Inspection on 21/09/07 for Allambie Court

This inspection was carried out on 21st September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 29/11/06

Allambie Court 19/04/06

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 McCarthy Unannounced Inspection 21st September 2007 09:30 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.V344971.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V344971.R01.S.doc Version 5.2 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 vacant post 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.V344971.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2006 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. Written information about the current scale of charges for the home was not available on the day of this inspection visit. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The visit to the home was made on 21st September 2007 between 9.30am and 5.30pm. The lead inspector was accompanied by an additional inspector who undertook a 1 ½ hour period of observation in a communal lounge looking at the way residents interacted with staff and each other. 30 people were living in the home on the day of the visit. It was the assessment of the home manager the majority of people living in the home had medium or high dependency nursing care needs. A random unannounced inspection was made by the specialist pharmacist inspector on 10th November 2006. The medicine management was poor and a Statutory Requirement Notice was issued requiring the provider to improve the medicine management to protect residents from harm. A further pharmacist inspection on 21st December 2006 found that the medicine management had not significantly improved to safeguard the people living in the home and further requirements were made. On 14th March 2007 a pharmacist inspection found that the medicine management had improved to a safe level. Documentation maintained in the home was examined including staff files and training records, records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspector had the opportunity to meet most of the residents by visiting them in their rooms, spending time in the communal lounges and talking to some of them about their experience of living in the home. There were opportunities to observe working practices and staff interaction with the people living in the home. The home manager was present throughout the day. The inspector also spoke to care staff and a laundry assistant. The care of two people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 6 of the care provided is matched to outcomes for the people using the service. Care plans and monitoring records of other residents were examined randomly. An Annual Quality Assurance Audit was completed and returned to us before the inspection visit. Feedback was given to the manager at the end of the inspection visit. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be developed and implemented when new or changed needs or risks are identified. This should ensure that people get the care they need. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This is to make sure that risks to the health or well being of residents are identified and reduced. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 7 Sufficient stock of medicines prescribed for people living in the home must be available in for administration at the time they are required. This is to make sure people get the medication prescribed for them. Arrangements must be made to make sure that medicines prescribed for people living in the home are given accurately. This is to prevent the risk of harm from medication administration errors. Arrangements must be made to ensure that the home is conducted in a manner which upholds the privacy and dignity of the people using the service. This is to make sure residents are treated with dignity. Arrangements must be made for people living in the home to be assisted to eat their meals in a way that is acceptable to them. This is to ensure that people living in the home benefit from a nutritious diet and can enjoy each meal in a dignified way. A system must be implemented to make sure that the numbers of staff required to meet the needs of residents are available on duty at all times. The service must be able to demonstrate that the needs of residents are considered when deciding the number of staff required. This is to ensure that the needs of people living in the home are consistently met in a way that is acceptable to them. Arrangements must be made to make sure the manager appointed to run the home is registered with the Commission for Social Care Inspection. This is comply with legislation. Arrangements must be made to make sure the home is managed with care, competence and skill to provide clear direction and leadership which staff and residents understand and can relate to. Systems must be in place for the review of working practices and quality of service delivered to people living in the home. This is to make sure that the home is run in the best interests of people living in the home. Arrangements must be made to check the safety of the Fixed Electrical Installation in the home. A certificate confirming safety must be available for inspection in the home. This is to promote the safety 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 Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 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.V344971.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of two residents admitted since the last inspection were examined to assess the pre admission assessment process. The manager said that it was usual practice for him to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. One file contained detailed records of the individual’s needs and abilities. The other file contained less information but this was supplemented with a Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 11 complete needs assessment from Social Services prior to the person’s admission to the home One assessment was not dated or signed therefore we cannot be sure who carried out the assessment, or when. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is poor. Residents each have a plan of care but care plans are not always developed for new or changed needs which puts residents at risk of not having their needs met. The failure to sustain improvements in the safe management of medicines puts people at risk of harm from medication errors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection visit people living in the home looked cared for with their personal care needs met. Most residents were clean with groomed hair and fingernails, male residents were clean shaven (where this was their choice) and all wore appropriate, well laundered clothing. One female resident had very dirty dentures with food debris on them. The case files of two residents identified for case tracking were examined. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 13 All the case files in the home have a standard ‘layout’ and are methodically structured in a way that allow staff ease of reference to information about each person. Care plans held a range of information including physical and mental capacities, nutritional needs, personal care needs, health care needs and interventions. There are care plans in place for most of the identified needs of residents and are reviewed each month. However, new care plans are not developed when there is a new or short term need. For example, • One person with sticky eyes was prescribed antibiotic cream by their GP. There was no care plan to address this new need and give staff direction about cleaning the person’s eyes or applying cream. The same resident was prescribed antibiotics for a ‘swollen face’. There was no care plan developed to address this new need or give staff directions about monitoring changes or pain relief. • The home uses risk assessment tools to identify each person’s risk of falls, risk of developing pressure sores and risk of poor nutrition. Appropriate action is not always taken to minimise risks identified. For example, • One person was identified as having a high risk of developing pressure sores. It was identified that the person required an ‘airflow’ pressure relieving mattress but a foam mattress was in use. The fall risk assessment tool used by the home has a numeric scoring system but there is no ‘legend’ or ‘key’ to tell staff what the numeric score means. Staff are therefore unable to identify whether a person has low, medium or high risk of falls and consequently cannot implement appropriate action to minimise any potential risk. • The home monitors well being with monthly recording of vital signs and weight. The care plans, daily records and other documentation held showed that people have access to other health professionals such as GP and community psychiatric nurses. A random pharmacist inspection on 10th November 2006 found poor practice in the management of medicines a Statutory Requirement Notice was issued on 20th November 2006. On 21st December 2006 a further random pharmacist inspection found the medicine management had not significantly improved to safeguard the people living in the home although the Statutory Requirement Notice had been partially met. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 14 On 14th March 2007 a further random pharmacist inspection was undertaken to check compliance with the Statutory Requirement Notice and found that medicine management had improved to a safe level. The medication prescribed for two people involved in case tracking was audited and several shortfalls were found. One resident was prescribed Furosemide 40mg (a ‘water tablet’) daily. The first two entries on the monthly Medicine Administration Record (MAR) sheet recorded that this medication was ‘out of stock’. This means the resident did not receive their prescribed medication which leaves them at risk of a deterioration in their health. Staff must make sure there is a sufficient stock of medicines prescribed for people living in the home so they can be administered at the intervals prescribed. One person was prescribed Lorazepam 1mg (used as a sedative ) tablets ‘when necessary’. Records show: • 28 tablets were received into the home. • 4 tablets were signed for as having been administered. • 3 tablets were signed for as having been refused and destroyed. Consequently there should have been 21 tablets remaining but only 19 were counted. This leaves 2 tablets unaccounted for which suggests inaccurate record keeping and/or medicine administration error. One person was prescribed two Quinapril 10mg tablets (used to control blood pressure) each morning. Records show: • 28 tablets were received into the home. • 6 tablets were signed for as having been administered. • 24 tablets were signed for as having been refused and destroyed. The resident had an identified need of non-compliance with medication. • 6 tablets were counted still in stock. These records account for 30 tablets plus 6 remaining tablets when only 28 were recorded as received into the home. This suggests inaccurate record keeping and/or medicine administration error. In addition, staff had failed to monitor the person’s blood pressure or seek medical advice when the resident was not compliant with taking this medication as prescribed which leaves the person at risk of deterioration in their health. One person’s co-amoxiclav (antibiotic) tablets were audited and found to have been administered correctly. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 15 The service has failed to sustain the improvements in the safe management of medicines that were evidenced in March which leaves people using the service at risk of harm from medication errors. The way the service upholds the dignity of residents was variable. People were treated respectfully by most staff but in the ‘Activities and Daily Living’ section of this report there is evidence that staff can be uncommunicative and complacent. Personal care was provided in private, residents were spoken to respectfully, and addressed by their preferred names. In one female resident’s bedroom drawers were labelled with the name of the previous male occupant. This does not uphold the dignity of this person. The practice of displaying a bath list in the office is considered institutional and should be discontinued. The personal hygiene care needs of individuals should be recorded in their care plans according to their preference. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is poor. People living in the home are not effectively supported to maintain their independence and enduring interests to enhance their quality of life. There is insufficient assistance available to help people eat their meals so mealtimes are not always enjoyable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a part-time community support worker (16 hours weekly) with responsibility for devising a programme of individual and group activities for the benefit of people living in the home. Residents were observed to spend time in the privacy of their own rooms or join others in communal areas for company or meals. The home organises occasional visiting entertainers, group activities and regular church services in the home. Activities provided include musical quizzes, a range of board and card games and art and pottery. Decisions about most activities are made on a daily basis and are based on residents’ willingness to participate. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 17 In the absence of the community support worker residents are reliant on care staff to provide individual and group, social and therapeutic stimulation. It is difficult to see how this can be achieved when the home frequently does not have a full staff complement. Evidence from observation showed that the majority of staff interaction took place during an intervention to meet a personal care need rather than a social or recreational need. This limits residents’ choice in how they spend their day. Records showed that not all residents participate in meaningful or engaging activities. There was no interests or lifestyle preferences for one of the people involved in case tracking admitted to the home seven weeks previously. One resident said, ‘I’d like people to pop in more often or pass the time of day. I’m lonely.’ One inspector undertook a period of observation in the main lounge on the ground floor between 11.45am and 1.15pm. Lunch was served during this time. During this time any contact by care staff with the residents was task orientated. The main contact was from the manager. Some, but not all residents were offered a cup of tea; there was no time given to have a chat while the tea was being passed to them. One person was sitting in their dressing gown; they were asked if they wanted to get dressed, but said ‘No’. No further attempts were made to encourage the person to dress. The same person was seen listening to music being played in the smaller part of this ‘L’ shaped lounge. It was clear they were enjoying this and sang along quietly and tapped their hand to the songs on occasion. It was evident they knew the words to quite a lot of the songs. The music was the only stimulation or activity observed during the morning. There was no evidence of other meaningful activity to stimulate residents. Two care staff and a cleaner entered the room during this period of observation. This was to perform tasks or care interventions, such as hoisting residents to their wheelchairs in preparation for lunch and brining lunch to the residents who wished to remain in this lounge. One of the care staff was kind and explained in a clear voice what she was doing to the two people she assisted to move using a hoist. She took her time and was gentle with the residents. The other carer did not communicate. This carer was observed bringing lunch on a tray to one of the residents and leave it with her on her lap. The resident asked for her meat (it was fish) to be cut up; the carer cut off one piece the resident, put it on their fork and left them. The resident ate a few chips, but threw most of them on the floor, told the carer she was finished and the carer Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 18 removed the full meal. No effort was made to encourage the resident to eat a little more Lunchtime service began at 12.45pm with food arriving in a heated trolley from the kitchen to the dining room on the first floor. Staff told the inspector that the home has one trolley and the first floor residents are served first because ‘we have more people who need help with feeding’. It was established that four or five people needed physical assistance to eat their meals while the remainder all needed to be supervised or monitored. At 12 midday two residents were already sitting in the dining room on the ground floor waiting for their lunch that would not be served until 1pm. At 12.10pm 2 people were sitting in the dining room waiting for lunch to be served while staff assisted other residents in moving to the dining room for lunch. It is not acceptable for people to be seated up to one hour before their meal is served as this could lead to increased frustration and agitation in people who have dementia. The choice of main meal was fish and chips with mushy peas or Quiche (replacing the fish). Four people on the first floor have a special textured diet indicating they have difficulty chewing or swallowing so consequently need to be closely monitored when eating to avoid aspiration or choking. The meal looked appetizing and was pleasantly presented by the care staff serving it. The inspector asked one person if they had a choice of meal and they replied, ‘No. We get what we’re given.’ When asked what they do if they don’t like what they’re given the person replied, ‘Just leave it.’ Meals were served to people in the lounge on a tray which they had to balance on their lap, no-one was offered a table. The meal service was functional and hectic. Several residents needed to be prompted to return to their meals as they persistently left the table. Staff were rushed because they needed to help people who had remained in the lounge as well as in their rooms. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. The visitor’s record demonstrated that people can visit when they want to. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy. The manager discussed that it was not useful to give a copy of the complaints procedure to each resident as they may have limited understanding because of their dementia. People are encouraged to raise their concerns with the staff on duty. One resident said, ‘He (the manager) has lovely manners. I tell him what I need. He always wants to do things for us.’ We have not received any complaints about this service since the last key inspection. A record of complaints is maintained in the home. None have been recorded since the last key inspection. The manager said that residents and their relatives raise minor concerns which are often easily sorted out. It was Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 20 discussed that recording the home’s response to minor, verbal concerns as well as more serious complaints would demonstrate that all concerns are taken seriously and acted upon. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff have received abuse awareness training. One resident said. ‘I feel safe in my house – I never give it a second thought.’ Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 21 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): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. Most of the communal areas are comfortable and well maintained but some bedrooms are sparse, unwelcoming and institutionalised so people do not have comfortable surroundings to live in and enjoy. Unpleasant odours in parts of the home do not uphold the dignity of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Communal areas traditionally and comfortably decorated; they were warm, bright and clean on the day of inspection. Communal areas do not provide any tactile stimulation; there are no scatter cushions, toys or games, or residents own belongings around. The areas were tidy but looked quite sparse. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 22 The inspector viewed one double room and the bedrooms of the people involved in case tracking. The quality of the furnishings and fittings in residents rooms varied. In two of the three rooms viewed a hard vinyl flooring is used as an alternative to fitted carpet. One resident involved in case tracking was accommodated in a double room. It was difficult to discern which space belonged to which resident as neither had any personal effects evident. A hoist is used to assist the person in and out of bed but an ordinary divan type bed is in use as opposed to a variable height bed which would assist staff in moving and handling the person safely. The double room has been refurbished to a satisfactory standard since the last Key inspection with new carpet and co-ordinating soft furnishings. A privacy curtain was available. Residents accommodated in this room had taken the opportunity to personalise their space with photos and some soft toys. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Dining areas were also sparse and somewhat institutional in appearance. In particular, the large bay windows in the ground floor dining room do not have suitably fitted curtains. The reception area of the home had a very unpleasant odour. This issue has been ongoing since before the last key inspection and has not been resolved. This does not uphold the dignity of people living in the home, particularly as all visitors to the home use this area. The home has systems in place for the management of dirty laundry and the disposal of waste. Systems are in place to manage the control of infection. The Environmental Health Officer inspected the home’s kitchen in February 2007 and action was required to improve the cleanliness of parts of the kitchen and some of the kitchen equipment. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is poor. The home does is not consistently staffed with enough people to meet the needs of the people living in the home. Robust recruitment procedures protect residents from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told the inspector that the usual staffing complement planned in order to meet the needs of people living in the home is: 8am – 2pm 2pm – 8pm 8pm – 8am 1 Registered Nurse and 5 Care Staff 1 Registered Nurse and 4 Care Staff 1 Registered Nurse and 2 Care Staff Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 24 The examination of three weeks of duty rota between 10th and 30th September 2007 confirmed that the staffing complement in the table above is planned but not always achieved. For example, between 10th and 21st September there were only four care staff instead of the planned five on duty for 40 of shifts between 8am and 2pm. This leaves residents at risk of not having their needs met. One of the care staff spoken to explained that on an 8am – 2pm shift two carers are usually allocated to work with residents accommodated upstairs and two carers are allocated to work with service users accommodated downstairs with one member of staff ‘floating’ between the two floors. The manager relies on staff working overtime to cover any absence and maintain the staff complement. The use of agency staff must be authorised by the company’s head office in Leeds. There were only four care staff on duty on the day of this inspection visit; the manager said he had requested authorisation for the use of agency staff from head office on 17th September (4 days ago) but had received no response. The home does not have a system or tool to decide the number of staff required to meet the identified needs of residents in the home; this is monitored informally. The manager said that there is a ‘written company directive’ to decide the staffing levels but a copy was not available in the home. This means that the home is unable to demonstrate that the needs of residents are kept under review and the home staffed accordingly. The planned staffing complement for night duty was consistently met. On the day of this inspection visit it was evident that the numbers of staff on duty were sufficient to meet the physical personal care needs of residents with the exception of meal times when staff were hurried due to the numbers of people requiring assistance to eat their meals. Evidence in the ‘Activities and Daily Living’ section of this report demonstrate that there are not enough staff available to support people with their social, psychological or recreational needs. There are sufficient ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. For example, • • The kitchen is staffed by a cook between 8am and 6pm every day of the week. The laundry is staffed by a laundry assistant for 5 hours every day of the week. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 25 • • There are two domestic cleaning staff on duty for five hours each every day of the week. A maintenance person is employed for 24 hours each week. Seven out of the 16 care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 44 , falls just below the National Minimum Standard for 50 of staff to be qualified. However, a further three staff members are working towards the award. This has improved since the last key inspection and should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. The provider has appointed a training officer who delivers mandatory training such as moving and handling, infection control and abuse awareness to all staff. Training records were available to demonstrate that the majority of staff were up to date with mandatory training. Some staff have enrolled in an Open College Network (OCN) Distance Learning Course in Dementia Care. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 26 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): Standards 31, 32, 33 and 38 were assessed. Quality in this outcome area 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. This judgement has been made using available evidence including a visit to this service. Standard 35 is not included in this judgement, as the home does not hold service users’ personal monies or valuables for safekeeping. EVIDENCE: The present manager returned to this post in August 2006 after resigning the position in December 2005. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 27 The current manager is a Registered Mental Nurse (RMN) with experience of caring for older people with dementia and has attained the Registered Manager’s Award (RMA NVQ Level 4). This appointment is subject to the Commission’s registration process, as the manager is not registered with the Commission for Social Care Inspection. The manager covers a full time nursing post as well as undertaking administrative tasks and the overall running of the home. Duty rotas examined failed to demonstrate that the manager has supernumerary time in order to effectively discharge his management responsibilities. It is not clear how the manager will have sufficient time to implement action plans for improving this service while undertaking a full time nursing post working ‘in the numbers’ providing nursing care to service users. For example, it is evident from the errors noted in medicine management during this inspection that the manager is not effectively auditing systems for the safe management of medicines. At the last Key inspection in November 2006 the operations manager had undertaken a review of the service which resulted in objectives for improvement being set and action plans developed to achieve this. The home’s Quality Assurance file was examined and there was little evidence that the action plans had been reviewed or progress against objectives recorded. The manager told the inspector that the service does not currently have an operations manager; the manager is currently making requisitions to the Head Office in Leeds for resources. It is not clear who will be undertaking Regulation 26 visits. The provider has failed to sustain an effective management structure to support implementation of the actions needed to make the identified improvements. Several requirements made at previous inspections have not been met. An Annual Quality Assurance Audit (AQAA) was completed and returned to us electronically. The AQQA recorded that it was completed by the manager. The manager said that he recorded some details on a handwritten document and sent it to Head Office where it was amended. The manager did not retain a photocopy of his original handwritten document to support this. The AQQA was incomplete. Not all the information requested was supplied. Some responses in the AQAA demonstrate that the provider and manager believe they are not responsible for assessing the service that is provided, or for identifying and improving the service provided. For example, one response recorded was ‘We are not the judges’. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 28 Shortfalls in the service are blamed on the lack of funding available from the local council. For example, when asked to provide information about barriers to improvement in the service in the last 12 months the AQAA records ‘Failure of the local council to notify us and process funding as per national guide re improvement to care facilities.’ and ‘beaurocratic error’. The only response recorded in the AQAA for improvements planned in the next 12 months are for maintaining the environment. No plans for improvement were recorded in any other outcome group. A selection of records were examined to assess the home’s performance in maintaining equipment and systems which demonstrated that service and maintenance are mostly carried out: • Hoists were serviced in May 2007 • Fire alarm systems were serviced in June 2007 • Hot water outlet temperatures are recorded monthly and were noted to be within recommended limits. • Annual Portable Electrical Appliance tests were made in January 2007 • Certificates for annual gas safety checks were issued in December 2006 The fixed electrical installation in the home (‘5 year check’) was examined in January 2007 and the certificate confirmed it as ‘unsatisfactory’. There is no evidence of remedial work to make the improvements recommended. Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 29 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X N/A X X 2 Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Care plans must be developed and implemented when new or changed needs or risks are identified. This should ensure that people get the care they need. This requirement is outstanding from previous inspections and was not complied with by the original timescale of 15/08/06. The extended timescale of 28/02/07 has not been met. 2 OP8 13 Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This is to make sure that risks to the health or well being of residents are identified and reduced. This requirement is Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 31 Timescale for action 15/11/07 15/11/07 outstanding from previous inspections and was not complied with by the original timescale of 31/01/07. 3 OP9 13(2) Sufficient stock of medicines prescribed for people living in the home must be available in for administration at the time they are required. This is to make sure people get the medication prescribed for them. Arrangements must be made to make sure that medicines prescribed for people living in the home are given accurately. This is to prevent the risk of harm from medication administration errors. Arrangements must be made to ensure that the home is conducted in a manner which upholds the privacy and dignity of the people using the service. This is to make sure residents are treated with dignity. Arrangements must be made for people living in the home to be assisted to eat their meals in a way that is acceptable to them. This is to ensure that people living in the home benefit from a nutritious diet and can enjoy each meal in a dignified way. This requirement is outstanding from previous inspections and was not complied with by the original timescale of 31/05/06. The extended timescale of 08/12/06 has not been met. 31/10/07 4 OP9 13(2) 31/10/07 5 OP10 12 31/10/07 6 OP15 12(1) 15/11/07 Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 32 7 OP27 18 A system must be implemented to make sure that the numbers of staff required to meet the needs of residents are available on duty at all times. The service must be able to demonstrate that the needs of residents are considered when deciding the number of staff required. This is to ensure that the needs of people living in the home are consistently met in a way that is acceptable to them. This requirement is outstanding from previous inspections and was not complied with by the original timescale of 28/02/07. 15/11/07 8 OP31 18 Arrangements must be made to make sure the manager appointed to run the home is registered with Us. This will demonstrate that the home is managed with care, competence and skill to provide clear direction and leadership which staff and residents understand and can relate to. This requirement is outstanding from previous inspections and was not complied with by the original timescale of 28/02/07. 15/11/07 10 OP33 24 Systems must be in place for the review of working practices and quality of service delivered to people living in the home. This is to make sure that the home is run in the best interests of people living in the home Arrangements must be made to DS0000004383.V344971.R01.S.doc 30/11/07 11 OP38 13 30/11/07 Page 33 Allambie Court Version 5.2 check the safety of the Fixed Electrical Installation in the home. A certificate confirming safety must be available for inspection in the home. This is to promote the safety of people in the home. 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 OP12 Good Practice Recommendations Arrangements should be made for people living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. Arrangements should be made 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 when making decisions. The home should review the individual accommodation for residents and plan a programme of refurbishment and replacement of worn furniture so we can be sure residents are provided with a pleasant environment to live in and enjoy. Action should be taken to make sure the reception area is free from unpleasant odours. This is to uphold the dignity of people living in the home and provide a pleasant environment. 2 OP14 3 OP19 4 OP26 Allambie Court DS0000004383.V344971.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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