Inspection on 22/11/05 for Allambie Court

This inspection was carried out on 22nd November 2005.

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 21/09/07

Allambie Court 29/11/06

Allambie Court 19/04/06

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 Suzette Farrelly and Yvette Delaney Unannounced Inspection 22nd November 2005 10:45 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.V267895.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 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 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.V267895.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 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.V267895.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second full inspection of this service during the 2005/06 inspection year. The home has also had three visits between these inspections and information gathered during these visits will also be referred to within this report. The inspection commenced at 10:30 and was concluded at 18:30. The inspection was conducted by two inspectors who spent time examining various records related to the care provided to residents, the management of the home, staff employment records and the health and safety of the home. Various staff were spoken to and time was spent with residents and two relatives were seen and spoken to. Both inspectors conducted a tour of various areas of the home. At the conclusion of the inspection three immediate requirements were left with the registered manager related to assessment of resident needs and accessibility of records. Time was spent feeding back the findings of the inspection with the manager at the end of this inspection. A letter of Serious Concern was sent to the registered provider and manager following this inspection concerning: • • • • • • • Pre-assessment and continued assessment of the residents to ensure that they receive the care required. The lack of psychological assessments enabling staff to recognise changes in mental health and to take appropriate action. The lack of suitable care planning and the monitoring of health. The lack of good pressure damage management. Poor hygiene of the residents resulting in greasy hair and dirty fingernails. Proper care of a resident seen in their room with very sticky eyes and unable to open them. The lack of hot running water in various bedrooms throughout the home, staff had to get water from the sluice room. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas that the registered provider and manager of the home must address three Immediate Requirement Notifications were issued. • The registered provider and manager must ensure that all new admissions have a full and comprehensive pre-admission assessment to ensure that the home can meet the resident’s needs prior to admission. The registered provider and manager must ensure that the residents care plans reflect the needs of the resident and are up dated as required. There are broken seals on both fridges in the kitchen and black mould was seen on the inside of the doors, also black mould was seen on the seal of the chest freezer, these must be cleaned and the seals replaced. The registered provider and manager must ensure that the residents are assisted to maintain a higher level of hygiene, such as ensuring that the residents’ hair is washed, hands and nails cleaned. The registered provider and manager must ensure that residents are given drinks when they request one and that biscuits and snacks are served from plates giving the residents a choice. The registered provider and manager must ensure that those residents with high risk of pressure damage have suitable care plans to prevent tissue breakdown and suitable equipment is supplied. Poor nutritional management, there was a lack of concern where a resident had lost 5 of their body weight, The home had failed to weigh this resident regularly nor record the daily action taken to prevent further weight loss. DS0000004383.V267895.R01.S.doc Version 5.0 Page 7 • • • • • • Allambie Court • The registered provider and manager must ensure that there are up to date policies and procedures and that these are readily available at all times for the staff. The registered provider and manager must ensure that the policies and procedures related to the protection of vulnerable adults reflect both national and local policies, including a whistle blowing policy and management of challenging behaviours. The registered provider and manager must ensure that all care staff receive supervision six times a year and that they are aware that supervision is occurring. The registered provider and manager must ensure that there is running hot water in residents’ bedrooms and where there is a problem a risk assessment must be carried out to ensure that hot water is transported safely from the sluice rooms. • • • 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.V267895.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Assessment of standards 1, 2, 3, 4 & 5 were carried out. Residents and their representative do not have the full and complete information they need available to them, which could support them in making informed choices about moving into the home. The home does not carry out a full assessment of residents prior to admission therefore the home is unable to demonstrate that they are able to meet the residents needs before admission. The home cannot demonstrate that the complex needs of the residents can be met due to poor assessments and care planning. Relatives and the residents are invited to visit prior to admission to assess the suitability of the placement. EVIDENCE: The Statement of Purpose for the home was examined and 10 of the required 18 areas were not complete or require further information, these include the criteria for admission to the home and the arrangements made for dealing with complaints. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 10 A contract of residency is available for all residents, which details the terms and conditions for living in the home. Three residents profiles were fully examined and the residents were seen. It was observed that there was no evidence that a pre-assessment of potential residents abilities and needs had been conducted prior to admission. One resident had been admitted in 1996, however the remaining two residents had been both admitted during 2005. In one profile the initial information related to an admission in 2002, however this resident was discharged to hospital, as the home could no longer manage their challenging behaviour. The resident was re-admitted this year. The information from the home did not clarify this and all care plans and information available related to 2002. The only information available was a pre-admission care plan from social services that contained a full history and the reasons for a re-admission. There were no suitable care plans in relation to the information received from social services for this resident. The assessments for the second profile of a resident admitted in June 2005 indicated that the resident was fully mobile. It was found that this was not the case. The resident was immobile and relied on the home to meet all his needs. The risk to pressure damage indicated ‘No Risk’ yet this was inaccurate considering his mental health status and immobility. An assessment of his mental health indicated a change demonstrating possible depression, although this assessment had been completed twice the home had failed to recognise the need to investigate further and take appropriate action. It was difficult to assess if residents and their families visit prior to admission to assess the quality of the services, One relative spoken to stated that the decision was based on advice from the social worker and the fact that the home is close by enabling frequent visits. The relative stated that her relative had settled well into the home and that the recent re-decoration had made the home ‘nicer’. Due to a lack of care plans and the general observation during the inspection the home could not demonstrate that they are able to meet many of the complex needs of the residents in relation to their dementia. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The residents’ health, personal and social care needs were not clearly set out in an individual care plan increasing the risk of an oversight in care and inconsistent approaches to challenging behaviour. The residents’ health care needs are not fully met by the home increasing the risk of deteriorating health and poor outcomes for the residents. The privacy and dignity of residents is inconsistent and may result in poor selfesteem and outcomes for the residents. The medicine management must improve to ensure the safety of the service users. At the time of the inspection the medication records did not reflect accurately what had been administered to the service users in all instances. EVIDENCE: Three profiles were fully examined and there were inconsistencies between the care prescribed and the actual needs of these residents. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 12 In one profile there was mention that the resident had inappropriate sexual behaviour; there were no corresponding care plans to ensure consistency of approach and care for the resident. This resident also demonstrated aggressive behaviour during care interventions, a care plan was available stating how the staff should behave toward the resident. However, the daily records did not indicate the frequency of this behaviour, the behviour exhibited and the reaction of the staff and residents and how the situation was managed. It also stated that the resident had pressure area damage, the last entry was July 2005 indicating that the sore was healing, no further entries had been made, on discussion with staff it was evident that some damage still remained and treatment was ongoing. A further resident who is immobile had been left sitting in a chair for approximately 12 hours, there was no propad to relieve pressure. Toward the evening the resident was slipping from the chair and when asked stated that his bottom and back were hurting him. Another resident was noted to have lost 5 of their body weight in a twomonth period. This resident had not been weighed since September and although there was a care plan indicating poor nutrition it was unclear and the directions given were not followed. This could result in further malnutrition for the resident. A care plan for mobility, risk or pressure damage and safe practices for mobilising were mixed together in one plan, making it difficult to establish the actual care to be given. This profile also had a mixture of information from the initial admission in 2002 and the present admission in 2005. There was evidence from the social service pre-admission assessment for the most recent admission that the residents mental and physical health had deteriorated from the previous admission. In one profile a resident review had taken place including the family where three main issues were discussed, one related to the need for new glasses, as they no longer fitted correctly. On the day of the inspection the resident was seen in the lounge without glasses. The care plans in all three profiles were evaluated in an ad-hoc manner, some more frequently than others. In one profile related to the resident losing weight there was no recognition that the resident’s weight had not been carried out as requested nor whether there was a change in the nutritional status of this resident. The residents’ dignity and privacy is partly met. All examinations took place in the residents’ own rooms and personal care is conducted in private. However, Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 13 some residents were seen with poorly maintained clothes, buttons missing and poorly fitting. Many of the female residents had very greasy hair and their hair was poorly cut and styled. A number of residents had dirty fingernails and their hands were sticky. Some of the male residents had not been shaved. Staff were noted to address the residents in a respectful manner and address them by their preferred name. One relative stated that the staff were always caring and friendly and was happy with the care given. The home does not have a system to check the prescriptions from the general practitioner against the medicines received from the pharmacy. The quantities of medicines received or balances carried over from previous cycles had not been recorded in all instances so it would be difficult to demonstrate that all medication had been administered as prescribed. Medicines had been signed as administered when they had not been. Gaps were seen on the Medicine Administration Record (MAR) chart. Some medicines had been administered but not recorded but others not administered with no reason for non-administration. There were no written protocols for “when required” medicines. Medicines in the small medication room had not been secured away despite adequate storage facilities to do so. The nurse interviewed during the inspection had a good understanding of the clinical needs of the service users and was keen to improve practice within the home. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 There was no evidence that the life style experience in the home matches residents’ expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs reducing the positive outcomes and mental stimulation for the residents. Residents are assisted to maintain contact with their family and friends; contact with the local community is limited. There is little evidence that the residents are assisted to make choices and have control over their lives which could result in diminished self worth and result in a poor experience of living at the home. The residents receive a varied diet that is served in the lounge and dining areas dependent on mobility, reducing the experience of eating as a social activity. EVIDENCE: The activity organiser no longer works at the home and there are no plans to fill this role. It was noted that the registered provider and manager wish to encourage the staff to carry out activities and to buy in outside entertainment. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 15 On the day of the inspection staff were seen talking to some residents and spending time with them, however, there were no activities available and most residents were seen snoozing in their chairs and those that are mobile wandering around from room to room. One resident stated that it was boring most of the time and watching TV was difficult. There was no record in the profiles to indicate the likes and dislikes of the residents and no record of activities that have taken place or those that are booked. The residents can receive visitors in the lounge areas, the reception area and the residents’ own rooms if they wish. Two relatives spoken to stated that they are always made welcome and can go to their relatives’ own room if they wish. Three residents talked about their visitors and the enjoyment of seeing them. It was seen that there is information in the Residents’ Guide related to visiting, however, one relative stated that they had never been given information about visiting. The home does not have links with any community groups; the church visits once a month for communion. One of the inspectors ate lunch with the residents in the downstairs dining area. The meals were brought to the dining room plated with covers and the residents were given a choice by being shown both meals. There was no facility to keep the meals warm. The food was nicely presented and was enjoyable to eat. The resident sitting with the inspector said that the meal was ‘alright’ but said that they preferred ‘sweet things’. Staff were seen assisting residents to eat, however, due to the number of residents requiring assistance and no facility to keep food warm residents assisted last ate warm or cold food. Neither the staff nor the residents could tell the inspector what was for dinner before it arrived. The home has a two-week rotating menu, and the cook for the day stated that at times this varies depending on what is available. From discussion with the cook on the day of the inspection it was found that there was no evidence that the cook was aware of those residents who required a high calorie diet due to weight loss. This situation existed at the last inspection and re-enforces the home’s lack of planning to care for residents with poor nutrition. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 16 The menus were examined and it appeared that the home does not offer a varied and nutritious diet at all times and it is suggested that the menus are checked by a dietician and advice sought. Time was spent in the upstairs lounge during the morning, it was seen that a number of residents asked for a drink and stated they were thirsty. The member of staff stated that they would have to wait until the other member of staff came back from her break. A drink was finally given over half an hour later. Biscuits were offered when the tea was given out, one resident asked for more than one and was told that there were insufficient to have more than one, and the member of staff would get some more from the kitchen, which did not occur. It was noted that there were sufficient biscuits in the kitchen, but the member of staff had failed to bring more to the unit for the residents. The teatime meal consisted of sandwiches and cake with tea. For residents who cannot eat sandwiches a soft diet of mashed potatoes and tomatoes was served. There was no soup available at this time and the selection of sandwiches was limited. From discussion with staff it was stated that residents could request different meals if they wished but there was no evidence that they were made aware of this choice. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 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): 18 Policies and procedures concerning the protection of vulnerable people are inadequate, putting residents at risk. The contents of the policy/procedure will not support staff in dealing effectively with allegations or evidence of abuse that may occur in the home. EVIDENCE: A copy of the policy intended to safeguard residents from abuse was examined. The contents of this document demonstrates that staff do not have access to a robust procedure for responding to suspicion or evidence of abuse or neglect (including whistle blowing) and therefore are not effectively supported in ensuring that residents living in the home are safe and protected. The policy provides definitions of the different forms of abuse followed by the procedure for dealing with and investigating the suspicion or incidence of abuse within the organisation as if dealing with a complaint. Procedures to be followed in conjunction with and involving local and national policies and procedures have not been included. Specific reference is not made to the organisations and professionals that must be contacted in the event of any suspicion, allegation or evidence of abuse which must include the Commission for Social Care Inspection. The document is also not titled, dated or signed. There is no reference in the policy to whistle blowing, the Public Interest Disclosure Act 1998 and the Department of Health guidance No Secrets. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 The residents live in an environment that is in the process of refurbishment and where there are some areas and equipment that are not properly maintained which may result in a poor experience of living at the home and increased risk of injury or harm to the residents. The residents’ personal space is safe but lacked warmth and comfort at the time of the inspection. The home is not cleaned properly in all areas. There are poor infection control practices which may result in a risk of cross infection. EVIDENCE: The home is in the process of a full re-decoration programme to all communal and personal spaces. It was noted that all the bedrooms have been painted magnolia; there is no evidence that any consultation with the residents had taken place in regard to the colour of their rooms. However it is recognised that these areas are cleaner and more suitable since painting. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 19 The main dining room, corridors and bathrooms have been completed on the ground floor and there is a marked improvement. The home has plans for the purchase of new furniture as the chairs available are in poor repair and there are insufficient for the number of residents using these areas. The registered provider and manager could not give a date when this would occur and stated that when the decorating is completed then they will order new furniture. It was noted that some of the bedroom furniture was in poor condition, in one bedroom the vanity unit was disintegrating at the bottom and wood dust was seen on the carpet. A number of bedroom carpets were stained and worn, one bedroom carpet had a ridge in the middle increasing the risk of tripping. A number of rooms had non-slip flooring and the corridor downstairs also was covered with this type of flooring. This has an institutional feel; the managing director informed that this would probably remain to reduce unpleasant smells due to inappropriate urination. There are no bedroom door locks and residents do not have access to a locked facility within their bedroom to store personal items. It was found in one shared room that the resident’s clothes were in the wrong wardrobe and there was evidence of shared toiletries as named residents toiletries were found in other residents rooms and the shower rooms and bathrooms. The bathroom facilities still require work to bring them to acceptable standard; this is programmed as part of the re-decoration and refurbishment of the home. The lighting in the corridors was poor with patches of darkness; this could increase the risk of falls and injury due to the reduction in vision at night. The standard of cleanliness in the home has improved slightly since the last inspection. There are still areas that require further cleaning and attention should be taken to toilets, windowsills and the laundry area. During the inspection the cook was cleaning the extraction fans, however food debris was seen on shelves, the interior of the fridges was not clean and black mould was seen on the inside of the doors. The residents have access to a small garden area from the downstairs lounge area, the rear exit and a fire exit. This area has been reduced as a fence has been erected cutting off a large area of land. The managing director explained that this area was no longer available for the residents. One resident referred to the fence as ‘the Berlin wall’. As stated earlier in this report a number of bedrooms did not have a hot water supply, this is due to faulty thermostatic mixing valves and the hot water supply has been turned off. The home had received a quote to replace these but no date for the work to be carried out has been agreed. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 20 The staff get hot water from the sluice rooms on each floor and carry it to the residents rooms. There are no risk assessments to ensure that this is done safely. The laundry was inspected and it was noted that the washing machine and tumble driers are all working properly. It was found that the laundry was disorganised and on entering three baskets of washing were seen. On inspecting these it was noted that wet and smelling towels were in amongst dry resident clothes. It was difficult to determine clean from dirty laundry. The poor management of this area may increase the risk of damaged clothing and increase the risk of cross infection to the residents. The home has a shaft lift to assist residents in accessing all areas of the home. There is one hoist, which requires servicing as the top of the lifting mechanism was held together with tape and this may increase the risk of injury to the residents requiring assistance with mobility. No other manual handling equipment was seen in the home. The use of wheelchairs to transport residents was seen. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The numbers of staff on duty are not sufficient to meet the nursing and personal care needs of residents living in the home, and the roster does not take into account the deployment of additional non-care duties which will impact on the time available to provide effective and appropriate care, which meets the needs of residents. The home’s recruitment policies and procedures have improved but need to be maintained to ensure that systems are in place to support and protect the residents from harm at all times. Training is not currently up to date for all staff and due to the lack of qualified care staff the skill mix of staff employed in the home is not adequate which could result in inappropriate care being given and deterioration in the quality of life for individual residents. EVIDENCE: Examination of the rosters demonstrated that there are four care staff on duty during the morning with a further carer who works a shorter shift to assist with care, four care staff in the afternoon and two at night. There is also a qualified nurse on each shift. This is insufficient to meet the needs of the residents as it has been evidenced through out this inspection that care profiles are poorly manages, personal care is not carried out to an expectable standard and the home is poorly maintained. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 22 A cook covers the kitchen between the hours of 8.00am and 2.00pm after this time the care staff are responsible for completing the evening meal and tidying the kitchen. There are two staff employed to clean the home. The current nursing and care staff levels do not allow for extra duties such as activities and domestic duties, which include laundry and catering to be undertaken by care staff without affecting care delivery. The duty rota also demonstrates that the manager has now been provided with time, a minimum of 4 days per week, to carry out management responsibilities. Three staff files examined demonstrates that employment practices have improved; improvement is needed to ensure that effective recruitment practices are maintained at all times. Two of the staff files examined it was found that a Protection of Vulnerable Adults check had been made and the Criminal record Bureau check had been applied for. One new member of staff is supervised. Training for staff to update statutory training requirements has commenced. Recent training attended by staff includes fire, abuse and health and safety, which also incorporates food hygiene. Moving and handling training is not up to date for most of the staff. The training is delivered in-house and there was no information available to demonstrate the content of training offered. A training matrix is available the information it provides indicates that work is still needed to ensure that all staff are up to date with statutory training, which includes Control of substances hazardous to health (COSHH) and infection control. Training, which relates to the care and changing needs of residents living in the home is as much as 7 years old and a minimum of 2½ years old. The lack of up to date training for nursing and care staff related to the care needs and safety of residents living in the home could lead to poor and inappropriate care practices which harms or has an adverse effect on the safety of residents. An improved induction programme has been introduced. Staff have also been issued with copies of the General Social Care Council Code of Practice for Social Care Workers. There are only two care staff that have completed NVQ Level 2 in Care, a percentage of only 18.5 and not the required minimum of 50 . Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 23 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): 31, 32, 33 & 36 The home has not got an effective management structure in place, from which to demonstrate how the manager is able to fulfil his responsibilities within an organised management system of policies and procedures. The result is a lack of direction and guidance to ensure residents receive consistent quality care within a risk management system that protects the interests of residents and is supportive of a safe environment. EVIDENCE: Since the last inspection the registered manager has been allocated a minimum of four days per week to undertake management duties. From poor assessments, care planning, general care of the residents and records within the home it was evident that the manager has not taken full advantage of this opportunity. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 24 A quality review plan is available for 2005, the plan provides details of 15 areas that are to be reviewed, the frequency and whose responsibility it is to carry out the audit. To date the plan indicates that 2 of the 15 areas have been completed. The topics incorporated in the plan, include the annual review of policies and procedures, care plans and accident records. Work has not commenced on auditing these areas and procedures are dated 1999. Care plans have not been audited and the information provided following the audit of accident records was not robust so as to provide an audit trail, which would identify trends, confirm that the action taken was appropriate and identify whether a follow up investigation was needed. The quality agenda also involves sending questionnaires to residents and relatives. Five completed questionnaires were returned for November these were seen and read. Relatives had completed questionnaires and responses indicate that generally the respondents felt services related to the internal environment, laundry, catering and housekeeping services were good. One respondent felt that laundry and catering services were satisfactory. Relative’s comments state that they are happy with the care their relative is receiving and that staff are all very helpful and friendly. One relative commented, “Now that everywhere is being decorated the home is more pleasant to live in.” Concerns were raised about the loss of clothing. The manager has commenced supervision of nursing and care staff. Care staff spoken to were aware that they had been involved in an assessment carried out by the manager but were not aware that they had been supervised. Records available did not fully demonstrate that supervision procedures implemented monitor care practices delivered by staff ensuring that residents’ health, safety and welfare is maintained at all times. Staff meetings have taken place in the home, the last meetings taking place on 22 October 2005. Staff were very supportive of the home, residents, the manager and each other. Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 25 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 3 1 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 2 3 2 1 3 2 1 1 STAFFING Standard No Score 27 2 28 1 29 2 30 2 REGISTERED PROVIDER AND MANAGER AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 X X Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? Yes *indicates that these requirements are outstanding from the previous inspection. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4, 5 Requirement The registered provider must ensure that the information in the Statement of Purpose and the Residents Guide is up to date and gives an accurate description of staff and the environment. The registered provider and manager must ensure that a full pre-assessment of needs is conducted prior to admission to demonstrate that the assessed needs of a prospective reesident can be met can be met by the home. Timescale for action 31/01/06 2 OP3 14 31/12/05 3 OP4 S.31 & 32 CSA ‘01 15/01/06 The registered provider must ensure that the staff are aware of the needs of the residents and how these are to be met through: • Suitable care plans • Systems ensuring that care is prescribed and assessments carried out. DS0000004383.V267895.R01.S.doc Version 5.0 Page 27 Allambie Court 4 OP5 13 The registered provider must ensure that the there is evidence that residents and /or their relatives visit the home prior to admission to the home. The registered provider and manager must ensure that the care plans are up to date and address the needs of the residents and are related to up to date clinical guidelines. 31/01/06 *5 OP7 15, 13, S. 3 31/12/05 Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 28 *6 OP7 15 S.3 The registered provider and manager must ensure that the resident and/or the family are involved in the care planning process where possible. 31/12/05 *7 OP7 15 S.3 The registered provider and 31/12/05 manager must ensure that the care plans are evaluated monthly and changes to care needs are clearly indicated. The registered provider and manager must ensure that the care planned reflects the actual needs of the residents and when changes occur these are clearly indicated and new plans developed. The registered provider and manager must ensure that all residents have full risk assessments and where a risk is demonstrated an appropriate plan of prevention must be devised. These risk assessments must be assessed monthly and changes in risk factors clearly recorded. 31/12/05 *8 OP7 15 S.3 *9 OP8 17 15 14 17 S.3 S.4 31/12/05 *10 OP8 13 The registered provider and manager must ensure that all residents have psychological assessments on a regular basis and changes are clearly recorded and appropriate plans of action devised where required. All prescriptions must be checked prior to dispensing and a system installed to check the dispensed medication and the MAR charts received into the home DS0000004383.V267895.R01.S.doc 14/01/06 12 OP9 13(2) 07/01/06 Allambie Court Version 5.0 Page 29 13 OP9 13 S. 3(3)(i) 17 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 The MAR chart must be referred to before the administration and signed or the reason for nonadministration recorded immediately afterwards 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. All medicines no longer in use must be stored in a locked cabinet until removal by a licensed waste collection company The registered provider and manager must ensure that all personal care including hairdressing is carried out in a designated private area. The registered provider and manager must ensure that there are suitable activities during the day that meet the interests, hobbies and abilities of the residents, records must be available for inspection. The registered provider and manager must ensure that the residents are consulted on issues related to their daily lives, the DS0000004383.V267895.R01.S.doc 14/12/05 14 OP9 13(2) 14/12/05 15 OP9 13(2) 18(1) 19(1) 21/12/05 16 OP9 13(2) 14/12/05 *17 OP10 12 31/01/06 *18 OP12 4 16 S.1 31/01/06 19 OP14 12 31/12/05 Allambie Court Version 5.0 Page 30 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 decission. *20 OP15 16 The registered provider and manager must ensure that the residents have sufficient food during the day and that snacks are available at suitable times to suit the residents. The registered provider and manager must ensure that the cleaning schedules are completed and that the level of cleanliness in the kitchen is of a high standard. The registered provider must ensure that appropriate policies and procedures related to the protection of vulnerable adults; are written and available to staff and ensure that the document clearly details the local procedure for reporting incidents of actual or suspected abuse. The registered provider must ensure that there is a Whistle Blowing policy available in the home and staff are aware of their accountability and responsibility ensuring that vulnerable adults are protected from harm. The registered provider and manager must ensure that compliance to requirements made in the last report in relation to care practices and the environment are met as required by the Commission for Social DS0000004383.V267895.R01.S.doc 31/12/05 *21 OP15 13 31/12/05 22 OP18 12, 13 31/12/05 23 OP18 12, 13 31/12/05 *24 OP19 36 31/01/06 Allambie Court Version 5.0 Page 31 Care Inspection and evidence of action plans with time scales must be made available to demonstrate compliance. *25 OP19 & OP24 16 The registered provider and manager must replace all worn and damaged furniture in the residents’ bedrooms. The registered provider and manager must ensure that all sluice room doors are locked when not in use to prevent possible harm to the residents. The registered provider and manager must ensure that there are grab rails in the residents’ toilets and bathing areas to assist with mobility. The home must ensure that all manual handling equipment is serviced appropriately and in good working order. *28 OP22 23 The registered provider and 14/01/06 manager must ensure that there is suitable designated storage for wheelchairs and manual handling equipment. The registered provider and manager must ensure that there are suitable locks fitted to the bedroom doors to enable residents to lock their rooms if they wish. The registered provider and manager must ensure that there are suitable locked facilities available to all residents to store personal items. 31/01/06 28/02/06 *26 OP21 13 31/12/05 *27 OP22 23 14/01/06 *29 OP24 12 30 OP24 12 13 23 31/01/06 Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 32 *31 OP25 23 The registered provider and manager must ensure that the lighting in the corridors and resident bedrooms is brighter to prevent accidents and injury to residents and staff. The registered provider and manager must ensure that there is hot water available to all residents in their own bedrooms. The registered provider and manager must ensure that the procedures for laundering follow guidelines for the control of infection and that the laundry area is maintained in a clean, organised and suitable fashion. The numbers and skill mix of staff must be appropriate at all times to meet the health and welfare needs of service users. Any extra non-care duties must be clearly identified on duty rosters and separate to care hours provided. 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. The Registered Manager 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. DS0000004383.V267895.R01.S.doc 31/01/06 32 OP25 16 23 31/12/05 33 OP26 13, 16 07/01/06 34 OP27 18(1)(a), 3(a)(b) 31/12/05 35 OP28 18(1)(a) (c) 31/01/06 36 OP29 19 S. 2 31/12/05 Allambie Court Version 5.0 Page 33 37 OP30 18(1)(c) The Registered Manager must ensure that all staff are up to date with Statutory training requirements and attend training related to the care of residents living in the home. The registered manager 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. The registered provider and manager must ensure that suitable quality assurance and monitoring systems are in place, the outcome of these must be shared with the Commission and reports available for inspection. 31/01/06 38 OP31OP32 10 31/01/06 39 OP33 24, 26 10/02/06 40 OP33 24 Policies and procedures in the 31/01/06 home must be updated to ensure they reflect current good practice and local and national guidance. 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. 31/12/05 41 OP36 18 Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 34 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 OP9 Good Practice Recommendations Nursing staff must write written protocols for the administration of “when required” medicines. A clinician must endorse these. It is good practice to move residents to the dining area for meals increasing the social aspect of eating and to ensure that non- mobile residents are moved. 2 OP15 Allambie Court DS0000004383.V267895.R01.S.doc Version 5.0 Page 35 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.V267895.R01.S.doc Version 5.0 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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