Inspection on 26/02/08 for Aldwick Residential Care Home

This inspection was carried out on 26th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aldwick Residential Care Home 28/01/09

Aldwick Residential Care Home 05/03/07

Aldwick Residential Care Home 06/01/06

Aldwick Residential Care Home 03/08/05

Aldwick Residential Care Home 29/09/04

Aldwick Residential Care Home 17/06/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Aldwick Residential Care Home 92-94 Aldwick Road Bognor Regis West Sussex PO21 2PD Lead Inspector Jan Aston Unannounced Inspection 26th February 2008 09:20 Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 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 Aldwick Residential Care Home DS0000014352.V358998.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 Adults 18-65. 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 Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldwick Residential Care Home Address 92-94 Aldwick Road Bognor Regis West Sussex PO21 2PD 01243 865569 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) Mr Ashok Kumar Sewpaul Mrs Premila Sewpaul Mr Ashok Kumar Sewpaul Care Home 27 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (27), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (27) Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only services users aged 40-65 years of age may be admitted in the cathegory mental disorder, excluding learning disability or dementia (MD). 5th March 2007 Date of last inspection Brief Description of the Service: Aldwick Residential Care Home is a care home registered to accommodate up to twenty-seven service users who have a mental disorder, eleven of whom may be over the age of sixty-five years. The registered providers are Mr Ashok Sewpaul and Mrs Premila Sewpaul. Mr Sewpaul is also the registered manager. The property consists of two terraced houses, which have been joined together internally and extended for its current use. The accommodation consists of eleven single and eight double bedrooms located on the ground, first and second floors. Communal areas include, a dining room and a lounge on the ground floor, whilst a second lounge, a hairdressing room and small smoking room are located on the first floor. The home is located in the town of Bognor Regis close to the seafront and local shops and amenities, with easy access to local rail and bus stations. Aldwick Residential Care Home DS0000014352.V358998.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 that people who use this service experience adequate quality outcomes. This key inspection has been undertaken using the Inspecting for Better Lives Methodology. Prior to the inspection surveys were sent to the home for the Manager to distribute to people living in the home, relatives, members of staff, Health Professionals and a number of G.P’s. The Annual Quality Assurance Assessment (AQAA) provided by the manager of the service was also used in the preparation and planning of this inspection. A visit to the home was made on Tuesday 26th February 2008 and six and a half hours were spent in the home. The Inspector looked around the home, examined a sample of records in relation to care plans, training, staff, complaints, accidents and Health and safety checks. The Inspector spoke with seven people living in the home. Three members of staff were spoken to throughout the inspection. A visitor and a relative who were visiting the home were spoken with privately. There were no surveys received from people living in the home, two surveys were received from relatives and four from members of staff. After the visit to the home the Inspector telephoned two Health Professionals to obtain their views and feedback about the service. The Registered Manager was not in the home at the time of the visit so the Deputy Manager facilitated the inspection. All members of staff were friendly and helpful throughout the inspection and a person living in the home showed the Inspector around the home. What the service does well: Aldwick care home provides an environment where people are treated as individuals as their rights, wishes and choices are respected and they feel safe. People are supported by members of staff who know them well as they have worked in the home for a number of years. The home has a very friendly, comfortable and relaxed atmosphere. The inspector saw positive contact between the staff and people who live in the home. The home is clean and tidy and free from any unpleasant smells. Rooms are comfortable and are very individual and kept as the person wishes. People who use the service told the inspector that they felt very happy with their private rooms and the communal spaces. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 6 Visitors, relatives and Health Professionals told the Inspector that people are well cared for and the service very much meets the needs of people living there. A Health Professional said, “you can always find someone to discuss things with, they treat people with real dignity, they accommodate their different ways, the staff are kind, caring and so understanding.” A relative said, “My relative often comments that she is pleased with the care she is receiving. It is clear that she feels safe in their care. There is a very friendly supportive atmosphere. If there is a cause of concern action is taken promptly and I am informed” What has improved since the last inspection? At the last key inspection in March 2007 seven requirements were made for improvement in the following areas: • • • • • • Assessments undertaken prior to a person moving into the home. Contracts for all people living in the home. Review of assessments and care plans. Medication policies and procedures and training. Staff training. The recruitment process for employing new staff. At this key inspection information was gathered to ensure that these requirements had been met. There was evidence that work had been undertaken to improve pre-admission assessments, contracts, medication policies and procedures and training, staff training and the recruitment process. Areas of the home have been re-decorated and the smoking room has been removed from within the home. What they could do better: The requirement made in respect of reviewing assessments had only been partially met. This means that the support required by some people living in the home has not been updated or reviewed. Fire precautions are taken and the fire alarm and fire fighting equipment are regularly checked. A fire risk assessment was not in place for the home. Members of staff have not received individual supervision or annual appraisals. Training has improved but some members of staff have not received training in all of the mandatory health and safety topics. People living at Aldwick House who need to use an assisted bath should not have to go through the garden to access this. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient and up to date information about what the home can offer to people thinking about moving into the home. An assessment undertaken prior to admission to the home ensures that accurate information about their needs has been obtained from them or people close to them. People know about their rights as they have been provided with a contract that includes how much they will pay and what the home provides for the money. EVIDENCE: The Statement of Purpose and Service User Guide have been reviewed and updated since the last inspection. There was evidence in the personal files for the people living in the home that they have received a copy of the service user guide. Members of staff confirmed that the forms used for recording an assessment undertaken prior to admission to the home have been reviewed and updated. As there had been no new people admitted to the home the pre-admission process could not be tested but the Inspector was satisfied that sufficient information would be obtained about a person in order that the Manager could be clear that the service could meet a person’s needs. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 10 People have a care plan that records all information in respect of their needs. Where people’s needs had changed and they had required extra support the care plans had been reviewed. However others that were examined had not been reviewed for some time. Information about care plans is provided in more detail under standard 6. Each person also has a personal file that holds correspondence and other personal details. From a sample of the personal files it could be seen that the person’s contract with the home had been reviewed in December 2007 and the person or their representative had signed this. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Standards 6, 7, 8, 9. This judgement has been made using available evidence including a visit to this service. People living in the home have not been consulted within the last six months about their needs, wishes or support they require. Members of staff do not have up to date information to ensure they support an individual appropriately, according to their wishes and to safeguard them from risks. EVIDENCE: The recording system used in the home is a standard “Standex” format. For each person there is a record of an initial assessment that records basic information in respect of next of kin, GP, health problems, date of admission, religion and wishes after death. A more detailed assessment is in place that covers all aspects of a person’s needs. There is a section that records any potential risk for a person and what actions or support is required to keep the person safe. There are sections for the recording of care or support provided, activities undertaken and a daily record of events. There was evidence that the person had been consulted about the support to be provided and had signed the care plan. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 12 When fully completed the care plans and records provide good information for staff to know how to support a person. The majority of information in the sample of records examined had been completed. However there were gaps in information about a person’s activities and interests. The assessments and care plans relating to two people living in the home had been reviewed in the last six months and had updated information about the support they required. There was no evidence for the remaining four that a review of the assessment of their needs, their care plan or assessment of risk for that person had been undertaken since 2006. This means that members of staff do not have up to date information about how to support a person and the person themselves have not been consulted on the support they require. This could lead to the person’s needs not being met, inadequate monitoring of a person’s health needs and potential risks to a person not being addressed. The requirement made at the last inspection has only partially been met and is repeated in this report. The majority of people living in the home were able to communicate with the Inspector and were able to voice their wishes. The people who were spoken with confirmed that they are able to express their views and wishes and this was respected. There were leaflets available about advocacy service and a person spoken with who was visiting the home was from a local church and acted as an informal advocate for two people. There was evidence that residents meetings are held the last one was held on the 3rd January 2008 and the topics discussed were recorded. Within the personal files examined there were completed questionnaires relating to what the person thought about the service. An improvement plan had been compiled in September 2006 that had used some of the feedback from the questionnaires and actions taken. There was no evidence that this had been undertaken in 2007. Assessments are undertaken on potential risks to a person living in the home in respect of any aspect of living in the home or when going out into the community. Out of the sample of care records examined only the risk assessments for two people had been reviewed in the last six months. There was evidence that where a risk had been identified there were clear written agreements made with the person. The remaining four had not been reviewed since 2006. This means that not all people living in the home are safeguarded against risks. As the risk assessments for the majority of residents in the sample had not been reviewed a requirement has been made. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style. A varied programme of activities ensures that people have opportunities to satisfy their social, cultural, religious and recreational interests and needs. People are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: People living in the home said that they were happy and content living in this home. One person said that he goes out to the local shops, travels on the bus, has a mobile phone so he can let the home know if he is going to be late or is in any difficulty. Others confirmed that there are activities arranged or provided within the home such as bingo, art & craft sessions, exercise class, music groups visiting monthly and outings to the theatre or garden centres or to the local café. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 14 There is a quiet lounge on the first floor where there is a selection of music, puzzles and drawing materials for people to use. The home is situated in an ideal location that is near shops, cafes, the seafront and other community facilities. People living in the home confirmed that they use the local community facilities as much as they are able. Relatives spoken with during the visit to the home and from comments made on surveys received prior to the inspection confirmed that they feel able to visit the home at any time and are made to feel welcome. A relative said, “There is a very friendly supportive atmosphere.” A telephone is available in the dining area for people to use or the home has a mobile phone that can be taken into individual’s rooms. A relative spoken with said that she visits and takes her son out and there was evidence from a care plan that another person is supported to visit her Mother. A relative and a visitor in the home during the visit said that they felt the home allowed people the freedom to be individuals and staff understood their sometimes different ways. There was evidence that at the last staff meeting members of staff had been made aware of the implications of the Mental Capacity Act and how they should respect a person’s rights to make decisions and to support them with this. People living in the home said they liked the food. The meal provided on the day of the visit looked well cooked and presented. When people were asked what was for lunch they did not know and would not know until it was put in front of them. If they don’t like the meal they are offered an alternative but this is after a meal has been put in front of them. The Chef knows the people living in the home well and is aware of their likes and dislikes but this practice reduces choice. It was observed that that two people have their meals liquidized. The components of the meal had been liquidized together. This was raised at the last inspection and has not been changed. Food guidelines recommend that the components of a meal should be liquidized separately. It is recommended that this is addressed and improvements are made in informing people of meals in advance and of the alternative. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical and emotional needs of service users are met. Improvements to the medication system and the storage arrangements ensure people receive their medication when they need it and in a safe way. EVIDENCE: The majority of people living in the home require minimal assistance with personal care and no one has mobility difficulties. A relative said, “my mother always appears to be well fed and cared for and her bedroom is clean and comfortable.” The Inspector spoke with two Health Professionals who both said that the service was good and met the needs of the people they supported. One said, “the home is very satisfactory, they always contact us, you can always find someone to discuss things with, they treat people with real dignity, they accommodate their different ways. The staff are kind, caring and so understanding, they always accompany a resident to appointments so they aware of any changes to medication. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 16 They provide entertainment regularly, I see people coming in to sing. I always find the home clean and staff polite and respectful, the home certainly meets my clients needs.” Another said, “The Deputy and staff team are excellent and know how to work with people to support them, we have had a good relationship with Mr Sewpaul and good communication with him about our clients.” Daily recording notes provided evidence of advice and treatment from health professionals being accessed for example, chiropodists, district nurses, community psychiatric nurses, and consultant psychiatrists. The Inspector observed that a person requested an appointment with a Doctor and this was done straight away with the person present. The storage of medication and the system used to administer medication was safe. Members of staff have now received refresher training in the handling of medicines. From the sample of staff records examined it was noted that six out of the eight in the sample received training in May, June or July 2007. A new checklist has been introduced that records any changes in medication or where medication has been delivered at different times. A sample of the recording sheets used for keeping a record of when a person takes their medication was examined and had been completed correctly. The observation of the administration of medication at lunchtime was undertaken safely. A new medication trolley has been purchased to improve storage and to assist in the administration. All care plans examined recorded a person’s religion and their wishes in the event of their death. A survey was received prior to the visit to the home from a relative of a person who was very ill and has since died. She said, “My sister often commented that she was pleased with the care she was receiving and that without exception staff were very friendly and supportive. I am impressed at their efficiency in promptly advising me of any changes.” The care plan and records relating this person were examined; they had been regularly updated and reviewed and provided comprehensive information. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and their representatives know how to make a complaint and feel that this will be listened to. The service safeguards people from abuse, neglect or harm. EVIDENCE: The AQAA states that five complaints had been received in the last year and all had been resolved within 28 days. The Commission have not received any complaints about this service. A complaints policy and procedure is provided as part of the Statement of Purpose and service user guide. It was seen that a copy of the service user guide and complaints procedure had been provided to each person and was kept in a personal file. The people living in the home told the Inspector they knew who to speak with about any suggestion, concern or complaint. They also said they could raise anything at the residents’ meeting. A relative said that they were aware of the complaints procedure and who to speak with. When they have raised any issues they have been dealt with promptly. A relative who responded to the inspection through a survey said they knew how to make a complaint and when they had raised anything it was responded to appropriately although they said, “very rarely necessary.” The complaints book was examined. Very few complaints had been recorded but where they had been they had been made by people living in the home and one from members of staff. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 18 The complaints book did not record how the complaint had been responded to, what actions had been taken or the date action or response had been made. The Deputy Manager confirmed that this information would be kept on the person’s personal file. The Inspector is satisfied that people living in the home would raise concerns and would complain and know how to do this. It is recommended that the recording of complaints be improved to ensure all the information and action taken is recorded in one place. The AQAA recorded that there had been no safeguarding adult allegations made in respect of the service. The Commission has not received any safeguarding allegations. The service has a copy of the new safeguarding adult procedures and members of staff received training in the new procedures on 1st February 2008. A relative who returned a survey said, “It is clear that my relative feels safe in their care.” People living in the home are supported to manage their financial affairs and arrangements. People said that they received their money and were in agreement to this arrangement. Where people are unable to do this Mr Sewpaul acts as an Appointee for those people. This allows him to deal with any benefit payments and their personal allowance. The Deputy Manager confirmed that each person has their own bank/building society account and his or her benefits are paid into this. Mr Sewpaul withdraws money each week to pay personal allowance. The Inspector saw a personal allowance book where people sign to say they have received their personal allowance each week if they are able. It was confirmed also that receipts are kept of any money spent and an account kept. A relative who returned a survey asked that Mr Sewpaul send an update on his relative’s finances every six months. This was passed on to the Deputy who agreed that Mr Sewpaul would do this. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26 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 lack of planning for evacuation in the event of a fire could put people living in the home at risk. The environment is clean, comfortable and homely. EVIDENCE: A tour of the premises was undertaken. The Inspector asked a person living in the home to show them around. This was done well and was very useful. It was observed that all radiators in the home are protected to safeguard against any risk of burning. The Inspector was informed that a thermostatic valve prevents the temperature reaching an unacceptable heat on all hot water outlets. It was observed that thermometers are kept in all bathrooms so the temperature can be checked when assisting someone with a bath. Checks on the hot and cold water temperatures are undertaken on a monthly basis to ensure that thermostatic valves are working. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 20 Checks on the documentation relating to the safety of the premises confirmed that gas and electricity supplies had been inspected, a test for legionella was undertaken in December 07 and regular checks for hazards within the home had been undertaken and recorded. The fire fighting equipment had been inspected on the 14/1/08. Checks on the fire alarms and emergency lighting had been undertaken every week. A Fire officer had provided training to the staff team on the 19/9/07. Although a fire drill had been recorded in the fire logbook it was not dated. New members of staff had been given instructions about fire procedures on the 10/11/07 and the 22/12/07. The property consists of two terraced houses and an extension and this makes the arrangement of rooms within the home unusual. At least three fire exits are through people’s bedrooms. Access to the fire escape is through a person’s bedroom. The last inspection report states, “Fire officer reports from 2003 and 2006 both highlight the fire escape situation as a problem. The fire officer was consulted who acknowledged that it was a difficult issue and confirmed that the home must have clear, robust risk assessments in place to cover all eventualities. At this inspection assessments of hazards around the building were seen but there was no overall fire risk assessment or evacuation plan in place. A requirement in respect of this had been made as having this is in clear breach of fire regulations. The AQAA stated that the smoking room within the home was now not used and that anyone wishing to smoke now goes outside of the building into the garden. This adheres to the new smoking policies however there is no shelter outside. The AQAA stated that there are plans to provide a shelter. There are eleven single and eight double rooms in the home. On the day of the visit some rooms were vacant due to the number of people living in the home reducing to twenty. The vacant rooms had been redecorated and were in the process of being completed. People’s rooms looked very individual, as they had been personalised with the person’s furniture and belongings. A person living in the home had a lot of belongings but said this is how he liked it. Some doors can be locked and it was noted that some people had locked their rooms. However not all doors can be locked due to fire exits being located within the room. Two people who share a room told the Inspector that they liked sharing their room and they were good friends. There was no lockable drawer or cupboard for items of value to be stored. As some people cannot lock their rooms it is recommended that a lockable facility be provided. Where people share rooms there was no screening to protect privacy and dignity. It is recommended that this is also addressed. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 21 There are sufficient numbers of bathrooms and toilets within the home. Some bedrooms have en-suite facilities. The Inspector was informed that some of the toilets have been replaced recently. An assisted bath is available for those people who cannot get into an ordinary bath. This is situated on the ground floor and only accessible via other people’s bedrooms or through the garden. A person who uses this bathroom said the bathroom is warm but it is cold getting to and from the bathroom. People living in the home are becoming older and their needs will change and perhaps their mobility will deteriorate. In order for them to remain in the home for as long as possible and their needs to be met a suitable bathroom must be provided that does not have to be accessed via other people’s rooms or through the garden. The sinks in rooms 10 & 12 required deep cleaning or replacing and one of the baths looked stained with lime scale otherwise the home looked clean and there was a good cleaning programme in place. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. Training in mandatory health and safety topics must be improved to ensure the health and welfare of people living in the home. Members of staff would be better supported if they received regular individual supervision and annual appraisals. EVIDENCE: The Inspector was informed that the home is fully staffed. Seventeen people are currently employed as care staff. There have been difficulties with staffing with a member of staff being on long term sick leave and with annual leave and other sickness. This has meant that the Deputy Manager and other staff have had to pick up extra shifts. A person working in the home during the visit confirmed that she has worked in the home for many years and although now retired does work on a casual basis when needed. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 23 The difficulties with staffing have taken the Deputy Manager away from her managerial duties hence the review of care plans and assessments have only been undertaken where a person has changing needs and members of staff have not received individual supervision. Training records relating to eight members of staff were examined. From these it could be seen that relevant training has been provided to staff over the years. Some staff who have worked in the home for some years have attended training in dementia, mental health workshops, principles of care, health & safety risk assessments, night care for people with mental health problems, emergency aid, challenging behaviour and moving and handling. Training has been undertaken in the last year in infection control, fire, safeguarding adults, medication, health & safety and food hygiene. A refresher training course in moving and handling has been booked. Members of staff have been supported to undertake training in National Vocational Qualifications (NVQ). The AQAA recorded that three members of staff have achieved NVQ 2 and seven are working towards this. Once these members of staff have completed the NVQ 2 this will achieve 50 of the staff team trained to NVQ 2. Despite the Manager and Deputy Manager making training available not all staff have completed each topic and some staff have not completed the mandatory training topics or updates. The Deputy Manager has developed a training checklist for each member of staff that records recent training undertaken and what is required. It is clear from these that there are gaps in staff training and concentration needs to be given to achieving all staff trained in the mandatory training topics; first aid, infection control, food hygiene, moving and handling, fire and health and safety. The Inspector was told that a training programme for last year and the forthcoming year is not in place not a training matrix that provides an overview of training and skills within the staff team and where there are gaps. The recruitment records relating to four new members of staff were examined. There was evidence for all four that checks against the protection of vulnerable adult register (POVA first checks) had been made and criminal record checks were in place before the person started working in the home. Two references were not in place for all four people. The Deputy Manager confirmed that verbal references had been taken up but not recorded. The requirement from the last inspection has been partially met and this must continue to be addressed to ensure all checks have been undertaken. Staff meetings are held regularly and there is evidence of minutes being kept. Members of staff who returned surveys said that the Manager and Deputy Manager provide them with the support they need and are approachable. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 24 Although members of staff are supervised on a daily basis there was no evidence that members of staff have ever received individual supervision or annual appraisals. As this has been referred to at previous inspections a requirement has been made in respect of this. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Deputy Manager needs to be supported in managing the home in the absence of the Registered Manager. People living in the home and other stakeholders have not been consulted about the quality of the service as part of the homes ways of making sure they continue to get things right. A risk assessment in relation to fire prevention and evacuation of the building in the event of a fire would promote the safety of people living in the home. Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mr Sewpaul is the owner and registered manager of the home. He is qualified as an RMN and has many years experience of providing a service for people with mental health problems. He has been unable recently to spend as much time in the home has he has previously. The Deputy Manager has taken on more responsibility but due to staff leave and sickness and in dealing with a difficult situation with a person living in the home some areas of the service have not been kept up to normal standard. The Inspector can see that generally the health and welfare of people living in the home has taken priority and areas such as reviewing care plans and assessments, staff supervision and a quality assurance exercise has lapsed. The Inspector did receive feedback from a Health Professional after the visit to the home. The feedback overall was positive and they felt the service was good and met the needs of the people they are responsible for. However it was felt that over the past six months the communication and liaison with the home has been affected by Mr Sewpaul’s absence. They said that one person had experienced a lapse in their mental health and this perhaps could have been prevented. They felt the service had become more reactive to people’s problems or difficulties rather than preventative. It is essential that Mr Sewpaul reviews the staffing levels in order to support the Deputy and the staff team to maintain the quality of the service and to meet the requirements made in this report. There is evidence that a quality assurance exercise has been undertaken in the past but there was no evidence that this had been undertaken in 2007. Health & Safety policies and procedures are in place and documentation relating to safety checks in the home is up to date. Not all members of staff have received training or refresher training in the health & safety topics. A fire risk assessment must be put in place. Aldwick Residential Care Home DS0000014352.V358998.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 Adults 18-65 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 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 28 No 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 YA6 Regulation 15 Requirement The registered provider must ensure that care plans and risk assessments demonstrate that the needs of people living in the home have been reviewed every six months. Timescale for action 03/06/08 2. YA32 18 The registered provider must 03/09/08 ensure that all members of staff receive training in the mandatory health and safety topics; fire, first aid, food hygiene, moving and handling, infection control. The registered provider must ensure that a risk assessment in relation to fire and evacuation of the home in the event of a fire is in place and kept under review. The registered provider must ensure that members of staff receive individual supervision at least six times a year and an annual appraisal. 31/03/08 3. YA42 23 (4) c iii 4. YA36 18 (2) 03/06/08 Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 29 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 Aldwick Residential Care Home DS0000014352.V358998.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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