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Inspection on 07/01/09 for Allendale House Residential Care Home

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CARE HOMES FOR OLDER PEOPLE Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR Lead Inspector Peter Dawson - Ian Henderson – Pharmacist Key Unannounced Inspection 7th January 2009 08:45 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 DS0000004907.V373664.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. DS0000004907.V373664.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 DS0000004907.V373664.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 29th July 2008 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 13 people resident at the time of this inspection, including one in hospital. 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 who is also the Registered Manager. The Service User Guide does not include the fee range for the service and people wishing to use this service and/or their supporters should contact the provider for this information. DS0000004907.V373664.R01.S.doc Version 5.2 Page 5 DS0000004907.V373664.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 0 star. This means the people who use this service experience poor quality outcomes. This service was last inspected on 29th July 2008 when a key inspection was carried out. An improvement plan was required from the service to outline the actions taken by the provider to meet the requirements of the inspection report. This is a legal requirement and was received on 22nd October 2008. Five requirements and eleven recommendations were made as a result of the last inspection. This key unannounced inspection was carried out by Peter Dawson Regulation Inspector and Ian Henderson, Pharmacist Inspector on 7th January 2009. It focussed upon monitoring compliance with the requirements made following the key inspection of 29th July. This inspection was carried out on one day from 08:45 – 19:00. There was an inspection of records relating to medication records, care plans, risk assessments, staffing files and rota’s, daily records and logs and other documentation relevant to the inspection process. All people using the service were seen and 9 spoken with together and separately in private. Two visitors were seen and spoken with. There was an inspection of the communal areas of the home and a sample of bedrooms. The Registered Manager was present for the majority of the time and other staff on duty including the Deputy Manager were also spoken with and provided helpful information for our inspection. Requirements previously made at the time of the last inspection were checked for compliance with the regulations. It became clear that requirements made in relation to medication had not been met. Notices were served under Code B of the Police and Criminal Evidence Act to inform the service that evidence would be taken in the form of copies of documentation relating to medication, as it was felt that there had been a breach of the Care Home Regulations 2001. The Manager was advised that enforcement (legal) action may be taken to ensure compliance with the Regulations. DS0000004907.V373664.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Our previous requirements about the safety aspects of the environment have been met. A new bath hoist has been purchased bringing a second assisted bathroom into use. This gives greater choice to people although there are no shower facilities available. Controls to regulate hot water temperatures have been installed in the two bathrooms in use and the hand basins in toilet and some bedroom areas. This has improved safety for people using them. Efforts have also been made to “soften” the bathroom areas which look more homely, they were previously bare and unappealing. Some areas have been redecorated and improvements made to damaged and peeling wallpaper in other areas of the home. This improves the general presentation of the home. An uneven floor in the rear corridor area that people have access to has been made even and no longer presents a potential trip hazard. Training of staff has continued with updates for all basic training required in the home. This will ensure staff have the skills and training to meet peoples needs. Staff recruitment procedures evidenced that the improved procedures had been maintained and ensure continued protection for people using the service. The Registered Manager was unavoidably absent from the home at the time of the last inspection and this together with staff shortages at that time put DS0000004907.V373664.R01.S.doc Version 5.2 Page 8 considerable pressure on the Deputy Manager and other staff. The Manager has now returned to her usual duties and management of the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can DS0000004907.V373664.R01.S.doc Version 5.2 Page 9 be made available in other formats on request. DS0000004907.V373664.R01.S.doc Version 5.2 Page 10 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 DS0000004907.V373664.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 – 6 were inspected on this visit. 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. Full assessments would also ensure that the service is suitable for them and that their needs can be met. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose and Service Users Guide, both available in the reception area of the home for people using the service and visitors. The information in the Statement of Purpose gives all the required information. A recommendation of the last report to include the range of weekly fees DS0000004907.V373664.R01.S.doc Version 5.2 Page 12 charged by the home in the Service Users Guide has not been acted upon. It is important that people are aware of the costs involved when considering the suitability of the service. The recommendation is repeated in this report. Needs are assessed prior to admission to ensure that all needs can be met. Two records of people recently admitted were seen. Both had an assessment by the home prior to admission. One person’s assessment had been completed on the day of their admission to the home due to hospital pressure for discharge. Although there had been discussions with the social worker, the multi-agency assessment was not provided to the home until 10 days after admission. The home must ensure that assessments are received prior to admission to ensure that all defined and assessed needs can be met and the service can provide the care the person needs. It is the homes preferred option that all people wishing to move into the service should spend time in the home prior to making a decision about its suitability for them. This is not always possible for the reasons stated above, but relatives are always involved in pre-admission discussions and procedures. This home does not provide intermediate care. DS0000004907.V373664.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10 were inspected on this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. People using the service cannot be sure that their support and healthcare needs will be met. The poor management of medication potentially places people at risk. EVIDENCE: We looked at 2 care plans in detail and others were used for reference. We found that recording in care plans is patchy and there are some shortfalls in information about healthcare issues. Neither of the 2 care plans seen had completed social histories. This disadvantages staff in knowing important details about the persons past life, DS0000004907.V373664.R01.S.doc Version 5.2 Page 14 interests, hobbies, family and lifestyle. Some diagnosed and current medical conditions were not clear/not recorded. After reading the care plan and information for one person the final page stated she had dementia, this was not known or clear and not recorded in the care plan. In the other instance the final comments stated the person had dementia and sometimes suffers hallucinations. This information again was not included in the assessments or the care plans. Reviews of care plans were listed monthly but signed only once by one member of staff, in fact the last date for review was 3 weeks following this inspection. The Manager said that reviews had taken place on the recorded dates but this was not corroborated. It was recorded in a care plan that a person had 2 hearing aids. Daily notes recorded 3 months previously “hearing aid missing- refer to Audiology”. There was no record of a referral to an Audiologist or subsequent mention of the missing aid. The person was wearing only 1 hearing aid when seen in the lounge during the inspection. There was evidence of other healthcare needs not being met. Records are conflicting, with little evidence that action is taken as a result of staff making entries expressing their concerns. In one instance there were days worth of entries and no action taken resulting in a person becoming very distressed and uncomfortable. It was clear that there had been a change in the person’s behaviour in the preceding few days but referral to the GP had been slow. We also saw an example where a person’s discomfort and various methods of alleviation were recorded over a period of days. When checked with the medication records neither of the creams were prescribed nor recorded. Staff later confirmed the unlabelled creams were in the person’s bedroom and their origin not known, their application was not authorised or recorded and did not constitute part of the care plan for this person. The quality of daily reporting by staff is poor. There were repetitive entries seen stating “no problems to report” or “no problems for x this a.m.” This was brought to the attention of the Manager who agreed recording was inadequate and said that training in recording in care plans had been arranged for staff in the past but there had been little improvement. In relation to the 2 care plans seen one did not have a weight recorded since admission 6 months ago, the other had been weighed monthly, although there were no entries for August or December 2008. A discrepancy was noted in the monthly recording of weights in October and November – there had been a loss of 10lbs (for a person 7 stones in weight). Staff stated that there had been no obvious physical change and that it may have been an inaccurate recording. The Manager agreed this should have been further DS0000004907.V373664.R01.S.doc Version 5.2 Page 15 checked/pursued. She stated that she would like to purchase sit-on scales for this purpose. Recording of information in care plans must be improved and clearly state the healthcare needs of each person. Any concerns must be immediately actioned. A system must be established to monitor entries in records stating, “Please observe and report”. The quality of recording in daily notes is inadequate and must also be improved. This will ensure that people have the necessary support and healthcare they need. The pharmacist inspector visited the home on the 7th January 2009 as part of the key inspection to see what progress had been made in meeting the requirements made at the previous key inspection. We found that the home is still failing to record the receipt of all medication received into the home. We found that medication that had been carried over from previous months is still not being accounted for in the records and therefore as a consequence the home does not know whether this medication is being used appropriately. We found a number of problems with the administration records. We found that one person had had their prednisolone dose increased for a period of three days. This person was already on a smaller dose of prednisolone on a daily basis and the staff were using a combination of the regular tablets and the new tablets to make up the increased dosage requirements. We found that the staff had not done this correctly and had failed to give five of the required tablets over the three-day period. We also found that a person had been prescribed an antibiotic over a five-day period and one antibiotic capsule was to be given on a daily basis. We found that five capsules had been received and the antibiotic had been given for three days. We therefore expected to find two capsule remaining in the box but we only found one capsule. The deputy manager said that normally this particular antibiotic was given by the home in the morning but this supply had to be given at teatime and this change could have meant that one of the staff had given a dose in the morning and another member of staff had given one at teatime as well. We found evidence where members of staff had signed the MAR charts but had not administered the medication. A person had been prescribed some “water tablets” of which one tablet was to be give each morning. We found that the administration record showed that eight tablets had been administered but the audit showed that only seven had in fact been administered. We also found that 12 Potassium effervescent tablets had been received into the home but 14 tablets had been administered. We found medication had not been administered and a generic abbreviation had been used. The lack of defining of these abbreviations meant that the reason for the non-administration was not evident. We also found confusion between the staff as to whether a blood DS0000004907.V373664.R01.S.doc Version 5.2 Page 16 pressure tablet was being administered since the start of some new heart tablets. We found that the home is failing to make records of the quantities of medicines leaving and returning to the home when people were away from the home on social leave. Therefore the home is not able to effectively monitor that medicines have been taken properly whilst away from the home. We don’t expect that the home has control over what medicines are taken whilst away from the home but we do expect that they are aware and in a position to manage the consequences for the person on their return to the home. We found that a number of people who use the service had been administered an influenza injection but there was no documented evidence that these people were given the choice and had given their consent to the procedure. As a result of the errors in the administration of medicines seen during the inspection we established that the staff are not fully competent to administer medication safely to the people using the service. We also found that the medication administration training assessments that had been carried out on the staff are not rigorous enough to ensure that the administration of medication to people who use the service is carried out in a safe and effective way. We found that medicines are still being stored in the same place as at the previous inspection. This area is a small cupboard that also houses the electricity meter and it was again found to be in a poor state of repair. The shelves were still dirty and on the whole not a good environment to store medicines that are going to be consumed. The temperature in this cupboard was recorded at 26°C, which meant that medicines were still not being stored at the correct temperature, as medicines should not be stored above 25°C. We found that the home had obtained a fridge to store medicines that require cold storage conditions and were not using the kitchen fridge anymore. We found that the home was not using a maximum and minimum thermometer to monitor the fridge temperature on a daily basis and as a consequence the home was not able to ensure that the medicines being stored in the fridge were being maintained at between 2 and 8 degrees centigrade. In summary the medicines management systems within the home were still poor and as a result evidence was photocopied and removed from the home under Code B practices set out in the Police and Criminal Evidence (PACE) Act 1984. We believe that the current medication practices are unsafe and put people using the service at risk, therefore we are taking enforcement action against the home. DS0000004907.V373664.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15 were inspected on this visit. People using the service can be confident of choices in routines and food. Continued improvement in activity choice will further enhance quality of life. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation of the last report was made to: Provide more varied opportunities for people to be involved in activities and maintain accurate records of these. There was evidence that some improvements have been made in extending activities but not in recording them. Several people in the lounge area were asked about their involvement in activities and responses included, “There is not enough to do.” When asked what they did all day someone said, “We just sit here all day.” One person said that she used to do embroidery and knitting in a previous home but does not do anything here, she also likes to play bingo and this does not happen. Records of activities for individuals are kept and the record seen in relation to DS0000004907.V373664.R01.S.doc Version 5.2 Page 18 this lady showed that in the past month she had been involved with bingo sessions, had manicures, talked to staff regularly (recorded), been involved in exercise to music and been to the pantomime at the theatre. Most of these activities had been recorded. Additionally an organist had visited twice during the month to entertain the group and also a ventriloquist provided entertainment. There were no social histories completed in the 2 care plans seen. These would provide a basis of knowledge of past interest, hobbies and life experiences and would inform a foundation for individual activity programmes. In one care plan it was stated, “has always been a busy lady, lots of interests and hobbies” – none were recorded. Her activity records showed only minimal involvement, although it became clear that she had been involved in activities not recorded. She likes to paint and she and staff evidenced that she had been involved in painting sessions. She had also been involved in external visits arranged by the home. There was evidence of chosen lifestyles being accommodated. A man spoken with has two main interests/passions - music and cricket. He has an extensive collection of CD music, was listening to his portable CD player in the lounge during the morning of the inspection and as usual, returned to his bedroom in the afternoon to listed to his music and spend some time alone as he wished. In the summer he listens to the cricket commentaries and spends all the time he can outside in the pleasant private patio/garden area. He confirmed he is happy at Allendale House and said, “I am able to do the things that I want to do and follow my interests”. Staff have commenced a photograph album recording the events and activities that people are involved in. Efforts have been made to improve and extend activities, although these are not always evidenced. During our inspection several people responded very positively to approaches and some made approaches themselves, clearly seeking engagement. Staff are expected to promote activities as part of their role. The Manager said that staff had complained of insufficient time to engage in activities, but there was usually time in the quieter period in midafternoon. – There are basically 2 carers on duty throughout the day and sometimes a manager during weekdays. At weekends there are mainly only 2 carers without a manager present. The two carers on duty throughout the day of the inspection were seen to be consistently very busy with little time to spend sitting and engaging with individuals. All people spoken with said that food provision was good. They had varied meals with choices and could request alternatives if they wished. People said that the quantity and quality of food was good. DS0000004907.V373664.R01.S.doc Version 5.2 Page 19 DS0000004907.V373664.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 – 18 were inspected on this visit. People can be sure that staff have an understanding of safeguarding procedures and that steps would be taken to protect them. They are further reassured by the robust complaints procedures, which are in place and feel they would be listened to. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is available in the home for people using the service and visitors. It is concise and contains all the necessary information if someone wishes to make a complaint. Although not seen, the manager said that there was a copy of the procedure in all bedrooms. Two people were asked what they would do if they were dissatisfied with anything in the home, one said, “I would speak to Marcia or Alison,” (Manager or Deputy), the other said, “I would speak to my daughter first who would deal with it for me”. No complaints have been received by the home in the past year and none received by us. DS0000004907.V373664.R01.S.doc Version 5.2 Page 21 When asked if staff spoke to them correctly and with respect people said, “The staff are marvellous, they never run out of patience even with people who continually ask the same questions”. Records showed that all staff have received training in Safeguarding. One member of staff spoken with had a clear understanding of the forms of abuse and the procedures to be followed in the event of actual or suspected abuse. Two visitors seen said that they were entirely happy with their relative’s care who has been at Allendale House for 7 years. When asked, they said they had never had reason to complain, but were aware of the procedures and felt able to raise any areas of concern with the manager or staff if that became necessary. DS0000004907.V373664.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 – 26 were inspected on this visit. People who use the service now benefit from an improved environment and equipment that ensures their safety. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made at the last inspection stating that the environment must be maintained to a good standard and equipment in good working order. This related to some areas of decoration and furniture and in particular that only one of the three bathrooms had assisted facilities that were operational. DS0000004907.V373664.R01.S.doc Version 5.2 Page 23 The two bathrooms on the ground floor are now both fully operational including the bath hoists. Only one bath hoist was operational, but a new hoist has been purchased and fitted to the other bathroom. Also hot water controls have now been fitted to each of the two bathrooms and two adjoining bedrooms and a toilet area. Both bathrooms have wash hand basin and toilet and radiator covers to ensure safety. Efforts have been made since the last inspection to “soften” the bathroom areas has improved presentation. New soap dispensers have been fitted in the bathroom and toilet areas, they already have paper towel dispensers. The decision was made to make the 2 ground- floor bathrooms fully operational with assisted facilities and not to use the first floor bathing facility. The hoist has not been removed from there but the room is used only as a toilet. There are now adequate bathing facilities in the 2 ground floor bathrooms, although there are is no shower. Hot water temperatures continue to be checked regularly. Some excessive temperatures were identified at the last inspection. A sample of hot water outlets were tested during this inspection and the wash hand basin in the first floor bathroom had a temperature exceeding the required 43C. The temperature must be reduced to ensure the safety of the 2 people reportedly using this area as a toilet only. We inspected all communal areas and the majority of bedrooms. There has been some redecoration and where identified decoration has been made good, closing gaps in wallpaper etc. Generally the presentation of the home was satisfactory. All bedrooms were re-carpeted and most decorated in June 2007. Some bedroom and other furniture is dated, but in reasonable condition and satisfactory. Bedrooms are comfortable and generally well personalised, reflecting the individuality of the person. There are presently 2 shared bedrooms, one has had new privacy curtains fitted and the previous hospital-type portable screen removed. The other shared room has a privacy curtain fitted. All bedroom doors now have name plates and some bedroom doors are now lockable with keys if people wish to lock them. Six new self-closing devices have been fitted to bedrooms doors and smoke-seals added/replaced. Additionally 3 automatic self-closing devices have been fitted to bedrooms where people prefer to leave their bedroom door open whilst in use. Also 5 new fire-evacuation hammocks have been supplied in first floor bedrooms to increase speed and safety of evacuation in the event of fire. The kitchen is spacious, if dated, but presentation has been improved with the fitting of new doors to the units. Loose tiles have been refitted and a new fridge purchased. In the dining room the area around the bay window was cool, this was because the handles/locks to the two top-opening windows in the double glazed units were missing. It was not possible to close these windows fully - creating DS0000004907.V373664.R01.S.doc Version 5.2 Page 24 draughts were people sit for meals. It is recommended that this is remedied swiftly to reduced draughts for the remainder of the winter. An uneven area of flooring in the rear corridor referred to in the last report has been levelled. There is an area beneath the carpet housing an inspection cover, the cement had perished and has now been replaced. This area is now safe. The standards of cleanliness and hygiene throughout the home are good. A recommendation was made at the last inspection to keep us informed of the progress of the plans for an extension and development of the home. Evidence of this was returned with the improvement plan and the Manager confirmed during this inspection that planning permission was being finalised this week by the Local Authority in relation to the application for planning consent to build an extension to the home that would virtually double in size. DS0000004907.V373664.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 – 30 were inspected on this visit. People using the service can be sure that staff have received basic training to ensure they have the skills to meet care needs. They must also be confident that staff are provided in sufficient numbers to meet their needs. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made at the last inspection that staff should not work excessively long hours or continuous days (7) without a break. – At that time the Registered Manager was required to be away from the home for a long period due to urgent commitments. This meant that the Deputy Manager had taken over the day-to-day management of the home and together with staffing shortages at that time, meant that she was working continuously long periods without a break. This has now changed, the Manager has been able to return to her normal former duties and staff recruitment has improved the shortages. DS0000004907.V373664.R01.S.doc Version 5.2 Page 26 There were 13 people using the service at the time of this inspection including one recently admitted to hospital. The home operates with 2 carers on duty throughout the daytime and the Manager works generally 5 days additionally. The Deputy Manager is generally on duty as one of the 2 care staff on duty. At weekends there are generally 2 staff on duty throughout each of the two days. The demands of care during this inspection demonstrated that staff were continuously busy throughout the day. In fact when the Manager had to leave at teatime it was not feasible for us to spend any time with the Deputy Manager who was on duty with another carer. The demands of care, visitors, telephone; dealing with enquiries meant that at times one person was caring for the whole group. When asked the Manager felt that staffing numbers were adequate. It is important that the minimum staffing levels are constantly reviewed in the light of changing levels of need and dependency. Two staff files were inspected and both contained all required information indicating that recruitment practices were good and the protection of people paramount. Police checks, references and all other required information and checks had been carried out prior to employment of staff. A check of staff training indicated that all required training has taken place, although it was not possible to quantify the number of staff who have undertaken, or are involved in NVQ training. Supervision of staff was not taking place at the time of the last inspection due to the absence of the Manager. Evidence showed on this visit that supervision had been resumed and was ongoing. DS0000004907.V373664.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 – 33 & 36 – 38 were inspected on this visit Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in the management of healthcare and medication would ensure the safety and wellbeing of people using the service. EVIDENCE: The Registered Manager is also the sole provider. She is a qualified nurse and has experience of care for older people. She has been the owner of Allendale house for the past 8 years. DS0000004907.V373664.R01.S.doc Version 5.2 Page 28 Some areas of management at the time of the last inspection were poor and required improvement. These included medication, poor maintenance of the environment and some equipment and no evidence of involvement of the Registered Manager - the Deputy working excessive hours and consequently no regular supervision of staff. Improvements have been made in some areas: Aspects of the environment and safety of equipment have been improved. The Manager was unavoidably absent but has now returned and is in day-to-day control of the home, reducing the pressure upon the Deputy and the hours she was required to work. Staff are now receiving regular 1:1 supervision. Surveys are sent to people using the service to seek their views of the standards of care provided at Allendale House. There is however no annual improvement plan to identify those areas that need and can be improved. The Management of medication has not improved since the last inspection and changes are required to ensure the safety of the medication system in the home. Additionally, on this inspection there were indications that the healthcare needs of people were not being met and that recording generally and specifically relating to healthcare needs is poor. DS0000004907.V373664.R01.S.doc Version 5.2 Page 29 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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 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 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X 3 2 2 DS0000004907.V373664.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement 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. Timescale of the 29/07/08 not met 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. Timescale of the 03/08/08 not met Staff who administer medication must be competent and their practice must ensure that residents receive their DS0000004907.V373664.R01.S.doc Timescale for action 21/02/09 2. OP9 13(2) 21/02/09 3. OP9 13(2) 21/02/09 Version 5.2 Page 31 4. OP9 13(2) 5. OP8 13(1) 6 OP25 13(4) medication safely and correctly. Timescale of the 12/08/08 not met Medication must be stored within 21/02/09 the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. Timescale of the 12/08/08 not met Adequate recording and 31/01/09 appropriate actions must be taken to ensure the health and welfare of people using the service. Hot water temperatures must 31/01/09 not exceed safe limits. This will ensure the safety of people using the service. 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. Refer to Standard OP1 OP8 OP19 OP7 OP9 Good Practice Recommendations The fee range should be included in the Service Users Guide and every person have their own copy. This will ensure all people know the cost of the service. DNAR declarations must be on the forms prescribed by the Primary Care Trust. This is the only way people can be sure their wishes are known and acted upon. It is recommended that replacement handles/locks are fitted to the dining room windows to reduce draughts and improve the comfort of people using that area. Improvements in care planning and daily records will ensure that the personal and healthcare needs of people are known and met. 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. DS0000004907.V373664.R01.S.doc Version 5.2 Page 32 6. 7. OP9 OP9 All staff administering medication should undergo regular assessments to ensure their ongoing competency to follow the home’s procedures correctly. The fridge temperatures are 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. DS0000004907.V373664.R01.S.doc Version 5.2 Page 33 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. 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