Inspection on 29/11/06 for Allambie Court

This inspection was carried out on 29th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Allambie Court 29/01/09

Allambie Court 10/10/08

Allambie Court 07/01/08

Allambie Court 21/09/07

Allambie Court 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 O`Brien Key Unannounced Inspection 29th November 2006 08:30 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.V322710.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.V322710.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 *** Post Vacant *** 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.V322710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 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. The currently weekly charge is £439 - £480 per week with additional charges for chiropody and hairdressing. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report uses information and evidence gathered during a key inspection process, which involves a fieldwork 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 fieldwork visit was undertaken by two inspectors between the hours of 8.30am and 6.15pm. 27 service users were accommodated in the home on the day of the visit. It was the assessment of the nurse in charge that the majority of current service users had high dependency dementia care nursing needs. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspectors had the opportunity to meet most of the service users by spending time in the communal lounge and talked to several of them about their experience of the home. Some of the service users found it difficult to engage in conversation due to their medical condition but were able to express their feelings with verbal and non-verbal communication. General conversation was held with other service users along with observation of working practices and staff interaction with the people living in the home. The home manager and operations manager were present for most of the day. Inspectors also spoke to nursing staff, care staff, kitchen staff and support staff. There was opportunity for inspectors to speak to the relatives of some service users. The care of six service users 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 of the care provided is matched to outcomes for residents. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 6 This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: What has improved since the last inspection? What they could do better: This service must sustain a stable and effective management structure to enable staff to have clear leadership and direction to deliver appropriate care to meet the needs of service users. This includes ensuring that the manager has sufficient supernumerary time to discharge their responsibilities. The manager must be registered with the Commission for Social Care Inspection. Staff must ensure that a care plan is developed and implemented when there is a new or changed need of service users so that staff have clear information about the care required to meet their needs. The systems for the management of medicines in the home must be improved to reduce the risk of harm to service users. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 7 The manager, along with the community support worker, need to review the activity programme within the home so that all service users are given opportunities for stimulation through leisure and recreational activities, which match their cultural preference. The management must assess the environment and make adjustments to reflect research in dementia care. Replacement of damaged or worn furniture and fittings in some of the service users’ rooms must be replace to ensure people live in a safe and homely environment. The registered provider must ensure that there are sufficient numbers of staff on duty at all times that are competent and experienced to meet the diverse needs of the service users in all areas of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, and 3 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is provided to service users and their families about costs and the services the home provides to help them make a decision about moving into the home. Service users have their needs assessed before they move into the home and sufficient information is recorded to ensure that a care plan can be developed. Standard 6 is not included in this judgement, as the home does not provide intermediate care. EVIDENCE: A large print service user’s guide is available in the entrance hall of the home for service users and their families to look at. The manager informed the inspector that service user guides are not placed the rooms of service users. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 10 There was evidence in the pre admission notes of one service user that a service user guide had been sent to their social worker to enable them to discuss it with the individual. Separate financial case files are kept in the home’s office for each service user. These included copies of contracts informing service users of their rights and responsibilities and the cost of their care. There were copies of letters informing privately funded service users of annual increases in their care. Service users who receive funding from social services are informed of any increases in their contribution directly from social services. It was not appropriate to discuss funding with the service users involved in case tracking because of their limited understanding due to their dementia. It was noted that contracts and letters are directed to the representatives of service users who are nominated to take care of their finances. There was evidence in the case files of service users that they are provided with a contract informing them of their rights and responsibilities. It is the home’s procedure that a nurse from the home visits prospective service users before they are admitted to the home to make an assessment of their needs. The home has developed a pre-printed form to record information gathered during the assessment process. Not all pre-admission assessments were signed therefore; the home cannot be sure who carried out the assessment. Inspectors examined the case files of three service users for evidence of the pre-admission assessment. Two of these service users had been admitted since the last inspection. All of the case files contained a pre-admission assessment by a nurse from the home that documented sufficient information to develop plans of care for these individuals. Pre admission information was also provided by professional health and social care agencies and generally used to inform care planning. Shortfalls in the process were identified and have been included in the health and personal care outcome group of this report. The assessments included details of any special resources, such as specialist equipment, necessary to meet the needs of the individual. One pre admission assessment read included details of personal property brought into the home including, walking frame and head protector. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 and 10 were assessed. Standard 9 was assessed during a specialist pharmacist inspection on 10th November 2006. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place to meet most of the identified needs of service users but staff sometimes fail to implement timely action to reduce identified risks to health. Medicine management must also be improved to protect service users from potential harm. EVIDENCE: The general appearance of service users varied with some appearing generally well cared for with hair combed and finger nails trimmed; well presented and wearing their choice of make-up. Other service users were less so; for example, a number of male service users were unshaven and instead of wearing trousers wore a type of tracksuit bottom two of which were dirty. One person who had very dirty fingernails and another had very sticky eyes. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 12 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 service user. Each service user has a care plan that includes some of the information secured during the initial care needs assessments. The regional manager and the manager were available to discuss progress with the previous requirement to develop the service users plans of care. This requirement has not been met and an extended timescale is provided in this report. The case files of six service users were examined. Each service user had a care plan, daily recording records and monitoring records. Care plans were generally based on information secured during the initial care needs assessment and were developed as staff got to know the service user’s strengths and limitations. Care plans held a range of information including physical and mental capacities, nutritional needs, personal care needs, health care needs and interventions. Examples of good practice noted in care planning and monitoring noted include: • • • Details of how staff are to support a service user to maintain their personal hygiene and the need to explain to the service user before any intervention were included in the care plan. Daily records of one service user indicate deterioration in the service user’s ability to stand unaided. The care plan had been revised and updated to include the use of a hoist for transfers. Photographs of wounds and information held in monitoring records showed that wounds are well managed. Comments made directly to the inspector by a visitor include she had a pressure sore but that is now healed. Care plans generally supplied staff with the information needed to make sure service users needs were met safely and appropriately. Two staff spoken with said they familiarised themselves with service users’ care plans but felt plans were not always up-to date. Some care plans contain insufficient detail of the actions required to meet each need. For example: • • The care plan of one service user with challenging behaviour identified the person as requiring ‘regular checks’. Details of the frequency of monitoring were not documented. The absence of detailed information advising staff of possible reasons that might cause service users to have challenging behaviours, and details of how these behaviours are to be managed. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 13 • • A care plan identifies the need for personal care to be provided by two or three carers but fails to state why this is necessary or what is required of each carer. A care plan review includes will weight bear with two support workers but fails to include what is expected of the support workers. One person who was admitted to the home one week ago did not have care plans written for all their identified needs. An evaluation of the care plan for each identified need is documented each month but are not consistently reviewed following a change in need. For example, the case file of one service user documented a hospital admission for a period of one month for an assessment and review of their mental health needs following deterioration in their condition. Details of the outcome of this assessment period was not documented and no new care plans were implemented following this service user’s readmission to the home. Consequently, it was unclear whether the existing care plans were still appropriate. Relatives are encouraged to sign care plans to agree the care given during reviews of care with nursing staff. This was evident in one of the case files examined. One relative spoken to said he was aware of his relatives care plan. The home monitors well being with monthly recording of vital signs and weight. Service users case tracked were noted to have maintained or put on weight. Most service users are registered with the local surgeries and receive health care support services as required. A number of new service users have yet to be registered with a surgery. It is strongly recommended that the home consider securing GP services before service users move into the care home. There was evidence that service users are supported to access care from other health professionals; visits from hospital consultants, chiropodist, optician, dentist, speech and language therapist were documented. The home uses risk assessment tools to identify each service user’s risk of falls, risk of developing pressure sores and risk of poor nutrition. These risk assessments are reviewed and evaluated each month but are not always cross referenced to the care plans or reviewed following a change in need. One recently admitted service user was identified as having a high risk of falls. This person experienced a fall on the day after admission sustaining bruising to the side of their head. It was documented in the daily records that this person went on to have three further falls during the same night. There was no evidence of monitoring vital signs (blood pressure and pulse) to establish well being despite the head injury. The use of cot sides was implemented the following day without a risk assessment for the use of this restraint. The risk assessment for falls was not revisited for review. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 14 Pre admission information supplied in respect of one service user by the Primary Care Trust showed the service user is at risk of falls and should use a “low bed. Documentation held at the home shows this information was disregarded and a standard height bed equipped with bed rails was supplied. This action led to two incidents overnight when the service user fell out of the bottom of the bed. Observations in the service user’s room confirm a low height bed has now been supplied and additional measures taken to protect the service user when in bed include a mattress placed on the floor next to the bed and a duvet on the floor at the base of the bed. A separate pharmacy inspection was undertaken to assess the home’s systems for the safe management of medicines on 10th November 2006. The medicine management was found to be poor and affected the safety of the service users who live in the home. Evidence of poor practice included: • • • • • • • • Medicines had been prescribed but not administered, Medicines had been recorded as administered when they had not been given, Incorrect doses of medicines had been recorded on the Medicines Administration Record (MAR) chart, Medicines had been recorded on the MAR chart for administration but none were available for administration, An alternative supply of one medicine had not been sought following directions “out of stock”, Medicines had been duplicated on the MAR chart and recorded as administered twice indicating that double the dose had been administered, Medicines were stored incorrectly, Staff had not been routinely assessed for their competence in medicine management. A statutory notice was issued on 20th November 2006 requiring the provider to improve the medicine management to reduce the risk of harm to service users. On the day of this inspection visit the operations manager was meeting with nursing staff in order to develop and implement an action plan to address the issues identified in the pharmacy report. It was evident from observation of working practice that staff are knowledgeable about the abilities and needs of the people they are caring for and are aware of their likes and dislikes. One staff member was observed responding to some non-verbal communication from a service user who used gestures to indicate their needs. One service user told the inspector, ‘They look after me here, they’re always bringing me tea.’ Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 15 The relative of another service user told the inspector that their loved one received ‘good care’ and had improved since coming to live in the home. Service users were generally treated with respect and their dignity maintained; for example, personal care was provided in private and service users were spoken to respectfully, and addressed by their preferred names. Shortfalls were identified and have been referred to in the Complaints and Protection section of this report. The practice of displaying a bath list in the office is considered institutional and should be discontinued. Staff use of ‘a moving and handling summary’ that does not accurately reflect service user’s needs is unsafe. Allambie Court DS0000004383.V322710.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 adequate. This judgement has been made using available evidence including a visit to this service. The home satisfies the social, cultural and recreational needs of some of the service users to enhance the quality of their lives. Further work is required to ensure that all service users are supported to maintain their enduring interests and are with provided safe, sensitive and pleasurable dining experience. EVIDENCE: The home has an open visiting policy that takes into account the individual needs and wishes of service users. Two are service users and a visiting relative spoken to confirm visiting is flexible and visitors are made to feel welcome. One relative spoken to said he usually visits at lunchtime so that he can feed his relative. Visitors were observed visiting their relative in the privacy of their own room or in communal areas of the home. 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 service users. Service users were observed to spend time in the privacy of their own rooms or join other service users in communal areas for company or meals. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 17 The home will organise occasional visiting entertainers, group activities and regular church services at the home. The community support worker talked about the arrangements for the provision of activities, which 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 service users’ willingness to participate. Talking books are available for those requiring them and the community support worker reads to one service user on a regular basis. Records of participation in activities are held and include the aim of the activity. In the absence of the community support, worker service users are reliant on care staff to provide individual and group social and therapeutic stimulation. Records showed that not all service users participate in meaningful or engaging activities. The care plan and daily records of a service user with dementia failed to show how and where she spent her time and what suitable options were open to her in terms of daily life activities. Serious consideration should be given to the introduction of tactile boards and other appropriate sensory equipment, which provides stimulation and helps to maintain finer dexterity skills. Training undertaken by the community support worker includes therapeutic and reminiscence activities related to dementia. It is recommended that further training be arranged to include ‘reality orientation’ and when it may be appropriate for this to be used. The hairdresser visits weekly and provides services at the home. The home is developing lifestyle diaries, which involved the service user and their relatives in producing a story about the service users life, highlighting important events from the point of view of the service user, and including some pictures and photographs where appropriate. This is often done in ‘scrapbook style’ and can be as short or as long as the service user wishes. The activities organiser takes the lead in developing the life story. The environment lacked stimulation and failed to engage those service users with dementia, who spent long periods with little or nothing to occupy them. Two staff spoken to were not fully aware of the individual interests of service users but thought this information could be found in care plans. One care plan shows the service user likes to hold soft toys; daily records and observations on the day of the visit failed to confirm the service user was given a soft toy to hold. Three service users were observed playing a game of Scrabble and a number of service users were invited to attend ‘flower arranging’. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 18 A tour of the premises found the kitchen was generally clean and well managed. Temperature records were held of the fridge, freezers and high risk cooked foods. The cook talked about the arrangements for cleaning the kitchen and said there was a cleaning schedule in place to make sure all areas of the kitchen were routinely cleaned. Store cupboards held a range of provisions including fresh fruit. Menus were displayed in the kitchen and showed a varied and nutritious diet that offered alternatives. The cook talked about the menus and said service users were offered either a cooked or continental breakfast on alternate days and alternatives at lunchtime and teatime were always available. Menus had not been revised for over 10 months and therefore require revising to ensure that a variety of nutritious meals are served in the home, which reflect personal preferences and dietary needs of service users. Meals provided in the home are adequate with special diets catered for. Snack meals must be readily available and accessible to service users with dementia so that the home can be sure nutritional needs are met. Observations at a mealtime showed that breakfast was served from 10am and one service user on the first floor had to wait until 10.45am. When the inspectors arrived at 8.30am there were two service users sitting at tables in the dining room on the ground floor who waited until 10am to have breakfast. Cooked food is transported to dining areas in a heated trolley and service users on the first floor have to wait until food has been served to those on the ground floor. The two designated staff on the first floor offered service users a choice of cereals or porridge and a cooked breakfast. Unless they choose to do, so service users should not have to wait until 10am for breakfast. Practices must be reviewed so that service users can have their breakfast when they get up and significant gaps between mealtimes eliminated. Service users requiring assistance to eat their food also had to wait until meals had been served before receiving the attention they needed to eat their food. The inspector was informed that five of the 12 service users on the first floor of the home required assistance to eat their food. Staffing levels at mealtimes should be reviewed to take into account the individual needs of service users and sufficient resources made available to insure service users needs are met in a timely manner. Staff support and assistance was generally provided in a sensitive manner but occasionally hurried as other service users were also waiting for the support they required to eat their food. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 19 Unless service users are on a dietary monitoring chart, records are not routinely held of snacks provided in the evenings. A record of all food supplied should be held so that the home can be sure service users are being offered a balanced and nutritious diet. Opportunity was taken to speak to a visiting relative who commented, staff are approachable and my xxxx is cared for very well.” Two service users were asked as to their views of the meals provided; positive comments were received as to the quality of the food, one lady said she was satisfied with the food provided. One service user did not know what Profiteroles were so a staff member showed her. Not all service users were offered choices. The provision of meals is an important one, and the ascertaining of service users wishers should be central to the day-to-day running of the home, enabling service users to express choice and control over their daily lives. Service users with dementia should be offered visual choices so that they can choose in the moment and not be dependent on memory. The menu for the day should be displayed. At one mealtime, the inspector observed two service users becoming increasingly emotionally distressed because there were not enough staff in the dining room to observe the exacerbation of an argument between service users. Staff noticed elements of the conflict and intervened when they were present, but through a lack of continuous observation, there was not enough knowledge of the way in which this problem was growing and it was not properly prevented. (This matter has been referred to again in the complaints and protection section of this report) Service users were put at risk through poor supervision on at least two occasions during the inspectors period of observation. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. The people using this service have enough information to help them make a complaint if they wish. The lack of staff training in safely restraining service users with challenging behaviours puts service users at risk from harm. EVIDENCE: The home has a complaints policy, which is included in the service user guide in the home. The manager discussed that it was not useful to give a copy of the complaints procedure to each service user as they may have limited understanding because of their dementia. People are encouraged to raise their concerns with senior staff on duty. Because of the nature of their dementia, many of the service users in the home depend upon their relatives to raise concerns on their behalf. One relative commented, ‘there’s always someone to ask if I want to know anything’. During a discussion with a group of service users in the lounge they were able to identify staff by name that they ‘talk to’ about ‘anything that’s bothering them’. Two service users said they ‘didn’t have any worries’. Staff spoken to said they would report any concerns raised by service users or their representatives to the nurse in charge or the manager. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 21 The home’s record of complaints was examined. The home has recorded one complaint received since the last inspection. The complaint had been received by the Commission and referred to the home to investigate and respond to. The complaint raised concerns about manual handling practices, offensive odours in the home and poor infection control. There was evidence that the home had conducted an investigation and responded to the complainant in a timely manner. Information was shared with the Commission from a member of the public in July 2006 raising concerns about staff having insufficient time to complete care records for service users, care staff undertaking domestic cleaning duties which took them away from their caring duties, the manager having insufficient supernumerary hours to effectively discharge their management responsibilities and a lack of prompt reporting to the necessary agencies about incidents which affect the well being of service users. This information was taken into consideration during the inspection process and the inspectors’ findings are included in the ‘Staffing’ and ‘Management and Administration’ outcome groups in this report. Observations showed physical interventions being used by staff to manage challenging and disruptive behaviours; for example, two staff used physical intervention to restrict the movements of a service user and to escort him to his room. It was noted that the service user had sustained an unexplained skin tear to his arm. Staff restricted the movements of another service user by transferring the service user into a wheelchair and applying the brakes. It is of concern that physical restraint was used in the home by untrained staff and not in accordance with Department of Health guidance and this is putting service users at serious risk of harm. The operations manager provided evidence that the home’s policy about how to respond to suspicions or allegations of abuse had been reviewed and updated but at the time of inspection this was held as an electronic record only and all staff did not have access to it. The provider must ensure that this information is available to all staff so that service users are protected from the risk of harm. Staff spoken to said service users were well cared for and they would report any issues of concern to the nurse on duty. Staff have received Abuse Awareness training. Comments made by relative directly to the inspector include staff view residents as naughty children who dont know what they are doing. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 22 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, 24 and 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the communal areas are comfortable and well maintained but some service users’ bedrooms are sparse, unwelcoming and institutionalised so service users do not have comfortable surroundings to live in and enjoy. EVIDENCE: Inspectors toured the communal areas of the home and the bedrooms of the service users involved in case tracking. The quality of the furnishings and fittings in service users’ rooms varied. One room visited had been furnished to a high standard by relatives and was personalised with photographs, ornaments and small items of furniture making the room feel warm and homely. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 23 Other rooms visited were sparse, not personalised and in need of refurbishment and redecoration; for example the door of a hand basin vanity unit in a double room was missing. A number of curtains were not properly fitted to the rails including curtains in communal areas of the home. In some of the bedrooms a hard vinyl flooring is used as an alternative to fitted carpet. Equipment is available to assist service users and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. In response to shortfalls identified during the last inspection, privacy screens were available in a double room. Service users’ toiletries were held together in a cabinet under the sink and ownership could not be identified. Such practices are considered institutional and should be discouraged. Water was leaking from a pipe in a toilet on the first floor and a waste bin used to collect the water. A seat cover on the hoist in the ground floor bathroom was dirty and unhygienic and requires either cleaning or replacing. Dining areas were also sparse and somewhat institutional in appearance. There was an odour in several service users areas in the home. Carpets in the home are heavily patterned and therefore unsuitable for people with dementia. A number of service users were confused by the patterned carpets and were observed trying to pick things up off the floor. Three staff spoken with said they had received training on the prevention and control of infection and were required to wear white gloves and aprons when providing personal care. Blue gloves are available and must be worn when serving or handling food. Staff said gloves were disposed of after each task. Observations showed staff did not always wear protective clothing when entering the kitchen therefore practices are unsafe and may place service users at risk of infection or cross contamination. The improvements to the laundry area and laundry service provided by the home that were observed at the last inspection have been sustained. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. There are not always sufficient staff to meet all the identified needs of service users and the effectiveness of training needs to be monitored to ensure that service users receive appropriate care. EVIDENCE: The inspector was informed that the current usual staffing complement for the home is: 8am – 2pm 2pm – 8pm 8pm – 8am 1 Registered Nurse 5 Care Staff 1 Registered Nurse 4 Care Staff 1 Registered Nurse 2 Care Staff This was confirmed by examination of duty rota supplied by the manager before the inspection and examination of the current duty rota. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 25 There are sufficient catering and domestic staff to ensure that that nursing and care staff do not spend undue time undertaking non-caring tasks. The home uses minimal agency staff with any absence such as sickness or holidays being covered by the home’s own staff or ‘relief bank’ staff. The home does not employ an administrator. The manager covers a full time nursing post as well as undertaking administrative tasks and the overall running of the home. The operations manager informed the inspector that a ‘relief bank’ registered nurse is employed occasionally to release the manager to undertake management duties. This could not be established from any of the duty rotas seen. The manager was advised that the duty rota must accurately reflect the number and grade of staff on duty. On the day of this inspection visit it was evident that the numbers of staff on duty were sufficient to meet the physical needs of service users with the exception of meal times when staff were hurried due to the numbers of service users requiring assistance to eat their meals. Three staff members spoken to all felt service users would benefit from having an additional carer available at mealtimes. One of the care staff spoken to explained that on an 8am – 2pm shift two carers are allocated to work with service users 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 carer went on to say, “There’s a lot to do, we’re very busy before breakfast getting people up. There’s not enough of us to get them up.’ On the day of inspection inspectors observed that most service users were up and dressed before 10am when breakfast was served. Staff were observed to be kind and committed to meeting the needs of service users in their care. Staff interactions with service users were generally good. However, most staff interaction with service users was during a task to meet a basic care need and there was little evidence of staff spending time with them to address any social needs. Three out of the twelve care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 25 , is below the National Minimum Standard for 50 of staff to be qualified. However, arrangements are in place to ensure that all care staff have the opportunity to achieve the qualification and a further six members of the care staff are currently registered and working towards the award. The personnel files of two recently recruited staff were examined and one contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references were obtained before staff started working in the home. However, one file contained a CRB from a previous employer. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 26 CRB checks are not transferable between employers and must be applied for again along with a PoVA check before a person starts working in the home. There was evidence in one of the files that staff undertook an induction programme when they commenced employment. Training records seen and discussions with care staff confirmed that mandatory training such as moving and handling, abuse awareness and fire safety had been attended by most staff with the exception of recently recruited staff members. Despite having moving and handling training and updates, staff were observed using unsafe moving and handling methods when assisting service users to transfer; for example, two staff used a technique known as a ‘drag lift’ when assisting a service user to transfer and foot rests were not always fitted to wheelchairs used to transfer service users. Two staff spoken to said they often had problems locating the footrests, which were regularly removed by night staff. These issues were brought to the attention of the operations manager and home manager as it is evident that staff supervision is required to ensure that any training received by staff is understood and implemented correctly and safely. Most staff attended Dementia training session in June 2006 although staff spoken to commented that this consisted mainly of information about types of dementia and medical treatment rather than how to care for people with dementia or how to support people with challenging behaviours. Two staff spoken with said they had not received training on the effects or treatment of mental illness. It is evident from information contained in the ‘Health and Personal Care’ and ‘Complaints and Protection’ sections of this report that staff require further training and monitoring of the effectiveness of any learning in: • • • • risk assessment and management safe management of medication safe moving and handling safe and appropriate use of restraint in service users with challenging behaviours. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 27 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. This judgement has been made using available evidence including a visit to this service. The service has failed to maintain stable and effective leadership to ensure that staff have clear direction in delivering appropriate care to service users. 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. Between January 2006 and August 2006 Allambie Court has three other managers. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 28 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. In particular, evidence in this report demonstrates that the manager requires sufficient time to supervise and monitor staff to ensure that they are delivering appropriate, safe and effective care to service users and that the learning outcomes for staff training are achieved. The operations manager for the provider organisation (ADL) has been involved with this service since June 2006 and is currently spending two days every fortnight in the home to assist the manager in developing and implementing action plans for improvement. The operations manager has undertaken a review of the service and evidence was seen in the home’s Quality Assurance file that audit and reviews have been made of service users’ care plans, staff files, environment and refurbishment. This has resulted in objectives for improvement being set and action plans developed to achieve this. The provider must continue to sustain an effective management structure to support implementation of the actions needed to make the identified improvements. Relatives meetings have been established to give the representatives of service users an opportunity to voice their opinion in how the service is run and these have taken place in July 2006 and October 2006. The operations manager has begun sending copies of monthly Regulation 26 visits to the Commission for Social Care Inspection providing information about the quality of the service and action implemented to improve. 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: - Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 29 • • • • • Hot Water Outlet temperature checks, which should be recorded monthly, are carried out every one or two months. A Fire drill and Fire Safety lecture took place in June 2006. Records demonstrate that the Fire alarm is tested weekly. The adapted ‘Parker’ bath was fitted with a new pump and tested in June 2006 Hoists requiring six monthly service and safety checks were last checked in March 2006. The health and safety of people in the home is compromised by some unsafe working practices identified in this report; in particular, the management of medicines, moving and handling practices and the safe and appropriate use of restraint must be improved. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X 1 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 X N/A X X 2 Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 31 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 The registered provider must ensure that care plans are developed and implemented when new or changed needs or risks are identified. This is to include potential risks to self or others as a result of challenging behaviour. This requirement is outstanding from the previous inspection and was not completed by the timescale of 15/08/06. The registered provider must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. 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. This requirement is outstanding from the previous inspection and was not completed by the timescale of 31/05/06. DS0000004383.V322710.R01.S.doc Timescale for action 28/02/07 2 OP8 13 31/01/07 3 OP9 13(2) 08/12/06 Allambie Court Version 5.2 Page 32 4 OP9 13(2)18(1 )19(1) The registered provider must ensure that staff drug audits are 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. This requirement is outstanding from the previous inspection and was not completed by the timescale of 31/05/06. The MAR chart must be referred to before any administration of medicine and the medicine checked before its administration and the transaction recorded directly afterwards. The right medicine must be administered to the right person at the right time at the correct dose as prescribed by the doctor and records must accurately reflect practice. 08/12/06 5 OP9 13(2) Sch 3(3)(i) 08/12/06 6 OP9 13(2) 7 OP9 13(2) This requirement is outstanding from the previous inspection and was not completed by the timescale of 31/08/06. Nursing staff must ensure that 08/12/06 all medicines are available for administration if prescribed and alternative sought in the event of a manufacturers delay. All medicines must be stored as 08/12/06 their product licence dictates to maintain their stability. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 33 8 OP9 13(2) Sch 3(3)(i) 9 OP9 13(2) All MAR charts must record the directions accurately as the doctor prescribed on the prescription and must be dated. The quantities of all medicines received or balances carried over must be recorded. The registered provider must ensure that the policies for the ordering, receipt, storage, administration and disposal of medicines in the home are reviewed to reflect the practices in the home and Royal Pharmaceutical Society Guidelines. This requirement is outstanding from previous inspection and was not completed by the timescale of 31/08/06. The registered provider must, having regard to the needs of service users, provide facilities for all service users to engage in meaningful and stimulating occupation. The registered provider and manager must ensure that the residents are consulted on issues related to their daily lives, the environment and that their wishes are taken into account when planning care and daily life in the home. If consultation is not possible their wishes should be recorded and considered when making decisions. This requirement is outstanding from previous inspection and was not completed by the timescale of 31/05/06. 08/12/06 08/12/06 10 OP12 16 31/03/07 11 OP14 12 31/03/07 Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 34 12 OP15 12(1)(a)( b) The registered provider must ensure that mealtimes are unhurried with residents being given sufficient time to eat and that staff are available to offer individual assistance as required. This requirement is outstanding from the previous inspection and was not completed by the timescale of 31/05/06. The registered provider must make arrangements ensure that staff are trained and are competent in the safe and appropriate use of restraint of service users. The registered provider must ensure that appropriate policies and procedures related to the protection of vulnerable adults are available to staff. The registered provider must replace all worn and damaged furniture in the residents’ bedrooms. 28/02/07 13 OP18 13 31/03/07 14 OP18 13 31/01/07 15 OP24 16 31/03/07 16 OP24 12 This requirement is outstanding from previous inspection and was not completed by the timescale of 31/07/06. The registered provider must 31/03/07 ensure that there are suitable locks fitted to the bedroom doors to enable residents to lock their rooms if they wish. This requirement is outstanding from previous inspection and was not completed by the timescale of 30/06/06. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 35 17 OP24 12,13,23 The registered provider must ensure that there are suitable locked facilities available to all residents to store personal items. This requirement is outstanding from previous inspection and was not completed by the timescale of 30/06/06. The registered provider must ensure that all parts of the home are free from offensive odours. This requirement is outstanding from previous inspection and was not completed by the timescale of 31/05/06. The registered provider must ensure that the numbers and skill mix of staff is appropriate at all times to meet the health and welfare needs of service users. The registered provider must ensure that staff files contain of evidence of satisfactory pre employment checks before a person starts working in the home. 31/03/07 18 OP26 16 31/01/07 19 OP27 18 28/02/07 20 OP29 19 31/01/07 21 OP30 18(1)(c) This requirement is outstanding from previous inspection and was not completed by the timescale of July 2005. The registered provider must 31/03/07 make arrangements to 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. Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 36 22 OP31 23 OP32 24 OP38 The registered provider must ensure that the manager appointed to run the home is registered with the Commission for Social Care Inspection 10 The registered provider must ensure that the home is managed with care, competence and skill to provide clear direction and leadership which staff and service users understand and can relate to. 12, 13, 16 The registered provider must ensure that there are systems in place to ensure the health, safety and welfare of residents. This requirement is outstanding from previous inspection and was not completed by the timescale of July 2005. 8 28/02/07 28/02/07 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Allambie Court DS0000004383.V322710.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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