and given a light lunch of toast and tea. Another person that refused to eat any lunch was offered various alternatives and eventually accepted some tea and biscuits. One person was very sleepy, so was left in bed. Staff provided a cup of tea and late breakfast for this person. Residents said that staff arranged for them to see their GP if they were unwell and the records showed that some people had seen other health care professionals such as the district nurse and optician in recent months. The home had experienced some difficulties arranging NHS chiropody and dental treatment but was now aware of the referral process and had arranged appointments for some residents. One visiting health care professional said that they had visited the home for many years and had always found that staff were “competent” and had a good understanding of peoples needs. Relatives said that staff were always able to meet their family members needs and usually informed them about important issues such as hospital visits and appointments. The medicine room, cupboards and refrigerator were unlocked. We were able to gain access to a variety of different medicines and boxes containing sharp items such as needles and lancets. This issue was drawn to the deputy manager’s attention and the room was locked. An immediate requirement Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 13 notice was issued. The provider was asked to advise the commission about how they intend to ensure that medicines are stored securely. See requirement 2. The manager said that staff were told that the medicine room must be kept locked and a sign was put up to remind staff to lock the door. We examined three medication charts. Records were kept about medicines that were bought into the home and medicines that were given to residents. A code was used to explain why some medicines were not given to residents such as when the person was in hospital or on leave. We found at least one error on all of the charts that we examined. The records for one person showed that they were given their medicines but some doses were still in the blister pack. When we deducted the amount of medication given to a resident from the amount of medication received in the home we found that some residents did not have adequate tablets left and others had too many tablets. When a person was prescribed a variable dose of medicine i.e. 1 or 2 tablets for pain, staff did not record how many tablets they gave the person. This made it difficult to audit medicines. Most of the information on medication charts was printed but some entries were written by hand. Staff must ensure that hand written entries are checked and countersigned by a second person. See requirement 3. Care staff were responsible for giving one resident regular insulin injections. One staff member who was responsible for undertaking this task said they received training from a district nurse in 2006. There was no evidence of this training or a competency assessment in the home. The residents care plan did not make any reference to staff giving insulin injections. See requirement 1 and 4. The medication room felt hot. Staff said the air-cooling unit was not working properly and someone would be coming to fix it on 07/04/08. The refrigerator temperature was monitored but it was not maintained at a suitable temperature. See requirement 3. The home had some medicines that required special storage arrangements. In the period since the last inspection, the law regarding the facilities that must be provided in residential care homes to store these medicines had changed. See requirement 5. We observed one member of staff giving out medicines in the lounge. The staff member spent time telling people what they needed to do and ensured that people swallowed their medicines before moving onto the next person. The manager had arranged a medication training update session for senior staff. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 14 Aldington House DS0000006853.V361354.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some activities were taking place but they did not always meet people’s individual needs or expectations. People said their friends and family could visit at anytime and were made to feel welcome. People were satisfied with the choice and quality of food provided in the home and received support to eat, if necessary. EVIDENCE: The home employed a dedicated activities coordinator. There was an activities programme displayed on the notice board near the kitchen. The programme included board games, arts and crafts and bingo and there was a weekly shopping trip for two residents to Lewisham. The programme was developed over a year ago and did not usually change unless residents said they wanted to do something different. There was entertainment on Fridays and two residents said the entertainment provided was very good. The activity coordinator had not received activities training. See requirement 6. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 16 Activity records showed that the range of activities and outings was limited and one person had not received any support to meet their social needs. Two relatives said that “residents did not have enough to do” and “more activities” would be good such as daily movement with music. See recommendation 3. The manager said the programme would be reviewed and updated and would then be displayed in residents rooms. The activities cupboard was very cluttered. This made it difficult to reach equipment at the back of the cupboard and to see what equipment was available for use. People said their family and friends could visit whenever they wanted and they could receive visitors in the privacy of their room or in any of the communal rooms. Some people said they liked to spend time in their room but went to the dining room for meals and to the lounge when there was entertainment. People said they could decide how and where they spent their time in the home and were able to choose what they ate and when they wanted to get up or go to bed. We observed staff supporting people with their breakfast and lunch in the lounge/dining room. Assistance was provided to cut food up and some people were prompted or supported to eat. The atmosphere in the dining room was relaxed and people were able to eat at their own pace. People received a variety of different foods including cereals, toast, eggs and bacon and were offered alternatives if they did not like the food offered. The food looked appetising and everyone that we spoke with said they enjoyed their meal. The menu was varied and people confirmed that they were able to choose what they wanted to eat. The evening menu consists of a light cooked snack or sandwiches. The staff that were on duty in the kitchen told us what sandwich fillings people liked and how some people liked their sandwiches prepared. One person said the food was considerably better than where they lived previously and another person said the food was “very good”. Aldington House DS0000006853.V361354.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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had procedures in place for managing concerns, complaints and allegations but some issues such as unexplained injuries were not always investigated. EVIDENCE: Relatives were familiar with the complaints procedure and said their concerns were usually dealt with appropriately. The complaints procedure was displayed on the wall inside the front door and there was a summary of the procedure in the ‘Service User Guide’. The home had received two complaints about staffing and communication issues in the twelve months prior to this inspection. The complaints were received by CSCI and were forwarded to the provider to investigate. The concerns raised were investigated promptly and a formal response was sent to the complainant. One complaint was not thoroughly investigated. This issue was discussed with the area manager and it was agreed that additional support would be provided for staff. See requirement 7. The home had an adult protection procedure, which was reviewed in June 2007, and a copy of the local authority safeguarding procedure. The homes procedure provides useful information about the different types of abuse and Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 18 about the roles of different agencies such as the police and social services. The procedure stated on page 3 that “actual physical abuse” must be reported to social services. This gives the impression that other forms of abuse do not need to be reported to social services. See recommendation 4. The local authority had investigated one concern about the service under their safeguarding procedures, since the last inspection. No evidence was found to support the concerns. One resident was had some unexplained bruising. Staff recorded the injury in the daily care records, but there was no evidence that the issue was investigated and no further reference was made to the issue in the person’s notes. A possible explanation for the bruising was recorded in the persons moving and handling assessment but there was no evidence that this was considered or discussed with the GP. An unexplained injury was also noted when we examined the accident records. Information relating to this issue was requested. See requirement 8. Staff said they would report allegations or poor practice to senior staff and would talk to the manager if necessary. Most of the staff had attended a safeguarding training update in 2008. Aldington House DS0000006853.V361354.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, 20, 22, 23 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All of the areas used by residents looked homely and welcoming and were clean, tidy and comfortable. EVIDENCE: All of the communal areas and a selection of bedrooms were inspected. The communal areas were pleasantly decorated and comfortable. Residents were able to choose where they sat and there were quieter areas for people who wanted to read. A new decking area had been fitted in the front garden under some mature trees. This will provide a shaded area for residents and visitors during the warmer weather. There is also a small patio area off the dining room with an awning for shade. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 20 Four bedrooms were viewed. All of the rooms were clean and comfortable and residents said they could bring some of their own furniture and belongings into the home. This made the rooms feel homely and welcoming. There was a musty odour and dark patch on the carpet in room 35. See recommendation 5. Some of the windows did not close properly into the frame and were draughty. The area manager said that all windows would be checked and would be repaired or replaced if necessary. The commission should be notified about progress with this work. Although it was snowing outside the home felt warm and people looked comfortable. We noted that some people could stand with assistance but had difficulty moving. The care records showed that some people’s mobility had declined and they were requiring more support from staff. The home should consider purchasing a standing hoist. See recommendation 6. Some of the wall and ceiling tiles in the main kitchen were stained and the floors in the three food storage areas were dusty. The vinyl floor covering in the first floor storage area was damaged. See requirement 9. The cleaning schedules indicated that these areas were cleaned regularly. The area manager said the main kitchen would be redecorated in April 2008. Hand washing facilities were good and clinical waste was stored appropriately. The laundry room was well organised and all of the equipment was working. The person that worked in the laundry used ‘marigold’ type gloves when handling dirty laundry but did not wear an apron. See recommendation 7. Aldington House DS0000006853.V361354.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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing had improved but the service has some difficultly sustaining adequate staffing levels during periods of staff sickness and absence. Pre- employment checks were taking place but they were not always checked or followed up properly. Staff received regular training updates and support to gain recognised qualifications. EVIDENCE: The commission received an anonymous complaint about staffing issues in January 2008. Our enquiries showed that there were some difficulties maintaining adequate staffing levels in the home in December 2007 and January 2008. There were five care staff on duty when we visited the home on Sunday 6th April 2008 and Tuesday 8th April 2008. Staff carried out their work in a calm and relaxed manner and there was no evidence that people’s needs were not being met. Staff indicated that staffing levels had improved and said staff sickness and absence was being monitored. The manager had recruited some new temporary and permanent staff. The staff duty rosters that we examined confirmed that staffing levels were stable. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 22 We received a further concern about weekend/bank holiday staffing levels after the inspection. We plan to carry out a further random inspection to assess this issue. See requirement 10. 42 of care staff had a recognised care qualification and eight staff were working towards attaining a vocational qualification in care. Relatives said that staff usually had the right skills and experience to look after people properly. We checked two staff recruitment files. Although the main checks such as criminal record bureau disclosures and proof of identification were obtained one reference that was not on headed paper or company stamped was not checked to ensure that it was genuine. One reference was from an employer that was not listed on the applicant’s employment history and one applicant had two references from people with the same surname. The manager was not certain whether the referees were related. See requirement 11. Since the last inspection some staff had attended food hygiene, medication, health and safety, moving and handling, Control of Substances Hazardous to Health (COSHH), induction, safeguarding adults, first aid and fire safety training sessions. Staff said they received adequate training and support. Aldington House DS0000006853.V361354.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager had spent time getting to know staff and residents and had identified areas for improvement. The atmosphere in the home was home was open and relaxed but senior staff did not always identify practice issues or health and safety concerns. EVIDENCE: A new manager was appointed in July 2007. Mr Seyler has a National Vocational Qualification in care at level four and is currently working towards attaining the Registered managers Award (RMA). The manager was assessed Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 24 and registered by the Commission for Social Care inspection (CSCI) in April 2008. Staff said the new manager was approachable and “listens”. One staff member said the manager was very understanding in relation to some medical problems they had experienced and had provided advice about what they should do if they felt unwell or tired. Some relatives said they had met the new manager and had found him understanding and helpful. The home had some systems in place for obtaining feedback about the service and for monitoring the quality of care provided in the home. A senior member of staff visits the home regularly to talk with residents and staff and the reports compiled as a result of these visits were sent to the manager. The manager had completed care profile, medication, nutrition and catering audits. The paperwork that staff completed when they were undertaking audits had recently been adapted to include information about any action that they were planning to take in respect of their findings. Some of the medication and nutritional issues that we found during this inspection were not identified by the company’s quality assurance monitoring systems. See recommendation 8. A satisfaction survey was completed in November 2007. The manager had recently received a copy of the findings. The report showed that most people were satisfied with the environment and meals but felt improvements were required in relation to activities, communication and some aspects of care. The manager said that an action plan would be developed to address the findings. Some of the staff that we spoke with had attended a recent staff meeting and said there were opportunities to make suggestions or raise concerns about the service during their working day or in supervision. A resident and relative meeting was planned and a copy of the minutes was supplied to the commission. We examined the personal money records for two people. Incoming and outgoing money was recorded but there were no receipts for services such as hairdressing or chiropody and some entries were not signed. One person was charged for a service that the records stated they did not receive. The manager agreed to investigate this issue. See requirement 12. When we arrived in the home the front door was wedged open with a bean bag. This could compromise resident’s health and safety. This issue was drawn to the deputy manager’s attention and the door was closed. An immediate requirement notice was issued. The manager said staff were told that the door must be kept closed and signs were displayed to remind staff to keep the door closed. See requirement 13. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 25 Health and safety and fire safety records were sampled. Fire safety equipment was tested regularly to ensure that it was working properly and a specialist company serviced the alarm, emergency lighting system and extinguishers. The previous requirement to ensure that night staff had an opportunity to attend fire drills was addressed but it was not always clear in the records how staff responded to drills. This information would highlight staff training needs. The homes fire risk assessment was reviewed and updated in September 2007. Records showed that portable electrical appliances, the main electricity installation, gas appliances, the lift and water storage systems were serviced regularly. A number of ‘in house’ checks were carried out to ensure that wheelchairs were safe for use and hot water was maintained at a suitable temperature. Cleaning substances were left in the sluice room whilst staff were on their tea break. This could pose a potential risk to some residents. See requirement 14. Staff assisted people to move and walk. Most of the moving and handling practices seen were satisfactory but one staff member assisted a resident to move back in a chair by standing behind the person and pulling them towards the back of the chair and another resident was assisted by two staff to move back in the chair using an underarm move. Staff had received moving and handling training. See requirement 15. Aldington House DS0000006853.V361354.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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X 3 3 X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 X X 2 Aldington House DS0000006853.V361354.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 Timescale for action Care plans must be reviewed and 24/06/08 updated when people’s needs change. The plan must show how staff will meet people’s current needs and maintain their health and safety. Medicines must be stored 16/04/08 securely. (An immediate requirement notice was issued at the time of the inspection in respect of this issue) The response from the provider indicates that action was taken to ensure that medicines are stored securely. The home must make adequate 24/06/08 arrangements for the safe recording, storage, handling, administration, and disposal of medicines. Staff that administer insulin 15/07/08 must receive adequate training and be assessed as competent at undertaking this task. A specialist cupboard that 19/08/08 complies with legislation must be obtained and used for the DS0000006853.V361354.R01.S.doc Version 5.2 Page 28 Requirement 2. OP9 13 3. OP9 13 4. OP9 13 5. OP9 13 Aldington House 6. OP12 18 7. OP16 18 8. OP18 13 9. OP26 13 10. OP27 17 11. OP29 19 12. OP35 17 storage of controlled drugs. Staff must receive appropriate training for the work they perform. Specifically, the activities coordinator must receive activities training. Senior staff must receive additional support and training about the management of complaints. The registered person must ensure risks to residents are identified and as far as possible eliminated. Injuries to residents such as unexplained injuries and injuries sustained during transfer must be followed up by management to try and establish why and how the injury occurred and to identify if action could be taken to prevent a recurrence. (The previous timescale of 30/06/06 was not met) The main kitchen and food storage areas must be kept clean and the damaged floor covering in the first floor food storage area must be replaced. A contingency plan must be developed to cover planned and unforeseen staff absence. A copy of the plan must be forwarded to CSCI by 24/06/08. Staffing rotas must be sent to the lead inspector on Monday mornings until further notice. Vetting procedures must be thorough and robust. References that are not on headed paper or are not company stamped must be verified to confirm that they are genuine. Adequate records must be maintained about money or valuables that are handed to staff for safekeeping. DS0000006853.V361354.R01.S.doc 19/08/08 19/08/08 24/06/08 15/07/08 24/06/08 24/06/08 24/06/08 Aldington House Version 5.2 Page 29 13. OP38 13 14. 15. OP38 OP38 13 13 The front door must be kept 16/04/08 closed. This will reduce the risk of unwanted visitors entering the building and will help to maintain peoples safety. (An immediate requirement notice was issued at the time of the inspection in respect of this issue) The response from the provider indicates that action was taken to ensure that the front door is closed. Hazardous substances must be 24/06/08 stored securely. Staff must use safe handling 24/06/08 techniques when assisting people to move. 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed and updated to ensure that information is accurate and up to date. The Service User Guide should include all of the information listed in regulation 5. The Registered Person should review and update the terms and conditions to ensure that information that is provided for residents is accurate and up to date. The activities programme should be reviewed and updated. Activity records should show how the home meets people’s social needs and interests. The safeguarding procedure should be amended to state that all allegations or suspicions of abuse would be referred to the local authority. The dark area on the carpet and the musty odour in room 35 should be investigated and addressed. The home should consider purchasing a standing hoist. Staff should wear an apron when handling dirty laundry. Internal audits should identify and address the issues DS0000006853.V361354.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. 7. 8. OP2 OP12 OP18 OP26 OP22 OP26 OP33 Aldington House found during this inspection. Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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. Extracts may not be used or reproduced without the express permission of CSCI Aldington House DS0000006853.V361354.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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