Inspection on 07/01/08 for Allambie Court

This inspection was carried out on 7th January 2008.

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

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 21/09/07

Allambie Court 29/11/06

Allambie Court 19/04/06

Allambie Court 22/11/05

Allambie Court 06/07/05

Allambie Court 15/02/05

Allambie Court 23/04/04

Similar services:

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

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

CARE HOMES FOR OLDER PEOPLE Allambie Court 55 Hinckley Road Nuneaton Warwickshire CV11 6LG Lead Inspector Michelle McCarthy Key Unannounced Inspection 7th January 2008 11:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Allambie Court DS0000004383.V357450.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.V357450.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 vacant post Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number disorder, excluding learning disability or of places dementia (30) Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2007 Brief Description of the Service: Allambie Court Nursing Home is situated in Nuneaton approximately 1 mile from the town centre, and is easily reached by a local bus service. The home is an Edwardian building converted into a nursing home and has had an extension built to accommodate 30 people who have a diagnosis of dementia and mental health problems. There is a small secure garden to the rear of the property and sufficient parking to the front. The home has a mixture of single and shared occupancy and all bedrooms are fitted with a hand washbasin. Written information about the current scale of charges for the home was not available on the day of this inspection visit. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The inspection visit took place over two days; 7th January between 11.40am and 5.15pm and 8th January between 9.40am and 1pm. 26 people were living in the home during the inspection visits. It was the assessment of the home manager the majority of people living in the home had medium or high dependency nursing care needs. A random unannounced inspection was made by the specialist pharmacist inspector on 20th December 2007 and the outcome is included in the ‘Health and Personal Care’ section of this report. A couple of hours was spent sitting with a number of residents in a communal area of the home, this was to enable us to have a look at resident’s welfare and staff interaction during this period. These observations were used alongside other information gathered to assess the quality of care. Documentation maintained in the home was examined including staff files and training records, records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspector had the opportunity to meet most of the residents by visiting them in their rooms, spending time in the communal lounges and talking to some of them about their experience of living in the home. There were opportunities to observe working practices and staff interaction with the people living in the home. The home manager was present throughout the day. The inspector also spoke to care staff and a laundry assistant. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. Care plans and monitoring records of other residents were examined randomly. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 6 Feedback was given to the manager at the end of the inspection visit. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be developed and implemented when new or changed needs or risks are identified. This should ensure that people get the care they need. This is outstanding from previous inspections. Arrangements must be made to check the safety of the Fixed Electrical Installation in the home. A certificate confirming safety must be available for inspection in the home. This is to promote the safety of people in the home. This is outstanding from previous inspections. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 7 Proper provision must be made for the health and welfare of people living in the care home. This is to make sure people’s health and welfare needs are met. Systems must be in place to ensure that staff do not start working in the home until satisfactory pre employment checks, including references, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. 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.V357450.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.V357450.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): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of three residents, including one person admitted since the last inspection, were examined to assess the pre admission assessment process. The manager said that it was usual practice for him to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. All three files contained a pre admission assessment of each person’s needs and abilities. This means that sufficient information was available so that the Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 10 home could confirm they could meet each person’s needs and develop care plans. One assessment was not dated or signed therefore we cannot be sure who carried out the assessment, or when. Allambie Court DS0000004383.V357450.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, 9 and 10 were assessed. Quality in this outcome area is adequate. People are treated respectfully and are protected from harm by the safe management of medicines. Care plans are not always developed for new or changed needs, which put residents at risk of not having their needs, met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection visit people living in the home looked cared for with their personal care needs met. Most residents were clean with groomed hair and fingernails, male residents were clean shaven (where this was their choice) and all wore appropriate, well-laundered clothing. A couple of hours were spent sitting with a number of residents in the ground floor lounge during the lunchtime service on 7th January. The inspector used the Short Observational Framework for Inspection (SOFI) to enable us to have a look at resident’s welfare and staff interaction during this period. Staff were Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 12 observed interacting with residents while they served meals or assisted them to eat. An analysis of the results showed that staff interaction with residents was good or adequate. There was a moderate level of resident engagement during the observation, which is to be expected, as people were busy eating, their meals. Residents’ care files in the home have a standard ‘layout’ and are methodically structured in a way that allow staff ease of reference to information about each person. Care plans held a range of information including physical and mental capacities, nutritional needs, personal care needs, health care needs and interventions. Three people were identified for case tracking. Two of the files examined contained appropriate care plans for each of the identified needs of the individual and were reviewed each month. For example, the psychological / behaviour care plan for one person who becomes agitated and resists intervention contained strategies for staff to take to minimise any agitation so that care needs could be met with the minimum of distress to the person. The home uses risk assessment tools to identify each person’s risk of falls, risk of developing pressure sores and risk of poor nutrition. Care plans were available to minimise any risks identified. For example, a risk assessment for one person identified that they had a high risk of developing pressure sores. A care plan was developed detailing the actions staff need to take to minimise the risk. Evidence was available that the care plan had been implemented; for example, pressure relieving aids such as cushion and mattress were in place and the evaluation records documented the person’s skin was intact. The service documents any decision to implement the use of bedrails for residents to demonstrate they are used in their best interests. Risk assessments were available to minimise the risk of entrapment where bedrails were in use. Evidence was available to demonstrate that the service has not complied with a requirement to make sure that care plans are developed and implemented when new or changed needs or risks are identified. A wound care assessment chart, body mapping record and daily records for one person record a grade 2 pressure sore to their blistered right heel on 14th December 2007. No care plan was developed or implemented for the care of this identified need. Daily records for 29th December document ‘pressure area noted to whole of R heel (blister). Allevyn heel applied’. A care plan for the wound dressing was not developed or implemented. There were no other entries documented in daily records, wound assessment or evaluation records. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 13 The service failed to develop a care plan to address the needs around this person having an identified grade 2 pressure sore to their right heel. This means staff have no direction about the actions they need to take to care for the wound, promote healing or prevent deterioration. This leaves this person at risk of deterioration in their health and well-being and we cannot be certain that this identified need has had the appropriate care. We cannot be certain whether the wound was improving or deteriorating because there is no wound evaluation documented. The requirement to develop and implement care plans for new or changed needs is outstanding from previous inspections and was not complied with by the original timescale of 15/08/06. Residents’ blood pressure, pulse and weight are recorded each month to monitor the health and general well being of people living in the home. Evidence in case files demonstrate that residents have access to other health professionals such as GP, chiropodist and optician. Records for one person recorded ineffective pain relief on Friday 4th January 2008 and a GP visit was requested but there is no evidence that this took place. A care plan was not implemented to monitor the effects of pain relief medication. Daily records indicate that the person continued to be agitated with pain over the weekend but no action was taken to review medication or seek further medical advice. There was no evidence of further contact with the GP until Monday 7th January when antibiotics were prescribed during a telephone consultation. There is no evidence that pain relief was discussed during the telephone consultation. This leaves this person at risk of distress and experiencing pain. Staff were observed to use a hoist to move people from their chairs to their wheelchairs. On two occasions staff applied the hoist sling in a way that did not correspond to the manufacturer’s instructions. This was brought to the attention of the manager and senior nurse who committed to investigate and take action to ensure the appropriate use of moving and handling equipment. The medicine management has improved to a safe level since the last key inspection on 21st September 2007. A pharmacist inspection on 20th December 2007 lasted just under one and a half hours. Six residents medicines were looked at together with their medicine charts. Supporting care plans were also inspected. All feedback was given to Peter Jones, the manager of the home who was present during the inspection Audits indicated that the majority of medicines had been administered as prescribed. The home uses a good system to check the prescriptions prior to dispensing and to check the dispensed medication and charts received into the home. Many medicines had been discontinued but these were still printed by Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 14 the pharmacist on the medicine charts. These discontinued medicines were clearly crossed out indicating that staff are ensuring that these are accurately checked when received into the home. A few errors were seen where staff had failed to record the correct reason for non-administration but this was recognised by the manager before the inspection started and he was encouraging staff to accurately record the correct code on the medicine chart. Care plans documented the use of medicines well and supported their use. All “when required” medication had supporting written protocols detailing their use. All Controlled Drug balances were correct and recorded correctly in the controlled drug register and medicine chart. The lock on the CD cabinet was broken and a new lock had been ordered. The CD cabinet was kept within a second locked cabinet in the medication room. Storage facilities were acceptable and the refrigerator temperatures were monitored daily and lay within the range to safely store medication. Staff were observed to treat people respectfully and addressed them by their preferred names. Staff were sensitive to the psychological well being of people with dementia care needs. For example, one resident was anxious because she believed she had to go home to care for a sick relative and made repeated requests to staff to help her. Staff engaged this resident in conversation to relieve her anxiety on each occasion she approached them. This means that staff took appropriate action to relieve the distress and anxiety this person was experiencing which should improve their quality of life. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. People living in the home are not effectively supported to maintain their independence and enduring interests to enhance their quality of life. Residents benefit from a nutritious diet and are given sensitive assistance to eat their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a part-time community support worker (16 hours weekly) with responsibility for devising a programme of individual and group activities for the benefit of people living in the home. Residents were observed to spend time in the privacy of their own rooms or join others in communal areas for company or meals. The home organises occasional visiting entertainers, group activities and regular church services in the home; this includes an art session every three weeks, a singer visits the home to entertain residents on most Thursdays and an aroma therapist visits some of the residents. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 16 The community support worker completes ‘Lifestyle diaries’ for residents to document their enduring interests and relationships. Lifestyle diaries were examined for two of the people involved in case tracking and neither had been completed. One of these people had evident interests in Country and Western Music and completing jigsaws, based on the collection in their rooms. There was no evidence that this person had been supported to engage in either of these activities. Decisions about most activities are made on a daily basis and are based on residents’ willingness to participate. The community support worker maintains a record of people involved in activities. In the absence of the community support worker residents are reliant on care staff to provide individual and group, social and therapeutic stimulation. After lunch on 7th January staff played a ‘Hoopla’ game with people in the ground floor lounge. This engaged two residents, one visiting relative and two staff members. Evidence from observation showed that the majority of staff interaction took place during an intervention to meet a personal care need rather than a social or recreational need. This limits residents’ choice in how they spend their day. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. The visitor’s record demonstrated that people can visit when they want to. Arrangements for mealtimes were observed to have improved. On 7th January the inspector undertook a period of observation during the lunchtime service for people living on the ground floor of the home. People were assisted to the dining room just before meals were served so that no one waited an excessive amount of time before their meal arrived. Three people remained in the lounge area for their meals. Two of the care plans examined for these people contained information about the preference of these people to remain in the lounge, one care plan did not document any instructions or reason for one person who was not offered the opportunity to attend the dining room. One care plan contained very detailed instructions for a resident who is easily agitated; for example, ‘Meals should be on a tray placed on a hard surface – not a table as XXXX will knock it over. Staff to hold the tray or place it on an armchair in front of XXXX.’ This means that staff are aware of the very specific needs of this person and take appropriate action to make sure their nutritional needs are met in a way that is acceptable to them. The meal was a choice of gammon or chicken accompanied by potatoes and vegetables. The meal was nutritious and well presented. Varied textures such as pureed food were available for people identified as needing it. Each food was liquidised separately so that residents could enjoy the differing tastes of each part of their meal. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 17 There were sufficient staff to give sensitive assistance to people who needed it. Staff made note of people who refused or ate very little and ‘put a dinner by’ for them to offer later. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy. The manager discussed that it was not useful to give a copy of the complaints procedure to each resident as they may have limited understanding because of their dementia. People are encouraged to raise their concerns with the staff on duty. Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. We have not received any complaints about this service since the last key inspection. A record of complaints is maintained in the home. One complaint has been recorded since the last key inspection. A relative raised a verbal concern about Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 19 the absence of a gate in the garden to make sure the environment was secure for residents. Records documented that the concern was resolved by repairing the gate. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff have received abuse awareness training. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. People living in the home are provided with comfortable surroundings to live in. Unpleasant odours in parts of the home do not uphold the dignity of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Communal areas traditionally and comfortably decorated; they were warm, bright and clean on the day of inspection. Communal areas do not provide any tactile stimulation; there are no scatter cushions, toys or games, or residents own belongings around. The areas were tidy but looked quite sparse. The inspector was told that games and resources for activities are locked away separately; this means people living in the home have no access to them unless staff bring them out. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 21 The inspector viewed the bedrooms of the people involved in case tracking. The quality of the furnishings and fittings in residents’ rooms varied. Some rooms have hard vinyl flooring as an alternative to fitted carpet. The home has provided cushions and throws for some bedrooms since the last inspection One single room was attractively decorated with good quality furnishings to provide comfortable accommodation. There were lots of the person’s own belongings in the room, such as jigsaws, music collection and photographs. The vanity unit housing the hand basin had been repainted but still looked quite worn. Another single room benefited from en-suite facilities of a toilet and hand basin. The furniture in this room was mismatched consisting of two white wardrobes, a pine dressing table and pine chest of drawers. The room was carpeted and attractively decorated. The room was personalised with some of the resident’s own possessions and looked like it ‘belonged’ to them. An offensive odour was evident in the room; this was brought to the attention of the manager on the day of inspection. In another room a chest of drawers was labelled with the name of the previous occupant. This was remarked upon at the last inspection and had not been removed. The manager arranged for housekeeping staff to remove the label on the day of the inspection. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattresses is available for people who have an identified need for them. Dining areas are functional and somewhat institutional in appearance. An offensive odour in the reception area of the home noted during the last inspection was less evident. It was evident that the staff were trying to address this problem caused by the challenge of managing the urinary incontinence of a particular resident. The home has systems in place for the management of dirty laundry and the disposal of waste. Systems are in place to manage the control of infection. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. The home is staffed with enough people to meet the personal care needs of the people living in the home. Recruitment procedures are not consistently robust to safeguard vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told the inspector that the usual staffing complement planned in order to meet the needs of people living in the home is: 8am – 2pm 2pm – 8pm 8pm – 8am 1 Registered Nurse and 5 Care Staff 1 Registered Nurse and 4 or 5 Care Staff 1 Registered Nurse and 2 Care Staff Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 23 The home does not have a system or tool to decide the number of staff required to meet the identified needs of residents in the home; this is monitored informally. The examination of three weeks of duty rota between 24th December 2007 and 13th January 2008 confirmed that the staffing complement in the table above mostly achieved. Three out of 21 ‘early shifts’ (8am – 2pm) had four care staff on duty instead of the planned five care staff because of absence due to staff illness. The service has improved the way it maintains the planned staff complement since the last inspection. The manager relies on staff working overtime to cover any absence and maintain the staff complement. The service does not use agency staff. This means that people living in the home benefit from a continuity of care given by staff who are familiar with their needs but there is no other contingency to maintain the staff complement if staff are not available for overtime. One of the care staff spoken to explained that on an 8am – 2pm shift two carers are usually allocated to work with residents accommodated upstairs and two carers are allocated to work with service users accommodated downstairs with one member of staff ‘floating’ between the two floors. The service has recruited an additional registered nurse since the last inspection so the manager has one supernumerary day each week to assist him in discharging his responsibilities to manage the home. For the remainder of his full time hours, the manager works ‘on the floor’ as the registered nurse. This means the manager is familiar with the needs of residents and working practices in the home. On the day of this inspection visit it was evident that the numbers of staff on duty were sufficient to meet the physical personal care needs of people living in the home. Evidence in the ‘Activities and Daily Living’ section of this report demonstrated that there are not enough staff available to support people with their social, psychological or recreational needs. There are sufficient ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. For example, • • • • The kitchen is staffed by a cook between 8am and 6pm every day of the week. The laundry is staffed by a laundry assistant for 5 hours every day of the week. There are two domestic cleaning staff on duty for five hours each every day of the week. A maintenance person is employed for 24 hours each week. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 24 Training records show that six out of the 18 care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 33 , falls below the National Minimum Standard for 50 of staff to be qualified. However, a further three staff members are working towards the award which should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA). One file contained two satisfactory references. The other file contained only one reference, which was a character reference from a ‘family friend’. Robust recruitment checks, including satisfactory references, must be obtained before staff start working in the home to safeguard the vulnerable people living there. Meticulously detailed training records were available to demonstrate that staff receive training and each staff member had a programme of development identifying the training they needed for their role. Staff receive ‘Basic Skills for Care’ induction training and mandatory training such Fire Safety, Moving and Handling and Abuse Awareness. Evidence in the ‘Health and Personal Care’ section of this report details incidence of the incorrect use of a hoist sling when moving residents. This indicates that although moving and handling training is given, staff competency and understanding is not checked. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 25 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 adequate. The provider has not been consistent in reviewing progress against objectives to make improvements to ensure the home is run in the best interests of the people living there. This means that residents cannot be certain they will receive consistent quality of care. This judgement has been made using available evidence including a visit to this service. Standard 35 is not included in this judgement, as the home does not hold service users’ personal monies or valuables for safekeeping. EVIDENCE: Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 26 The provider re appointed the manager in post in August 2006 after he resigned the position in December 2005. He 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). The manager must make an application to us to be registered as manager of this service. The manager said he had completed the application form but had not yet returned them to us. The manager covers a full time nursing post as well as undertaking administrative tasks and the overall running of the home. The supernumerary time available to the manager has improved since the last inspection. This should mean he has more time to discharge his responsibilities. We received an improvement plan to address the requirements made at the last key inspection in September 2007. The manager received a copy of the improvement plan on 7th January 2008 detailing the actions he needs to take. The provider organisation, ADL Plc, have recently implemented a temporary senior management structure. This identifies an operations manager for the home to review the service provided and supervise the implementation of actions for improvement and monitor the conduct of the care home on behalf of the provider. A recent meeting with the organisation has resulted in a commitment to make permanent changes to the senior management in the organisation and to continue to improve and sustain improvements made in their services. Regulation 26 visits have not been regular. The manager did not have copies of the reports made during regulation 26 visits but asked Head Office to fax copies during the inspection visit. A copy of the report from the regulation 26 visit in September 2007 was faxed to the home for examination. There was no evidence of more recent visits, since the last key inspection in September. The home’s Quality Assurance file was examined and there was little evidence that action plans for making improvements had been reviewed or progress against objectives recorded. The most recent action plan available in the Quality Assurance file was dated 8th March 2007. There was further evidence of audits in quality file related to medicines, accidents and staff files but there is no evidence that the information collected from the audits is analysed or used to develop plans for improvement. The fixed electrical installation in the home (‘5 year check’) was examined in January 2007 and the certificate confirmed it as ‘unsatisfactory’. A requirement was made at the last key inspection to make arrangements to check the safety of the Fixed Electrical Installation in the home. The manager said that some work had been undertaken to make the necessary improvements but not all the work had been undertaken. There was no evidence of remedial work to make the improvements recommended and a certificate confirming safety was Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 27 not available. This means people living in the home are at continued risk of harm. Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X N/A X X 2 Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be developed and implemented when new or changed needs or risks are identified. This should ensure that people get the care they need. This requirement is outstanding from previous inspections and was not complied with by the original timescale of 15/08/06 or the extended timescale of 28/02/07. 2. OP38 13 Arrangements must be made to check the safety of the Fixed Electrical Installation in the home. A certificate confirming safety must be available for inspection in the home. This is to promote the safety of people in the home. This requirement is outstanding from the Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 30 Timescale for action 08/01/08 08/01/08 inspection of 21st September 2007 and was not complied with by the original timescale of 30/11/07. 3. OP8 12 Proper provision must be made for the health and welfare of people living in the care home. This is to make sure people’s health and welfare needs are met. 4. OP29 19 Systems must be in place to ensure that staff do not start working in the home until satisfactory pre employment checks, including references, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. 15/02/08 15/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Arrangements should be made for each person living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. 2. OP14 Arrangements should be made that the residents are consulted on issues related to their daily lives, the environment and that their wishes are taken into account when planning care and daily life in the home. If DS0000004383.V357450.R01.S.doc Version 5.2 Page 31 Allambie Court consultation is not possible their wishes should be recorded and considered when making decisions. This is to make sure that people living in the home have some control about what happens in their life. 3. OP19 The home should review the individual accommodation for residents and plan a programme of refurbishment and replacement of worn furniture. This is to make sure residents are provided with a pleasant environment to live in and enjoy. 4. OP26 Action should be taken to make sure all parts of the home are free from unpleasant odours. This is to uphold the dignity of people living in the home and provide a pleasant environment. 5. OP30 Arrangements should be made to check staff competency in the use of moving and handling equipment. This is to protect people from the risk of harm. Arrangements should be made to make sure the manager appointed to run the home is registered with us. This should make sure the home is managed by a person who is fit to be in charge. Systems should be in place for the review of working practices and quality of service delivered to people living in the home. Regulation 26 reports should be available to the manager so that improvements can be. Improvements plans should be developed in conjunction with the manager and a copy kept at the home and up dated as improvements are made. This is to make sure that the home is run in the best interests of people living in the home 6. OP31 7. OP33 Allambie Court DS0000004383.V357450.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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.V357450.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!