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Inspection on 15/11/06 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 15th November 2006.

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

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

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

The manager ensures that appropriate assessments are obtained for any prospective resident. This includes Local Authority assessments by social workers and assessments by the manager. The residents` health care needs are monitored. Access to medical health professionals is obtained as required. There have been no complaints made to the Commission for Social Care Inspection or the manager regarding the service provided at Allendale House. The manager keeps the Commission for Social Care Inspection informed of any significant events or changes in the Home. One of the residents said, "I`m very well cared for".

What has improved since the last inspection?

Amendments have been made to The Statement of Purpose, Service Users` Guide and contracts in May 2006 and copies are available. The manager held a staff meeting during which the issue of flexible bedtimes was discussed. A meeting was also held with the residents and their families. The manager continues to look at ways in which the residents can be encouraged to make more choices in their daily lives. All of the residents have been given a copy of the complaints procedure and all relatives informed at the above meeting. Existing staff have received training in the recognition of Adult Abuse and the procedures to follow. Questionnaires have been sent out to the residents and a meeting has been held with the relatives. A suggestions and comments book is available and there are a number of thank you cards. During a random unannounced inspection by the Commission for Social Care Inspection in August 2006, concerns were raised regarding the quality and nutritional value of the food. This was checked during this visit and some improvements noted.

What the care home could do better:

There are presently twelve people living in Allendale House. One resident needs two care workers at all times, others may require two care workers at times. The manager must ensure that safe systems are in place to ensure that staff are also available for the other residents during these times. Residents requiring the support of two care workers during the day should also be provided with this level of support during the night. At present there is one care worker working through the night and the manager, who lives next door is on-call. Allendale House has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. The owner has reported that major refurbishment work is planned. Discussions have been held at every inspection as to why the work has not yet commenced and no date has been given. Specific requirements have been made regarding the environment, some of which are Health and Safety concerns. In August 2006 a major improvement in training provision was noted, however new staff employed since that date have not completed all aspects of their induction and there are quite a few gaps. The manager acknowledges that shehas difficulties finding the time to organise and keep up with training requirements and therefore she has employed a consultant to help her. Care records are maintained and reviewed monthly. However the manager must ensure that there is a care plan and risk assessments for all residents. The manager is planning to introduce a new care plan format. One of the residents requires liquified food. The manager was reminded that each food item should be liquified separately in order that it be appealing in terms of presentation, texture and flavour. The most recent Commission for Social Care Inspection report should be made available to the residents and their families.

CARE HOMES FOR OLDER PEOPLE Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector Sue Jordan Key Announced Inspection 15 November 2006 10:00 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.V316699.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.V316699.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.V316699.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 12/04/06 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 twelve 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 10/04/06 that Allendale House charges its residents £317 to £368 per week. The Home is managed and owned by Mrs Marcia Anderson. Allendale House Residential Care Home DS0000004907.V316699.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 five hours and was undertaken by two inspectors, Sue Jordan and Rachel Davis. The methodologies used were scrutiny of pre-inspection information completed by the manager and six Commission for Social Care Inspection comments cards; two from relatives, one from a practice nurse and three from residents. Discussions were had with a number of the residents, the manager and some staff. Four residents’ care records were checked and the records for three new staff employed since the last inspection, including recruitment and training documents. A random selection of the maintenance records was seen and a tour of the environment was taken. Since the last key inspection on 12/04/06, the Commission for Social Care Inspection undertook a Random Inspection one evening in May, held a meeting with the manager and undertook another random inspection in August. Mrs Anderson said that she had to leave at 14:00hrs therefore it was only possible to deliver brief feedback following this inspection. What the service does well: The manager ensures that appropriate assessments are obtained for any prospective resident. This includes Local Authority assessments by social workers and assessments by the manager. The residents’ health care needs are monitored. Access to medical health professionals is obtained as required. There have been no complaints made to the Commission for Social Care Inspection or the manager regarding the service provided at Allendale House. The manager keeps the Commission for Social Care Inspection informed of any significant events or changes in the Home. One of the residents said, “I’m very well cared for”. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are presently twelve people living in Allendale House. One resident needs two care workers at all times, others may require two care workers at times. The manager must ensure that safe systems are in place to ensure that staff are also available for the other residents during these times. Residents requiring the support of two care workers during the day should also be provided with this level of support during the night. At present there is one care worker working through the night and the manager, who lives next door is on-call. Allendale House has been in need of environmental refurbishment for some time and requirements were initially made in February 2005. The owner has reported that major refurbishment work is planned. Discussions have been held at every inspection as to why the work has not yet commenced and no date has been given. Specific requirements have been made regarding the environment, some of which are Health and Safety concerns. In August 2006 a major improvement in training provision was noted, however new staff employed since that date have not completed all aspects of their induction and there are quite a few gaps. The manager acknowledges that she Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 7 has difficulties finding the time to organise and keep up with training requirements and therefore she has employed a consultant to help her. Care records are maintained and reviewed monthly. However the manager must ensure that there is a care plan and risk assessments for all residents. The manager is planning to introduce a new care plan format. One of the residents requires liquified food. The manager was reminded that each food item should be liquified separately in order that it be appealing in terms of presentation, texture and flavour. The most recent Commission for Social Care Inspection report should be made available to the residents and their families. 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.V316699.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.V316699.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): 1, 3, 4, 6 Quality in this outcome area is adequate. Some information is available to help prospective residents to make a choice of where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service Users Guide are both available in the hallway area of the Home. A Commission for Social Care Inspection report from August 2005 is available. The manager was advised that this should be the most recent. There have been one key and one random inspection of Allendale House since August 2005. Amendments required at the last key inspection have now been made to the Statement of Purpose, Service Users Guide and contracts. There have been no new admissions to the home since the last inspection in April 2006, when it was ascertained that appropriate assessments are received Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 10 prior to accepting a referral. The manager also undertakes her own assessment to ensure that the home can meet their needs. However it was noted that some initial assessment information has not been transferred into the care plans. For example the management of difficult behaviours. Allendale House is registered to provide care and support to seventeen older people, two of whom may have dementia care needs and five of which may have a physical disability. Historically the home has a high turnover of staff and training is not up to date for all members. This includes dementia and manual handling. Discussions during this inspection indicate a lack of communication and that staff are not always clear as to how support is to be given. Care plans do not provide staff with clear information as to how service users needs are to be met. Allendale House does not provide intermediate care. Allendale House Residential Care Home DS0000004907.V316699.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): 7, 8, 10 Quality in this outcome area is adequate. Care records are maintained for each resident, however they do not always supply staff with the information needed to provide the required support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care records were checked. There was no care plan or risk assessments for one of those checked, although there are daily and other records. Some behavioural difficulties are described in the daily records, which require risk assessment and information for staff as to how the behaviour is to be managed. All of the care records seen had been reviewed within a ‘dependency profile’. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 12 The manager has employed someone to help with the development of clearer more concise care records. An example of the format to be used was seen and could prove to be a positive development. The care records show evidence that the support of medical, health professionals is sought when required. A practice nurse responded positively to the questions asked in a Commission for Social Care Inspection questionnaire. Three questionnaires were completed by residents, one said that they always receive the medical support needed, one said ‘sometimes’ and another declined to answer. Two of the residents confirmed that they had recently had their flu injection. One of the residents is mostly being cared for in bed but joins the others for meals. Discussions with staff and examination of the records indicated some confusion as to what support is actually required. Some staff thought that the resident required turning in bed and were unaware of the availability of equipment and there was some doubt as to whether all of the staff had received the correct practical manual handling training. The manager explained the manual handling procedures but she was asked to make this clearer in the records and to staff. This particular resident has complex needs which should be clearly stated in the care plans to ensure that all staff have the current information required. This includes dietary requirements and assistance, including fluid intake, mobility, communication and the care and/or prevention of pressure areas. This resident has been provided with a special mattress and the district nurse last provided input in June 2006. The medication systems were not checked at this inspection. They were satisfactory when inspected in April 2006. Two of the present residents share a bedroom and they told the inspector that this is by choice. Screening is provided. A bedroom door catch was seen to be broken and the door continually banging. This was discussed with the resident who said that she was a sound sleeper and not disturbed. However, this needs to be addressed as a privacy and dignity issue and is included in the environment requirements. The staff were seen to be treating residents with respect and one resident said “I’m very well cared for”. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 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 requirement was previously made that the manager and staff team should, together with the residents, explore further the whole issue of choice and flexibility for the residents. The manager has taken some positive steps to address this issue and as a result held a relatives and residents meeting in June 2006. One of the subjects discussed was activities and the following are available; a visiting theatre company, organist, TV karaoke and exercise classes with gentle movements. The staff do manicures. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 14 One of the residents said, “Most of the other residents sleep all day and it is really boring”. She did emphasise however that she was happy at Allendale House and felt safe. A new menu is presently being devised but as yet is not available for inspection. Notices have been put up in the home stating that relatives are welcome to take their ‘loved ones’ out and that wheelchairs are available on request. A relative said that they had recently taken some of the residents to a local school. In a comments card one resident said, “I would like to go out more, but I can’t walk far”. Two relatives completed Commission for Social Care Inspection comments cards and said that they are welcomed into Allendale House. The relatives were informed that they are free to visit at any time at their meeting in June 2006. A concern had previously been raised that the residents were going to bed earlier than they wished. This was explored by the Commission for Social Care Inspection and was unfounded. During this visit one of the residents said that she usually went to bed after her evening medication and was happy with this. A notice has been put up stating the meal times within the Home. A degree of flexibility has been given; each meal has an allocated timeslot. It was positively noted that some residents were finishing their breakfast when the inspectors arrived at 10:00. There is a bath rota on the wall, which informs staff of when residents are to have their bath and bed changed. At their meeting in June, the residents and relatives were told that baths could be taken at any time during the day. This was not however confirmed during this visit. Discussions with staff indicated that baths are always given in the evening. Reference was made to the inspector during this visit about a ‘strict routine’. It is suggested that additional work is needed to encourage more relaxed and flexible practices. During a random unannounced inspection by the Commission for Social Care Inspection in August 2006, concerns were raised regarding the quality and nutritional value of the food. This was checked during this visit and improvements noted. Fruit juice, salad and a small quantity of fruit were available. Joints of meat were in the freezer. UHT milk was no longer in evidence although long-life was being used. A member of staff confirmed that fresh milk is also sometimes brought into the home. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 15 Lunch on the day of this visit was stew, (‘lobby’-a meal traditionally from Stoke-on-Trent). Three of the residents were asked about the quality of the food and two said that it was good and one said it was ‘ok’. One resident said, “The food is very good and there is plenty of it”. Three residents completed Commission for Social Care Inspection questionnaires and all said that they ‘always’ liked the meals in the home. One added that the food is “very nice”. The cook is now dating all food placed into the fridge and freezer, although it is recommended that this be expanded to include jars, e.g. mayonnaise, pickles and jam. One of the residents requires liquified food and assistance from staff to eat. The manager was reminded that each food item should be liquified separately in order that it be appealing in terms of presentation, texture and flavour. It is recommended that the manager obtain a copy of the Commission for Social Care Inspection ‘Highlight of the Day’ publication regarding food and nutrition for older people. The environmental health officer visited Allendale House on 14/11/06. Two recommendations and one requirement were made. The environmental health officer recommends that the kitchen be refurbished. This is also the opinion of the Commission for Social Care Inspection and requirements have been made in the environmental section. Allendale House Residential Care Home DS0000004907.V316699.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): 16, 18 Quality in this outcome area is poor. The residents and relatives have been given information as to how they can express their concerns. However there are a number of areas requiring improvement to ensure the residents’ safety and protection, including staffing and Health and Safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints made to the home. The manager has put a copy of the complaints procedure in each of the bedrooms and informed the relatives and residents of its presence at a meeting in June 2006. Three residents, two relatives and one health professional completed Commission for Social Care Inspection questionnaires. All said that they knew who to express their concerns to and one resident mentioned the manager, Mrs Anderson in particular. One relative commented, “Mrs Anderson and the staff are always obliging and if I need to speak to them regarding my mother I can make an arrangement. If Mrs Anderson is not available at that particular time, she will get in touch with me”. Existing staff have now received Protection of Vulnerable Adults training, but this will need to be extended to new staff. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 17 Care planning information, staff recruitment and training must be improved to ensure the protection of the residents. The manager must also ensure that there are enough staff on duty to maintain their safety. There is a number of Health and Safety concerns, including infection control procedures, unprotected radiators and pipe work and environmental issues referenced to in National Minimum Standard 19-26. A number of which are potentially hazardous to the residents and staff. Allendale House Residential Care Home DS0000004907.V316699.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): 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 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. The owner has reported that major refurbishment work is planned. Discussions have been held at every inspection as to why the work has not yet commenced and no date has been given. In the interim period the Commission for Social Care Inspection had required the owner to make sure that the environment is safe and to undertake regular Health and Safety audits. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 19 During this visit, a tour of the environment was undertaken and the following identified: 1. On the day of this inspection, the ceiling in the staff and visitors’ toilet was considered to be unsafe and in danger of falling in. An immediate requirement was left and the manager was asked you to provide alternative arrangements for staff and visitors. This area was put out of bounds during the inspection. It must be made safe. The door lock on bedroom one is broken. The tap in bedroom one is broken. The hoist in one of the downstairs bathroom is out of action. There are loose floor tiles on the downstairs bathroom floor. There is exposed piping, which needs to be boxed off if hot. Some of the radiators still require covering. This includes the downstairs toilet and upstairs bathroom. There is no heating in one of the toilets upstairs. The call system does not work in the same toilet. There were no light shades in one of the downstairs toilets and the upstairs bathroom. The flooring in the upstairs bathroom is not sealed. There was no hot water in one of the upstairs toilets. The bedroom furniture in room four is broken. There is a broken drawer and the trim is falling off the wardrobe. The window frames are rotting. One of the upstairs bedroom ceilings is damp. There are wires visible around the light fitting on the landing/hallway area. There is damp in the stairway area and wall. The Commission for Social Care Inspection were told that there are residents with asthma. The kitchen cupboards are broken and a number of the drawers and cupboards are taped together. The environmental health officer also recommends that the kitchen be refurbished. The carpets are taped down in a number of areas, particularly in doorways. There is a hole in the wall of bedroom three, caused by the door handle. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. The above concerns do not suggest that thorough Health and Safety/maintenance audits have been undertaken. The manager was informed that these concerns would be listed and individual requirements made. The manager has previously been asked to seek the advice of an infection control nurse to ensure adequate infection control measures in the home and during the laundry procedures. Since that inspection, a hand-washing sink has been provided in the laundry. However, during this visit, a commode was seen to be soaking in a bath due to the lack of a sluice area. This is not acceptable practice and compromises safe infection control measures. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 20 Hard bar soap and toiletries were seen in the communal bathrooms. Soiled washing is taken to the laundry in cloth bags and there was an element of doubt as to whether it is washed above 65 degrees Celsius. Staff must receive training in infection control issues. 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 is in general need of re-decoration and refurbishment. However the layout and setting provide potential for a very cosy and pleasant environment. The home provides a large lounge area, which has within it four separate seating areas. Therefore the residents are able to choose whether they sit with others or retain their privacy. There is a pleasant entrance to the home, which leads to the lounge areas on the right or the separate dining room on the left. There are bedrooms on the ground and first floor. Access to the first floor is provided by a stair lift. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. The manager must make sure that at all times the residents are properly supported and protected by sufficient numbers of well recruited and trained workforce. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Allendale House has a history of high staff turnover. However, since the last inspection in August 2006, some new permanent staff have been employed. One was on duty during this visit. During the morning of this inspection, there were two care workers, a cleaner and the owner/manager on duty. The manager was cooking. Two care workers work during the afternoon/evening and one during the night. The owner/manager lives next door and is on-call. The manager must keep the staffing levels under review dependent on the needs of the residents. There are presently twelve people living in Allendale House. At the time of this inspection one of the residents is being cared for primarily in bed requiring regular support from two care workers. The manager/owner must ensure that safe systems are in place to ensure that staff are also available for the other residents during these times. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 22 The manager has employed the services of an independent consultant who will organise the staff training and induction. During this inspection it was identified that some training had been delivered to the new staff during their induction period but that other mandatory training courses are still required. Up to date the manager/owner has been responsible for accessing, organising and delivering some training. A new member of staff reported that she had ‘shadowed’ other members of staff for a week and had watched some Health and Safety videos. Fire safety guidance was also received. This member of staff said, “Mrs Anderson is a good teacher”. New staff also attend a one-day external induction training. Mandatory training provision should include Health and Safety, manual handling, fire safety, first aid, food and hygiene, infection control, Protection of Vulnerable Adults, medication and any other training required to meet the needs of the service users living in the home. For example, dementia care. The training records and discussions with staff during this inspection did not indicate that all staff have received the appropriate mandatory training. The staff spoken to were enthusiastic about their role as care worker and keen to learn. Three of the thirteen staff have achieved National Vocational Qualification level 2 in care or above. There was an expectation that 50 of the care staff team should have achieved National Vocational Qualification 2 or above by 2005. The recruitment files for three new staff were checked. Criminal Records Bureau and Protection of Vulnerable Adults checks were undertaken for all. Application forms were completed and returned to the manager, although she was reminded that she should explore any gaps in employment. Two references were obtained for two of the staff and the manager reported that she is waiting for a second for the third member of staff. One of the referees declared lack of knowledge of the candidate and an alternative is required. The recruitment procedures must be strengthened to ensure that a safe staff team supports the residents. All three staff had completed a health declaration. The manager needs to obtain proof of identity and photographs for all files. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is poor. The environment poses a potential risk to the health, safety and welfare of the residents and staff. 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. It was established at the Commission for Social Care Inspection in August 2006 that questionnaires have been sent out to the residents and a meeting held with the relatives. A collation of the Quality Assurance results was not seen in the Service Users Guide. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 24 A suggestions and comments book is available and there are a number of thank you cards. The residents and relatives were encouraged to complete the Commission for Social Care Inspection questionnaires. At the Commission for Social Care Inspection in August 2006 the manager reported that work has commenced on new fire evacuation procedures. These were not checked during this visit. The fire safety officer has not visited Allendale House. A random selection of the maintenance records were checked during this inspection and found to be satisfactory. For example, servicing of the hoists and legionella checks. However a number of Health and Safety concerns were raised during this inspection, including unsafe areas of the environment, deficiencies in staff recruitment and training in safe working practices, indicating that management practices require further strengthening. The Registered Person is required to produce an improvement plan setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided. Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 3 1 2 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 2 X 3 X X X X 1 Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 1 (d) Requirement The most recent Commission for Social Care Inspection report must be available to the residents. Original timescale 28/12/06 2 OP7 15 A care plan and risk assessments 28/02/07 must be developed for all residents. Original timescale 28/12/06 3 OP14 12, (2, 3, 4) 16 (2m, n) 13 (6) The manager and staff team must continue to explore further the whole issue of choice and flexibility for the residents and encourage more relaxed practices. The manager must ensure that systems and procedures are in place to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Original timescale 28/12/06 28/03/07 Timescale for action 28/02/07 4 OP18 28/02/07 Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 27 5 OP19 23 (2b) The ceiling in the staff and visitors’ toilet must be made safe. Immediate Requirement left 15/11/06 Original timescale 28/12/06 28/02/07 6 OP19 23 (1a, 2b, d) The Registered Person shall ensure that the premises are of sound construction and kept in good repair externally and internally. Original timescale 01/02/07 01/03/07 7 OP19 23 (2b) Rotting window frames must be repaired. Original timescale 01/02/07 01/03/07 8 OP21 23 (2j) 13 (4a, c) 16 (2j) The flooring in the upstairs and downstairs bathrooms must be made safe and suitable for maintaining standards of hygiene. Original timescale 01/02/07 01/03/07 9 OP21 23 (2j) Hot water must be available to the residents using the upstairs toilet. Original timescale 01/01/07 The call alarm system must be in working order. (In this instance the upstairs toilet). Original timescale 01/02/07 When the home is at full capacity, the hoist in the downstairs bathroom must be repaired. Broken bedroom furniture must be replaced. DS0000004907.V316699.R01.S.doc 01/03/07 10 OP22 12 (1a, b) 01/03/07 11 OP22 23 (2c, n) 01/03/07 12 OP24 16 (2c) 01/03/07 Allendale House Residential Care Home Version 5.2 Page 28 13 OP24 23 (2j) Original timescale 01/02/07 The tap in bedroom 1 must be repaired. Original timescale 28/12/06 The door lock on bedroom 1 must be repaired Original timescale 28/12/06 Heating must be provided in the upstairs toilet. Original timescale 01/02/07 Suitable lighting must be available in all parts of the care home used by service users. In this instance the toilet areas. The light fitting in the hall must be made safe. Original timescale 28/12/06 Action must be taken to ensure adequate ventilation and heating and eliminate damp and fungus. Original timescale 01/02/07 The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In this instance, exposed pipe work and unguarded radiators must be made safe in all areas used by service users. Original timescale 01/02/07 Adequate sluicing facilities must be provided. Original timescale 01/02/07 The registered person must ensure that suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection at the care home. This DS0000004907.V316699.R01.S.doc 28/02/07 14 OP24 12 (4a) 28/02/07 15 OP25 23 (2p) 01/03/07 16 OP25 23 (2p, 2b) 13 (4a, c) 28/02/07 17 OP25 23 (2p, d, 5) 13 (4a, c) 23 (2p), 13 (4a, c) 01/03/07 18 OP25 01/03/07 19 OP25 23 (2k) 01/03/07 20 OP26 13 (3) 16 (2k) 28/02/07 Allendale House Residential Care Home Version 5.2 Page 29 includes laundry procedures, sluice procedures and staff training. 21 OP27 18 (1a) Original timescale 28/12/06 The registered person must ensure that all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and safety and welfare of the service users. The manager must undertake a review of the staffing levels. Original timescale 28/12/06 22 OP29 19 (1b) Schedule 2 The registered person must not employ a person to work at the care home unless the information and documentation specified in paragraphs 1 to 7 of Schedule 2 is first obtained. Original timescale 28/12/06 Staff training must be provided appropriate to the role and at the required frequencies. Previous Requirement 01/06/06 Original timescale 01/02/07 24 OP31 21A The Registered Person shall produce an improvement plan setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided. Original timescale 31/12/06 25 OP38 23(4a, b,c),13 (4)12(1a) The registered manager must ensure so far as is reasonably practicable the health, safety DS0000004907.V316699.R01.S.doc 28/02/07 28/02/07 23 OP30 18 (1c-i) 01/03/07 28/02/07 28/02/07 Allendale House Residential Care Home Version 5.2 Page 30 and welfare of service users and staff. Previous Requirement 01/06/06 Original timescale 28/12/06 26 OP38 23 (4a, c) The registered person must ensure that any trip hazards are identified and made safe. In this instance the tape on carpet joins, particularly in doorways. Original timescale 28/12/06 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations It is strongly recommended that each food item be liquified separately in order that it be appealing in terms of presentation, texture, flavour so that appetite and therefore nutrition is maintained. It is recommended that the manager obtain a copy of the Commission for Social Care Inspection ‘Highlight of the Day’ publication regarding food and nutrition for older people. Consideration should be given to the provision of door locks to all of the bedrooms as part of the environmental refurbishment. Consideration should be given to the use of alginate bags for soiled laundry. The registered person must make sure that all staff are aware that soiled linen must be washed at least 65 degrees Celsius. This should be included in the infection control procedure. 2 OP15 3 4 5 OP24 OP26 OP26 Allendale House Residential Care Home DS0000004907.V316699.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Stafford 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.V316699.R01.S.doc Version 5.2 Page 32 - 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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