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Inspection on 14/05/07 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 14th May 2007.

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

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

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

There is information readily 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 made positive comments about the care and service that they receive. These included "the staff are very kind", " nothing is too much trouble," "this is my home now." Good practice was evident in all aspects of medication. Personal and healthcare needs are met, and the privacy and dignity of the residents is maintained. Residents who commented stated that "staff are always helpful and available if I want anything," "if I need some one in the night I can use the buzzer and staff will come to me." Staff were able to give a satisfactory account of how they would interact with residents and demonstrated through their actions during this visit that they were sensitive to the needs of the residents. Residents said, "staff are very good," " they try their best to make sure we are cared for properly," " I know if I want anything staff will sort it out for me."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?

A new model for care planning for residents has been introduced with positive effect. Past inspections have raised concerns about the quality of some food provided. It was clear from this visit that the provider had made efforts to improve this. Samples of menus showed a variety of nutritionally balanced meals. A resident said " I love the lunch on Saturday." Others said " the food is good, you can`t complain about it," " I can choose something else if I don`t want what is offered," "they bring fresh fruit round everyday." A record of activities undertaken by residents has been introduced. Some residents said that activities in the home are good. One said " I went in to Newcastle last week with staff, we were out for about 4 hours, went to the market and had lunch out, I really enjoyed it and would like to go out to Trentham when they go next week." While there remains several areas of concern, some aspects of the environment had improved. These included repairs to furniture and fittings in residents` bedrooms. Staffing levels were considered satisfactory to meet the needs of the current residents. This was not so at the last inspection. The training of staff in national vocational qualifications in care is improving. A business consultant and architect have been commissioned to progress work on the environmental refurbishment that is needed. There was some evidence of these plans moving forward.

What the care home could do better:

Allendale House has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. The owner has previously reported that major refurbishment work is planned but to date this has not happened. The commission will expect to see the plans for the refurbishment that are identified above progressing at an acceptable pace. Specific requirements have been made regarding the environment, some of which are Health and Safety concerns.Information about recruitment checks and staff training in the protection of vulnerable adults from abuse must be better recorded. This is needed to support the safety of residents. There needs to be better records kept of staff training so that it can be easily identified that staff have received all of the training that is required.

CARE HOMES FOR OLDER PEOPLE Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector Irene Wilkes Unannounced Inspection 14th May 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.V339281.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.V339281.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.V339281.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 15th November 2006 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 villages and main town is via a main bus route. The Home is registered to provide care to seventeen older people, although there were thirteen people resident at the time of this inspection. They are 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 manager informed the Commission for Social Care Inspection on the day of the inspection that Allendale House charges its residents £325 to £368 per week. The Home is managed and owned by Mrs Marcia Anderson. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over eight and a half hours and was undertaken by two inspectors, Irene Wilkes and Wendy Jones. Due to the timing of the inspection pre inspection information was not available. This was not related to any shortfall of the home. Discussions were held with a large number of the residents, with four in more depth, and with the manager, some staff and a visitor. Five residents’ care records were checked and the records for three staff, which included recruitment and training documents. A random selection of the maintenance records was seen and a tour of the environment was taken. What the service does well: There is information readily 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 made positive comments about the care and service that they receive. These included “the staff are very kind”, “ nothing is too much trouble,” “this is my home now.” Good practice was evident in all aspects of medication. Personal and healthcare needs are met, and the privacy and dignity of the residents is maintained. Residents who commented stated that “staff are always helpful and available if I want anything,” “if I need some one in the night I can use the buzzer and staff will come to me.” Staff were able to give a satisfactory account of how they would interact with residents and demonstrated through their actions during this visit that they were sensitive to the needs of the residents. Residents said, “staff are very good,” “ they try their best to make sure we are cared for properly,” “ I know if I want anything staff will sort it out for me.” Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 6 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: Allendale House has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. The owner has previously reported that major refurbishment work is planned but to date this has not happened. The commission will expect to see the plans for the refurbishment that are identified above progressing at an acceptable pace. Specific requirements have been made regarding the environment, some of which are Health and Safety concerns. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 7 Information about recruitment checks and staff training in the protection of vulnerable adults from abuse must be better recorded. This is needed to support the safety of residents. There needs to be better records kept of staff training so that it can be easily identified that staff have received all of the training that is required. 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.V339281.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.V339281.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. Information is available to help prospective residents to make a choice of where to live. The home must ensure that the assessment information from the local authority, where relevant, is always obtained prior to the resident moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The latest inspection report is on display in the main foyer along with the Statement of Purpose and the Service user Guide, as was required at the last inspection. The Statement of Purpose and Service user Guide were last reviewed in May 2006. It was recommended that a further review is undertaken to ensure that the documents reflect the current arrangements in the home, for example, the Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 10 Statement of Purpose refers to a deputy manager. This position no longer exists. The Service User Guide should also contain the required information about the total fees payable for services as identified in the Care Homes Regulations 2001, which were amended to include this requirement in September 2006. During the site visit 4 people who use the service were interviewed, including a person receiving respite care. All made positive comments about the care and service they received, comments included “the staff are very kind”, “ nothing is too much trouble,” “this is my home now.” A sample of 5 care files showed that each service user had an assessment of care needs, this checklist 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. Mrs Anderson discussed the recent admission for a resident who had been admitted following discussion with a social worker, but a promised social work assessment had not been promptly forwarded to her. Fortunately the resident could discuss her needs with the staff. Mrs Anderson stated that she would usually visit any prospective resident in their own home or place of residence to undertake an assessment to ensure that their care needs can be met. The assessment tool used followed good practice guidance in this area. Mrs Anderson was asked to ensure that in future no admission to the home would take place even in an emergency until appropriate paperwork is provided by the referring social worker. As previously discussed the care plans for residents are based on a detailed assessment of care needs, which looks at physical, emotional, social, psychological, spiritual aspects. Risk assessments in terms of dependency are also carried out. This service uses a waterlow assessment tool for this purpose. Allendale House Residential Care Home DS0000004907.V339281.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 care records that are maintained for each resident have improved. There is safe practice in the home in all aspects of medication administration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection in November 2006, Mrs Anderson has introduced a new model for care planning, and this was seen to be a very positive move. The evidence in the records showed all of the files contained a ‘consent to care plans’ form; some had been signed by residents or their representatives, but others had not been signed. Care plans were reflective of the assessed needs of individuals. Monthly reviews of care plans were undertaken and had also been recorded. Unfortunately there was no evidence that people who use the service had been Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 12 involved in these reviews. This recommendation was discussed with the provider for her attention. Care plans identified the action staff should take to address the specific needs of the individual. At the last key inspection there were some concerns about how those residents who had complex care needs were cared for. In an example at this visit where an individual was recorded as requiring sensitive management due to confusion, the care plan stated that staff should ensure that the resident was told what they were doing to prevent her becoming anxious. It was a concern that this did not give staff explicit enough information to ensure her welfare. Following discussion with two care staff however it was evident that they were fully conversant with the needs of the individual and the best approach to use. The medication in the home is stored in a locked facility; access is limited to those who have received training in the safe management and handling of medication. A senior care worker stated that she had completed this training, as had a number of others. The sample of medication records showed that they were completed appropriately. Staff had recorded each occasion when medication had been given, refused or when not required. Staff showed that they had two medication reference books to refer to if they needed to know about any medication prescribed. It was noted that one of those books was dated 1993, and therefore staff could not be sure that any newer medication would be recorded in it. Some of the medication that was dispensed in its original package also had information about the purpose and effects of the medication on leaflets and these leaflets were stored in the medication file. A senior care staff stated that she would ask the pharmacist to provide this information for all current medication. One resident self medicates all her medication and stated that she had a lockable cupboard to store it and had been provided with a key. A ‘consent to self administer’ medication form was found in her care records. This form included a simple check-list to ascertain the level of the individuals understanding and ability to self administer. The form had been signed by the resident and the provider, a check of the social work assessment information confirmed that this was appropriate. The home did not have any controlled medication on site, although there is a storage facility provided. Topical treatments and liquid medications were stored in the main cupboard. The provider was asked to monitor the temperature of the room in which the medication is stored to ensure that no medication is stored at temperatures above those which is required. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 13 Night staff who are employed at the home do not usually take any responsibility for the administration of medication, this matter was discussed both with a member of staff and the provider. They said that if a resident required medication during the night the night staff would contact the Provider, or the sleep in staff who would be on duty if the provider was not on call. Residents who commented stated that “staff are always helpful and available if I want anything,” “if I need some one in the night I can use the buzzer and staff will come to me.” Staff were discreetly observed in their approach to residents during the visit. They were seen to afford dignity and respect. For example, one member of staff was seen escorting a resident to the toilet. She allowed her to go at her own pace, and talked to her in a calm and reassuring way. Two staff discussed how they would meet the needs of residents who had short-term memory loss or confusion; both gave a satisfactory account of how they would interact with residents and demonstrated through their actions during this visit that they were sensitive to the needs of the residents. Residents said, “staff are very good,” “ they try their best to make sure we are cared for properly,” “ I know if I want anything staff will sort it out for me.” A bedroom door catch that was broken at the time of the last inspection visit and was causing a concern around the issue of privacy and dignity has been repaired. Allendale House Residential Care Home DS0000004907.V339281.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. The manager continues to explore ways in which the residents can be offered more choice in their daily lives and make a more varied and nutritional diet available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new four-week menu plan has been introduced; the records showed that a choice of meal was available at all mealtimes. People who use the service stated, “ the food is good, you can’t complain about it,” “ I can choose something else if I don’t want what is offered,” “they bring fresh fruit round everyday.” Past inspections have raised concerns about the quality of some food provided. It was clear from this visit that the provider had made efforts to improve this. Samples of menus showed a variety of nutritionally balanced meals, with a hot meal at lunchtime. There is a tradition on Saturday’s when a mixed grill is Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 15 provided for the lunchtime meal, and hot dogs and onions for the evening meal. A resident said “ I love the lunch on Saturday.” Biscuits and fruit are offered with tea, coffee and cold drinks in between meals. One resident chose to not to have any lunch during the day of the inspection visit, but was offered alternatives and dessert throughout and she did accept a yoghurt. She said “ I don’t always feel like a meal at lunchtime, but I will enjoy my evening meal.” It was of concern that this person may not be having a nutritionally balanced diet, but it was also clear that she was making informed decisions. This was discussed with the provider, who was asked to consider a review of meal time choices and think about providing more hot choices for the evening meal. While talking to residents, they were not sure what the meal choices for the day were, saying “ the cook asks us what we want or tells us what is on the menu.” It was recommended that the meal choices for the day are displayed in the home to act as a visual reminder for residents, particularly for those who may forget what they have been told the choices are. The general appearance of the kitchen has not improved since the last inspection visit. Some kitchen cupboards remain in a poor state of repair, this whole area is in need of refurbishing throughout including in the storage area leading from it where some of the ceramic tiles were missing, presenting a possible infection and hygiene problem. A report from the Environmental Health Office had also recommended that the kitchen is refurbished, they had also recommended that Mrs Anderson obtain a copy of and adopt the standards of the new Safe Hygiene Regulations. She had done this. On the afternoon of the visit a paid instructor came to do gentle exercise to music. The instructor said that she visits every two weeks. Later the staff played bingo with the residents. In the care files seen during this visit, the service had adopted a method of recording any activities that residents had been involved with. This record was particularly useful, to show the frequency of engagement and type of activities enjoyed, this would be helpful for any quality audit of the service Mrs Anderson chooses to undertake. Unfortunately the records were not always properly maintained, in two examples records had not been completed since the 30/04/07, but residents said that they had been involved in activities since that time. 5 residents were asked to comment on their lifestyles. Comments were generally positive. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 16 One resident said “I occupy myself mainly by reading books and the paper, I enjoy listening to music and watching sport on the television, I can do this in my own room if I want to.” Another said, “I’m used to being busy, so this is a nice break for me, but if I stayed for very long I think I’d become bored, some residents don’t seem to do an awful lot.” One resident said “ I went in to Newcastle last week with staff, we were out for about 4 hours, went to the market and had lunch out, I really enjoyed it and would like to go out to Trentham when they go next week.” Two staff were asked to identify any area where they felt that residents quality of life could be improved, one said “more varied activities.” Some, but not all residents have discussed in the past that the home has rigid regimes. Minutes of a staff meeting that was held at the end of last year evidenced that Mrs Anderson had reminded staff about the importance for residents of making their own choices and the need for flexible arrangements in the home. All residents were asked if they felt that they were able to make real choices about their day to lifestyle, they were asked questions that included information about retiring and waking. One resident said “ staff come around with a cup of tea at about 6am, and I usually get up then, I sometimes have to wait a long time before staff take me downstairs for breakfast, which is usually served at 8.30am.” Another said “staff ask me if I would like a cup of tea at about 7am, sometimes I get up then, sometimes I lie in a little longer” One resident said “ some residents like to go to bed early, and start to go from about 8pm, I don’t and usually stay up until I’ve watched the late news.” One resident said “ I’ve been very pleased to stay here and will come again, I would recommend it.” Another said, “I chose to come here for respite, but decided to stay, when I’d been here for a while.” During this visit, one resident had a visitor; other residents said that their visitors were made welcome at any time. There was also evidence from the records available that there were regular visitors to the home. These included relatives and friends of residents, a lay preacher who visits the home to give a service and communion once per month. A number of residents said that they also often went out of the home with relatives. The visitor said that he was made welcome in the home and he and other family members had been told that they could visit at any time. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 17 Allendale House Residential Care Home DS0000004907.V339281.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 Quality in this outcome area is adequate. The manager needs to improve the records relating to employment checks and staff training to robustly evidence the health and safety of residents. 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. There have been no complaints made either to the home or to the commission. A folder is kept showing positive comments made to the manager and staff, including several thank you cards. Residents said, “ if I have any problems staff will sort them out quickly,” “ Mrs Anderson tries to ensure I have everything I need.” “I haven’t got anything to complain about, I have been satisfied with the care I receive, staff are kind and treat me with respect.” Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 19 Mrs Anderson confirmed that as would be expected in any home the residents raise minor grumbles with staff about issues such as laundry being mislaid. It was recommended that a ‘grumbles’ book be kept to record brief details about these incidents and their outcome. This would assist in quality assurance by providing evidence that such concerns are listened to and acted upon. 3 staff files were selected at random and these included staff who had commenced work in the last 8 months and staff who were on duty at the inspection. While in each case a POVA First (Protection of Vulnerable Adults) check followed by a full CRB (Criminal Records Bureau) had been obtained, in 1 case the POVA check showed a date of 10 days after the date that employment commenced. Mrs Anderson said that the employees start date was wrong in the file, but it remains of concern that this employment record was not suitably robust to show a clear audit trail of evidence linking the receipt of the POVA check’s receipt before the staff member started working in the home. The 3 files inspected did not show any evidence that abuse training had been given. The relevant sections in the induction training record had not been completed and there was no other written evidence. Mrs Anderson provided a copy of a booklet ‘Recognition and Prevention of Abuse’ written by a training provider for Allendale House that she said all staff have to work through at induction and answer questions on at the end of the training, but as stated above there was no evidence in the 3 staff files seen that this had been completed. There has been evidence seen at previous inspections, however, that more established staff have received this training. The senior carer had received training in behaviours that challenge. No other staff had received this training or training in dementia. Two staff stated that they had completed an application form, had a Criminal Records Bureau (CRB) check carried out and had provided the details of two referees. Allendale House Residential Care Home DS0000004907.V339281.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, 20, 21, 22, 24, 25, 26 Quality in this outcome area is poor. Improvements are required to ensure that the residents live in a safe and wellmaintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Access to the home is via a ramped area to the front door, the foyer is spacious and inviting, and from this area people who use the service have a choice of communal areas. There are four distinct lounge areas, all are interlinked, but do provide residents with a choice of quiet or livelier rooms. There is also scope for relatives and friends to visit and chat relatively privately, because of the layout. Furnishings and fittings in these areas are generally well maintained. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 21 A separate dining room provides adequate space for all residents to dine if they choose to. The home has a number of double bedrooms that have adequate screening in place. None of the bedrooms are en-suite. Allendale House has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. The owner has reported in the past that major refurbishment work, which includes some new build, is planned but this has not been forthcoming. There have been architect’s plans drawn up previously that are also linked in to the refurbishment work, but this has not to date gone ahead. In April this year however copies of letters from business consultants and architects, and plans for building work and improvements were submitted to the commission. Mrs Anderson said that once the approval had been gained that work would commence via a phased approach with refurbishment of the existing building taking priority. She was advised that we would be seeking firmer timescales for this refurbishment via an improvement plan. Mrs Anderson had provided an action plan following the last inspection identifying how she had met some of the requirements made at that visit. During this visit a tour of the home was undertaken which included inspection of all of the areas previously identified. The following progress has been made: The ceiling in the staff and visitors’ toilet has been made safe with the addition of a ‘false ceiling’ that provides a complete seal. The door lock on bedroom one has been repaired resulting in the door staying at closed when shut. The tap in bedroom one has been repaired. The hoist in one of the downstairs bathrooms is out of action. It had previously been required by the commission that this must be repaired when the home is full, which is not yet the case, and therefore this requirement is deemed met until such time. Loose floor tiles on the downstairs bathroom floor have been fixed. However Mrs Anderson confirmed that this is a recurring problem and this will need to be monitored. Hot water is now available in all of the upstairs toilets. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 22 The bedroom furniture in bedroom four has been mended. The light fitting on the landing/hallway area has been made safe. The damp patches in the stairway area and in a bedroom have been painted over. These appear to be from a water leak. Light shades in one of the downstairs toilets and the upstairs bathroom have been provided. Residents who were asked were satisfied with their accommodation, one resident said “ My room is lovely, I have my bits and pieces, photo’s and television, and have it how I like it.” Another said, “ My room has as lovely view, I have a comfortable armchair and often sit watching the local comings and goings.” Areas that still require addressing are: There is exposed piping, which is hot. Some of the radiators are not covered and are hot. This includes the downstairs toilet and upstairs bathroom. There are no risk assessments in place for the exposed piping or any of the uncovered radiators and these are required. The residents must be kept safe from any hot surface temperatures should the risk assessments identify a risk to health and safety. There is still no heating in one of the toilets upstairs. Mrs Anderson said that only one resident uses this toilet. When asked at the visit the person said that they do not feel cold when using the room. It is recommended that if any other residents commence using this toilet then the issue be revisited. At the last inspection the call system was highlighted as not working in the upstairs toilet mentioned above. This has still not been repaired some 6 months later. This was discussed with Mrs Anderson and it is required that this is addressed with urgency. The kitchen refurbishment is included in the planned alterations, including an extension to the current kitchen. It has been identified previously that there are tiles missing in the ante-room of the kitchen near food and medication storage. These tiles must be replaced. Areas of carpet, particularly in doorways, remain taped. However on the day of the inspection wherever the tape was used it was securely in place and Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 23 minimised the risk of tripping as far as possible in these circumstances. These areas require constant monitoring. The hole in the wall of bedroom three, caused by the door handle has been covered by a piece of hardboard that is not very pleasant to look at. It is recommended that this be painted to blend better with the wallpaper in the room. There are a number of window frames that are rotting. Areas of the home require general redecoration. The upstairs toilet referred to earlier in this report, for example, has wallpaper peeling from the walls. Bedrooms do not have a lock fitted to enable privacy and it is recommended this be addressed. It is recognised that plans are in progress that should ultimately address all of the above concerns. However in the interim period the environment must be maintained appropriately to ensure that the residents are kept safe. The manager is required to undertake regular health and safety audits of the whole environment and to address any areas that would compromise any resident’s safety. Since the last inspection some work has commenced towards this. Mrs Anderson has purchased the Croner publication ‘Health and Safety Management System Plans’ and has done some limited work to identify what is required to maintain safety in the home. The Fire Officer visited the home on 6 February 2007 and made some recommendations regarding the need for improved closure and seals on some of the fire resisting doors, different locks to the front and side entrance doors, provision of fire resisting glazing to 1 window, and an extension of the fire alarm system to the second floor of the premises and an area between the kitchen and the dining room. Some work has been undertaken on the fire resisting doors and entrance doors. Mrs Anderson was unsure about the further recommendations of the Fire Officer and is therefore required to make contact with the Fire Officer to establish exactly what she is required to do. There was concern at the last inspection about a commode being soaked in a bath due to the lack of a sluice area. The Action Plan submitted to the commission at the end of December 2006 states that more suitable arrangements have been made. However, at the inspection visit Mrs Anderson confirmed that the bath is still being used as a sluice. This is not acceptable practice. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 24 Mrs Anderson was referred to guidance about good practice in the control of infection. She confirmed that she had copies of all good practice guidance. Laundry procedures were discussed and Mrs Anderson confirmed that red water soluble bags are now available for wet and soiled linen. It was also confirmed that the washing machine operates above 65 degrees Celsius. Minutes of the staff meeting held in December 2006 were seen and these clearly set out the procedures for laundry to be followed by all staff. Evidence was seen that this has since been followed up with external training in infection control for all staff in April this year. There is plenty of clean bedding and towels available and the staff have access to protective clothing, i.e. disposable gloves and aprons. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 25 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 adequate. There is some evidence that staff training is improving, but records about staff recruitment and training need to be more robust to provide a clear audit trail. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Allendale House has a history of high staff turnover. Mrs Anderson confirmed that she still experiences some problems in keeping staff; she considers this due to only part time hours being available. However, there was evidence of some longer serving team members, and some newer staff employed since September 2006 were still working in the home. One member of staff had previously been employed at Allendale House, but had left to pursue a career with another service user group. She had since returned to Allendale, stating she had made a mistake previously and now recognised that working with older people was the right career choice for her. She also was able to compare other employment experiences and gave a positive account of Allendale House and Mrs Anderson’s management style. Another member of staff recounted her induction at the home, stating, “ I was shown around the home, so that I was familiar with the layout and fire safety. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 26 I then was able to shadow staff until I understood the routines in the home and became more familiar with the care needs of residents. I have worked in other care services and my induction experience at Allendale has been positive. I have been asked if I would like to enrol on NVQ (National Vocational Qualifications) training and am pleased about this, I have received some training since I have been here and have some other training planned.” During the day of this inspection, there were two care workers, a cleaner, a cook and the owner/manager on duty in the morning. Two care workers work during the afternoon/evening and one waking night from 10pm. The owner/manager lives next door and is on-call. The staffing rotas were seen and these confirmed that this is the usual pattern of staff cover. There is currently one night staff vacancy and these hours are being covered by some of the staff team working additional shifts. There are presently twelve people living in Allendale House, plus a person was resident for two weeks respite care. Based on the needs of the current residents it was considered that the staffing levels at this visit were satisfactory. At the last inspection there were 3 care staff out of 13 who had achieved an NVQ (National Vocational Qualification) of NVQ 2 or above. Presently out of 12 staff there is a senior carer who has NVQ 3, with 2 further staff planning for this level of qualification, 3 staff have NVQ 2 and 6 people are currently working towards this qualification. This improvement is noted. The recruitment files for 3 newer staff were checked. Reference has been made earlier in the report about the inability to clearly evidence that a POVA First (Protection of Vulnerable Adults) check had been in place for one of these staff before they commenced working at the home. Application forms were completed and returned to the manager. There was no evidence in one of the files that a gap in employment had been investigated. 2 references were available in all 3 files. All 3 staff had completed a health declaration. There was a photo and proof of identity in 2 of the 3 files. There was evidence that all staff receive a statement of terms and conditions. There was a comprehensive induction training record book in each of the 3 files seen. However, although these staff had worked at the home for some 8 months there were only very limited sections of the record completed. Mrs Anderson said that staff had worked through the majority of the areas but that she had not had chance yet to ‘sign them off.’ She is reminded that this is required to ensure that staff are competent in their work to safely support the residents. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 27 There was documented evidence of some staff training in the 3 files sampled. This record did not consistently tally with the training that both Mrs Anderson and the care workers on duty said that they had completed, making it difficult to determine exactly what training the staff had received. There were training videos available on moving and handling in care homes, food hygiene and health and safety. Mrs Anderson said that all of the staff had received all of this training and training in the recognition of abuse but the three files did not evidence that all three had received training in each of these areas. One file had no record of any training whatsoever having been completed and she had been employed in the home since the end of September 2006. There was evidence that fire safety guidance had been provided to all staff by way of a video. COSHH (Control of Substances Hazardous to Health) training had been provided to all staff, as had infection control. Mrs Anderson needs to ensure that clear records are kept that all mandatory training for all staff is provided and is up to date. This cannot be evidenced without these records being available. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 28 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, 37 and 38 Quality in this outcome area is poor. There remains a number of aspects of the environment that pose a health and safety risk to residents that should have been addressed prior to this inspection visit. Record keeping requires improvement. 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 is undertaking NVQ 4 in management. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 29 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 this inspection, although there remain several areas where requirements from the last inspection in November 2006 have not been addressed. These outstanding requirements are linked to the health, safety and welfare of the residents and must be addressed. There is no real office space within the home. There is a store-room that is locked where a number of records are kept, but Mrs Anderson confirmed that of necessity she has to complete amounts of the necessary paperwork for the running of the home at her home address next door. There are several areas identified earlier in the report where record keeping is not satisfactory. Mrs Anderson talked about the problems that she has faced regarding lack of office space and that she is linking the work needed to improve the environment in with other development plans for the home. An improvement plan, with timescales, is required to show how all of the outstanding concerns will be addressed. It had been established at the inspection in August last year that quality assurance questionnaires had been sent out to residents and a meeting was also held with relatives. The outcome of the survey was still not available at this inspection. The Service User Guide contained some positive collective quotes from residents. A suggestions and comments book is available and there are several thank you cards. Minutes of a staff meeting held following the last inspection evidenced some discussion with staff about quality issues around the promotion of independence and choice for residents, and there was also evidence that several of the home’s policies and procedures had been discussed. Service users’ money was not inspected at this visit. The Fire Officer visited the home in February 2007. Mrs Anderson must take advice from the Fire Officer about some of the work that remains outstanding. Fire records are up to date. Individual fire risk assessments were in place. There was no evidence of any environmental risk assessments or of a contingency plan should there be an emergency at the home that required the temporary transfer of residents to a place of safety. A random selection of the maintenance records were checked during this inspection and found to be satisfactory. There was up to date servicing of the hoists, stair lift and gas installations. PAT (Portable Appliance Testing) was Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 30 due. However a number of Health and Safety concerns were raised during this inspection, as evidenced earlier in the report. Since the last inspection Mrs Anderson has purchased the Croner publication ‘Health and Safety Management System Plans’ and has started working through this to identify the work that is required to maintain safety in the home. This needs to be addressed with some urgency. Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 31 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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 3 2 2 x 2 1 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x x 2 1 Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 32 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 OP29 Regulation 12(1)a Requirement 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. Pipe-work and radiators within the home must be assessed for the risk they present to residents, and action taken to minimise any identified risk. Timescale for action 15/06/07 2 OP25 13(4)a 15/06/07 3. OP22 12 (1a, b) (There was a previous requirement to cover pipes and radiators– original timescale of 01/02/07) The call alarm system must be in 29/05/07 working order throughout the home. (In this instance the upstairs toilet alarm is still not working). This is needed to ensure that the health and safety needs of the residents are promptly addressed. (This was a previous requirement - original timescale 01/02/07) Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 33 4 OP26 13(3) Replace the ceramic wall tiles that are missing in the anteroom of the kitchen. This is to ensure hygiene and minimise the spread of infection as the area referred to is in an area where food is stored. 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 replaces previous requirements with original timescale of 01/02/07 that were linked to rotting window frames, and redecoration, that should nevertheless be included in the health and safety audits.) 15/06/07 5 OP19 23(2)b 15/06/07 6 OP26 13(3) 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. 15/07/07 7. OP31 21A (This requirement is linked to a previous requirement about the need for sluicing facilities – original timescale 01/02/07) An improvement plan must be 15/07/07 provided setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided. DS0000004907.V339281.R01.S.doc Version 5.2 Page 34 Allendale House Residential Care Home This will need to address the plans and timescales for the refurbishment, and all of the areas listed as requirements within this report. (Further information about the improvement plan will be sent to the provider). Consult with the Fire Officer about his recommendations following his visit in February 2007 to find out if work completed to date is acceptable, and to gain information about the areas of work that have not been addressed because of a lack of understanding of his requirements. This is to ensure the safety of the residents. Undertake a fire risk assessment for the home and produce a contingency plan in the event of an emergency. This is to ensure the safety of the residents. 8 OP38 23(4)a, b 15/06/07 9 OP38 23(4)c 15/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations Undertake a review of the Statement of Purpose and Service User Guide to ensure that it is up to date, including the necessary information about the total fees payable. This is to ensure that residents and prospective residents have accurate information about the home. No admission to the home should take place until appropriate needs assessment paperwork is provided by the referring social worker, to ensure that the home can be assured that the person’s needs can be met. DS0000004907.V339281.R01.S.doc Version 5.2 Page 35 2 OP3 Allendale House Residential Care Home 3. OP7 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. Provide more explicit information in the care plans about the needs of each individual resident, to provide staff with as much information as possible about the best way to support each person. Consider a review of meal time choices and think about providing more hot choices for the evening meal. This will ensure that all residents are having sufficient choices and that their nutritional needs are being adequately met. Staff training records should be fully completed. This refers in this instance to training about adult protection and whistle blowing procedures. This is needed so that it is clear that training for all staff is up to date, to ensure that residents are not at risk of harm or abuse. Display the meal choices for the day to act as a visual reminder for residents, particularly for those who may forget what they have been told the choices are. Keep a ‘grumbles’ book with brief details and their outcome. This would assist in quality assurance by providing evidence that such concerns are listened to and acted upon. Provide training in the understanding of dementia and behaviours that challenge to all staff. This will help the home to meet the individual needs of those people with dementia. Consult with all residents who may use the upstairs toilet that has not got a radiator fitted to ensure that the room is warm enough for them. Consideration should be given to the provision of door locks to all of the bedrooms as part of the environmental refurbishment. Records of staff training should be fully completed to ensure training for all staff is up to date. This is good practice supporting the health, safety and welfare of residents. Full staff training cannot be evidenced without these records being available. 4. OP7 5 OP15 6 OP18 7 OP15 8. OP16 9 OP18 10 11 OP25 OP24 12 OP30 Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 36 Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES 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 Allendale House Residential Care Home DS0000004907.V339281.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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