Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 29/07/08 for Allendale House Residential Care Home

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

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 service provides up to date information in the form of a Service User Guide and Statement of Purpose, it also has the current inspection report on display in the home. All prospective people using the service are assessed before they are admitted to the service, care plans are then developed based upon the assessed needs. Where appropriate the service liaises with social workers, health professional and relatives and supporters of each people using the service. People using the service said: "The staff are great nothing is too much trouble and I`ve been very happy here", "The food is good we can have a choice of what we want, staff always tell us what`s on the menu", "Visitors can come and go at any time." Information about how to complain is displayed in the home and the service maintains a record of any areas of concern they have been told about. People using the service said, "If I have any concerns I can go to any of the staff and I know they will sort it out for me", "I have no complaints about this home, very satisfied." The service has a committed deputy manager who has a good knowledge of the needs of the people using the service and the standards expected in residential care services. There has been little turn over of staff, which provides some stability to the home. Risk assessments have been undertaken for each individual and more generally, these have been subject to regular review.

What has improved since the last inspection?

There has been improvements in the number of staff who have received mandatory training and other training that is relevant to the needs of service users for example dementia care. An office has been created in the main area of the home, which provides dedicated office space from which staff and the deputy manager can work. This is accessible to the people using the service and ensures that all relevant information is available to those that need it. It also offers an area of privacy when needed. The kitchen has been updated and refurbished, staff sleep in`s have been introduced, radiator guards have been fitted where necessary. The lounge has been redecorated and a new sluice area has been created. Water temperatures are now recorded, and we have been told that some bedrooms have been redecorated and re carpeted. Care plans are routinely reviewed and a key worker system has been introduced, all staff are in the process of receiving new contracts. Monthly visits to the home to monitor the quality of the service are now undertaken on behalf of the provider. The fire safety officer has stated that he is satisfied with the service`s current fire prevention and safety standards.

What the care home could do better:

The service should include in the Service User Guide a record of the range of fees charged. Each person using the service should have his or her own copy. Further thought should be given to how the service involves people using the service in planning their care and how the care plans can be developed. The variety and frequency of activities provided to service should be improved. The management of medication must be improved to ensure the safety and well being of people using the service is not compromised. Equipment in the home must be maintained in good working order, and the environment generally should be better maintained throughout. Staff should receive regular 1:2:1 supervision and sufficient staff should be provided to ensure that current staff team do not work excessively long hours. The manager should demonstrate that she is in day-to-day control of the service. And if not, ensure that the person with delegated responsibility applies to be registered with us. Ensure that all staff working on nights are involved in fire drills. An annual development plan for the service should be created to evidence the on going improvements in the home.

CARE HOMES FOR OLDER PEOPLE Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector Wendy Jones Unannounced Inspection 29th July 2008 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.V369317.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.V369317.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 allendalehouse@aol.com 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.V369317.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 12th November 2007 Brief Description of the Service: Allendale House is a privately owned residential care home, located close to the villages of May Bank, Wolstanton and within close proximity to Newcastleunder-Lyme. Access to the village and main town is via a main bus route. The Home is registered to provide care to seventeen older people, although there were only ten people resident at the time of this inspection. It is also registered to care for two people with dementia care needs and five people with a physical disability. The property is a large detached Victorian house that provides spacious accommodation. There is a secluded garden area. The Home is owned by Mrs Marcia Anderson. The Service User Guide does not include the fee range for the service, prospective service users and their supporters should contact the provider for this information. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection site visit of this service undertaken on 29 August 2008 by the allocated lead inspector and a pharmacist inspector and included formal feedback to the deputy manager. In total the visit took approximately 7.30 hours. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous key inspection visit of 12/11/07 and the random inspection visit of 15/01/08 have been acted upon; looking at information the service provides for prospective people using the service, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menu’s, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The deputy manager, staff and residents were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided it’s own assessment of it’s performance in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent out to residents, relatives and any professional that has involvement in the service. We have received 2 staff surveys and one from a relative but have not received surveys from people using the service or their relatives. Because of this we spoke to at least 6 people using the service during this visit to ascertain their views of the service. Comments included: “ I have been very happy at this home, we are well cared for and the staff are lovely”, “My relatives came and visited the home before I decided to move in”, “The home was recommended to me and I have been more than satisfied”. Recent changes of our guidance means that some areas of concern previously identified and recorded as requirements cannot now be recorded as such. The report has been amended to reflect these changes. We have made five requirements and 11 recommendations as a result of this visit. We will be undertaking a management review of this service and will ask them to send an improvement plan indicating what action they have taken to address the areas of concern we have identified. A management review is a planning meeting we Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 6 hold to monitor and discuss any areas of concern and action we should be taking to ensure that the service improves. Since the key visit the provider has written to us to confirm the action she has/will be taking to put right the things we are concerned about. What the service does well: What has improved since the last inspection? There has been improvements in the number of staff who have received mandatory training and other training that is relevant to the needs of service users for example dementia care. An office has been created in the main area of the home, which provides dedicated office space from which staff and the deputy manager can work. This is accessible to the people using the service and ensures that all relevant Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 7 information is available to those that need it. It also offers an area of privacy when needed. The kitchen has been updated and refurbished, staff sleep in’s have been introduced, radiator guards have been fitted where necessary. The lounge has been redecorated and a new sluice area has been created. Water temperatures are now recorded, and we have been told that some bedrooms have been redecorated and re carpeted. Care plans are routinely reviewed and a key worker system has been introduced, all staff are in the process of receiving new contracts. Monthly visits to the home to monitor the quality of the service are now undertaken on behalf of the provider. The fire safety officer has stated that he is satisfied with the service’s current fire prevention and safety standards. What they could do better: The service should include in the Service User Guide a record of the range of fees charged. Each person using the service should have his or her own copy. Further thought should be given to how the service involves people using the service in planning their care and how the care plans can be developed. The variety and frequency of activities provided to service should be improved. The management of medication must be improved to ensure the safety and well being of people using the service is not compromised. Equipment in the home must be maintained in good working order, and the environment generally should be better maintained throughout. Staff should receive regular 1:2:1 supervision and sufficient staff should be provided to ensure that current staff team do not work excessively long hours. The manager should demonstrate that she is in day-to-day control of the service. And if not, ensure that the person with delegated responsibility applies to be registered with us. Ensure that all staff working on nights are involved in fire drills. An annual development plan for the service should be created to evidence the on going improvements in the home. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 8 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.V369317.R01.S.doc Version 5.2 Page 9 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.V369317.R01.S.doc Version 5.2 Page 10 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, 2, 3, 6. Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. People who may use the service can be sure that they will receive information about the service but need to know what they will have to pay. They are also assessed prior to deciding if the service is suitable, which means they can be confident the service can meet their needs. EVIDENCE: The deputy manager told us that the Statement of Purpose and Service User Guide have been revised since our last key and random visits. The records show that the Statement of Purpose and Service User Guide were updated in March 2008 and copies are on display in the main foyer of the home. The fees for each person are included in the individual contracts. The contracts form an integral part of the Service User Guide, as are the views of Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 11 the people using the service. We recommended that the range of fees charged by the service is also included in the guide. The deputy agreed this. The service told us that they continue to assess prospective people who may wish to use the service, prior to admission. We looked at a sample of two people’s care records and can confirm this is the case. The information available includes the services own assessment and any assessment provided by social workers. Additional assessments of risk are completed at or during the period of admission. We didn’t receive any surveys from people using the service prior to this visit, but on the day we were in the home, people said, “My relatives came and had a look around the home before we decided I should move in”, “ I knew some one who had lived here before and I decided I would like to come here”, “I’ve been happy here, I couldn’t ask for more”. A relative said, “ My family and I cannot speak highly enough of Allendale. When we began to look at a selection of residential homes for our relative, we were looking for a ‘home from home’ and we feel we have found it at Allendale.” The home does not provide intermediate care. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 12 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, 9, 10 Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. People using the service can be sure that their care and health needs are known and that they will be supported to ensure these needs are met. The poor management of medication potentially places people using the service at risk. EVIDENCE: The service told us in the AQAA that: “We meet all care needs of each resident within an individualised care plan. All needs are assessed. Appropriate outside services are involved i.e. dentists, district nurse, optician and audiology”. We looked at a sample of two care records, both have full assessments of need, including an assessment of risk, they both contain care plans, reviews of plans, daily’s records and accident records. The services own standards of monthly care plans is not always met and gaps were noted in one of the Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 13 records with the last review recorded on 25/05/08. The service should also consider further ways of involving the people using the service in the development and review of their care plans. It was not clear from the information available or from discussion with people using the service that they are. We spoke to 6 people using the service, all of whom are happy with the care, food, staff and manager, they said, “We can come and go as they please, but sometimes get bored”, “I don’t know what staff write about me, but I know they keep records.” In the sample of files we looked at, the health records show that people using the service have access to health checks on a regular basis and are supported to seek medical advice when the need arises. A relative said, “My relative is referred to a GP without delay and the attention given to her by the home is of the highest standard”. A relative said, “ I feel that Allendale is a home from home, my relatives individual needs are taken into consideration and she has not lost her individuality.” We found that the medication records were poor and could not be used to evidence that medicines were being administered as prescribed: • The quantity of medication received into the home is not being recorded. • Any medication carried over from the previous month is not being taken into account and added to the new quantities at the start of the next month. • We found gaps in the administration record and therefore it could not be confirmed whether the person concerned had received their medication. • We also found that where variable doses had been prescribed the records did not show what quantity had been given. • Also where medication had not been administered and a generic abbreviation had been used there was no definition of the abbreviation and therefore the reason for the non-administration was not evident. It was therefore not possible for the home to demonstrate that they had been administering medication as prescribed by the doctor. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about: (i) The administration of when required medication, (ii) The administration of as directed medication and, (iii) The changes made to the doctors original directions. We found that a person using the service is holding and administering part of their own medication. We found that there was no documented assessment of Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 14 the risks, to either the person themselves or to other people using the service, associated with this activity. We also found that there is no monitoring programme in place to ensure that the person using the service is administering the medication as prescribed by the doctor. We observed the lunchtime medication round and witnessed some poor practices being undertaken by the staff, which places the people who use the service at great risk. We also found that staff have been “secondary dispensing” tablets into the Monitored Dosage System. This practice is outdated and unsafe and puts people using the service at risk of receiving incorrect doses of medication. We found that the administration of non-prescribed medication or “homely remedies” is taking place without there being any documented safety assessments carried out by the residents’ doctors. In light of the issues found with the administration records and the poor practices seen during the lunchtime medication round we found that the staff were not fully competent to administer medication safely to the people using the service. We found that only one member of staff had undergone an assessment to establish whether they were able to administer medication safely and in accordance with good administration practices. In light of some of the issues identified during the inspection the assessment of the care staffs’ competency to administer medication safely must be carried out as a matter of urgency. The storage area for medicines, a small cupboard that also houses the electricity meter, is in a poor state of repair. The shelves are dirty and on the whole are not a good environment to store medicines that are going to be consumed. The temperature in this cupboard was recorded at 28°C, which means that medicines are not being stored at the correct temperature, as medicines should not be stored above 25°C. Concerns were raised about the security of the medicines within this cupboard because on arrival the keys to the cupboard door were in the lock and the door was unlocked. When asked about this the member of staff locked the cupboard door and then placed the keys in a basket, which is located in the kitchen annex. These practices could lead to unauthorised persons being able to access the medication. The fridge in which medication is stored is located in the kitchen and the cook was measuring the temperature of the fridge using an ambient thermometer. This means that the maximum and minimum temperatures of the fridge are not being recorded on a daily basis and therefore the home cannot guarantee that the medication in the fridge has been stored at the correct temperature. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they are afforded choices in routines and menu’s but the availability of activities in the home remains limited. EVIDENCE: The service told us in the AQAA that, “Residents enjoy a lifestyle that gives them the opportunity to practice their religion, cultural and social needs. All are taken into consideration. We arrange Communion for those who wish to take part 4-6 weeks. Activities and celebrate events throughout the year, i.e. birthday, Easter, entertainments and outings. Outside entertainers visit the home. Open visits from families and friends. Residents have the right to be involved. Choice of menus for meals.” People using the service said, “I occupy myself and have made friends since I’ve been here, so we chat among ourselves and watch the TV”, “ We don’t have a lot to do and it can be a bit boring at times, but the staff do try, and I Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 16 think they are arranging a trip out soon”, “I like living here, but they could do a bit more to stop us getting really bored, it’s the same thing day after day.” A relative said, “The home encourages individual interests, nothing is too much trouble, staff go beyond the call of duty to ensure residents are happy.” Information available in the home shows that staff are recording the activities that are offered to residents, and a notice board shows that a day trip is being organised later in the summer. The records of activities that have taken place in July show that the hairdresser has visited on four occasions, one music and movement session has taken place, a manicure session has taken place, tea on the patio had been arranged for one evening, one “question time” session had been held, and one other activity session organised. We saw that the notice board in the main entrance of the home contains many letters and cards from relatives complimenting and thanking the service for the care they have provided to residents past and present. Staff said, “We need more time to get residents involved in activities, we don’t have a lot of time to talk to them really.” The deputy manager stated that she was trying to introduce relative/resident meetings, one had been arranged but attendance was poor, she hopes to try again and generate a little more interest. She also said that surveys have been sent out to relatives and residents, she has received a number of responses and will be analysing the information to help develop the service. Records show that there is a choice of meal at every mealtime. The deputy manager said that some improvements have been made since our last inspection; fresh bread and milk are now delivered regularly. The cook asks the people using the service what they want to eat from the choices available to them. We observed the evening meal being served. The service traditionally serves sandwiches with a choice of fillings; we saw that this was accompanied by mixed salad, beetroot, coleslaw and pork pie. We also saw evidence that people using the service can have a hot alternative if they want to. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 17 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 (good). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that staff understand about safeguarding and know what to do if they suspect abuse, this should give them the confidence that they will be protected and any concerns they have looked into and dealt with. EVIDENCE: The service told us in the AQAA, that, “We put a copy of the complaints procedure in every room, and we have a grumbles book. We have also ensured that staff have received training in recognising and reporting abuse since the last inspection visit”. People using the service said, “I have not got any complaints about the home if I did I would speak to the staff or the manager”, “I know I could go to the staff if I needed to, the new manager is very good”. We saw notes and letters of thank from families of current and ex service users on display. A relative said, “I cannot fault the care and attention my relative receives.” A member of staff said she had been on annual leave when the abuse training had taken place, but she was able to give an account of what constitutes abuse Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 18 and what she needs to do about it. The deputy manager is aware of the need to provide additional training sessions and updates when they become necessary. A complaints procedure is on display in the home and is available in the Service User Guide. We discussed the need to update it with the deputy manager. We have not received any formal complaints about this service. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 19 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, 21, 24, 25, 26 Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure they live in a warm and clean environment, but cannot be confident that the home is well maintained or equipment is in a good state of repair. This potentially places them at risk. EVIDENCE: The service told us in the AQAA, that, “Residents have a safe well maintained environment. The environment has improved in some areas including repairs in bathrooms where needed and the kitchen has been refurbished, and we plan to redecorate outstanding rooms, fit new carpets and put locks on remaining bedroom doors.” Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 20 We checked compliance to our previous concerns about the environment and saw that risk assessments have now been completed and regular checks are carried out. These include recording hot water temperatures, but we saw from the records that on occasions, water temperatures have been excessive. We understood that thermostatic controls valves had been fitted to individual baths and some wash hand basins, but during this visit were informed that changing the temperature control on a boiler, controls hot water temperatures. We have referred this matter to the Local Authority Environmental Health and Safety office for their attention. We have been informed that they will visit the home to advise. During this visit we visited a number of areas in the home and saw areas that require decoration. There is evidence of damaged and peeling wallpaper in communal areas, and the bathrooms currently used are bare and unappealing. We noted an uneven area of flooring in the ground floor hallway to the rear of the property; the deputy manager stated that this had been reported to Mrs Anderson. Since the last key inspection an office has been created, this provides the deputy manager dedicated space for meetings, and ensures that all paper work and records relating to the service are now maintained on site. The service offers a large open plan lounge area, which is divided into two smaller lounges; there is a third smaller lounge and a separate dining room. A number of bedrooms have previously been used as doubles but Mrs Anderson has made a business decision to now market some of these as singles, this means the occupant has a very spacious room. The deputy manager said that in some of these rooms they have tried to create a lounge area for the occupant. We saw an example of this, but also noticed that some of the furniture is now looking old and worn. We have been told that the service has only one usable bathroom because a hoist in another bathroom cannot be used and the deputy manager said that another in the third bathroom wasn’t working properly. The provider must take action to provide suitable bathing facilities in sufficient numbers for the people using the service in the home, by ensuring that bath hoists are maintained in good working order. At previous visits we have been informed that improvements in the environment will be undertaken as part of a larger project of redevelopment and plans to extend the home. We had previously received information about this and have been given assurances. We now understand that there will be some delays and we will write to Mrs Anderson about this. Allendale House Residential Care Home DS0000004907.V369317.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, 29, 30 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that staff have received basic training and induction which ensure that they understand their needs, but need to be confident that on going training and updates are available. They must also be confident that staff are provided in sufficient numbers to provide care. EVIDENCE: The service told us in the AQAA that, “Staff have a good understanding of residents care needs. We have arranged training both internal and external, and have introduced a key worker system. We now provide 1 sleep in and 1 waking night staff, and ensure we have references obtained before employment commences”. People using the service said, “The staff are great, they are always busy, but they make sure we are looked after”. A relative said, “ Mrs Anderson has a good staff team, and runs a very happy home”. When we looked at copies of staff rotas we saw that the deputy manager is working an excessive number of hours, working 7 days a week and doing a high number of sleep in duties. We could not see evidence that the current Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 22 registered care manager Mrs Anderson is on duty from the sample of records we saw. The records show that there are usually three care workers during the early shift of 8am-2pm and then two from 2pm-10pm. Additional staff includes a cook a cook and domestic. We are concerned about the staffing arrangements and recommend a review to ensure that staff are not working excessive numbers of hours per week and that the current care staff numbers during the afternoon and evening shift are sufficient to meet the needs of the current people using the service. The deputy said that the current staff vacancies stand at 60 hours, but these have been advertised and a new senior care worker will be starting soon. Staff vacancies have occurred because two members of staff have reduced their weekly hours and one member of staff has left. Some agency hours have been used to ensure the staffing levels are maintained. We spoke to one member of staff who said, “I have been at the home for 18 months, have completed National Vocational Qualification (NVQ) at level 3, have also received training in first aid, fire training, medication, COSHH and manual handling. Training for infection control, dementia care and abuse has taken place, but I was away”. She confirmed that she had received an appraisal, and said, “Staff meetings are held approximately every three months, all staff receive a copy of the minutes of the meetings even if they are not able to attend. I have concerns about staff shortages sometimes”. We looked at the records of staff training and saw that there have been improvements in the numbers of staff who have received mandatory training. The deputy manager confirmed that training sessions for medication, abuse and dementia care have taken place as well as infection control. Most staff have received basic food hygiene and manual handling training and the deputy manager has enrolled as a manual handling assessor. Four care of the staff have completed NVQ training at level 2 or above and 4 others have enrolled to do this. We could not evidence from the records available to us that staff are receiving regular 1:2:1 supervision sessions, the deputy manager confirmed that she had not been able to complete these due to pressure of work. We looked at two staff files, both have application forms, two written references, dates of employment, POVA checks, induction and one showed a record of supervision. One did not have a current Criminal Record Bureau (CRB) check, but the deputy manager was able to evidence that this had been sent for. In a survey one member of staff confirmed that she had received an induction, and had received mandatory training. Allendale House Residential Care Home DS0000004907.V369317.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, 36, 38 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service must be sure that their health and safety is not compromised by the service’s inability to sustain planned improvement. EVIDENCE: The service told us in the AQAA that, “We provide and undertake training. Ensure that the aims and objectives of the home are met. The home is flexible in meeting the needs of residents. Health and safety of residents is maintained, promoted and protected. We need to continuously update our policies and procedures and ensure the environment is safe. We have improved in the last 12 months by, the recruitment of a deputy manager who Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 24 has enrolled on the Registered Managers Award, created office facilities, improved recruitment practices, provided more staff training”. Mrs Anderson the current registered care manager and provider was not available in the home during this visit and it was not evident from the staff rota when she had last been in the home. The deputy manager has taken over the day to day management of the home, but as yet has not applied to be registered with us. If the current registered manager intends to handover the management of the home to the deputy, this needs to be formulised and the deputy must be registered with us as the manager. Risk assessments generally have been reviewed and the deputy manager confirmed that fire safety risk assessments for individuals are now in place. We spoke to the fire safety officer prior to our visit, who confirmed that he is satisfied with the current fire safety arrangements at the home. During this visit we saw that records show that some fire safety checks are not being carried out as frequently as recommended and although there is evidence that fire drills are being carried out, some night staff haven’t been included in them. We will refer this to the fire safety officers for their action. We saw the records of monthly visits to the home that have been carried out on behalf of Mrs Anderson by a third party. These visits are designed to check and report on the conduct of the service when a provider is not in day to day control of the home. The deputy manager said she had sent out surveys to relatives and people using the service to seek their views on the quality of the service provided but has yet to analyse the feedback received. When this has been completed she will use the information provided to create a development plan for the home, which will be reviewed annually. There are a number of areas of improvement since our last key inspection, but there remain ongoing concerns. These relate to the poor management of medication and the poor maintenance of the environment and some equipment. Although the service has a registered manager there is no evidence that she has been involved with the day to day running of the home in recent months and there is concern that current staffing arrangements have resulted in the deputy manager working excessively long hours for a period of time. Staff have not received regular one to one supervisions sessions. We have been told previously that plans to improve the home are linked to the proposed extension, but we have not been informed if the plans have been accepted or are progressing. Although we recognise the importance of this in moving the service forward from a business point of view, we feel that the rights or safety of the people using the service should not be compromised because of any delays in the plans. Allendale House Residential Care Home DS0000004907.V369317.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 1 X X 2 1 3 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement Timescale for action 29/07/08 2. OP9 13(2) The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. 03/08/08 Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required”, as directed, self administered and homely remedy medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Staff who administer medication must be competent and their practice must ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range DS0000004907.V369317.R01.S.doc 3. OP9 13(2) 12/08/08 4. OP9 13(2) 12/08/08 Allendale House Residential Care Home Version 5.2 Page 27 5. OP24 23(2) recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. The environment must be maintained to a good standard and equipment in good working order. 29/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP1 OP9 OP9 Good Practice Recommendations Where possible evidence that people using the service are involved in planning and reviewing their care. The fee range should be included in the Service User Guide and every person should have their own copy. All staff administering medication should undergo regular assessments to ensure their ongoing competency to follow the home’s procedures correctly. The fridge temperatures should monitored on a daily basis using a maximum and minimum thermometer to ensure that the fridge temperature is maintained at between 2 and 8°C. The medication storage area is kept clean and well organised. A new location for the storage of medicines should be identified and the medicines relocated there. Provide more varied opportunities for the people using the service to be involved in activities and maintain accurate records of these. Staff should receive regular supervision sessions. Staff should not work excessively long hours or continuous days with out a break. The service should ensure that night staff are included in the regular fire drills that are undertaken. An annual development plan for the service should be completed. 5. 6. 7. 8. 9. 10. OP9 OP12 OP36 OP27 OP38 OP33 Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 28 11. OP19 We should be kept informed of the progress of the plans for the extension and future development of the home. Allendale House Residential Care Home DS0000004907.V369317.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V369317.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!