Inspection on 01/04/08 for Aliwal Manor

This inspection was carried out on 1st April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aliwal Manor 03/04/07

Aliwal Manor 02/08/06

Aliwal Manor 20/12/05

Aliwal Manor 20/09/05

Aliwal Manor 23/09/04

Aliwal Manor 20/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Aliwal Manor Turners Lane Whittlesey Cambridgeshire PE7 1EH Lead Inspector Don Traylen Unannounced Inspection 1st April 2008 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 Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aliwal Manor Address Turners Lane Whittlesey Cambridgeshire PE7 1EH 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) 01733 203347 01733 203566 Aliwal Healthcare Ltd Margaret Charles Care Home 30 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (30) of places Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3rd April 2007 Brief Description of the Service: Aliwal Manor is a care home providing accommodation for up to thirty older people. The home is situated in the town of Whittlesey, Cambridgeshire with good access to local facilities, such as shops, churches and pubs. The city of Peterborough, with its wide range of leisure facilities, is within a 10-minute drive. The home is divided into four separate units: Wordsworth, Shelley, Byron, and Tennyson, one of which is for nine people with dementia. One unit accommodating five people upstairs is accessed by a lift or stairs and is for people who are more independent. Each unit has its own lounge, dining area and kitchen where snacks and drinks are prepared, and a number of bedrooms. The main meals are prepared in the central kitchen and there is a main laundry room. There are an adequate number of toilets and the home has five large bathrooms, with assisted bathing equipment. There is a separate shower room. The home employs an activities coordinator who works at the home over four days each week. There is a large lounge in the centre of the home which is used as a day centre by people in the local community on two days a week and can be used by people living in the home. The fees for accommodation and care at Aliwal Manor range between £300 per week for a smaller room and £419 for dementia related care. Twenty-four of these places are block-booked by Cambridgeshire County Council, with the other six available to people who privately fund their own care. In addition, residents pay for items of a personal nature, such as toiletries, newspapers, hairdressing, chiropody and so on. The Commission for Social Care Inspection (CSCI) produces a published report following each key inspection. These reports are available in the foyer of the home. Aliwal Manor DS0000015291.V361679.R03.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 2 star. This means the people who use this service experience good quality outcomes. The Commission for Social Care Inspection carried out this inspection on 1st April 2008. The inspection site visit started at 10 am and finished at 5.30 pm. An Annual Quality Assurance Assessment was requested from the home who completed this in time. Of the 25 survey forms sent to people living at the home 11 survey forms were completed on behalf of people using the service. Four people’s care plans were assessed. Two visiting relatives were spoken to. Three care staff were observed giving medication and giving care at lunchtime. They were asked about the care provided to people at the home. Informal discussions with people took place randomly throughout the inspection, when it was appropriate, to determine their level of satisfaction with the care they receive. Of the 25 survey forms sent to people living at the home 11 survey forms were completed on behalf of people using the service. There were indicators in these surveys that people were satisfied with the service. Feedback of the findings was given to the manager, during and at the end of the inspection. The organisation’s responsible individual was present when feedback was provided at the end of the inspection. What the service does well: The assessment information gathered for people admitted to the home was comprehensive. Care plans were good. They have been improved since the last inspection and contain comprehensive and detailed information about giving care. The home demonstrated that they have a staff team that were each considerate and worked well together. They put people first. They had a clear understanding of their roles and were seen to work and support each other. The manager leads by setting an example. She has arranged training and kept clear records and improved the content and structure of care plans. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The detail of care plans to record the frequency and amount of fluid intake, must be accurately maintained when this is a plan and treatment to help relieve pressure sore areas. The environment must be free from any offensive odours. The room used by the Team Leaders should be redecorated. There must be evidence that the home has appointed a person to supervise anybody whom the home has allowed to commence employment pending receipt of a CRB disclosure, so that people living at the home are guaranteed they are safeguarded. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 7 The detail, content and progress and competencies achieved for the Skills for Care Standards based induction programme, should be recorded for any person undertaking this induction. The home should ensure they have adequate provision of paper towels for people to dry their hands. 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. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5, Quality in this outcome area is good. People considering moving into the home are comprehensively assessed and have the opportunity to visit the home prior to making a decision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a suitable Statement of Purpose and User Guide. Both are available at the main entrance together with other relevant information about the home, including their last CSCI inspection report and the process of admission, assessment and advocacy support arrangements. The last report showed that the home may have other people accommodated outside of the ‘Wordsworth’ unit who have dementia related needs. During this inspection four people were identified with impaired memory related needs and were not living in this specialist unit, but were being suitably cared for and each person had primary needs that were of a physical nature. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 10 People are always assessed prior to moving into the home, usually by a PCT Care Manager as well as by the home. During the inspection the manager went to visit a person in their home to assess their needs. People have every opportunity to visit the home prior to moving there. The home has a contract with the Cambridgeshire PCT to provide 24 places for people who are part funded by the PCT. The home is also a valuable community resource for respite services. Intermediate care is not provided Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is good. People living at the home are assured of their care being planned and known by staff and that medication will be administered safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people’s care plans were read and two people’s care was tracked. The care plans were comprehensive and contained good information and instructions about actually giving care. They were well presented documents and were maintained in very good order and were clearly written and easy to read. They were indexed and it was easy to find relevant information. One person with significant needs was being cared for in her bed. Her care was observed and was given with respect and compassion. She was allowed time to communicate and to eat at her pace when being assisted to eat. A satisfactory plan for this approach had been recorded in her care plan. One aspect of her Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 12 care plan, the recording of her fluid intake and routine for turning to relief pressure sore areas, can be improved. This was discussed in full with the manager and a senior carer during the inspection and the record was immediately altered to allow for this detailed recording. Two relatives who were visiting another person were spoken to. They both felt the home was providing good care for their relative. Both of the above two people’s care plans indicated the involvement and interventions of Health professionals and recorded their visits. There were also District/Community Nurses’ assessments and nursing care plans for these two people that were kept in their rooms. Another person who had significant needs that were being addressed by his GP and District Nurses, informed us that he is fully aware of all these arrangements and his future prognosis and treatment. Observation of the lunchtime meal showed that people who needed assistance to eat were given this help in a manner that suited them and by staff who demonstrated a professional empathetic awareness and maturity. Medication was observed being given in two of the three units in the home. Medication Administration Records charts were checked and found to be satisfactory. PRN, or ‘as required’ medication was observed to be offered to people who stated whether they wanted it or not. PRN was approiately recorded on the charts. Amounts of medication were checked against the records for administering and were found to be accurate. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. People’s lifestyle and experience meets their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Dignity and respect were upheld by care staff when giving care. People were given time to respond when spoken to and when assistance was being given to help eat at the lunchtime meal. A care worker listened to one person who explained his health care needs to her. Nine people living at the home and two relatives who visit regularly stated the staff are kind and are good carers. They confirmed they were satisfied with the quality of care they received. Thirteen surveys returned to the Commission revealed that people were generally satisfied with their care. The home employs an activities co-ordinator who is also very competent at providing personal care, which she is expected to do during working pattern. People benefit from this flexible arrangement and high quality care. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 14 Twelve people were asked about the food they received at the home and they unanimously stated they were well fed and received choices of meals and enjoyed the food. A lunchtime meal of roasted chicken and three kinds of vegetables was served during the inspection. The meal looked appetising and the vegetables were not overcooked. Fresh vegetables are delivered twice weekly to the kitchens. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People living at the home are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a suitable written policy confirming their intention to protect vulnerable adults from abuse. There are posters within the home showing how to report an allegation or suspicion of abuse. The home has shown they are prepared to refer cases of suspected abuse to the Local Authority or the Police when necessary. All staff bar one care worker and two domestic staff have received training in protecting vulnerable adults from abuse. Other relevant information to promote protection and prevention of abuse that is supplied by Cambridgeshire County Council’s Adult Protection training team was discussed with the manager. The home has maintained a folder about the complaints they have received and have shown they have responded appropriately to these complaints. They provide information about their complaints process and forms to complete should anybody wish to report any complaint to the home. These forms were located inside the main entrance to the home for all visitors to see. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26, Quality in this outcome area is good. People living at the home experience a clean, warm and safe environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment was clean. The kitchen was clean and well organised on the day of inspection, despite only one person working as cook and managing all the preparation and cleaning tasks. The home is generally becoming worn in places and some fittings and fixtures are worn and need attention. One bath had lime scale collected around the overflow exit and the hoist in the same room was in need of a thorough cleaning. There is an old prefabricated shower cubicle in a bathroom/toilet that is not used by any person at the home. Some of the toilets did not have a supply of paper towels in the paper towel holders. The flat roof in the long corridor was damp and had flaking paintwork and a Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 17 small area of rotten wood. The manager showed us the recent financial budget allocated to repair this roof and stated this would be repaired in the near future. The office/room used by the Team Leaders was small and appeared to be in need of redecorating. The washing machine in the laundry appeared to be dented and old and had a collection of lime scale around the base at floor level, although the laundry room was cleanly maintained. Since the last inspection many of the corridors and communal areas with carpets have been deep cleaned. Some repainting of the internal rooms has been carried out. The front of the home has been tidied and overgrown shrubs removed and cut back. The side and rear external areas in two distinct parts of the home have been improved by making them into neat gardens equipped with new seats and benches and raised plant beds and recently grassed. These areas were inviting and provided safe and private places that were easily accessed. Only one room within the home had an offensive odour. This was discussed with the manager who was already aware of this and had a plan to eradicate this smell by supplying new replacement flooring and changing some strategies when providing individual personal care. All hazardous substances were kept in locked cupboards, or locked rooms. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. People are given care by trained and competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were four care staff, one team leader, the manger, an activities coordinator and an administration worker and a domestic cleaner working during the inspection. Three care workers are employed during the night. The staff roster showed this to be the usual staffing arrangement. The home also employs a maintenance person, who has been responsible for making improvements to the external areas of the home. The recruitment details of two care workers employed directly from overseas were assessed. The arrangements are made with another company who partly manage their recruitment and immigration status. The references supplied were “Recommendations” by the organisations where these two people had been employed prior to living in the UK. The reference had not been requested in writing; were not dated and were not addressed to the home or to anyone. Each person had completed an application form. A POVA First check and a Criminal Records Bureau (CRB) Disclosure had been obtained. Both people’s Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 19 CRB disclosures were received after they had been allowed to commence employment. Induction training was assessed for the two above persons. Their initial and brief induction programme is recorded as being given and the Skills for Care based Induction is initiated after this. Details about the content and progress and competencies achieved of the Skills for Care Standards based induction, had not been recorded or charted. A range of suitable training has been received by care staff and has been recorded as such. The home has ensured that staff have been trained in medication and this has led to an improvement in the recording of the MAR charts previously referred to. The manager has brought improvements to arranging and recording training since she has worked at the home. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38, Quality in this outcome area is good. People living at the home are assured their best interests are looked after. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has become registered with the CSCI since the last inspection. She leads by example and appeared respectful of people in her words and attitude and showed respect and understanding a person centred care perspectives. During the inspection she ensure immediate steps were taken to improve an aspect of care records. A senior carer later emulated this immediate action when she contacted the District Nurse on behalf of somebody whose needs she judged to have changed. The manager has brought Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 21 improvements to training arrangements and record keeping and has maintained a focused response programme to any complaints raised with the home. Supervision arrangements have been recorded for staff who receive supervision every two months. The manager stated that the two staff already referred to in this report who commenced employment pending a CRB disclosure, were working under supervision. However, there was no written evidence to indicate this or to record the arrangement for this supervision. Records of regulation 37 reports sent to CSCI were kept by the home. The organisation carries out various audits to monitor the quality of care within the home. Records of the Annual Fire Alarm certificate were read, as were the regular fire drills and the fire alarm tests and emergency lighting testing. A potential risk of cross infection through the lack of paper hand towels has already been referred to in the environment group of outcomes. Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 22 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 2 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 3 X 3 X X 2 3 3 Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP36 Regulation 19(11) & Schedule 2 Requirement The home must ensure and evidence that they have appointed a staff member to supervise any new worker pending receipt of a CRB disclosure, so that people living at the home are safeguarded. Timescale for action 01/06/08 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 OP7 Good Practice Recommendations The home should always ensure they immediately record the treatment they are providing for any person known to have a pressure sore, so that people living at the home are ensured of receiving the appropriate care. The home should prepare a list of references and information about the local authority guidance and training details relating to adult abuse in Cambridgeshire and information that promotes protection, so that staff can access this information. DS0000015291.V361679.R03.S.doc Version 5.2 Page 24 2 OP18 Aliwal Manor 3 4 OP19 OP30 The room used by the Team leader should be redecorated. Details about the content and progress and competencies achieved in the Skills for Care Standards based induction programme should be recorded for any person undertaking this induction. The home should ensure they have adequate provision for people to dry their hands and thereby prevent a risk of cross-infection. 5 OP38 Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 25 Commission for Social Care Inspection CPC 1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aliwal Manor DS0000015291.V361679.R03.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!