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Inspection on 12/11/07 for Allendale House Residential Care Home

Also see our care home review for Allendale House Residential Care Home for more information

This inspection was carried out on 12th November 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information is available in the home about the service that people can expect. This includes a copy of the last commission for social care inspection report. Residents were all happy about the service that they receive. Comments included `This is a lovely home, I really like it.` Good practice was evident in most areas of medication. The privacy and dignity of the residents is maintained. Residents were pleased with the food on offer. `We have what we want` was a statement made.Residents like all of the staff and say that they are well treated. Staff could explain well about the needs of the residents, and demonstrated through their actions during this visit that they were sensitive to their needs. There is information displayed in all of the bedrooms and in the entrance hall telling people how to go about making a complaint. The commission for social care inspection has not received any complaints about the home.

What has improved since the last inspection?

There were some improvements in the environment: A staff call alarm in an upstairs toilet that was not working at the last inspection had been changed. Missing tiles had been replaced in the ante-room to the kitchen. Exposed hot pipes had been covered. A menu board has been put up in the dining room displaying the day`s lunch time meal choices. A `grumbles book` has been started showing the investigation and outcome of any minor issues raised in the home. A check on the Protection of Vulnerable Adults list had been made on all staff before they had started work in the home.

What the care home could do better:

The home has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. Many of these requirements are still outstanding. These include: A number of radiators still need guarding. Water temperature regulators are needed on baths. There are raised floor tiles in a bathroom that could cause a tripping hazard. Residents` bedroom doors do not have locks fitted.There is no sink in which to clean commodes and urinals. A bath is used for this purpose. The bath is not used by residents, but a toilet in the same room is. The kitchen needs refurbishment. The home needs to comply with the fire officer`s report. Another member of staff is needed on duty at night. There is currently only 1 staff on duty. Better recruitment practices are needed, mainly around the receipt of 2 references for staff being obtained before they commence working in the home. Staff training requires great improvement.

CARE HOMES FOR OLDER PEOPLE Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector Irene Wilkes Draft - Unannounced Inspection 12th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Allendale House Residential Care Home DS0000004907.V350213.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. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Allendale House Residential Care Home Address 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR 01782 627388 01782 740466 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) Mrs Marcia Patricia Anderson Mrs Marcia Patricia Anderson Care Home 17 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (5) Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 PD(E) in bedrooms 7,8 & 9 only Date of last inspection 14th May 2007 Brief Description of the Service: Allendale House is a privately owned residential care home, located close to the villages of May Bank, Wolstanton and within close proximity to Newcastleunder-Lyme. Access to the village and main town is via a main bus route. The Home is registered to provide care to seventeen older people, although there were only ten people resident at the time of this inspection. It is also registered to care for two people with dementia care needs and five people with a physical disability. The property is a large detached Victorian house that provides spacious accommodation. There is a secluded garden area. The Statement of Purpose did not contain the fee information for the home. The Home is managed and owned by Mrs Marcia Anderson. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by 2 inspectors; Irene Wilkes and Peter Dawson. This was a key unannounced inspection. This means that all of the national minimum standards that the commission for social care inspection consider most greatly affect the health, safety and welfare of the residents were looked at. The inspection took place over approximately a 10 hour period. All of the current 10 residents were at home throughout the visit. A number of residents were asked their views of the home. The manager, and 4 care workers were on duty at different times throughout the day. The cook was on duty for a period. Staff contributed to the inspection process. The inspection included examining a sample of 3 residents’ files and a sample of health and safety documentation including maintenance records and the records relating to fire safety. The arrangements for administering medication were looked at and menu plans were discussed. The recruitment procedures and staffing rotas were looked at as well as the training provided to the staff. This included inspection of 3 staff files. A tour of the home was undertaken. An AQAA (Annual Quality Assurance Assessment) that is a legal requirement for the home to complete was submitted to the commission earlier this year, and information from this has also been used to inform the inspection. What the service does well: Information is available in the home about the service that people can expect. This includes a copy of the last commission for social care inspection report. Residents were all happy about the service that they receive. Comments included ‘This is a lovely home, I really like it.’ Good practice was evident in most areas of medication. The privacy and dignity of the residents is maintained. Residents were pleased with the food on offer. ‘We have what we want’ was a statement made. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 6 Residents like all of the staff and say that they are well treated. Staff could explain well about the needs of the residents, and demonstrated through their actions during this visit that they were sensitive to their needs. There is information displayed in all of the bedrooms and in the entrance hall telling people how to go about making a complaint. The commission for social care inspection has not received any complaints about the home. What has improved since the last inspection? What they could do better: The home has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. Many of these requirements are still outstanding. These include: A number of radiators still need guarding. Water temperature regulators are needed on baths. There are raised floor tiles in a bathroom that could cause a tripping hazard. Residents’ bedroom doors do not have locks fitted. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 7 There is no sink in which to clean commodes and urinals. A bath is used for this purpose. The bath is not used by residents, but a toilet in the same room is. The kitchen needs refurbishment. The home needs to comply with the fire officer’s report. Another member of staff is needed on duty at night. There is currently only 1 staff on duty. Better recruitment practices are needed, mainly around the receipt of 2 references for staff being obtained before they commence working in the home. Staff training requires great improvement. 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. Allendale House Residential Care Home DS0000004907.V350213.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 Allendale House Residential Care Home DS0000004907.V350213.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 and 3 Quality in this outcome area is adequate. People who may use the service and their representatives do not have the full information they need to determine that the home will meet their needs. Care needs assessments of prospective residents are however satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and the Service User Guide were on display in the entrance hall, together with a copy of the last inspection report. The service user guide had been revised in October 2007. However, it did not contain any information about the fees that the home charges and this is required so that people can make an informed choice. There was no information about how individual needs would be met, such as for people with dementia about the staffing levels, staff training to meet these needs, activities for residents or additional signage in the home to assist. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 10 A requirement is made that these omissions are addressed. There have been no new residents admitted to the home since the last inspection. The files inspected showed that full assessment information was available. New assessment/care plan paperwork was just being introduced at the last inspection and the checklist used is comprehensive and qualified by written observations of areas where assistance is needed. This information is then recorded in a care plan where the outcome required and the action staff should take to meet the need is also documented. Risk assessments in terms of dependency are also carried out. Allendale House Residential Care Home DS0000004907.V350213.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 Quality in this outcome area is adequate. The health and personal care that people receive is based on their individual needs, although there were some weaknesses that need improvement. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files inspected each had a care plan in place that that had been drawn up from the initial assessment information and by consultation with the resident. There was evidence that the plans had been reviewed on a monthly basis. As seen at the previous inspection in May 2007 there was no evidence to show that the residents had been involved in these reviews and it is recommended that this be addressed. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 12 The care plans generally identified the action staff should take to address the individual needs of each resident. However this could be improved on occasions to give staff better written instruction about how the specific needs of some individuals present and how they should be responded to, for example, where a resident with dementia needs may become aggressive. This was an issue raised at the last inspection and has not been fully addressed. It is a requirement of this report. There was a moving and handling risk assessment in place and also a fire risk assessment for all residents. The plans would benefit from other areas of risk presenting for individual residents to be discussed and documented, for example, there was no review or risk assessment for a resident who had fallen on an outing. This is required. There was evidence to show that residents’ are generally assisted to access health care services, with records seen of visits by district nurses and the range of health professionals. There was no incidence of any pressure sores. Where a resident had a tendency to skin becoming sore and inflamed there was good information available for staff about how to promote tissue viability. The home records information about any accidents to residents. There was good recording about one such accident and the detail of district nurse involvement. The home does not undertake adequate nutritional screening on a regular basis for all residents. This was of greater concern for one resident as the care plan stated in the ‘eating’ section ‘needs encouragement as much as possible.’ This resident had not been weighed since March 2007, when her weight was low. There was no evidence that any professional advice had been sought regarding nutrition for this resident. This was discussed with Mrs Anderson and she was required to take early action to address this. It is also a requirement of this report. Medication records were accurately completed. There were no gaps on MAR (Medication Administration Record) sheets and all medication returned to the pharmacy was documented and countersigned. There were some examples of self-medication, and it has been noted at previous inspections that appropriate self medication forms have been completed. It was noted that some medication had been discontinued some 12 months ago but was still appearing on the MAR sheet. It is important that MAR sheets accurately reflect the current prescribed medication to be administered. Only 2 members of staff have received accredited training (external source) and this is a significant shortfall. Internal training is given by the Manager. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 13 The staff must receive appropriate accredited medication training and this is a requirement of this report. The medication reference book kept by the home is dated 1993 has not been replaced. This was raised at the last inspection. This restricts reference for updates and new medications being prescribed. The manager is again recommended to get an up to date edition of this reference aid. The medication system was generally well recorded and safe. The way that staff responded to residents needs during the inspection was discreetly observed. They were seen to knock on doors and were patient and understanding. A member of staff who was relatively new to the home said that she enjoyed being able to spend time with residents individually, which had been less so in the previous larger home where she had worked. Comments from residents were positive. ‘This is a lovely home, I really like it’ was typical. There are some double bedrooms at this home and there were portable screens in place to ensure that privacy is not compromised. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. Residents are able to make choices about their lifestyle and a varied and nutritional diet is offered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the visit a paid instructor came to do gentle exercise to music. Although not spoken with on this occasion, the instructor also visited at the last inspection and said that she visits every two weeks. Residents’ past history and interests were recorded in their care records. There were some records made in the daily log book of activities that had taken place, including a trip out to a garden centre, activities in the home such as bingo and hand massages, and 2 members of staff on duty in the afternoon confirmed that a range of activities take place. The home’s policy to take people out into the community on a 1:1 basis where residents wish to do this was confirmed to be continuing by these staff. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 15 There was no evidence seen of any systems for checking how individual activities for each resident are promoted; rather it seemed to be left to individual staff to engage in activities with the residents in the way that they saw fit. It is recommended that an up to date record of activities each person takes part in be maintained in their file and be regularly audited. A relative when asked in a survey form of any changes that they would like to see said ‘more recreational activities perhaps?’ A resident spoken with said that they made their own choices about lifestyle and enjoyed being outside in the garden area as much as possible, when staff took their meals out if this was what was wanted. There were no visitors during the inspection, save for the exercise facilitator. The visitors book showed a good record of relatives/friends visiting the home. Residents were not asked specifically at this inspection about visiting times but 3 relatives survey forms returned to the home were seen and each was positive about the welcome received from staff and the arrangements in place for them seeing their relation. The AQAA (Annual Quality Assurance Assessment) states that visiting is left to the discretion of the relative. Residents confirmed that they make their own choices about their lives, and the AQAA and evidence seen at the inspection showed that residents can take personal possessions into the home. The AQAA also states that residents are encouraged to make personal choices and to handle their own affairs. Comments about food were positive. Residents variously said that they were ‘very satisfied’ with the food, that they had choices at mealtimes and one person said ‘we have whatever we want.’ The inspection started just as breakfast was finishing at 9:30am, lunch was taken about 1pm and included 2 hot choices, and the evening meal which was a choice of sandwiches and pastries was taken at about 5:30pm. There were hot and cold drinks on offer throughout the day. It was discussed at the last inspection that a menu board be displayed to remind residents, especially those with dementia needs, of what was on offer. This had been addressed at this inspection and the board was up to date. The AQAA evidenced that there is a 4 weekly changing menu. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is poor. There is good information for residents and relatives about how they can express their concerns. However there are a number of areas requiring improvement to ensure the residents’ safety and protection, including staff training, night staffing and Health and Safety issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a copy of the complaints procedure displayed in the entrance hall of the home and it was also seen that information about how to make a complaint is contained in the Service User Guide. It was noted at the last inspection that a copy of the procedure is displayed in all of the bedrooms and these remained in place at this visit. The complaints procedure contains appropriate information about timescales and how complaints will be responded to. There have been no complaints made either to the home or to the commission since the last inspection. There were positive comments seen from relatives about the care that is delivered. 1 said of staff ‘very happy to entrust the care of my mother in their capable hands.’ Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 17 It was recommended at the last inspection that a ‘grumbles’ book be kept to record brief details about more minor informal expressions of concerns to assist in quality assurance by providing evidence that such concerns are listened to and acted upon. This had been addressed at this visit. 7 such incidents were recorded since the last inspection. 5 of these also showed evidence of investigation and its outcome, but 2 did not. The proprietor was reminded to keep full records. The training of staff regarding the safeguarding of adults was discussed. Mrs Anderson said that all staff are issued with a document at induction called ‘Recognition and Prevention of Abuse’ This document was seen and it provided some good information. However, there was no documented evidence that this is either provided to staff or discussed with them to ensure their understanding, neither does it reflect the up to date safeguarding agenda. Further, when 2 staff were asked about what training they had received since working at the home neither included any mention of safeguarding adults in that training. Discussions with Mrs Anderson evidenced that she was not aware of the revised local authority procedures ‘Safeguarding Vulnerable Adults in Staffordshire and Stoke-on- Trent Policies and Procedures – May 2007). Without up to date information and understanding and a lack of staff training the owner/manager is not adequately safeguarding the residents. Reference is made in an earlier section about shortfalls in medication training. Some care planning information referred to earlier, and staff recruitment and training also identified in this report must be improved to ensure the protection of the residents. The manager must also ensure that there are enough staff on duty at night to maintain residents’ safety. There are a number of Health and Safety concerns, including infection control procedures, unprotected radiators and environmental issues also referred to later in the report which are potentially hazardous to the residents and staff. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is poor. There remain several areas of required improvement to ensure that the residents live in a safe and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Allendale House has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. Mrs Anderson has said at each visit that the work is to be addressed but although some requirements are addressed by the time of each visit, the complete works have not been forthcoming. Mrs Anderson was required in September 2007 to provide an improvement plan to the commission showing how the work would be addressed, with timescales. After further prompting, this improvement Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 19 plan was received in October 2007. This indicated that the refurbishment work would commence in November, but there was no action plan or timescales provided for when each area of the required work would be completed. At this inspection Mrs Anderson was required by 19/11/07 to provide written evidence of the work and timescales in which such work would be undertaken, and also confirmation that the required funding was in place. A full tour of the accommodation was made. The layout provides the basis for a comfortable home if the environment was improved. There is adequate personal and communal space and appropriate facilities. Some requirements made at the last inspection had been met. These include: Hot pipe-work to radiators had been covered. The staff call unit in the upstairs toilet had been replaced. This was tested and was in working order. Wall tiles in the ante room of the kitchen had been replaced. Work still required, includes: A wall tile in the toilet in the hallway was missing (new since last inspection). A requirement is made for this to be replaced. Radiators remain unguarded in several communal areas of the home and in some bedrooms. There were no individual risk assessments in place to assess the individual risk to each resident from these hot surfaces. Some radiators had been turned off to eliminate the risk, but the risk assessment had not been formally recorded in any instance. It is a requirement of this report that an assessment of the risk to each individual from the unguarded radiators is made. It is a further requirement that the remaining radiators are guarded. (Subsequent information was provided that this work will be completed by 20/11/07. This remains a requirement of this report until evidence is seen that the work has been completed). Water from a downstairs bath and sink was very hot. (new since last inspection). Mrs Anderson did not know whether there were any valves fitted to control the temperature on the bath. A thermometer was seen in the bathroom but in spite of being asked on several occasions for water temperature check records Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 20 Mrs Anderson was not able to produce these records. Water temperature regulators must be fitted if they are not in place, particularly to the bath. Risk assessments must be in place for the hot water to the sinks. Water temperature records must be maintained for an audit trail. The commission may discuss this further with the Environmental Health Department. A downstairs bathroom had raised floor tiles. Mrs Anderson said that these are secured and then become loose again. This is evidenced from previous inspection findings. These tiles need securing as soon as they become loose. A requirement to address this is made. (Subsequent information was provided that this work will be completed by 23/11/07. This remains a requirement of this report until evidence is seen that the work has been completed). While some bedrooms had been adequately decorated and furnished, some had not been decorated for some time and the furniture was old. It is recommended that this be addressed. (The schedule of works received for the refurbishment indicates that general redecoration will be carried out once the remedial work is completed). Residents bedrooms do not have locks fitted. A recommendation has been made at previous inspections that this be addressed. This has not been completed and the recommendation remains. The choice of whether to have a door lock fitted should be discussed with each resident and the outcome recorded in their care plan. (Subsequent information was provided that this work will be completed by mid January 2008. This remains a recommendation of this report until evidence is seen that the work has been completed). A downstairs bath is being used to clean commodes and urinals. Whilst residents do not use the bath, they use the toilet in this room. Mrs Anderson has been informed previously this is unacceptable because of the risk of the spread of infection. (Subsequent information was provided that this work will be completed by 30/11/07. This remains a requirement of this report until evidence is seen that the work has been completed). Laundry and the control of infection is otherwise adequately addressed. Alginate bags are in use, there is protective clothing, a hand-wash sink and liquid soap and paper towels in use. There is an industrial standard washing machine. Previous inspections have noted that the kitchen needs improvement. Missing wall tiles in the ante-room to the kitchen have been replaced since the last inspection but cupboard doors were falling off and the whole area is in need of Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 21 refurbishment. The Environmental Health Department has previously recommended that the kitchen be refurbished. It is a recommendation of this report that the kitchen is refurbished. (Subsequent information was provided that this work will be completed by mid December. This remains a recommendation of this report until evidence is seen that the work has been completed). There are 2 residents with dementia. There have been no extra efforts made within the home in terms of the environment to meet these residents’ needs, e.g. no pictorial signage or other indications to assist orientation. There were messages in large print in some bedrooms to remind residents to pull the cord for assistance. Issues relating to fire safety are addressed in a later section of the report. Allendale House Residential Care Home DS0000004907.V350213.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 Quality in this outcome area is poor. The manager has not made sure that the residents are properly supported and protected at all times by sufficient numbers of staff who are well recruited and trained appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 10 residents living at the home. At the inspection there were 2 care workers and the owner/manager on duty in the morning, plus the cook, and 2 care workers and the owner/manager in the afternoon. The staff on duty corresponded with the rota. 1 night staff was due on duty from 10pm. The rotas over a number of weeks were sampled for staff cover on various shifts. These confirmed the staffing numbers generally followed the same pattern as on the day of the inspection. The needs of the residents were discussed with 2 staff. This confirmed their care needs as identified in the individual plans, and that the staff had a good understanding of these needs. Mrs Anderson said that the waking night staff did observations every hour and although no-one currently needs 2 staff in the night, she is on call for emergencies from her bungalow at the rear of the home, and would be called if assistance was needed. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 23 It was discussed with Mrs Anderson that the current arrangements of only 1 waking night staff with a ‘walkie talkie’ arrangement to Mrs Anderson in her bungalow at the rear of the property, which has been recently introduced following the commission’s concerns about night staffing, particularly in relation to fire safety, still does not adequately protect the residents health and safety during this time, particularly given the numbers of residents and the layout of the home. (This is further addressed in the next section of the report). It was made clear to Mrs Anderson that an additional member of staff must be on duty at night, and this is a requirement of this report. A ‘sleep in’ member of staff would be currently acceptable, but this must be constantly reviewed and considered when linked to the needs of the residents. There are 13 staff working in the home. 7 out of the 13 (54 ) have NVQ 2, (National Vocational Qualification) with 1 of these with NVQ 3 and another working towards this. 2 staff are also currently working towards this award. A relatively new member of staff has been offered this training to start soon. The home does not employ agency staff. The number of staff with NVQ is satisfactory. Staff files were inspected. Each file had a check list on the front to enable a clear audit trail to be recorded from interview date, start date, receipt of references, POVA, (Protection of Vulnerable Adults) CRB (Criminal Records Bureau) etc. Unfortunately in the files seen this information was not always completed to easily evidence the information. The start date had to be confirmed by working back through the staff rotas, and cross referenced with the staff themselves. It is recommended that the checklist be maintained to enable an easily referenced audit trail both for Mrs Anderson’s own purposes and for the commission. Staff records and recruitment procedures showed some elements of improvement. There was a POVA First and CRB available in every case that complied with the regulations for timing of receipt of these. However, only 1 written reference had been obtained for 2 people whose files were seen. Mrs Anderson said that she had gained verbal references but there was no record of these. For another staff member there was no proof of identification in their file. The manager must demonstrate robust recruitment practices are in place to adequately safeguard the residents. There was evidence that staff receive appropriate induction training. Their induction training was discussed with 2 staff who had been working in the home for 9 weeks and their workbooks were seen. They discussed their first few days at the home and the discussions held and shadowing arrangements. Other staff training was inspected and discussed at length with the proprietor/manager and records were copied. The full list of mandatory Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 24 training required has been brought to the attention of Mrs Anderson at previous inspections. The manager seemed to conclude that if she was unable to secure free training the non- provision of such training was acceptable until she could do so. Mrs Anderson did not have an adequate training matrix whereby she could easily identify the individual training undertaken by each member of staff and when training was due. Such a matrix is recommended. There were training shortfalls in all areas of mandatory training except for moving and handling, for which Mrs Anderson is a trained trainer. Shortfalls in medication training have been identified earlier in the report. Shortfalls in ensuring that staff have adequate knowledge about safeguarding adults have been identified earlier in the report. Several staff required training in food hygiene and infection control. Only 2 staff have training in dementia awareness and there are 2 residents at the home with dementia. Mrs Anderson needs to assure herself that staff have appropriate training in health and safety. Fire training is addressed in the next section of the report. Only 2 staff have received First Aid training. None of the 3 night staff who cover the rota alone on a rotating basis have received First Aid training. There was no first aid risk assessment available to determine staff training requirements for the home. Workplace legislation was discussed with Mrs Anderson, and the fact that shifts operate, in particular at night, without staff having completed a first aid course and no first aid risk assessment exposes residents and the home to considerable risk. This is urgently required to comply with Health and Safety (First Aid) Regulations 1981. Allendale House Residential Care Home DS0000004907.V350213.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, 33 and 38 inspected. Quality in this outcome area is poor. There have been some requirements addressed since the last inspection but overall areas of staff recruitment and training and environmental issues must be improved to protect the health, safety and welfare of all residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Allendale House is owned and managed by Mrs Marcia Anderson. She is a qualified nurse and has some 10 years experience of managing care homes. Mrs Anderson has previously been studying for an NVQ 4 in management. Evidence was not seen that this has been completed. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 26 There is a history of shortfalls in the management of the home including recruitment practices, staff training, and health and safety concerns about the environment. There was some improvement seen at the last inspection in May 2007, continued in some areas of the environment at this inspection, although there remained several areas where improvements are urgently needed. These outstanding requirements are highlighted elsewhere and are linked to the health, safety and welfare of the residents. An improvement plan was required from Mrs Anderson following the last inspection. This was not returned and a statutory notice was issued about this. The notice was responded to and the improvement plan was returned within the revised timescale that had been set. At this key inspection Mrs Anderson was required to provide written evidence that funding is in place to complete the environmental refurbishment and a written plan, with timescales, about how all of the work will be addressed. This was needed by 19/11/07. Subsequently some, but not all, of the required information has been received. There is no office within the home. There are several areas identified earlier in the report where record keeping is not satisfactory. Appropriate record keeping would be aided by the installation of an office. Mrs Anderson also views this as essential. Mrs Anderson states in the AQAA that was received earlier in the year that she recruits in line with the relevant standard and provides safe working practices for fire safety, first aid, food hygiene and infection control by providing written documents and training. Appropriate training was not evidenced at the inspection. An accident report was seen in the home that contained details of injuries sustained from an accident by a resident from a fall when out of the home. An accident form had been completed but there is no evidence to show that this had been sent to the commission. Only 1 of 2 deaths in the home had been reported. Mrs Anderson must keep the commission informed in writing of all deaths, serious injuries and other events, in line with regulation 37. This is a requirement of this report. There was some evidence of quality assurance being undertaken. 3 relatives had returned survey forms that were over-arching positive about the care being provided to their relatives. 1 said ‘very happy to entrust the care of my mother in their capable hands.’ There was no evidence of any residents’ consultation since August 2006. There was no evidence of an annual development plan for the home. Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 27 A random selection of the maintenance records were checked during the last inspection and found to be satisfactory. There was up to date servicing of the hoists, stair lift and gas installations. Portable Appliance Testing had taken place since the last inspection, in June 2007. Reference has been made earlier in the report to very hot water from a bath tap and sink, and Mrs Anderson is unaware whether water temperature regulators are fitted. A requirement has been made about this. Reference has been made earlier in the report to the absence of sufficient staff trained in first aid. A requirement has been made about this. COSHH (Control of Substances Hazardous to Health) products were appropriately stored. The last inspection required Mrs Anderson to undertake regular health and safety audits of the whole environment and address any areas that would compromise any resident’s safety. Mrs Anderson was asked several times to produce the record of these audits but failed to do so. The requirement is carried over. There have been return visits by the fire officer to the home since the last inspection report, to establish progress against his requirements and recommendations of Feb 2007. These improvements are still outstanding. The home must comply with Fire Safety Regulations. Individual fire risk assessments were flawed, with instructions to take residents on the first floor to the chair lift. All staff had received fire drills, and for the 3 night staff the drills had taken place at least 3 monthly. There had been a total evacuation of the premises in April 2007 as part of a fire drill. Mrs Anderson did not evidence in discussion that the fire drills included a night time scenario of residents requiring evacuation from the first floor with no chair lift in use and only 1 staff. There was some discrepancy between the fire instructions posted in the home and those reported to have been given to individual members of staff. Training is by video or internal with the manager, although 1 member of staff has completed a fire marshall course. There is an absence of annual fire training for all staff by an external accredited fire safety specialist. Because of the particular issues above relating to fire safety the ideal would be an external specialist providing training in the home specific to the equipment and conditions present. Allendale House Residential Care Home DS0000004907.V350213.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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 3 1 3 X 2 1 1 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 1 Allendale House Residential Care Home DS0000004907.V350213.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 OP1 Regulation 4 ( c) Requirement Revise the Statement of Purpose to include all of the matters listed in Schedule 1 of the Care Home Regulations. This means that the detail of how the home intends to meet the needs of residents with dementia must be included so that prospective residents have the information they need to decide if the home will meet their needs. Revise the service user guide to include general information that broadly indicates the fees charged by the home. Timescale for action 12/01/08 2. OP1 5 12/01/08 3. OP7 15(1) This will give prospective residents the basic information they need to make comparisons about charges between homes. Provide more explicit information 12/01/08 in the care plans about the needs of each individual resident for all aspects of their care, to provide staff with as much information as possible about the best way to support each person. This includes how the needs of DS0000004907.V350213.R01.S.doc Version 5.2 Page 30 Allendale House Residential Care Home 4. OP7 13(4) b 5. OP8 13(1) (b) people with dementia who may become aggressive are best supported. Ensure that any activities undertaken by residents that may present a risk are fully discussed with them, and that agreements reached to minimise the risk are appropriately documented. This particularly relates to an injury sustained by a resident from a fall outside the home. A review and risk assessment had not taken place. Take action to monitor the health needs of residents and ensure that they receive any treatment or support that is required as a result of this monitoring. This specifically refers to nutritional screening and further professional advice in this instance. All staff that administer medication must receive training from an external source in addition to the training provided in the home. This will help ensure their competence to safely administer medication. 12/01/08 19/11/07 6. OP9 18(1) (c ) (i) 12/01/08 7. OP18 13(6) (Date shown is the date when courses must be confirmed by for all relevant staff). Arrangements must be made to 12/01/08 ensure that all staff have a clear understanding of adult protection (safeguarding) and whistle blowing procedures, and that evidence for this is documented. This is to ensure that residents are not at risk of harm or abuse. Replace the missing wall tile in the toilet in the hallway DS0000004907.V350213.R01.S.doc 8. OP21 22(2)b 30/11/07 Page 31 Allendale House Residential Care Home Version 5.2 9. OP25 13(4)a Radiators within the home must be assessed for the risk they present to residents, and evidence recorded. This is needed to as far as possible protect the residents from the hazard to their safety. (There was a previous requirement to cover pipes and radiators- original timescale of 01/02/07) The requirement has still not been addressed. Radiators within the home must be guarded, or low surface temperature radiators fitted, unless a risk assessment indicates otherwise. (There was a previous requirement to cover pipes and radiators – original timescale of 01/02/07) The requirement has still not been fully addressed. Ensure that hot water to baths is controlled, to ensure water is provided close to 43 degrees Centigrade. This is needed to protect residents from the risk of scalding. Undertake a risk assessment of all sinks where pre set valves to control the water temperature are not in place, record the outcome and take whatever action is indicated from the risk assessment to reduce the risk as far as reasonably possible. Maintain water temperature records for all baths, and take appropriate action if the water deviates from close to 43 degrees centigrade. DS0000004907.V350213.R01.S.doc 30/11/07 10. OP25 13(4) a 30/11/07 11. OP25 13(4) 12/12/07 12. OP25 13(4) 31/12/07 13. OP25 13(4) 13/11/07 Allendale House Residential Care Home Version 5.2 Page 32 14. OP26 13(3) This is needed to ensure the safety of residents to prevent scalding. Commode pots and urinals must be effectively cleaned in a suitable area in the home. Good practice guidelines about the control of the spread of infection should be followed to minimise any risk. (This requirement is linked to a previous requirement about the need for sluicing facilities original timescale 01/02/07) The requirement has still not been addressed. 30/11/07 15 16 OP19 OP19 13(4) a 10 17. OP27 18(1)a 18. OP29 19 (1) b (i) and Schedule 2 Secure the raised floor tiles in the downstairs bathroom to prevent a tripping hazard. Provide written information to the commission of the refurbishment work to be undertaken, with timescales and evidence that the funding is in place for the work. This is needed to demonstrate that the proprietor will now meet all of the environmental requirements needed in the home without further delay. There must be an additional member of staff on duty at night. This is needed so that the health and welfare of residents is more appropriately addressed. A system should be put in place to ensure the necessary checks are in place before employees start work in the home. This will protect people from possible harm. In this case this refers to receipt of 2 appropriate references for all staff before they commence working. DS0000004907.V350213.R01.S.doc 23/11/07 19/11/07 12/01/08 13/11/07 Allendale House Residential Care Home Version 5.2 Page 33 19. OP15 18 (c )(i) Food hygiene training must be provided for all staff that work with food, to ensure that they keep people safe in the way they handle food. (Staff training has been a previous requirement at 01/06/06, 15/11/06, considered met at 14/5/07 and then required again now due to staff changes and training not being evidenced). (Date shown is the date when courses must be confirmed by for all relevant staff). 12/01/08 20. OP26 18 (1) c Staff must be trained in procedures to control the spread of infection in the home, to safeguard residents from harm (Staff training has been a previous requirement at 1/6/06, 15/11/06, considered met at 14/5/07 and then required again now due to staff changes and training not being evidenced) (Date shown is the date when courses must be confirmed by for all relevant staff). 12/01/08 21. OP30 13(4) There must be at least one first aid trained person in the home at all times, to ensure that residents receive appropriate treatment in an accident. The home has not undertaken a first aid risk assessment to determine any other action. (Date shown is the date when courses must be confirmed by 12/01/08 Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 34 for all relevant staff). 22. OP30 18(1) c Dementia awareness training must be provided to staff so that they can better understand the needs of people with dementia that are admitted into the home. (Date shown is the date when courses must be confirmed by for all relevant staff). 23. OP31 37 (1) (2) Inform the commission in writing and in a timely way of any death, serious injury, infectious disease or other events relating to residents in the home, to meet managerial responsibilities Undertake regular health and safety audits of the whole environment and address any areas that would compromise any resident’s safety. This is good practice but is particularly required to ensure the health and safety of all residents in the interim period before the plans to refurbish the whole building are completed. (This is a previous requirement. It was made at the previous inspection of 14/5/07 and replaced previous requirements that had an original timescale of 01/02/07 that were linked to rotting window frames, and redecoration. These elements were to be included in the health and safety audits.) 25 OP38 23(4) (d) (e) 23(4) Ensure that all staff receive suitable training in fire prevention and the procedure to be followed in case of fire. Comply with the Fire Officers DS0000004907.V350213.R01.S.doc 12/01/08 13/11/07 24. OP19 23(2)b 13/11/07 12/12/07 OP38 12/01/08 Page 35 Allendale House Residential Care Home Version 5.2 26 Report of February 2007 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. 2. 3. Refer to Standard OP9 OP12 OP7 Good Practice Recommendations Provide an up to date medication reference book in the home to assist staff to identify and understand current medications provided to residents. Maintain a log of activities in their file for each resident, and audit this to ensure that all residents are given opportunities for stimulation. Involve the residents, where appropriate, in the review of their care plans, and document in their records that this has taken place. This is to ensure that residents are clear and confident that their needs are being met in the way that they wish. Consult with residents, document the discussion and provide suitable door locks to their bedrooms for those that wish this, to preserve choice, security and privacy. Refurbish the kitchen to an acceptable standard, to include kitchen doors and secure tiles on the walls. Keep the recruitment check list on the front of each staff file up to date, to enable a clear audit trail. Keep an up to date training matrix to identify staff training completed, training required and planned, and when refresher training is due, to easily identify such training requirements and to ensure that training is provided in a timely way. 4. 5. 6. 7. OP24 OP19 OP29 OP30 Allendale House Residential Care Home DS0000004907.V350213.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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