CARE HOMES FOR OLDER PEOPLE
Alicia Nursing Home 109-115 Marsh Road Luton Bedfordshire LU3 2QG Lead Inspector
Katrina Derbyshire Unannounced Inspection 7th October 2005 10:00 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 Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 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. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Alicia Nursing Home Address 109-115 Marsh Road Luton Bedfordshire LU3 2QG 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) 01582 560500 01582 561574 Apex Care Homes Limited Mary Mukangwa Tengenesha Care Home 61 Category(ies) of Learning disability over 65 years of age (16), registration, with number Mental disorder, excluding learning disability or of places dementia (33), Physical disability over 65 years of age (12) Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The accommodatation within the home is on three floors and the care is managed in four separate units. General Nursing Care (which may include elderly persons with mental disorder) Specialist nursing care may include adults or older people with an assessed low to moderate learning disability with a physical illness or disability. The maximum number of persons must not exceed twelve (29) within the Older person group. Categories of registration to be: Physical disabilities over the age of 65 (PD(E)) 12, Learning disabilities over the age of 65 (LD(E)) 16 and Mental disorder, excluding learning disability under the age of 65 (MD) 33. As previously agreed prior to National Minimum Standards no service users requiring the use of a wheelchair to be admitted to any room prior to a risk assessment for its suitability. 4th April 2005. 6. Date of last inspection Brief Description of the Service: Alicia Nursing home is situated on the Marsh Road in Luton close to a variety of local amenities such as shops, places of worship and public houses. The home provides accommodation over three floors. For operational purposes each floor provides its own style of care for a particular group of service users. Attached to the home is a day centre that is staffed to provide activities for any of the service users who wish to attend Monday to Friday. The care staff can open this centre at weekends or in the evenings. The home has a small-enclosed garden with parking space for staff and visitors. The home is close to the M1 and the A6 and is on a bus route. Leagrave railway station is easily accessible. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 7th October 2005. The Registered Manager, Mrs Mary Tengenesha was present throughout. During the inspection several areas of the home were visited and the inspectors spent time with many of the residents in one lounge garden area, day centre and their own individual rooms. The care of six residents was examined in depth by looking at their records and interviewing the residents and staff who look after them. What the service does well: What has improved since the last inspection? What they could do better:
There are a number of things that the home needs to do to make sure that the residents receive consistent care from staff who act appropriately following training and know what to do to meet their needs. The home is not providing a reliable, consistent service and this must improve in order to meet residents needs and give a service that they are all happy with.
Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 6 The most serious concern from this inspection was that the home had admitted people who they were not registered to care for. Even though the homes registration had been fully explored with the manager earlier in the year, following concerns about the category of people living at the home. An official letter was left at the home to inform the owner and manager that this be put right immediately. Another serious concern was the way staff helped residents move around the home and transfer from their armchair to a wheelchair. The assistance provided was dangerous to both the residents and the staff, and an official letter was left immediately to inform the owner and the manager that this must also be put right immediately. Other areas that will need to improve is how the home gives out medication to residents, how staff speak to residents, to make sure that there is a care plan for all their individual needs and their record keeping especially when writing about the residents. 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. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 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 the following standard(s): 4 The procedures in place to ascertain if the home is allowed to admit, or able to meet prospective residents needs are poor and puts residents at risk. EVIDENCE: The homes registration categories were reviewed as this area had been noted as requiring a change at the previous inspection in April 2005. On reviewing the needs of the residents living at the home it was evident that the home had admitted four residents outside of their categories of registration since that time. This put the four residents and those remaining in the home at risk, staff and the home did not have the needed policies, training and systems in place to meet their needs. An immediate requirement was made for the home to cease the admission of any resident outside of its registration and to review its overall service delivery and focus. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Medication systems in the home are not sufficient and put residents at risk of not receiving their prescribed medication. EVIDENCE: Care planning was noted to have improved since the previous inspection, however further change and development is still required. One resident required support with individual behaviour that impacted on all those around them, no plan was in place to guide or direct staff in how they should support this resident or how to help the behaviour reduce was in place. Daily notes for several residents frequently contained entries ‘ no inappropriate behaviour’ or ‘inappropriate behaviour today’, no explanation was given as to the meaning of this repeated statement and no care plan was in place to give clarification. The healthcare of some residents was noted to be satisfactory and residents confirmed that they received visits from nurses and Doctors. Although feedback received from some healthcare professionals voiced concerns that the home had on occasions failed to assess the risks associated with resident’s medical conditions and in turn their care had not been in accordance with their needs.
Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 10 Medication records and stocks were examined. The medication administration sheet of one resident and the stocks of medication indicated that on four occasions in the past two week period staff had signed to show that medication had been given when stock levels showed that it had not. This is dangerous practice as residents are not receiving needed medication and a requirement has been made. Observation of the interaction between residents and staff was made throughout the inspection. In most instances the interaction was noted to be supportive, encouraging and respectful. However on one occasion a resident was being assisted by staff who repeatedly stated “good boy” to him, this did not maintain his dignity and a requirement is made to cease this practice. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14. The activities and recreational opportunities available to the residents are of a good standard so resident’s social needs are met. EVIDENCE: The day centre in the home is run between Monday and Friday by dedicated staff specifically employed to focus on meeting the social needs of the residents. Alongside in house provision outside entertainment is also arranged and includes a music and dance troupe. Residents spoke of their enjoyment of the facilities at the centre and confirmed that the staff helped them in pursuing their individual interests. Within the care records of each resident documents were in place to evidence that when needed advocacy services were arranged. One resident was waiting for their solicitor to visit them at the home. Another resident spoke of the choices that they could continue to make while living at the home, one example was to choose who could visit them and when. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Systems in the home for the protection of vulnerable adults are not sufficient and put residents at risk from harm. EVIDENCE: The local protection of vulnerable adults policy was displayed throughout the home. Documentary evidence was also available for inspection that evidenced the home had reported to the appropriate authorities where an allegation or suspicion of abuse had been noted. However the recording of these notifications were not clear in all instances and did not provide sufficient information for the local authority to make an informed decision on how to proceed. Also through the examination of residents care records certain possible behaviours of residents had not been assessed by the home therefore no plan was in place to show staff how to minimise risk, this may have prevented recent protection of vulnerable adults referrals. A requirement has been made following this inspection. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. The home is clean and hygienic providing a pleasant environment for the residents to live in. EVIDENCE: Areas in the home seen were bright and well maintained. Residents said that they were happy and satisfied with their surroundings. Décor and furnishings were of a good standard and pictures, ornaments and plants were in place and assisted in creating a homely atmosphere. At the inspection in April 2005 a requirement had been made as at that time there were unpleasant odours in the home. On this inspection all areas visited were clean, hygienic and free of odours. Staff were observed wearing protective clothing when required and clinical waste was disposed of in an appropriate way. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28. The skill mix of staff is not sufficient and does not meet all assessed needs of resident’s. EVIDENCE: The training records of staff at the home were examined and showed that training in many areas had been undertaken. However the age and assessed needs of the current resident group is wide-ranging and staff had not received all the necessary training and guidance to meet all those needs. Through discussion with staff it was confirmed that staff were not able to describe the needs associated with a residents primary need. The need to have a staff group with the appropriate skill mix to meet all assessed needs is a requirement following this inspection. Staff training records also showed that staff’s induction did follow national guidance and staff actively sought to undertake the National Vocational Qualification in care. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38. The moving and handling of residents is unsafe and puts both residents and staff at risk from injury. EVIDENCE: Observation of care practice was made and this included the moving of residents from their chair to a wheelchair and moving from the sitting area to another space in the home. The use of illegal moving techniques was used by staff on four occasions in a two hour period. Residents were lifted under their arms and pulled by their hands from an armchair, this placed the resident and staff at risk of serious injury. An immediate requirement was made on the day of inspection for this practice to cease with immediate effect. Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 17 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 OP4 Regulation 10,11,12 & 13. Requirement No service user must be admitted to the home whose needs fall outside of the category of registration that the home holds. A care plan must be in place for all assessed needs of the service users. Care plans must contain sufficient detail for the needs of residents to be met and carried out. (Previous requirement timescale of 01/01/05 and 30/06/05 not met.) Systems must be in place to identify possible risks directly associated with service users diagnosis in consultation with health care professionals. Safe systems must be in place to ensure service users receive prescribed medication, and medication records must not be signed if medication has not been given. Service users must always be spoken to in a manner that meets their cultural needs and promotes their dignity and
DS0000017661.V257082.R01.S.doc Timescale for action 07/10/05 2. 3. OP7 OP7 12(1a)& 15 12(1a)& 15 30/10/05 30/11/05 4. OP8 12 & 13. 15/11/05 5. OP9 12(1)(a) & 13(2). 30/11/05 6. OP10 12(1)(a) & 12(4). 30/11/05 Alicia Nursing Home Version 5.0 Page 18 7. OP12 8 8. OP18 12(1) 13(6) 19(1)(a) 9. OP24 12. 10. OP27 12,18 & 19. 13,16 & 23. 11. OP38 respect. The home must ensure the wishes of residents for the time of death and funeral arrangements are documented. (Previous requirement timescale of 01/01/05 not met and not assessed at this inspection) All referrals made under the local Policy for Protection of Vulnerable Adults must be made in a timely manner and information must be sufficient in detail for an informed decision to be made on how to proceed. The registered person must ensure that all residents who want a key to their room have the opportunity to hold one. (Previous requirement, not assessed at this inspection. The skill mix within the home must be sufficient to understand and meet all the assessed needs of all service users. Evidence must be available to show that temperature checks have been undertaken in bathrooms to prevent scalding. (Previous requirement not assessed at this inspection) 30/06/05 30/11/05 01/01/05 31/12/05 30/06/05 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 Alicia Nursing Home DS0000017661.V257082.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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