Key inspection report CARE HOMES FOR OLDER PEOPLE
Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector
Peter Dawson Additional Inspector Yvonne Allen Key Unannounced Inspection 6th July 2009 09:00
DS0000004907.V376268.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Allendale House Residential Care Home DS0000004907.V376268.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 Provider in day to day control Care Home 17 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (17), Physical disability (5) of places Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 17 Dementia (DE) 5 Physical disability (PD) 5 The maximum number of service users who can be accommodated is: 17 5 PD in bedrooms 7,8 & 9 only. 2. 3. Date of last inspection 7th January 2009 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 for up to seventeen older people. There were 11 people resident at the time of this inspection. It is also registered to care for five 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 pleasant secluded garden area. The Home is owned by Mrs Marcia Anderson who is also the Registered Manager. The weekly fees for people at Allendale House is in the range £350 - £425 further information is available in the homes Statement of Purpose.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 5 Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is now 1 Star. This means that people who use this service experience Adequate quality outcomes.
The last key inspection of this service was on 7th January 2009. There were outstanding requirements from the time of the previous inspection. As a result Code B notices under the Police and Criminal Evidence Act were served to remove evidence of non-compliance in relation to medication. Enforcement action was taken in the form of a Statutory Requirement Notice being served, meaning that if requirements were not met within a given timescale prosecution would follow. An improvement plan was requested and received from the service and two subsequent random checks by our Pharmacist established compliance with the medication requirements. The result is a safe system of medication. This unannounced key inspection was carried out by two inspectors on one day from 9 am – 5.00 pm. An Annual Quality Assurance Assessment (AQAA) was completed and returned to us prior to the inspection by the service. The AQAA is a legally required self-assessment document containing information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. The AQAA was completed in detail and gave us all the information we required. We inspected a range of records including medication records, care plans, risk assessments, staff files, daily records and logs and other documents relevant to the inspection process. We inspected the communal areas of the home and a sample of bedrooms. The inspection was carried out with the Registered Manager and the new Care Manager (Deputy). We spoke to all staff on duty and all residents were seen and the majority spoken with. We were able to speak to one person visiting a relative and we received 6 completed surveys from people using the service and relatives who returned their surveys to us confidentially. People we spoke with were complimentary about the service and spoke highly of staff; they had no complaints or concerns. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 7 What the service does well:
This is a small home accommodating up to 17 people but presently occupied by only 11. Individual relationships are therefore easily established between people using the service, visitors and staff. Being small, there is a homely feel to the home and improvements have been made to the environment to improve presentation and safety. There are 3 small interconnected lounge areas that are bright and comfortable where people can choose to sit with others and talk or sit in the quieter recessed areas where they can read without interruption. There is an attractive patio and garden area leading from the main lounge area, where there is good seating and people can sit and enjoy sun or shade in this small but very pleasant private garden area. People said that they have been using the garden area during the good weather of the early summer. Staff spoken with said that there was a good atmosphere at Allendale House, they liked working there and it is clear that individual friendly and positive relationships exist between staff and the people who live here. During the morning it was good to see a carer sitting with a person, giving her a manicure/hand care, and engaging positively with her. The person does not have any verbal communication, but she was responding very positively, laughing and clearly enjoying the individual attention and experience. What has improved since the last inspection?
Considerable improvements have been made to the medication system in the home. Records of the receipt, storage, administration and disposal of all medicines are more robust and accurate, ensuring that all medication is administered as prescribed. Information relating to medication is now kept 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 remedies medicines. This ensures that all medication is administered safety, correctly and as intended by the prescriber to meet individual health needs. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 8 Staff who administer medication have now all had training and their competence assessed to ensure people are given their medication safely and correctly. Protocols for all medication prescribed ‘when required’ have been obtained from prescribers. This gives clear instructions to staff in its use. A new drugs trolley has been purchased allowing the medication to be stored more securely and at the temperature recommended by the manufacturer. Daily audits of the medication system and records are carried out by a manager. Any shortfalls identified are addressed with further training or other action that may be needed. More bedrooms have been fitted with safety valves to control the hot water temperature in those areas. There are now only 5 bedrooms where controls are not fitted. At the time of the last inspection a new bath hoist was fitted to one of the two assisted bathrooms on the ground floor and the decision made to make the 2 ground floor bathrooms fully operational with assisted facilities and not use the first floor bathing facility. The hoist has now been removed from the first floor area, the floor made good and it is now used only as a toilet. The care planning system has been significantly improved. Most care plans have been re-written and include information from previous records as well as additional information. There are now nutritional assessments, improved moving and handling assessments, waterlow and continence assessments. Daily notes now include more detailed information about the care and support given to people. Health care needs are now well documented with diagnosed conditions and the actions required for continued support by care staff and health care professionals. These changes ensure that the personal and health care needs of people are met. There is now a daily sheet for each person to record that hearing aids, denture and glasses are in place. This will address a previous situation where these were lost or not made available to the person. New social histories in the form of “Lifestyle and Interests” are being established for all people using the service. This will aid engagement with people and provide a basis for individual activity with people. Fees are now included in the statement of purpose. This will ensure all people know the cost of the service before making a decision about using it. Replacement handles/locks have been fitted to the dining room windows as recommended. This will improve the comfort of people using the area.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 9 Many improvements have been made following requirements and recommendations of the last report. Some are complete others require further work. We will be closely monitoring progress in all areas and expect to see sustained and continuing improvements. What they could do better: If you want to know what action the person responsible for this care home is
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 10 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 11 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.V376268.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 – 5 were inspected on this visit. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission information and assessments ensure that the home will meet the individual needs of the person. EVIDENCE: A recommendation of the last report to include fees in the Statement of Purpose has been actioned. The range of weekly fees for care at Allendale House is now included in the information people will have prior to making a decision about the suitability of the home. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 13 People sponsored by Local Authorities have contracts provided by them. People who fund their own care have contracts directly with the home and a random sample seen confirmed this. People’s needs are assessed prior to moving into the home. In the sample of records seen the home had carried out an assessment prior to the person being admitted and multi-disciplinary assessments had also provided by social workers prior to admission. These documents provide a comprehensive base on which care plans are established ensuring peoples needs can be met by the home before admission. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10 were inspected on this visit. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements made in the areas of medication, care planning and health care, reassure people that their healthcare needs are met and they have the medication to sustain their health and wellbeing. EVIDENCE: This outcome area was poor at the time of the last inspection. This was because people’s health care needs had not been adequately documented or acted upon. The medication system in place was also poor needing vast improvement. Five requirements were made for improvements in relation to medication and one made to ensure healthcare needs were known and met. Improvements had not been made in relation to medication from the previous report; therefore a statutory enforcement notice was served in relation to the medication issues to ensure swift compliance.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 15 It was pleasing to find on this key inspection that the requirements made had been positively addressed and there had been ultimate compliance with the regulations. Shortfalls in relation to care planning and health care information on the last inspection were: No social histories, unclear medical conditions, no regular reviews of care plans, hearing aids not actioned/replaced when lost, slow referrals to health care professionals, poor quality of daily recording and people not being weighed regularly. We were able to follow up the specific shortfalls mentioned by re-examining those care plans again and by observation and other records. The new care manager, who has been at the home since March 2009, has introduced a new system of care planning providing more detailed information. This has included nutritional assessments, moving and handling and waterlow assessments, a new daily notes record to include more than one line statements as seen previously. The majority of care plans have been rewritten the remainder are in process. We found that social histories had now been completed. A new document called “Lifestyle and Interests” has been introduced for all existing and new people to the service, giving a comprehensive social history. Diagnosed medical conditions were present in the records seen. There were regular monthly reviews by the Registered or Care Manager giving a resume of the month rather than brief comments and providing more detailed and pertinent summaries. The hearing aids not previously referred to audiology now have been and replacements obtained. There is now a daily record for each person, where care staff record daily that hearing aids, dentures, glasses required are present. There is now a health care record showing chronological visits by health care professionals with outcomes. The quality of daily recording has improved with more detailed notes of progress and how people have spent the day. Previous comments such as, “Please observe and report” are no longer used. Any health or personal care issues are recorded, referred to and monitored by managers. Records showed that people are now weighed more regularly, although there is doubt about the reliability of the scales. It is recommended that where there are discrepancies people should be weighed more regularly and some require weekly weighing. This was clear in relation to a record showing a person weighed 6 stones 5 lbs but two months later had lost 8lbs. This person should clearly be monitored closely and weighed weekly. There is in fact one person who has to be weighed daily to monitor her medical condition and any variation within a narrow band reported to the District Nurse. This had been carried out daily and records were clear and within the prescribed weight bands.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 16 Care plans that had not been signed at the time of the previous inspection were seen again. Plans had been re-written on the new more comprehensive format and were signed by the person or relative. In addition to the care plans reviewed from the last inspection, two further care plans were inspected. There is no one with pressure damage at this time, although a ‘reddened’ sacral area had been referred to the District Nurse and there were clear instructions for application of daily cream and also daily bed rest. A pro-pad mattress has been provided to maintain good skin integrity. A person with specific medical conditions requiring Warfarin has attended previous daily and now weekly clinics to monitor her condition and the levels of medication required. The records gave clear instructions to staff in administering the medication and monitoring her condition, supported by the district nursing team. Instructions to elevate her legs were given and confirmed when seen in the lounge with her legs supported. This person does not have verbal communication but the care plan addressed this and she can clearly make her wishes known to staff. Many likes/dislikes and choices were also recorded in the care plan. It was pleasing to see that charts had been established for each person to record daily food and fluid intake for people. The daily intake for some people was recorded on occasions below 800mls per day (minimum 1500mls) and the daily charts had not been totalled. It is important to do this to ensure good hydration for those people who have deficiencies in this area. In relation to a person there was a maximum fluid limit of 2 litres per day – although the limit had not been exceeded daily totals would give instant assessment. Changes were summarised by the service in the AQAA that stated, “ To improve health and personal care a great deal of hours have been spent developing the care plans with combined information received from the Social Work care plans received prior to admission.” Although there has been a vast improvement in the quality and quantity of the daily notes – in contrast the night recording was poor. This consisted of one line entries in a book with comments such as, “Slept well”. More detailed notes should give more information and evaluation of night care and would complement the improved recording of daily notes. The serious shortfalls in medication identified at the last 2 inspections were: • Incorrect and poor recording on MAR (Medication Administration Record) sheets.
DS0000004907.V376268.R01.S.doc Version 5.2 Page 17 Allendale House Residential Care Home • • • • • • Failing to record receipt of medication and unable to audit the system to ensure it had been administered appropriately. Not giving the correct medication as prescribed More rigorous competency tests required for staff administering medication. Incorrect storage of medication Not storing medication at the required temperatures. Protocols were not in place to advise staff when PRN (as required) medication should be given. Because these shortfalls were still present at the last inspection further requirements were made and enforcement action taken. This was to ensure compliance and to ensure a safe system of medication was in place to protect people using the service. All these requirements and issues have now been addressed. Our Pharmacist Inspector Ian Henderson has closely monitored improvements and carried out 2 random inspections, since the key inspection on 9/01/09 to ensure ultimate compliance. On this visit we were able to monitor that all the changes made and improvements were continuing. We again inspected the medication system and found that MAR charts had been completed correctly and accurately. A daily medication audit is now carried out by a manager and the results recorded. This monitors any omissions or errors on MAR sheets and if this occurs staff are given “counselling sessions”. A new drugs trolley has been purchased and is now kept more securely and appropriately in the office area. Temperatures for storage are recorded daily. All medication received, administered and returned to the pharmacy is accurately recorded allowing an audit of particular medication at any time. We monitored several MAR sheets together with the medication system on this visit and were satisfied that the changes put into place have been maintained and are monitored regularly. Two matters arise from this inspection of the medication practices: A person prescribed alendronic acid weekly is signed for on the day given. It is suggested a line through the other days when this is not given would avoid any confusion for staff. In relation to this medication the manager was aware that it should be taken when rising, given with a glass of tap water, the person should remain upright and breakfast or other medication given at least 30 minutes (preferably longer) after taking it. This medication should not be taken at the same time as calcium supplements but can be given later. This
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 18 person is also prescribed calcium supplements. It is suggested, to avoid any confusion, that clear instructions are confirmed by the GP and available with the MAR sheet. On two MAR sheets PRN medication was marked “NR” (Not required) and this needs to be defined in the grid at the bottom of the MAR sheet. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident of choices in routines and food. Recent extension of activities will further improve quality of life. EVIDENCE: At the time of the last inspection there had been some improvements in providing activities for people but there had no improvement in recording them. There were no social histories upon which to base individual activities. The AQAA states that this has been addressed as follows: “Care team have commenced completing individual ‘Lifestyle and Interests’ forms so that we may recreate a Life Story Book for each service user that will include family life, working life, photographs etc. This will be good for all staff, particularly new care staff, giving them insight into ‘the person they can see’. Also a reminiscence tool for service users with memory loss/dementia or other cognitive impairment”
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 20 This work has commenced and contains some good detailed, important and relevant information as a basis for staff to engage with people and also provides a basis for individual activities for people. A new person has recently been appointed as a carer and to lead on activities in the home. She has previous experience and holds certificates in providing activities. She provides activities sometimes in the mornings from 10 – 2 when she is sometimes counted as one of the carers, but leads on activities in the afternoon from 2- 4 pm. This is a recent appointment but has made a difference to the range of activities provided. There has been a trip to Trentham Gardens and Newcastle and the range of internal activities is increasing. There is an activity folder recording individual activities. Additionally external entertainment and activity is arranged. On the day of this inspection a person provided gentle exercise in the lounge that most people enjoyed. Two other people were in the quiet area snoozing, one had fallen asleep reading a newspaper, both are avid readers and there were lots of books around them. Improvements have been made in this area and we hope this continues. A visitor was spoken with whose mother has been at Allendale House for 3 years he said: “I am very happy with the care. We have noticed also that things have improved over the past few months. The new manager seems very good. They always let me know if there are any changes. They celebrate things like birthdays, make cakes etc. My mum has short term memory loss and won’t join in anything, but is quite happy watching TV – her choice” Other comments received in written feedback from people using the service and their relatives included: “It is a very nice home,” “All care is very well done; I have no problem at all,” “It is always clean; I enjoy the food and activities and also enjoy chatting to the staff,” In answer to the question - What does the home do well? The reply was “everything,” In answer to the question - What could the home do better? The reply was “Nothing that I can see.” Two people answered those questions by saying, “Maybe more activities”. One person said there could be, “More variety with the menu”. We observed the mid-day meal being served. It was presented well. The menus indicated there was always a choice of dish and the menus is displayed in the dining room. The variety and choices seen in menus indicated a varied wholesome diet.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 21 Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 – 18 were inspected on this visit. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a robust complaints procedure readily available in the home and people can be sure that staff knowledge of Safeguarding procedures will protect them. EVIDENCE: There is a clear and concise complaints procedure in the home. A copy is available in the reception area for visitors’ information and we saw a copy of the procedure in bedrooms. In the 6 surveys returned to us by people using the service, all confirmed that they know how to make a complaint. The home state they have not received any complaints in the past year, although we discussed the matter of some money that was reported missing but swiftly found and resolved. We recommend that all such incidents are recorded as complaints with stated outcomes. There have been no complaints to the home or to us in the last 3 years.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 23 Staff have received training in Safeguarding Vulnerable Adults. Since the last inspection 7 staff have had training in this area. Staff spoken with confirmed they had had this training and have knowledge of the various forms of abuse and the procedures for reporting actual or suspected abuse. Staff require training in the Mental Capacity Act and in the Deprivation of Liberty Safeguards. The latter came into force in April 2009 and it is important that staff have knowledge of this and the criteria for assessing whether people have capacity. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 – 26 were inspected on this visit People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now benefit from an improved, safer environment. EVIDENCE: A requirement of the last report to ensure hot water temperatures should not exceed the safe limit of 43C has been addressed. Controls to restrict the temperature of hot water in bathrooms and some bedrooms were in place at the time of the last inspection but further controls have been fitted to other bedrooms since that inspection. There are now only 5 bedrooms not fitted with these safety controls. As a further check, manual testing of hot water outlets is carried out weekly and records confirmed this.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 25 A recommendation of the last report to fit replacement handles/locks to the dining room windows to reduce draughts has also been actioned and improves the comfort of people using that area. Several improvements to the environment have been made following requirements made in the past two years. The improvements made to the environment over the past year are summarised in the AQAA, “New windows have been fitted to the front of the house with restrictors. New floor tiles fitted in the first floor bathroom. A new bath hoist provided in a ground floor bathroom. Thermostats have been fitted in bathrooms and bedrooms. Radiator covers have been fitted and new colour coded mops and buckets provided for different areas of the home and some dining chairs replaced”. The COSHH cupboard containing hazardous materials is secure and relevant data sheets for all items used are available. The home has been visited recently by the Environmental Health and Safety Officers of the Local Authority. No requirements were made in relation to these visits. The general presentation of the home on this visit was satisfactory. Standards of cleanliness and hygiene throughout the home were good. There is a very pleasant private patio and garden area at the rear of the property where people enjoy sitting during the summer months. The area is accessed from the sliding patio doors from the lounge area allowing people to remain inside but enjoy the fresh air and view. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 – 30 were inspected on this visit People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in training should be addressed to ensure staff have all the required knowledge to meet the needs of people using the service. EVIDENCE: At the time of this unannounced inspection there were 11 people in the home. Two Carers were on duty and the Registered Manager and new Care Manager (Deputy) were also present. The usual staffing is 2 carers throughout the day and usually either or both the managers are present. At weekends there is often a third person and Managers are on call at all times to support and give advice. At night time there is one waking night carer and a senior carer sleeping in and on-call. The staffing levels are adequate for the current numbers and dependency levels of the people using the service.
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DS0000004907.V376268.R01.S.doc Version 5.2 Page 27 We spoke to 3 members of staff on duty during the inspection day and also sampled the 3 staff files including training records. Two staff members of duty in the morning had not had training in use of the hoist. One person requires use of the hoist and she was being moved with handling belts on this day. One had received moving and handling training but the use of the hoist was not covered. The other was booked to attend moving and handling training, with other staff, later in the week of the inspection. The Manager was unaware of this shortfall in the training and will ensure this is covered in the training this week. Fire safety training had been arranged the day following this inspection. Records showed that training had been provided for the staff spoken with in: Food and Hygiene, Challenging behaviours, Dementia Awareness, Adult Abuse Awareness, Infection Control, Fire Safety, First Aid. Staff had completed the Health and Social Care Induction pack. Additionally staff had also received training in: Diabetes, Wound Care and Hydration Workshop. Training is clearly ongoing and we were aware of 2 courses pre-arranged for the week of this inspection and training later in July 2009 in Dementia Awareness, Health and Safety and Food Hygiene. At the time of this inspection, 8 of the 13 care staff have completed NVQ training, the remaining 5 commenced NVQ training on 22nd June 2009. The recommended 50 of staff trained to NVQ 2 or above is met. Shortfalls in training not covered in the details above are: Staff have not had training in The Mental Capacity Act, or the Deprivation of Liberty Safeguards. This is important training for all staff and has been arranged for September 2009. The AQAA states, “We are planning Equality and Diversity Training for staff”. Staff spoken with were enthusiastic and positive about their work. One said that she feels supported; there is a good staff team and always someone on call at weekends to contact if they need to do so. Staff files showed that POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) checks had been obtained prior to employment. Other documents required under Schedule 2 were present, with the exception of written references. In two records seen there was only 1 written reference. Two written references must be obtained in all instances. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 28 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 – 38 were inspected on this visit People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the management of medication, health care and recording means that people are safe and wellbeing is being positively addressed. EVIDENCE: Some areas of management at the time of the last Key inspection were poor and required improvement, some had failed to improve from the previous inspection. Improvements were required in the receipt, storage, administration and disposal of medication and also to improve the care plans,
Allendale House Residential Care Home
DS0000004907.V376268.R01.S.doc Version 5.2 Page 29 standards of recording and actions to ensure people’s health care needs were met. Requirements were made at the last inspection and because of non-compliance in relation to medication. A Statutory Requirement Notice (legal document) was served upon the provider to improve those areas. We can report that the improvements required have been made. The medication system has been changed and improved vastly. Two subsequent visits by our Pharmacist Inspector have confirmed that all areas of medication have now improved and are to the required minimum standards we expect for safety. In relation to improving records and health care - a new Care Manager (Deputy) was appointed four months ago and has made considerable progress in those areas, in a relatively short space of time. This work continues - but the improvements are significant. This has improved assessment, recording, care planning and monitoring of health care matters for people using the service. An area of recording that needs improvement is in the recording of night time care. This is poor in contrast to the improved daily recording for each person. We shall continue to monitor the service to ensure that compliance and progress continues. The home has given us a copy of their annual development plan for 2009-10 in relation to the environmental and practice improvements for the current year. The majority of objectives have already been met and many included in this report. Supervision of staff resumed at the time of the last inspection and this has continued. Staff spoken with confirmed they have formal supervision 6 times per year. This was also seen in records. Annual quality assurance questionnaires are obtained from people using the service and the results are available in the home. Some monies are held by the home for most people. This relates mainly to small expenditure items such as hairdressing. The system was inspected. We found an envelope for each person. Many balances had been crossed out and in some cases were misleading. An envelope recorded a balance of £20 but there was £22.01 in the envelope. One envelope recorded a balance of £20 but there was nothing in the envelope, although a receipt for £18 was stuck to the side of the cabinet. Also only first names were written on the envelopes. The method of recording peoples finances should be reviewed and a more robust and clear system established for keeping and recording them.
Allendale House Residential Care Home
DS0000004907.V376268.R01.S.doc Version 5.2 Page 30 Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 2 3 3 3 Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 32 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. Standard Regulation Requirement Timescale for action 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 5 6 Refer to Standard OP7 OP8 OP8 OP16 OP30 OP35 Good Practice Recommendations Review the method of recording the night time care of people. This will ensure there is a detailed 24 hour record of care for each person. Ensure people’s weights are accurately recorded and where there are concerns about weight people should be weighed weekly. Fluid intake charts should be totalled daily so that action can be taken if there are any shortfalls. All complaints should be recorded with outcomes ensuring there is a record of action by the home. Provide training for all staff in The Mental Capacity Act and Deprivation of Liberty Standards as planned. Review the method of recording monies held for people. This will ensure a clear record for the person and provide an audit trail of their finances.
DS0000004907.V376268.R01.S.doc Version 5.2 Page 33 Allendale House Residential Care Home 7 OP38 All staff must be given training in the use of the hoist. Allendale House Residential Care Home DS0000004907.V376268.R01.S.doc Version 5.2 Page 34 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.westmidlands@cqc.org.uk Web: www.cqc.org.uk
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