CARE HOMES FOR OLDER PEOPLE
Aldwick House Nyewood Lane Bognor Regis West Sussex PO21 2SJ Lead Inspector
Judith Farrell Unannounced Tuesday, 27 September 2005, 09.30am, V2487139
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Aldwick House Address Nyewood Lane, Bognor Regis, West Sussex, PO21 2SJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 842244 Mrs Elizabeth Ann Ciereszko CRH 32 Category(ies) of DE-32, MD-32, MD(E)-32, DE(E)-32 registration, with number of places Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Only Service Users over 50 years of Age in the categories DE and MD may be admitted. One service user under 50 years of age in the category DE and MD may be admitted. Date of last inspection 10/06/05 Brief Description of the Service: Aldwick House is a care home with Nursing. The property is a large detached house, situated in a residential area, within walking distance of the shops and seafround at Aldwick, on the outskirts of Bognor Regis. Residents are accommodated on the ground and first floors in thirty single and one double room. There is a large communal dining room and dayroom on the ground floor, which opens on to an attractive garden area.. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second statutory inspection of this year. The unannounced inspection took place on the 28th September 2005 and lasted six hours. There were 32 residents living at the home at the time of inspection. The overall impression of this home is that there is clear strong leadership, which is consistently looking to improve the high quality of care already received by the residents at Aldwick House. A tour of the premises took place, rotas and care records were inspected. Thirteen of the residents, four visiting relatives, five staff and the Manager were spoken with. The Inspectors observed breakfast and the lunchtime meal being served. The residents have different levels of communication ability and therefore it was difficult to ascertain all their views on how their needs are met. However relatives comments included ‘the staff are excellent’ ‘we have never had to make any sort of complaint’ ‘I am so happy my wife is here’. No requirements were made following this inspection. What the service does well:
At the time of this inspection the home was being efficiently managed. Systems are in place to ensure residents are safeguarded and their health and social care needs are being met. This home has a history of being well managed and has required very few recommendations over the years. The home has an experienced and competent team of staff who enjoy their work and have a good understanding and knowledge of the needs of the people living at the home. Relatives spoke highly of the support their relatives receive from staff and positive relationships were observed between staff and residents. Staff were also observed maintaining residents dignity and activity promoting their rights. There is a fulfilling programme of activities. A relative commented he was surprised at how much the residents are helped to engage in these activities and how it was noted that residents improve and ‘light up’ when they are occurring. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. The service is very welcoming to relatives and they are encouraged to visit residents at any time of the day. The residents spoken with liked their rooms and the way they are decorated. There are regular relative’s meetings where the senior nurse advises on new issues such as any decoration and any changes to staff. Meals are varied, balanced and well presented, offering both choice and variety. Mealtimes are flexible, particularly breakfast and lunch, which was noticed being continually served over several hours to accommodate the differing times people were getting up and to cater to their individual needs.
Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 6 Residents are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. Staff have a robust training programme which clearly shows the managements commitment to life long learning and the protection of the vulnerable people they look after. All records and files were found to be neat and easily accessable. What has improved since the last inspection? 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. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4,5 There are systems in place to ensure residents and their representatives’ make an informed choice about the home. No resident moves into the home without having had a thorough assessment of their needs discussed with them. Relatives and some residents confirmed that their varying care needs were being met. EVIDENCE: Four relatives spoken with in private were able to state that they had been provided with a copy of the Service Users Guide. They said they had visited the home prior to their relative being admitted on a trial short stay. A review of their care needs was discussed with them over the first two weeks of their relatives stay. One relative said that they had not expected their relative’s behaviour or health to improve. But it has and they believe this is because of the ‘excellent staff’ and that they don’t rely on drugs. Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was very thorough and well recorded. Good practice was noted in the way assessment is carried out over a number of weeks to ensure there is a progressive assessment leading to a robust care plan. This procedure ensures that new residents needs are properly assessed and planned for.
Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 9 Residents said they found it particularly helpful to have met with the manager prior to entering the home. A relative said her relatives needs and preferences had been discussed in detail during this initial assessment, which she said made her feel more confident about placing her relative in the home. The Statement of Purpose states the qualification details of the staff. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Arrangements are in place to ensure that the health care needs of residents are identified and met. The home demonstrated good medication handling practices. EVIDENCE: The care needs of residents are set out in their individual files. The inspector examined four files at random including two new residents. The system of care planning support plans to guide staff in the delivery of identified care needs. There was evidence that service users have been consulted in developing their care plans and those who are able have signed their name in agreement with the information held on them. The Inspector talked to four relatives, who confirmed that they were invited to participate in the reviewing process and received minutes from meetings held. Care plans identify goals for individual residents, which are then monitored as part of the ongoing review process. At this time, the goals are fairly basic and it is hoped that as this system develops, peoples’ experiences and aspirations will progress. The home has a range of risk assessments in place in respect of varying aspects of service users’ lives. Many of the risk assessments in place hold
Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 11 additional information about the affect controls in place have on the level of risk. Staff were observed entering residents rooms. They knocked the door and waited for permission before entering. Staff members said that there was strict guidance about respecting resident’s privacy. The manager advised that there is a very good working relationship with the residents GPs, the district nurse service and specialist nurses. The resident’s can choose which GP they wish to register with, in the locality. Relatives spoken with discussed how their relatives are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. Medication is stored, dispensed and administered appropriately. The trained nurse on duty confirmed that only staff who had received relevant training were permitted to administer medication. The inspector was impressed by the way a full explanation of the type of drug was given to the resident even though it was unlikely that the resident would be able to have a full understanding. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 Residents benefit from a robust programme of fulfilling activities. The home promotes positive relationships between residents and their relatives. Service users enjoy a range of appealing and nutritious meals. EVIDENCE: The home provides entertainment on most afternoons one resident particularly like’s the painting sessions discussing pictures they had made, these are now presented on the lounge wall. The inspector was impressed with a small garden which residents have made their own. Two relatives spoken with commented that ‘they always make sure my mother is ready when I come to take her out, with all the equipment she might need’ ‘when I call the home no matter what the time is they are always helpful and I don’t feel as if I am causing a problem’ ‘I can see my friend whenever I want to’ ‘I always feel welcome. All relatives and friends spoken with reinforced with the inspector the feeling of being welcomed and that the home was open and they felt they could ask staff anything. The lunchtime meal was observed and found to be appetising and well presented. One service user told the Inspector he regularly had his favourite meal cooked for him. The four relatives spoken to said they had never heard any complaints about the food at Aldwick and that personal choices and preferences were always respected. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 The home ensures that the service users rights are protected. EVIDENCE: Staff know their responsibility for reporting possible abuse. One member of staff said that she is doing training in dementia, which includes strategies for dealing with and diffusing aggression. Risk assessments in relation to challenging behaviour were evident on some of the care records sampled. Staff interviewed were proactive in promoting the residents rights enabling them to choose within safety limits choices for day-to-day living. If residents need the support of an advocate then help is sought. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,23,25,26 Service users benefit from a clean, comfortable and well-maintained home. EVIDENCE: The establishment is situated on rising ground close to Bognor centre. It is well maintained and a programme of regular maintenance is undertaken. The home has a vertical passenger lift that serves all floors. Grab rails have been fitted so that service users can move about the home independently. The establishment does not use CCTV cameras. The requirements of the local fire service and environmental health department are well met. At the time of the inspection, all communal areas and the ten bedrooms seen by the Inspector were found to be clean, tidy and well maintained. All relatives spoken with confirmed that the home was always clean and free from odour. The staff interviewed stated that they take pride in maintaining a very clean environment and all were very clear regarding the issues of infection control. A Legionella policy is in place, and regular health and safety checks are carried out. Water temperature checks are regularly recorded. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 15 Since the last inspection the home has continued with the redecoration and refurbishment programme. There were numerous pleasant floral displays at the front of the building. In the rear garden there were many potted plants. These were planted as part of the gardening club. Some residents were using a pleasant lounge on the day of the inspection. Outdoor space is a safe environment and was easily accessible to residents and staff confirmed that a number of residents enjoy being taken outside if the weather is fine. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The procedures for the recruitment of staff are robust and ensure that sufficient staff are on duty throughout the day and night. Staff are trained and competent to do their jobs. EVIDENCE: There is a cohesive staff group who have worked in the home for several years. Staff file checked at random showed that the home had undertaken all the necessary checks to ensure protection of residents. Staff members spoken with said that they had been asked to complete an application form and obtain a Criminal Records Bureau checks before starting work in the home. Visitors said that staff were kind and attentive whenever they visited the home. During the inspection staff were seen to go about their duties in an unhurried manner. The resident and relatives spoken with, who provided feedback about the home, said they were happy with the number of staff at the home and found them to be kind and knowledgeable. There is a sound induction process for new staff and well over 50 of staff now hold their NVQ in care level 2 or 3 qualifications. Staff interviewed talked about the benefit of undertaking these awards and how resident’s help them to achieve these qualifications. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,36 The homes management are approachable and staff feel they are supported Regular supervision is provided to care staff. Systems are in place to protect and safeguard the residents. EVIDENCE: Staff were very positive about the working environment at the Aldwick Nursing home and said that communication is good, handover is given at the beginning of each shift and staff meetings are held regularly. Staff said they received regular supervision from the deputy manager monthly and records confirmed this. The registered manager ensures that supervision is done every other month to meet the National Minimum Standards. Staff interviewed confirmed that supervision takes place at least 6 times a year. There are clear records of these supervision and a clear audit trail leading to training and development for staff. This also identifies the changing needs of the residents. Relatives confirmed that the manager holds a number of meetings a year so that they can discuss issues that they feel are important. They also confirmed
Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 18 that action takes place when they identify a problem. Residents talked about the manager’s open door policy and how they will see her ‘on the floor at least once a week but most times more often’. A great deal of evidence was gathered to prove that quality assurance in this home was of the utmost importance. The staff on duty demonstrated that they were aware of their responsibilities under Health & Safety. A maintenance person is employed to undertake a variety of checks and audits and to keep the home in a good state of repair. Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 4 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 x x 4 3 x 3 3 x x Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Aldwick House H60-H11 S24102 Aldwick House V248139 270905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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