CARE HOMES FOR OLDER PEOPLE
Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector
Sue Jordan Announced 2 August 2005 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 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 E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Allendale House Residential Care Home Address 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR 01782 627388 Telephone number Fax number Email 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 CRH 17 Category(ies) of DE(E) - 2 registration, with number OP - 17 of places PD(E) - 5 Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 5 PD(E) in bedrooms 7,8 & 9 only Date of last inspection 18 April 2005 Brief Description of the Service: Allendale House is a private residential care home, located close to the villages of May Bank and Wolstanton. The home is also within close proximity to Newcastle-under-Lyme, a thriving market town with a wide range of shops and community resources. Access to the villages and main town is relatively straightforward as it is on a main bus route.The property is a large detached Victorian house that provides spacious and attractive accommodation. The exterior and interior are in a good state of structural repair. The home has four small lounge areas, which are well furnished and decorated. The residents are able to integrate in small groups, which avoids an institutional feel. There is also a large communal dining room that contains adequate seating and is furnished and presented along domestic lines. The bedrooms are located on the ground and first floor and three of the ground floor bedrooms have direct access to the large rear garden via sliding patio doors. The garden is well maintained and is equipped with adequate garden furniture. It is popular during the summer months and was being used at the time of the inspection.The Home is managed and owned by Mrs Marcia Anderson. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over seven and a half hours and the methodologies used were discussions with the manager, Mrs Marcia Anderson, a number of the residents and some staff on duty. A tour of the Home was undertaken and lunch was shared with the residents. The pre-inspection questionnaire completed by the manager was scrutinised, along with some staff files, care records and policies and procedures. Four comment cards were completed by residents, five by relatives and one by a general practitioner and returned to the CSCI prior to the inspection. What the service does well: What has improved since the last inspection?
Of the eighteen requirements made at the last inspection in April 2005, only five have been carried over into this report and of those action has been taken towards addressing the issues and concerns. It was noted that there has been a positive response to the requirements made and the manager and staff team have worked very hard. In particular, the most impressive improvement is in care planning and the maintenance of the residents’ records. Staffing difficulties have been resolved with the recruitment of three new members of staff and this has allowed the manager the time to catch up with her managerial responsibilities. The manager is hoping to develop the role of the senior care worker team. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 6 Staff files have been re-organised and improvements in recruitment procedures are noted for the new staff recently employed. A staff supervision and appraisal system has commenced and some of the required training courses have been planned and attended. A domestic has been employed and the standard of cleanliness in the Home has improved. The manager has sent out quality questionnaires to the residents and/or their relatives, which are presently being returned. The information gathered will be collated and included in The Service Users’ Guide. What they could do better: 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.
Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 Assessment information and care planning has improved meaning that the Home can demonstrate being able to meet the residents’ needs. EVIDENCE: The Statement of Purpose and Service Users’ Guide were checked at this visit. Both are well presented documents and were reviewed in May 2005. They required only minor additions. The Statement of Purpose must include the room sizes and admission details do not stipulate whether Allendale House accepts emergency admissions. The manager was advised to make a decision regarding emergency admissions and update The Statement of Purpose accordingly. The Service Users’ Guide needs to include the views of the residents, however the manager was able to demonstrate that questionnaires have recently been sent out and that they are in the process of being returned. She reported that a collation of the results would be added to The Service Users’ Guide. The manager has developed new contracts for the residents. These are attached to The Service Users’ Guide. These were checked and the only addition needed is the actual room to be occupied.
Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 9 There have been major improvements in the maintenance of the care records. Assessment documentation is available and the manager reported that she or the deputy manager would visit a potential resident to undertake an assessment. She is also keen to train the senior care workers to assess prospective residents in her absence. There have been no new residents admitted into Allendale House since the last inspection, therefore the completed assessment documentation will hopefully be seen at future visits. Each resident has a separate file, in which Local Authority assessments, care plans and review records were seen. The manager was advised that she is correct to ensure receiving community care plans and assessments prior to accepting a referral. At the last inspection it was not possible to judge whether Allendale House was able to meet the residents’ needs. This was due to a lack of information in the assessments and care plans. The manager and staff have worked very hard since the last inspection, completing the care plan information ensuring that the assessed needs of each individual resident are much more obvious and clear. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10 Major improvements have been made to the care planning and record keeping in the Home and where possible the residents are encouraged to sign their understanding. This information will ensure that the staff have the knowledge necessary to meet individual residents’ needs. EVIDENCE: The manager and staff of Allendale House are to be commended for their hard work since the last inspection. The employment of new staff, some at a senior level has meant that time could be given to address previous concerns regarding the maintenance of vital records. The care plan information is now almost complete and where possible the residents are signing their agreement of them. Reviews of the care plans took place in July 2005. The manager plans to initiate monthly review meetings with the senior care team and to provide more training so that they can be more involved in care planning. The manager also wants to implement a key worker system. The manager is aware that some of the risk assessment information needs to be completed. It is hoped that the recruitment of this more stable and consistent staff team will mean that the systems introduced can continue to be developed and reviewed in the way the manager wishes.
Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 11 Lunchtime medication administration was observed. Allendale House uses the cassette system provided by the pharmacist and the records are signed appropriately. Records are kept of medication coming into and going out of the Home and stock control is well managed. There is facility for the storage of controlled medication, if needed. The manager was advised to request regular audits of the medication systems by the pharmacist. Some staff have undertaken a distance learning medication course and the manager intends to obtain this training for the new staff. The manager reported that medication instruction is given during induction. It was recommended that ‘she sign them off’ as competent prior to them receiving the external training. There is a medication policy in place. However the inspector is to send the manager guidance and information regarding ‘homely’ remedies. Discussions with the residents were generally very positive and some of the comments made were, “I’m very happy here, I wouldn’t want to live anywhere else” and, “The food is good”. The residents were looking well cared for on the day of this visit. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Visitors are made welcome at Allendale House and the residents praise the quality of the food provided. Activity recording has improved, although some of the residents are still saying that they’re bored. More emphasis on providing suitable stimulation for the residents is required. EVIDENCE: The manager has introduced a new format for the recording of activities. These are individual and there is evidence that greater efforts are being made to introduce more activities. In particular, a number of entertainers come into Allendale House. Interests and hobbies are now recorded in the care plans. Although this is an improvement, two residents said that they were bored and got “fed up” because there was not enough to do. A visitor to the Home who questioned whether there was enough stimulation for the residents confirmed this. During the afternoon of this visit a musician came into Allendale House and entertained the residents by singing and playing a guitar. It was noted that residents who normally slept became more animated and appeared to really enjoy the session. It is acknowledged that previous staffing problems did not allow for the planning of activities within the Home and the manager wishes to address this. It is recommended that a member of staff be given the responsibility of co-ordinating activities. A member of staff was manicuring the residents’ fingernails and one of the residents was sitting in the pleasant garden area.
Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 13 A previous concern was also raised that the residents were not able to go into the local community due to a lack of staff. The manager is keen to address this now that she has a more settled staff team and development. Developments in these areas will be observed during future inspections. Regular visitors are seen coming into the Home and they are made welcome. One of the residents said that on Saturdays she attends a social club and that she uses a taxi. A number of the residents said that they go to visit their families. Lunch was shared with the residents and observations were made of choices being offered. A resident opting to eat her meal in the lounge was enabled to do so. Three of the residents require either prompting or actual assistance to eat their meals. In one case this was given in a sensitive and discreet manner, however the manager was asked to give guidance to a new member of staff to ensure that all assistance is given in a way that promotes dignity. The residents continue to praise the Home’s cook and a friendly rapport was observed between them. The residents call him the ‘singing chef’. Four weekly menus have now been developed, although it was noticed that a number of the residents spoken to did not know what they were having for lunch. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 There have been no complaints made regarding the Home and training is now being organised in The Protection of Vulnerable Adults. This will ensure the safety of the service users. EVIDENCE: There have no complaints made to Allendale House or The Commission for Social Care Inspection, (CSCI), in the last twelve months. The manager was advised that the policy should reflect that the CSCI can be contacted at any stage. This is correct within The Statement of Purpose and the policy on the hall wall could easily be changed accordingly. The manager was able to demonstrate that she has got a copy of The Local Authority Adult Protection Procedures and the Department of Health’s ‘No Secrets’. New training booklets regarding Adult Abuse and Protection have been introduced. The manager was advised to request the Local Authority Adult Protection team to deliver training to the staff on the local procedures to be followed. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, 25, 26 Plans have been approved for the building improvements in the Home, which when realised will ensure that the environmental requirements are addressed. This will improve the Home’s environment further and ensure the safety and comfort of the residents. EVIDENCE: The manager reported that plans have now been approved to improve the environment. This would mean that, should the manager decide to go ahead, all of the residents would have a single bedroom with en-suite facilities and the addition of two more bedrooms. The manager agreed to notify the CSCI in September 2005 with her decision. At present the bedroom door locks are not suitable and there are a number of radiators, which need covering. These issues would be addressed as part of the renovation. A tour of the environment was undertaken and the Home, including the bathrooms was much cleaner than on previous visits. There was no evidence of malodours. A domestic has been employed for twenty hours a week since May 2005 and improvements are noted.
Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 16 As previously identified the washing machine has a sluice facility, however there are no hand washing facilities for staff and alginate bags are not used. The manager should still contact the infection control nurse for advice, to ensure that the Home is complying with present standards. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staffing difficulties have been resolved with the employment of three new staff. The recruitment procedures and training facilities have improved, assuring the residents of suitable, competent staff to attend to their needs. EVIDENCE: Allendale House has suffered severe staffing difficulties, which hopefully have recently been resolved with the recruitment of three new members of staff. This has resulted in obvious improvements and will ensure a more consistent approach to the care received by the residents. The new staff have started to complete an induction pack, although the manager was reminded that senior staff need to sign them off. The manager has organised more staff training and some recent courses attended include manual handling and first aid. Individual training records are being maintained, although the manager agreed that mandatory training is not yet completely up to date. Work is continuing to address this. Two of the care staff have NVQ awards and there are four more to be registered. The manager and the deputy are undertaking NVQ 4. The Home employs one member of waking night staff and either the manager is on call or a member of staff ‘sleeps in’. In order to ensure the safety of the residents and staff the manager was asked to develop a clear emergency procedure for the night staff. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 18 The manager has worked hard to re-organise the staff files and improvements were noted in those files belonging to the new staff. The manager is now going to update those belonging to existing staff, to ensure that they contain all of the required elements. Criminal Records Bureau disclosures were available for all of the staff files checked. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36, 37, 38 Management and Administration systems in the Home have greatly improved, protecting and supporting the residents and staff. EVIDENCE: Due to recent staff increases, the manager has been able to address many of the issues and requirements previously made. It is noted that major improvements have been made to care planning, record keeping, staff recruitment procedures, staff supervision and organising training. The manager is planning to train and utilise the new senior care team and delegate some of her responsibilities. The manager, Marcia Anderson is a qualified nurse and has started the NVQ 4 in management award. Quality assurance questionnaires have been sent out and the manager intends to collate the results, which will then be included in the Service Users’ Guide.
Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 20 The new contracts indicate clearly what is and what is not included in the fees. A staff supervision system has started and records are being kept. The manager has carried out an appraisal for the one member of staff that has worked at Allendale House for one year. As mentioned previously, major improvements have been noted in the record keeping. Following a brief perusal of the Home’s policies and procedures, it was recommended that they be re-organised. It was also recommended that the manager sign and date them as evidence of annual review. Staff are asked to read the policies and procedures during their induction. The manager has organised that the overdue maintenance/safety checks and or training have been completed since the last inspection. The staff have recently received training in fire procedures, first aid, COSHH, (control of substances hazardous to health), and manual handling. The manager is waiting for the data sheets before using new products. Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3
COMPLAINTS AND PROTECTION 2 x 3 x x 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 3 3 3 3 Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 22 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. 2. 3. 4. 5. Standard 1 2 12 13 19 Regulation 4, 5 5 (1b, c) 16 (2n) 16 (2m) 23 (2b) 13 (4a,b, c) 13 (4) 23 (2p) 23 (k)(5) 16 (2j) 13 (3) 18 (1ci) Requirement Minor amendments are required to The Statement of Purpose and The Service Users Guide. Minor amendments are required to the service user contracts. Additional consideration must be given as to how the Home can provide suitable activities. Additional consideration must be given as to how the residents can access the local community. The manager must notify the CSCI regarding the future environmental plans for the Home. Radiators must be covered as part of the environmental improvements. The manager should seek the advice of the Health protection team with regard to sluice & handwashing facilities and practices in the laundry Staff training must be provided at the appropriate frequencies. Timescale for action 01/10/05 01/10/05 01/10/05 01/10/05 22/09/05 6. 7. 25 26 To be discussed (22/09/05) 01/10/05 8. 30 01/11/05 & on-going Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 9 9 Good Practice Recommendations The manager should request that the pharmacist undertake regular audits of the medication systems. It is recommended that the manager sign staff off as competent in medication administration and the correct procedures to follow, prior to them receiving external training. It is recommended that activities co-ordination in the Home be delegated to a member or team of staff. In order to ensure the safety of the residents and staff the manager should develop a clear emergency procedure for the night staff. It is recommended that the policies and procedures be reorganised and that the manager sign and date them as evidence of annual review. 3. 4. 5. 12 27 37 Allendale House Residential Care Home E51-E09 S4907 Allendale House V238024 02.08.05 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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