Inspection on 19/04/06 for Allambie Court

This inspection was carried out on 19th April 2006.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Allambie Court 29/01/09

Allambie Court 10/10/08

Allambie Court 07/01/08

Allambie Court 21/09/07

Allambie Court 29/11/06

Allambie Court 22/11/05

Allambie Court 06/07/05

Allambie Court 15/02/05

Allambie Court 23/04/04

Similar services:

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

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

CARE HOMES FOR OLDER PEOPLE Allambie Court 55 Hinckley Road Nuneaton Warwickshire CV11 6LG Lead Inspector Michelle O`Brien & Kevin Ward Key)Unannounced Inspection 19th April 2006 09:40 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 Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 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. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Allambie Court Address 55 Hinckley Road Nuneaton Warwickshire CV11 6LG 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) 02476 383501 allambiect@btinternet.com www.adlcare.com ADL Plc Mr William Jeremy Davies Mr Peter Jones Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number disorder, excluding learning disability or of places dementia (30) Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Allambie Court Nursing Home is situated in Nuneaton approximately 1 mile from the town centre, and is easily reached by a local bus service. The home is an Edwardian building converted into a nursing home and has had an extension built to accommodate 30 people who have a diagnosis of dementia and mental health problems. There is a small secure garden to the rear of the property and sufficient parking to the front. The home has a mixture of single and shared occupancy and all bedrooms are fitted with a hand washbasin. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken to include a review of action taken by the providers in response to the Statutory Notice issued on 24th March 2006. A visit was made on 1st March 2006 in response to two complaints received by the Commission and to review the progress made since the inspection on 22nd November 2005. On 1st March it was evidenced that insufficient progress had been made to address requirements regarding care planning for service users, this resulted in a Statutory Requirement (Enforcement) Notice being issued to the providers on 24th March 2006 for their failure to comply with the Care Standards Act 2000 and the Care Home Regulations 2001. The home was required to ensure that assessments and care plans are up to date and changes in personal, social and healthcare needs are recorded and evaluated as required. They were also required to ensure that the staff are appropriately trained and monitored. An unannounced fieldwork visit to this service as part of a key inspection process involving looking at a range of information was carried out on 19th April 2006. This included the service history for the home and inspection activity, notifications made by the home, quality monitoring visits carried out by the provider and information shared from other agencies and the general public. This fieldwork visit was undertaken by two inspectors between 9.40am and 6.30pm. On the day of the visit 25 service users were accommodated in the home (including one in hospital) and it was the assessment of the nurse in charge that the majority of service users had high dependency needs. The inspectors had the opportunity to meet and chat with 12 of the residents about their experience of the home. Some of the residents found it difficult to engage in conversation due to their dementia but were able to express their feelings with verbal and non-verbal communication. 5 service users were ‘case tracked’. This involves investigating an individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences, looking at their care files and focusing on outcomes. The inspectors also talked to five relatives of service users, three of the care staff, the nurse in charge and the cook. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 6 17 completed comment cards from relatives were returned to the Commission. One completed comment card from a service user was returned along with another comment card stating, ‘The residents in our home are unable to communicate in this way, however the relatives have all received their questionnaires’. Documentation maintained in the home was examined including policies and procedures and records maintaining safe working practices. The inspectors would like to thank staff and residents for their co-operation and hospitality during this visit. What the service does well: What has improved since the last inspection? What they could do better: There were shortfalls in the majority of National Minimum Standards assessed during this inspection. ● The Statement of Purpose and Service Users Guide need to be updated to give accurate information to prospective and current service users and their families. Staff need to improve their knowledge and competency to prescribe care and devise care plans to meet the needs of service users to ensure their care needs are met. Care plans must be written to address short term needs for service users DS0000004383.V290101.R01.S.doc Version 5.1 Page 7 ● ● Allambie Court to avoid an oversight of care. ● The psychological care plans for service users must be developed to include an analysis of the possible reasons for any challenging behaviour in order to reduce the incidence of agitation and anxiety for service users. Some working practices must be improved to uphold the privacy or dignity of service users. The systems for the management of medicines in the home must be improved to reduce the risk of harm to service users. The programme of recreational activities within the home must be developed to ensure all service users have the opportunity for stimulation that reflects their preferences and capabilities. Service users must be given the opportunity to have some control over decision about their everyday life according to their capacity. The environment in the dining areas need to be improved and sufficient staff must be in number to improve the service user’s experience of eating as a pleasurable, social occasion rather than a functional event. The provider needs to take a more objective approach to responding to complaints or concerns received. Local Adult protection policies must be consistently followed to reduce the risk of harm to service users. Staff training is required in order that they can recognise and respond to suspicion or allegations of abuse. Further improvements are necessary in service user’s bedrooms. The décor is bland and rooms look institutionalised. There is little evidence that service users are encouraged to personalise their rooms. Some of the furniture in service user’s bedrooms are old, worn and need repair. The vanity units around handbasins are worn. Some of the bedroom carpets are stained and worn and need to be replaced. The offensive smells in some of the rooms need to be eliminated to uphold the dignity of service users and improve their quality of life. The vacancies for registered nurses in the home means that there are too few nurses to effectively run a named nurse system as each nurse has responsibility for care planning of too many service users. The number of care staff with a National Vocational Qualification (NVQ) in care needs to be increased so that service users are cared for by trained DS0000004383.V290101.R01.S.doc Version 5.1 Page 8 ● ● ● ● ● ● ● ● ● ● ● ● ● Allambie Court and competent staff. ● The absence of consistent leadership from a manager who has a sufficient amount of time to discharge their responsibilities effectively has had a negative impact on outcomes for service users. Staff must receive supervision at least six times a year. Checks and servicing of equipment and services in the home must be made regularly and recorded accurately to maintain the health, safety and welfare of people in the home. ● ● 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. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 9 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 Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 10 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): Standards 1, 3, 4 and 5 were assessed. The judgement for this outcome group is adequate. Service users have their needs assessed before admission but the delay in implementing care plans increases the risk of harm to service users. EVIDENCE: The Service User’s Guide and Statement of Purpose have been revised since the last key inspection and contain most of the information necessary to enable prospective service users and their families to make an informed choice about moving into the home. The list of staff and their qualifications, the name and qualifications of the manager and the statement regarding personal belongings, valuables and cash need to be revised. The description of catering staff as ‘Nutritional Care Staff’ is misleading and needs to be reviewed. Two relatives spoken to said that they had chosen the home for service users but the service users were unable to visit the home before moving in because it had not been practical to arrange this because they were in hospital. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 11 Admissions to the home have been stopped since 7th March so inspectors were unable to review any service users admitted very recently. However the care file of one service user admitted to the home after the last inspection was examined and found to contain pre admission assessment identifying and recording the needs of the individual. The file contained risk assessments for tissue viability, falls, nutrition, moving and handling the use of cot sides. Appropriate care plans were implemented although the moving and handling care plan was not written until 5 days after admission despite the service user being assessed as unable to weight bear and requiring the use of a hoist for transfers. Pressure relieving equipment identified as necessary for this service user was found to be in use. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 12 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): Standards 7, 8, 9 and 10 were assessed The judgement for this outcome group is adequate. Care plans are in place to meet most of the identified needs of service users but medicine management must be improved to protect service users from potential harm. EVIDENCE: The general appearance of service users has improved since the last random inspection. Most service users were observed to have had better attention paid to their personal care. Fingernails were trimmed and clean, hair looked clean and better groomed and clothes were well laundered. The nurse in charge informed that the majority of care plans have been reviewed and updated. The care files of the five service users ‘case tracked’ were examined. The files contained care plans that described the actions necessary to meet most of the needs of the service users. The care plans had all been updated very recently and contained relevant information. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 13 Psychological care plans have been implemented but these need to be further developed to include the ‘mapping’ of challenging behaviour for precursors and to describe actions which resolve the behaviour. For example, the care plan for one service user identifies potential physical and verbal aggression, however there is insufficient information about the possible reasons for this behaviour and actions to be taken by staff to reduce agitation and anxiety. Care plans must be devised in response to new or short term needs. The care file of one service user recorded a urinary tract infection but there was no care plan available. There is evidence that some reviews of care plans had been discussed with relatives and plans are in place to ensure all care plans are reviewed with relatives. 3 out of 17 relatives completing a comment card indicated that they did not feel well informed about matters affecting their relative in the home. Care planning, recording and outcomes for tissue viability (pressure area care) has improved. Records of a service user admitted to the home from hospital with pressure sores demonstrate that these are now healed. The care file of another service user recorded pressure sores developing to her heels and buttocks. However, the risk assessment identified a high risk and pressure relieving devices had been implemented. Records demonstrated good practice with a referral to the tissue viability nurse specialist, photographs, wound care charts and repositioning charts. This very physically frail service user was visited by the inspector; she was unable to communicate but looked well cared for, comfortable and pain free. During discussion with the nurse in charge it was discovered that many of the care plans had been reviewed and updated by a nurse ‘brought in’ by the providers from another home. It is of concern that while the requirements of the statutory notice have been met in updating the care plans, there is no evidence to confirm that a protocol has been devised and implemented to ensure that care plans are maintained and kept up to date. The provider has acknowledged in a letter to the Commission in November 2005 that it was identified through supervision that staff responsible for care planning ‘do not have the knowledge or skills to complete comprehensive care plans’. There is no evidence that a training programme has been devised or implemented to address this shortfall to ensure that service users have up to date care plans written by knowledgeable staff within the home. 13 out of 17 relatives completing a comment card were satisfied with the overall care provided by the home. Comments from relatives that were made during discussions with the inspector were positive and included, ‘my husband continues to improve’, ‘the home is improving’, ‘I am happy with the care’. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 14 The systems for the management of medicines were examined. A pharmacist inspection of the service was made on 21st February 2006 and five requirements were made. Three of these continue to be outstanding. The following concerns were identified in relation to medicine safety and discussed with the nurse in charge during the inspection: Prescriptions are not seen prior to dispensing and there is no system to check the dispensed medicine and Medicine Administration Records (MAR) against the original prescription. The nursing staff are still not regularly assessed to demonstrate their competence in medicine administration and recording. It was informed that the medication policies are under review and none were available in the home Of a random audit of medicines supplied in original packaging 2 out of 3 were accurate. There were two too many Epilim tablets remaining for one resident which suggests they were signed for and not administered. Medicine fridge temperatures are not recorded and there was no fridge thermometer in the fridge. The home uses a monitored dosage system (MDS) with medication being dispensed to the home every 28 days. Medicines were stored securely and there were no omissions of staff signatures on the medicine administration records. An audit of controlled drugs was made and found to be accurate. Individual protocols for ‘as necessary’ medication were available. Arrangements are in place for the safe disposal of excess medication. Staff were observed to be kind and caring towards service users and attentive to their needs but some working practices and environmental issues do not uphold the privacy and dignity of service users. There was no privacy curtain in one of the shared rooms, one care staff was observed standing up while feeding a service user between serving meals to others, a care staff member was observed to stand while cutting the fingernails of a resident who was sitting down. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. The judgement for this outcome group is adequate. Progress has been made in developing a programme to ensure that service user are supported to engage in meaningful activity which may enhance the quality of their lives. EVIDENCE: An activities support worker was appointed in January 2006. This has had a positive impact on providing meaningful stimulation for service users. ‘Life Story’ books for each service user are nearing completion and provide a good background to people’s past lives, current relationships and enduring interests. The support worker is pursuing some individual interests and group activities with some people; for example, supporting one gentleman to shop for his newspaper, one lady does flower arranging, the hairdresser visits and this is used as a relaxing activity. There are occasional art and pottery sessions, music sessions and quizzes. Money has been made available in the home’s budget to support activities by purchasing resource materials and paying for entertainers such as musicians to perform in the home. Service users were observed to receive visitors in the communal lounges. Two relatives commented that they were made to feel welcome when they visited. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 16 The home’s limited links with the local community should improve through the planned work of the activity support worker. There is a need to increase the level of activities as the support worker is involved in virtually all of the activities but only works 16hrs a week. Care staff are now taking a positive approach to activities and are recognising the value of encouraging and supporting service users to participate. It can be difficult to support service users with impaired cognition to exercise choice over their daily lives; however, service users were observed to be excluded in simple decisions such as the choice of meal. One of the inspectors joined service users in the dining room for their two course midday meal. There was a choice of pork or fish on the menu but not all service users were asked their preference but a meal chosen by staff was put in front of them. The dining room was sparse and unwelcoming and there were no attractive table settings. The atmosphere was functional rather than creating a social occasion around the pleasure of eating. The meal was served by care staff from a hot trolley and was well presented, tasty and nutritious. There are two dining rooms in the home and food is served to both dining rooms from the same trolley. On the day of this inspection visit the trolley was delayed in reaching the upstairs dining room and service users were becoming agitated and anxious at having to wait. One service user seated with the inspector during lunch chatted about the food provided and commented that it was always ‘good’ and ‘plentiful’. Drinks were served frequently to service users throughout the day. Staff were very busy during the meal service due to the number of service users that required assistance, prompting or supervision to eat their meals. Staff offered kind and sensitive assistance. One service user did not eat his liquidised meal but it was not clear if he may have been persuaded if staff had been less hurried and had more time to spend with him. An inspector visited the kitchen and talked to the cook. The kitchen was clean and well organised. Records of cleaning schedules, food temperatures and fridge and freezer temperatures were maintained. Menus are planned in advance and a choice of meal is provided each day at the time of service. Varied textures such as pureed are available for service users who have difficulty eating normal textured diet. A cooked breakfast is available in the home each day. The breakfast service was just finished when the inspectors arrived in the home at 9.40 am. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. The judgement for this outcome group is poor. The lack of staff awareness of the protection of vulnerable adults leaves service users at risk of harm. EVIDENCE: The home has an updated complaints procedure. The Commission has received three complaints since the last key inspection alleging poor care practice, poor staff attitude and concerns about the cleanliness of the environment. The Commission investigated and upheld two of these complaints. The provider responded to the third complaint and the letter of response to the complainant was forwarded to the Commission. Discussions with the complainant and the response received indicated that although the complaint was investigated and elements of it upheld, the provider took a defensive approach. Discussions with two relatives confirmed that they would ‘go to the nurse in charge or the operational director’ if they had any concerns. One relative felt that concerns raised were addressed and one relative felt that concerns are ‘sometimes’ addressed. The requirement made during the last key inspection to ensure local procedures for reporting incidents or allegations of abuse are available to staff has not been addressed. Discussions with the care staff evidenced that they have had training in recognising signs of abuse and confirmed that care staff would report this to the person in charge of the home. However, the nurse in Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 18 charge of the home was unable to demonstrate through discussion an adequate awareness of the local police or social services procedures for responding to allegations of abuse. The nurse acknowledged that she had not received any training in this area and confirmed that a copy of the local policy was not available in the home. During a discussion with the relative of a service user it was discovered that the service user had been ‘hit’ by another service user. This incident had not been reported to the Commission and there is no evidence that the home had considered referring the incident under Adult Protection procedures. In another incident one service user had been pushed over by another and required hospital treatment. There was no risk assessment included in the service user’s care file. Although this incident had been reported to CSCI there was no evidence in the service user’s records to indicate that the home had considered referring the incident under Adult Protection procedures. During the additional visit on 1st March 2006 the inspectors discovered that an incident of alleged abuse by one service user to another service user had occurred during the previous night shift. This incident was referred for consideration under Adult Protection procedures. It is of concern that incidents of one service user harming another are not considered to be incidents of potential abuse that may require investigation. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 24 and 26 were assessed. The Judgement for this outcome group is poor. Most of the communal areas are comfortable and well maintained but service users’ bedrooms are sparse, unwelcoming, institutionalised so service users do not have comfortable surroundings to live in and enjoy. EVIDENCE: Improvements have been made to the environment in the home as part of a redecoration programme. Communal lounges were bright, clean and comfortable and provided a pleasant area for service user to sit together. There were a number of new chairs in the lounge which were attractive but would not provide appropriate support for more physically frail service users due to their low backed design. The length of the new curtains in the upstairs lounge had been altered and they were hung during the inspection visit. There were no occasional tables for service users or relatives to use. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 20 The dining rooms remain sparse and unwelcoming. Dining furniture is old and worn and there were no attractive table settings. There was only one of the pair of curtains hanging at the large window in the downstairs dining room leaving the window half dressed. Communal bathrooms were clean and odour free. A bath panel has been fitted in the downstairs bathroom. Carpet tiles have been fitted in some of the communal halls and give a very pleasing appearance. Four single accommodation bedrooms and two shared bedrooms were viewed. Bedrooms looked sparse and two of the shared rooms had little evidence of personal belongings to identify that this was the service user’s own space within the home. Bedroom walls have recently been painted magnolia in colour as part of the programme of redecoration in the home. This looks clean but gives an institutionalised feeling to the rooms. Three of the rooms were not carpeted but one of these rooms had a homely warm laminate patterned vinyl cover while the other two had hard, unattractive floors. One of the rooms was noted to have stains on the carpet. One of the shared rooms had no privacy curtain between the service users beds. There has been little attention to detail in ensuring the curtains, lampshades and bedding co-ordinate in the rooms. The curtains in one of the rooms were not properly fitted to the curtain rail. New quilt covers were in use on the beds. Most of these were cream in colour although one was patterned. The bland colour of the bedlinen and the magnolia walls further lends itself to the institutional feel of the rooms. Some of the quilts were observed to be new but there are still some worn, thin quilts in use. Repairs are necessary to items of furniture in most of the rooms. Doorknobs were missing from wardrobes and vanity units. The handbasin vanity units in all of the rooms were old, water damaged and not in a good state of repair. Two of the bedrooms had an unpleasant odour but the remainder of the bedrooms were odour free. There was on offensive smell in the shaft lift in the home. One relative comment card returned to the Commission observed, ‘The home smells of urine’. The laundry was inspected and was much improved since the last inspection. The walls have been painted. The service has bedlinen supplied to the home Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 21 from an outside contractor so only personal clothing is laundered in the home. The laundry room was well organised. Clean and dirty laundry was separate. The wash handbasin was accessible and there was protective clothing available. Red ‘alginate’ bags were available and staff confirmed that these are used for soiled laundry to minimise the risk of infection. One relative spoken to commented that her husband’s clothes ‘sometimes go missing’, another relative also stated on a comment card that her husband’s clothes go missing. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 22 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): Standards 27 and 28 were assessed. The judgement for this outcome group is poor. There are insufficient, competent staff to meet the personal, social and healthcare needs of service users. EVIDENCE: On the day of this fieldwork visit there was one Registered Nurse and five care staff on duty. The current usual staffing complement for the home is: 8am – 2pm 2pm – 8pm 8pm – 8am 1 Registered Nurse 4 Care Staff 1 Registered Nurse 4 Care Staff 1 Registered Nurse 2 Care Staff This staff complement was confirmed by the examination of 2 weeks of duty rota. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 23 On the day of this inspection visit it was evident that the numbers of staff on duty were sufficient to meet the needs of service users with the exception of meal times when staff were hurried due to the numbers of service users requiring assistance to eat their meals. There are only three permanent members of nursing staff currently employed in the home; one full time day nurse, one night nurse working three nights each week and one day shift and one nurse working one night shift each week. The vacancies for Registered Nurses within the home account for three 12hr day shifts and three 12hr night shifts each week. Nurse Agencies are being used to fill the vacancies. It was informed that the home tries to use the same nurses from the agency to promote consistency. The reduced number of permanent nursing staff compromises the ability of the service to use a ‘named nurse’ system as it increases the number of service users that each nurse will have a responsibility for. This factor increases the risk of service user care plans not being kept up to date. In addition the home has an administrator for 27.5hrs each week, a maintenance person for 25hrs each week and a support worker to coordinate activities for 16 hrs each week. A full time cook is employed in the kitchen. Relief bank or agency staff are used to cover the vacancy in the kitchen. The home ‘contracts out’ the cleaning and has 2 cleaners in the home each morning on each day of the week. The home also employs a senior domestic who oversees the work of the contract cleaners. There are vacancies for laundry staff but these posts are being covered by the home’s relief bank of staff at present. The administrator and operational director were not present on the day of the inspection so staff personnel records were not accessible by the inspectors in order to assess recruitment procedures or confirm induction and training A training plan for 2006 has been produced and forwarded to the Commission but records were not accessible to assess whether any of the planned training had taken place. Discussions with care staff confirmed that mandatory training such as moving and handling and fire safety had taken place. 3 out of the 14 care staff employed have a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 22 , falls well below the minimum standard for 50 of staff to be qualified. One member of the care staff undertaking the qualification was being assessed by her NVQ assessor during the morning. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 24 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): Standards 31, 32, 33, 36 and 38 were assessed. The judgement for this outcome group is poor. The home is not adequately managed and this has resulted in a lack of direction and guidance to ensure residents receive consistent quality care. EVIDENCE: The home has been without a permanent registered manager since December 2005. Management cover has been provided by the Operational Director who currently spends a minimum of two days in the home each week and provides an ‘On Call’ service when she is not in the home. A temporary manager was in post for a period of 6 weeks. The Commission has been informed that a new manager has been recruited although the name or date for commencement of employment has yet to be confirmed. This appointment will be subject to the Commission’s registration process. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 25 The absence of consistent leadership from a manager who has a sufficient amount of time to discharge their responsibilities effectively has had a negative impact in outcomes for service users. Evidence to support this is reflected throughout this report. Inappropriate terminology has been used by the provider in letters to the Commission describing service users with challenging behaviour as ‘trashers’ who ‘work against our intentions’. This raises concerns about the ability of the service and its staff in valuing, understanding and meeting the care and behavioural needs of the people who use the service. Examination of the home’s quality review plan demonstrated that progress has been made in identifying issues that need to be addressed, in particular improvements to the environment. The quality plan was not on target to address all issues identified with in the timescales. The inspectors were informed that the home does not hold the personal monies of any service for safekeeping. Bills are produced and sent to service users or their relatives for additional services charged for such as chiropody or hairdressing. There is therefore an anomaly in the Statement of Purpose and Service Users Guide as service users are advised to hand valuables, cash or documents to the home for safekeeping. There were no records available to evidence whether or not the home is currently safekeeping any valuable for service users. Staff supervision records were not accessible for assessment, however a supervision matrix recorded that most staff were supervised in December 2005 and January 2006, two staff received supervision in February 2006 and one staff member was supervised in March 2006. Discussions with staff indicated that they had a lack of knowledge and understanding of formal supervision. Reports of monthly ‘Regulation 26’ inspections were available in the home. The home does not consistently provide the Commission with Regulation 37 notifications of incidents which affect the well being of service users and some notifications received are not fully completed. A selection of service records were examined to assess the home’s performance in maintaining safe working practices and demonstrates that service and maintenance is not consistently carried out:Portable Electrical Appliance Testing (PAT) was carried out in February 2006. Hot Water Outlet temperatures, which should be recorded monthly were undertaken in September 2005 and no more were recorded until April 2006. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 26 A Fire drill and Fire Safety lecture took place in January 2006. The emergency lighting in the home has not been tested since December 2005. Records demonstrate that the Fire alarm is tested weekly. The home has recently employed a maintenance person. This post has been vacant for some time. Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 3 X X 1 x 2 STAFFING Standard No Score 27 2 28 1 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X N/A 2 X 2 Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 28 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 OP1 Regulation 4, 5 Requirement The registered provider must ensure that the information in the Statement of Purpose and Service Users Guide is up to date and gives an accurate description of staff and the environment. (Outstanding from November 2005) The registered provider must ensure that staff have the knowledge and skills to devise care plans to meet the needs of service users. The registered provider must ensure that the care plans are up to date and address the current short and long term needs of service users. The registered provider must ensure that the psychological care plans for service user’s demonstrating challenging behaviour are further developed to give staff clear information about potential causes and direction to resolve the behaviour. All prescriptions must be DS0000004383.V290101.R01.S.doc Timescale for action 15/06/06 2 OP4 12 (1) 18 (1)(a) 15/06/06 3 OP7 15 31/05/06 4 OP8 13 (1)(b) 31/05/06 5 OP9 13(2) 31/05/06 Page 29 Allambie Court Version 5.1 6 OP9 13S. 3(3)(i)17 7 OP9 13(2)18(1 )19(1) 8 OP10 12(4)(a) 9 OP12 14(1)(a) 15(1) 16(2)(m)( n) 10 OP14 12 checked prior to dispensing and a system installed to check the dispensed medication and the MAR charts received into the home Outstanding from Pharmacist Inspection on 07/12/05 The quantities of all medicines received or balances carried over from previous MAR charts must be recorded to enable audits to take place to demonstrate staff competence in medicine management. Outstanding from Pharmacist Inspection on 07/12/05 Staff drug audits must be undertaken for all nursing staff that handle medicines on a regular basis to demonstrate staff competence in medicine management. Appropriate action must be taken when discrepancies are found. Outstanding from Pharmacist Inspection on 07/12/05 The registered provider must ensure that service users’ privacy and dignity are respected at all times. The registered provider must ensure that programme of activities in the home is developed to give all service users opportunities for stimulation which suit their needs, preferences and capacities. The registered provider and manager must ensure that the residents are consulted on issues related to their daily lives, the environment and that their wishes are taken into account when planning care and daily life in the home. If consultation is not possible their wishes should be recorded and considered DS0000004383.V290101.R01.S.doc 31/05/06 31/05/06 31/05/06 30/06/06 31/05/06 Allambie Court Version 5.1 Page 30 11 OP15 12(1)(a)( b) 12 13 OP16 OP18 22 12, 13 when making decisions. (outstanding from November 2005) The registered provider must 31/05/06 ensure that mealtimes are unhurried with service users being given sufficient time to eat and that staff are available to offer individual assistance as required. The provider must ensure that 31/05/06 complaints received about the service are handled objectively The registered provider must 31/05/06 ensure that appropriate policies and procedures related to the protection of vulnerable adults are written and available to staff. 14 OP18 15 OP19 16 OP24 Documents must clearly details the local procedure for reporting incidents of actual or suspected abuse. (outstanding from November 2005) 12, 13, 17 The registered provider must 31/05/06 ensure that all allegations or incidents of abuse are followed up promptly and action taken in response is accurately recorded. 36 The registered provider must 31/08/06 ensure that compliance to requirements for care practices and the environment are met as required by the Commission for Social Care Inspection and evidence of action plans that meet these needs must be made available including clear time scales and costs that are sufficient to complete these. (outstanding from July 2005) 12 The registered provider must 30/06/06 ensure that there are suitable locks fitted to the bedroom doors to enable residents to lock their rooms if they wish. (Outstanding from July 2005) DS0000004383.V290101.R01.S.doc Version 5.1 Page 31 Allambie Court 17 OP24 18 OP24 19 OP24 20 21 OP26 OP27 22 OP28 23 OP29 24 OP30 The registered provider must ensure that there are suitable locked facilities available to all residents to store personal items. (Outstanding from July 2005) 16 The registered provider must replace all worn and damaged furniture in the residents’ bedrooms. (Outstanding from February 2005) 12 (4)(a), The registered provider must 16(2)(c) ensure that screening is provided in double rooms to ensure privacy for personal care. 16 The registered provider must (1)(2)(j)( ensure that all parts of the home k) are free from offensive odours. 18(1)(a), The registered provider must 3(a)(b) ensure that the numbers and skill mix of staff is appropriate at all times to meet the health and welfare needs of service users. 18(1)(a)(c The registered provider must ) ensure that at minimum of 50 of care staff on duty have a National Vocational Qualification in care. A plan of training with dates must be forwarded to the Commission to demonstrate that this is being achieved. (Outstanding from November 2005) 19S. 2 The Registered Provider must ensure staff files contain evidence that appropriate checks have been completed through Criminal Records Bureau, the Vulnerable Adults Register and the Nursing Midwifery Council prior to working in the home. (Outstanding from July 2005 and not assessed during this inspection) 18(1)(c) The Registered Provider must ensure that all staff are up to date with Statutory training DS0000004383.V290101.R01.S.doc 12,13,23 30/06/06 31/07/08 31/05/06 31/05/06 30/06/06 31/07/06 31/05/06 31/05/06 Allambie Court Version 5.1 Page 32 25 OP31 26 OP31 27 OP32 28 OP33 29 OP33 30 OP36 31 OP38 requirements and attend training related to the care of residents living in the home. (Oustanding from July 2005 and not assessed during this inspection) 10 The registered provider must be able to demonstrate what management systems are in place to ensure suitable running and management of the home. Evidence must be available to demonstrate the effectiveness of these systems. 8, 9 The registered provider must ensure that the manager appointed to run the home applies to the Commission for registration. 10 The registered provider must ensure that the management of the home creates an open, positive and inclusive approach. 24, 26 The registered provider and manager must ensure that suitable quality assurance and monitoring systems are in place, actions planned are completed in a timely manner and reports available for inspection. 24 Policies and procedures in the home must be updated to ensure they reflect current good practice and local and national guidance. 18 The registered provider and manager must ensure that all care staff are formally supervised six times a year, clear and informative records must be maintained and available for inspection. (Outstanding from February 2005) 12, 13, 16 The registered provider must ensure that there are systems in place to ensure the health, safety and welfare of service users. DS0000004383.V290101.R01.S.doc 31/05/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Allambie Court Version 5.1 Page 33 32 OP38 37 The registered provider must ensure that the Commission is informed of any incidents that adversely affect the well being of any service user. 31/05/06 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 Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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 Allambie Court DS0000004383.V290101.R01.S.doc Version 5.1 Page 35 - 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. 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