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Inspection on 06/02/09 for Allerton Court

Also see our care home review for Allerton Court for more information

This inspection was carried out on 6th February 2009.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Allerton Court 234 Hydes Road West Bromwich West Midlands B71 2ED     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Seel     Date: 0 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Allerton Court 234 Hydes Road West Bromwich West Midlands B71 2ED 01215885494 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sandwell Community Caring Trust care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 48 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) 48 Date of last inspection Brief description of the care home Allerton Court is a residential home registered to provide 24-hour care for a maximum of 48 people over the age of 65. Purpose built, and situated at the end of a private drive, the Home benefits from extensive grounds and ample parking facilities. Accommodation is provided over two floors, which is sub-divided into four separate Units, each with its own lounge, dining room and kitchenette. In addition to the main staircase a passenger lift provides access to the first floor. The majority of the bedrooms (36) have en-suite facilities, with ample additional bathroom and toilet provision having the necessary adaptations. Situated in the Hall Green area of West Bromwich the Home enjoys easy access to local services and public transport. The Home also provides a day centre service for 12 people which has its own large lounge, Care Homes for Older People Page 4 of 32 Brief description of the care home toilets, shower, kitchenette and conservatory. Residents of the Home are welcome to attend and join in the activities of the Centre. Allerton Court will need to be contacted to obtain level of fees charged. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One inspector undertook this fieldwork visit to the home, over nine and a half hours and the registered manager assisted us throughout. The home did not know that we were visiting on that day. There were 42 people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Care Homes for Older People Page 6 of 32 Random questionnaires were given to staff and people who live at the home in order to gain their views about the service. Thirteen people who live at the home and six staff returned the questionnaires and their comments about the service provided and are included within this report. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. A list of good practice recommendations are detailed at the end of the report for people to look at if they wish. What the care home does well: What has improved since the last inspection? Managers and providers have worked towards meeting all of previous requirements, Care Homes for Older People Page 8 of 32 which suggests that they keen to ensure that people live in a home that complies with regulations. There is a choice of meals for individuals to choose what they would like on any specific day and are able to request alternatives. Hot water temperatures in relation to wash hand basins and baths appear to be regulated more closely to the standard set by guidance at 43c. Information is now displayed with regards to advocacy services for people to read if they choose in the main reception area of Allerton Court. Care plans have now been updated and contain the details of a persons individual need together with the actions required by staff to meet these needs. What they could do better: There needs to be some consideration in relation to reviewing the statement of purpose to ensure that it clearly states whether people who are considering living there are able to spend some time at the home and what fees are charged. Daily records to be expanded so that they reflect any personal care tasks that staff support and or assist individuals with so this practice can be monitored by all. All prescribed creams and lotions must be kept in lockable facilities either in peoples bedrooms if they prefer or the medication cabinet so that individuals are protected from harm. Care plans need to be reflect that a person centred approach has been adopted. For example, the individual and or their elected representative have helped to identify their needs together with how they would prefer for these to be met. End of life care plans need to be sensitively drawn up so that individuals can be reassured that the physical, practical, emotional and psychological care they receive is based on their own preferred choices. A record should be maintained to document the daily intake of individuals fruit and vegetable portions so that these can be monitored in line with the recommended five a day guidelines to maintain a health diet. Some consideration to staff receiving refresher courses in an awareness of adult abuse would ensure that staff are knowledgeable about any changes within this subject area. Staff training in the Mental Capacity Act would be advantageous in ensuring that people are assured that any care and support received is in their best interests. In all assisted bathrooms and toilet areas there needs to be good infection control practices for staff to follow, such as, liquid soap and hand towel dispensers so that any risk to cross infection is minimised. Care Homes for Older People Page 9 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person considering living at Allerton Court will be provided with information about the home and their needs will be assessed to ensure that the home is right for them prior to moving there. Evidence: We found a comprehensive service user guide and statement of purpose. These guides provide people with a good description of what the homes environment is like and fire procedures. It also confirms that Allerton Court provides care and support to people aged over 65 years old who may have a physical and or visual disabilities and mild dementia. However, the statement of purpose does not confirm whether individuals are able to have a trial stay and or spend the day there. Also the fees are not included so people have this information prior to making their decisions to live there. The service users guide is in each persons bedroom. The documents can be made available in large print and Braille so that people with visual impairments can access Care Homes for Older People Page 12 of 32 Evidence: the information. On the statement of purpose it confirms that it was last reviewed in January 2008 with the next review due in February 2009. This shows that the registered manager is proactive in ensuring that all information provided to individuals is correct and staff are updated on the aims and objectives of the home. The certificate of registration and public liability insurance certificate are on display and a copy of the previous inspection report is displayed so that people have access to this information. We sampled one care record of a person who had recently moved into the home. We found an assessment that had been undertaken by a social worker and another by staff at the home so that the person could be reassured that their personal care and health care needs would be met when moving into the home. The home does not offer intermediate care services. People told us:- I love it. This is a nicer place, we like it here. Very happy with all staff. Everyone made me feel welcome very friendly. Staff told us:The home has a very good reputation. Visitors, GPs or district nurses always comment that this is the place they would like to live. If I had to put a member of my family into residential care, this would be my only choice. Offers good care at all times. Constant support from staff and promtes residents independence. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 who live in this home receive the health and social care support but there needs to be further emphasis on promoting person centre planning. A robust medication system is in operation which means individuals receive their right medications. Evidence: We sampled three care records and found that each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. We were told that care plans have been updated since the last inspection visit. Also in the AQAA it is confirmed, Residents have input to all areas of their lives i.e. health care socialising choice of name they prefer who gives their personal care. In the care plans there were some good instructions for staff to follow when providing personal care assistance and support to people. In particular attention to individuals disabilities so that care is individualised and risks are not overlooked. For example, because of stroke Xs right hand is closed, water will put into sink and hand will be Care Homes for Older People Page 14 of 32 Evidence: placed in warm water so that hand can be relaxed and can be washed in soapy water this will be dried making sure that fully dried in between fingers. There were some good care plans and risk assessments in place for people who were at risk of falling wandering off the units self harming and incontinence. These ensure that peoples needs are met whilst all risk identified are met appropriately such as staff using distraction methods and manual handling instructions were given so that individuals are moved safely whilst maintaining their respect and dignity. Further consideration should now be given in respect of ensuring that care plans are person centred and their involvement and or their representatives when planning how care needs are met so that choices and times are upheld. All the care plans that we looked at did have a space to enable the person living in the home and or their representative to sign but these were blank. Staff told us:- Offer care when required support given. Promote independence dignity privacy. Staff help where the residents need it. Provides independent care with meeting health and safety. On the three care records that we examined we did not find any end of life plans and or last wishes and staff confirmed that none had been recorded. We therefore urge that sensitively staff engage with individuals and or their representatives to gain their choices and wishes when this time comes so that all health and personal care is provided in line with individuals preferences. We found that individuals needs have been formally reviewed by a social worker or care coordinator with individual present and their family member together with a staff member. These detail any changes in a persons needs and or whether staff at the home are still able to meet the persons needs appropriately. For example, one care record that we sampled confirmed that Allerton Court could not meet a persons increased mental health needs. Therefore family members were now looking for a more specialised home so that the individuals needs could be met appropriately. This proactive reviewing practice ensures that peoples needs are always considered a priority so that all risks to their personal and health care are not compromised. Daily records were reviewed and these showed some of the events in a persons day how they had been sometimes including food eaten and activities participated in. Further consideration must be given to expanding daily records to reflect any personal care tasks that staff have assisted or supported with. Also what portions of fruit and vegetables a person has been offered. By undertaking this practice staff will be able to monitor a persons health and personal care so that this does not get overlooked and any difficulties can be resolved in a timely manner. Care Homes for Older People Page 15 of 32 Evidence: There were good social profiles recorded which gave staff details about peoples past lives likes dislikes and interests. This will assist staff to have meaningful conversations with people about the things important to them such as places where the person has lived relationships where they worked and hobbies or interests. There was evidence of people receiving visits from external healthcare professionals including general practitioners district nurses physiotherapists opticians and chiropodists. People told us:- I tell the cares if Im not well. Always available to help and reassure. Positively we found and were told that in the main peoples weight is recorded when they come to live at the home and on a monthly basis thereafter so that any significant weight gain or loss can be investigated to avoid underlying health difficulties going undiagnosed. The management of medication was reviewed and all of the medications audited were correct. The management of controlled medication was robust. Medication is signed in upon receipt into the home and staff accurately records how much they had received so that an efficient audit trail can be sustained. We found that creams are labelled with the date when they are opened and which part of the body these need to be applied to for staff to follow. However, we did find one persons prescribed cream in their room on show with door unlocked. We confirmed with a member of staff that all prescribed creams and or lotions must be kept in locked facilities either in the persons room or in the homes medication cabinet to protect all people living in the home from harm. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. It was positive to note that on all the care plans that we looked at individuals were given the choice on whether they preferred a male or female to assist with personal care tasks. Staff were observed to assist people in a sensitive manner we observed staff giving people choices about the food they ate and what activities they would like to join in with. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for social stimulation are promoted both within the home and community. Meals are varied and people are able to choose their preference but recording fruit and vegetable portions offered will ensure healthy and nutritional diets are maintained. Evidence: There is a dedicated activities coordinator to support people in following their interests and hobbies as they choose. We found activity opportunities, schedules of events and photographs of events that had taken place on display in each unit. We were also told that there are a range of activities on offer and some which have also taken place which include bingo, sing-a-long, safari park, Sandwell Valley, fish supper and fetes. In the AQAA it is detailed that a further improvement in relation to social stimulation for individuals would be to ensure that one to one time is set aside which means people can be supported on their own with an interest or to go out in the community. This would be a positive move for people who prefer not to join in larger group activities. On the day we visited we observed people playing bingo in the day centre area of the home. People in the community and individuals who live in Allerton Court can attend Care Homes for Older People Page 17 of 32 Evidence: the homes day centre facility which is open for fifty-two weeks of the year from 10:00 until 15:30. Other people were watching television, spending time in their rooms or chatting with other individuals and staff to pass the time of day as they chose. Two cats live at Allerton Court and throughout the day people spoke fondly of them both with the enjoyment they bring into individuals everyday lives. A hairdresser visits twice a week and people can choose to have their hair attended to or their own hairdresser can use the homes facilities if they wish. A monthly church service is held every Tuesday so that people can continue with their religious beliefs if they choose. People are able to have newspapers delivered and this means that they can continue to keep up with articles of interest to them. We spoke with two people who were celebrating their wedding anniversary and we were told that flowers had been bought for them and they had a surprise party at the home with family and friends being invited. There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. People were seen to visit throughout the day and we also observed family members and friends gathering in the home after the persons funeral for refreshments. We were told that a lot of families welcome this. People told us:- Express and Star every night. We had a surprise party. I have some nice friends. The home has a varied menu where people are able to choose what they have at each meal time. We were told that if people did not want the choices on offer then they would be provided with an alternative wherever possible. The home is able to cater for special diets for reasons of cultural or medical needs. Staff were seen asking people what they would like for their meals. The lunchtime meal was observed and the atmosphere was calm and unhurried. People were able to sit where they chose and one of the improvements noted in the AQAA is to, Have a more flexible approach re mealtimes. Be less routine more like a home! Tables were nicely presented with table mats, cutlery, condiments and flowers to provide homely touches. People told us:- Meals alright. Menus good. Food is good and if you fancy an alternative you can have it. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 are safeguarded by a robust complaints procedure where individuals are heard and action is taken to resolve any concerns and or complaints in a timely manner. Staff have received training in safeguarding. Evidence: There have been no complaints received by the home in the last twelve months. Commission for Social Care and Inspection (CSCI) have also received no complaints. The complaints procedure is included in the statement of purpose and service user guide so that people know how to make a complaint if they need to. We were told that residents meetings are going ahead and the registered manager takes an open door approach to resolving any concerns and complaints from people who live in the home and their family members. There is room for further improvements as discussed with the registered manager in ensuring a proactive approach to receiving concerns, issues and or complaints. For example, the registered manager holding weekly surgeries for people and their families to bring along any concerns and or issues on a one to one basis. Also a suggestion box could be made available to people to use if they choose. In the main people we spoke with were happy and contented with the way their needs were met at Allerton Court. People told us:- I speak to senior carer on unit. Any staff members. Staff or Care Homes for Older People Page 20 of 32 Evidence: manager. All staff listen and help me with anything or any worries I may have. The training schedule confirms that all but one member of staff have received adult protection training with the majority having been on courses in 2004. There needs to be some consideration given to whether refresher courses need to be planned so that staff know what to do in the event of an incident or allegation being made, to ensure people are safe. There is a multi-agency protection manual to guide staff through the process. We found that there is no training planned on the homes schedule in relation to the Mental Capacity Act and we would therefore urge that this is considered for staff to attend as it will ensure that peoples best interests are always considered in practice. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An ongoing programme of redecoration inside the home is not only proactive with painting but also ensures that maintenance is completed so that individuals live in an enhanced environment that meets their physical needs and is homely. Evidence: A partial tour of the home was undertaken with the registered manager, we looked at communal areas and bedrooms and bathing facilities with individuals permission. We were told that there is an ongoing redecoration programme in place and the registered manager is ensuring that homely touches remain within this programme. The atmosphere was calm, relaxed and friendly and there were no unpleasant odours. There are four units, Millfields, Moorlands, Dartmoor and Leabrook. Each unit has a lounge and dining area, which are pleasantly decorated. There have been a number of improvements to the decor of the home making it a comfortable and pleasing environment for people to live in. Corridors are wide and all units are painted with different colours. People were seen moving around the home as they chose to. There are a number of smaller seating areas throughout the home where people can choose to sit on their own or with visitors, such as conservatories with comfy seating and homely touches. Chairs had been arranged to promote social interaction as far as possible. Care Homes for Older People Page 22 of 32 Evidence: There are a number of assisted bathing facilities throughout the home, which meet the needs of the people who live there. In the AQAA it confirms that bathrooms could now be upgraded. We confirmed with the registered manager that to ensure infection control practices are upheld in these areas, liquid soap and hand towel dispensers need to be provided. Each bedroom had a knocker, name and number on it. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. One person showed us their room which had their wedding anniversary cards displayed on the walls and their own personal items for their enjoyment including photographs and teddies. People told us: Rooms are nice and roomy. Everything always clean and nice. Couldnt have a better bedroom. Always clean and pleasant. The garden area is pleasant and people are able to walk and sit in this large area as they choose with their relatives and friends. The environmental health officer has visited the homed and undertaken a recent visit to the home to review the kitchen areas and no requirements were made. This means that the home should have good hygiene procedures in relation to food handling and this will minimise the risk of any cross contamination occurring. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home praise the care and support they receive from staff but there is some room for improvement in ensuring all mandatory training is kept up to date. An audit of staff personnel files will ensure that all of the necessary documentation is at hand for inspection. Evidence: We were told that there is a stable staff team working at Allerton Court, some staff having worked at the home for many years, and in the last twelve months only two carers have left. There are four staff on duty, one being a senior carer, throughout the day period undertaking varying shift patterns and three staff on duty throughout the night on each of the four units. On each unit there are twelve people for staff to provide care and support to. The registered manager told us that agency staff are not employed by the home as they prefer to use their own relief staff when required to ensure consistency for the people living at the home. In addition to care staff the home also employs kitchen, domestic, laundry and maintenance staff to ensure that all aspects of peoples needs are met whilst living at the home. We were told that 96 of staff have completed a National Vocational Qualification (NVQ) Level 2 including kitchen and laundry staff and this is also echoed in the AQAA . This means that the staff have exceeded the recommended numbers of staff who hold Care Homes for Older People Page 24 of 32 Evidence: this qualification. The registered manager takes a proactive approach to ensuring that staff are encouraged to complete NVQ Level 3 and those who have NVQ Level 3 are being supported to complete NVQ Level 4. This should ensure that a knowledgeable and skilled workforce can meet peoples needs individually and collectively. People told us:- Staff helpful and friendly. Yes, staff very good and management. Staff do their best and always have time for me. Staff told us:- All staff work well has team members. Always kept up to date. Always doing different courses to keep updated. Team work at a high advantage. Staff were observed to interact well with the people living at the home and the atmosphere was calm, friendly and relaxed. Three staff files were reviewed and on two file we could not find a job description and on another there was no application form. We confirmed our findings with the registered manager. All staff personnel files are held at the organisations head office and on the day we visited we requested three files be brought to the home for inspection purposes. However, we did find that all of the files contained were two written references and CRB checks (Criminal Records Bureau). Training records indicated that staff have received training in areas such as dementia awareness, fire safety, moving and handling, food hygiene, adult abuse and infection control. There were some gaps in some of the mandatory training where refresher courses were now required, such as, manual handling training, health and safety and infection control. However, on the staff duty rotas we found that some staff were booked on the next manual handling courses. The registered manager now needs to ensure that the training schedule accurately reflects all of the planned training to ensure staff receive timely updates. This should ensure that staff have up to date knowledge in order to care for people living at the home. Some staff had also had training in diabetes and bereavement. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Allerton Court is lead by an effective management team who understand individuals needs and aspirations so that Allerton Court can be run with their best interests at heart. Evidence: The registered manager is Carol Cooksey, has been in this role for ten years. Mrs. Cooksey has extensive experience in relation to older people having worked in this field for sixteen years and was originally a care assistant at Allerton Court in 1993. Mrs. Cooksey holds a National Vocational Qualification NVQ Level 4 and registered Managers Award together with an Assessors Award. The registered manager works Monday to Friday is supported by an assistant manager, Sharon Ancill, who also holds the Registered Managers Award. Throughout the day we observed registered manager speaking with people who live in the home in a warm and friendly manner. From our observations the registered Care Homes for Older People Page 26 of 32 Evidence: manager had good knowledge of individuals backgrounds and needs and stated that she enjoys having a hands on approach within her role as manager. The registered manager is looking to increasing the involvement of relatives and maybe start a league of friends. This will ensure that views and suggestions from relatives would be another valuable source of gaining any improvements that are needed or what is working well for the best interests of the people living at the home. At the present time there are no relatives meetings held but the registered manager confirmed that these were due to be started so that people have the opportunity to voice their concerns and suggestions for improvement. The organisations operations manager visits the home and completes Regulation 26 visit reports which focus on the quality of service being offered at the home. The organisation has a number of audits in place to monitor the service provided and we found that when each improvement had been made a note of the date was placed next to the action taken. Also each unit undertakes separate weekly audits in respect of medications, accidents, deaths and so on. This ensures that the organisation is taking a proactive approach to ensuring that Allerton Courts practices and procedures enhances outcomes for people living in the home together with securing safeguarding measures. Health and safety and maintenance checks had been undertaken in relation to gas safety, electricity, water, and equipment used in the home to ensure it is in safe and full working order. Maintenance checks are completed on the fire system so that people should be safe in the event of a fire occurring. Staff personnel records continue to be held at the providers head office. In view of this information required by the Care Homes Regulations 2001 are not held on the premises. New guidance was issued by CSCI in November 2005 with regard to storage and retention of Criminal Record Bureau checks, (CRB), and other information required by the Care Homes Regulations 2001, Schedule 4. The provider needs to decide whether this is relevant to the organisation and make an application for a formal agreement with CSCI to retain documents at their head office. Subject to written agreement with CSCI certain documents can then be kept within a providers centralized Human Resources department. The CSCI has also devised proformas upon which providers can record the information required. Individual records are maintained for people where the home holds personal monies. Receipts were available to confirm all expenditure on the accounts. The balance of monies was found to be correct and this should ensure that peoples money is held safely. Care Homes for Older People Page 27 of 32 Evidence: Accident records were reviewed and these are audited to monitor any trends that are occurring. We found all accidents were recorded appropriately with actions taken and they complied with the data protection guidance. Also the home are proactive in reporting any incidents to peoples safety and welfare to CSCI in line with Regulation 37 so that people can be confident that there health and safety are being maintained by the homes reporting procedures. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Clear information should be included in the homess statement of purpose confirming whether people considering living there are able to spend some time at Allerton Court together with the cost of living at the home. This will ensure that people have sufficient information to be able to make informed decisions about whether the home is right for them. The home should ensure that all people living in the home and/or their representatives are consulted and involved in relation to care planning processes so that people are able to make choices in relation to how their needs are met. All prescribed creams and lotions should be kept in lockable facilities so that people are protected from harm. End of life care plans and last wishes should be sensitively focused upon with individuals and or their representative so the peoples care, physical and spiritual needs are met in a way they choose and prefer at this stage in their lives. Peoples daily activities should be fully recorded within care records on a daily basis, to include, what personal care tasks have been delivered to individuals each day so that this can be monitored and assurance is provided that peoples personal hygiene is being undertaken. Page 30 of 32 2 7 3 4 9 11 5 12 Care Homes for Older People 6 14 All staff should receive training in the Mental Capacity Act so that they are aware of their roles in supporting people with dementia and awareness of their ability to make decisions Peoples intake of fruit and vegetables should be recorded to ensure that individuals are receiving their five a day recommended amount to sustain a healthy and nutritious diet is maintained. If individuals decline fruit and vegetables that are offered to them, this should also be recorded. All staff must attend adult abuse training including refresher course so that all people living in the home can be confident that they will be protected from abuse. In all assisted bathroom and toilet areas there needs to be efficient infection control, such as, liquid soap and hand towel dispensers so that any cross infection is minimised. To obtain and hold information and documents in respect of persons carrying on, managing or working at a care home as listed in Schedule 2 and 4 of the Care Homes Regulations 2001, (or make a formal request to CSCI to retain documents at head office and obtain approval using new guidance and documentation issued in November 2005). All staff personnel files need to provide all of the necessary recruitment information so that people living in the home are safeguarded by the recruitment process. Staff training in mandatory areas needs to be undertaken in a consistent manner and where refresher courses are needed these should be done in a timely method so that staff are competent to meet peoples needs. 7 15 8 18 9 26 10 29 11 29 12 30 Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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