CARE HOMES FOR OLDER PEOPLE
Allison House Swan Lane Sandy Beds SG19 1NE Lead Inspector
Dragan Cvejic Unannounced 18 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Allison House Address Swan Lane Sandy Beds SG19 1NE 01767 682998 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Gabriel Mitchel care home 42 (24) (24) (24) (24) Category(ies) of DE(E) - Dementia over 65 registration, with number LD(E) - Learning Disability over 65 of places OP - Older People PD(E) - Physical Disability over 65 Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 02/12/04 Brief Description of the Service: Alison House was opened in 1984 by Bedfordshire County Council and transferred to Care First Bedfordshire Ltd, part of BUPA Partnership Homes in July 1998. The house is a purpose built residential home for 42 frail elderly residents including those with dementia and learning disabilities. The home offered respite care for 2 service users and permanent care for 40, based on 24 hours care. Care was provided by experienced and trained care staff. The home is a two-storey building and has two units on the upper floor and three on the ground floor. Each unit has its own lounge, dining, and kitchenette area, which are individualised to meet the needs of service users. All bedrooms are single and service users are encouraged to bring personal belongings to make their rooms as homely as possible. The home has a pay phone, hairdressing salon and a mobile library comes to the home once a week. The home has a pleasant garden with a patio area. The home is situated in a residential area in Sandy, near Bedford; and the A1 allows easy access for those travelling to the home from a far distance. A car parking facility is also available on site for both visitors and staff. The shops and bus stop are within walking distance of the home. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one weekday morning. The home continued to offer good care and constantly worked on improving services and provisions. The inspector used a case tracking methodology to inspect the service. In circumstances where there were no concerns expressed about care and the functioning of the home, only some of the key standards were inspected. The inspector talked to the management, to 8 staff, to 4 service users and checked relevant documentation for 3 service users, one being a short stay service user. The findings are presented in this report. As the home continued to work within standards and there were no significant issues that would be cause for concern, a different discussion took place about general care for people with dementia. A general philosophy of care was discussed. The outcome is presented in “What can be better” section of this report. This was included in the report to demonstrate that people involved in care are committed and determined to improve services and provisions. What the service does well:
The admission assessment was carried out using the home’s own assessment form. They assessed prospective service users fully, despite not complete information received from the Social Services, as one file showed during the inspection. Thus, the home was quite clear as to what the needs of the admitted service user were. The home worked with a service user and eliminated incontinence as a problem for this person. Family members and continence nurse were involved in the process and helped achieve this progress. The home promoted independence. They risk assessed and minimised risk for service users who wanted to go out independently, without staff. Service users were pleased to be able to go to the local shop, as they had used to before admission. The home noticed agitation and anxiety in a service user, reported and discussed the case with the consultant who changed the timing of medication. This action resulted in the service user becoming settled and stable without the need to increase his medication. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 6 Staffing issues were inspected in detail on this inspection. The recruitment process was appropriate and successful. The home employed committed staff, keen to learn and passionate about care. They were keen to gain qualifications and the NVQ programme they attended gave them the desired qualifications and knowledge for better work with service users. The staff worked in the home in shifts that took into account service users needs. So, some morning shifts had 10 staff on duty; 6 staff covered afternoons that were quiet. 7 staff on duty covered evening time, again busier. The home effectively used a quality assurance review whereby the service users comments were taken seriously and used to produce an action plan to improve services. An example was the newly organised regular meetings of service users and catering staff that users asked for. Records kept in the home were in order, updated regularly and showed that the home worked in an organised, monitored and safe way. Service users’ files were up to date and the records of money were accurate and available to service users and families at any time. The home had certificates issued by other authorities that inspected their fields of work, such as gas inspection, inspection of equipment used in the home, fire safety, water checks etc. What has improved since the last inspection?
The home started using their own assessment form that was devised recently. The form used was detailed and allowed much better assessment prior to admission. By using this form the home made sure that only service users whose needs could be met in the home were offered places. The new format of care plans was introduced in April. The format was much better, service users’ needs were recorded on page per need and goals and responsibilities were much better presented. Also, the needs recorded were carefully set and the actions to respond to the needs were appropriate and realistic. Risk assessments were revised and related to other users’ documents. An example showed how the risk of a service user, a smoker, was properly managed and, apart from achieving the goal to cut down from her care plan, the actual risk of causing fire was gradually eliminated completely and this hazard was removed from her risk assessment. In another example a risk of falls was identified and action planned to minimise it, despite the fact that initial documents obtained from previous carers did not address this hazard. The main staff rota was drawn up as a master document, but the management used it to draw up a daily rota, 2-3 days in advance and to make sure cover for all shifts was arranged on time. It also was much clearer in identifying who was working when. This arrangement reduced the use of agency staff, for example, in the last month to only 20 hours in total.
Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 7 The organisation, BUPA, produced training leaflets covering Food and hygiene, Health and Safety, Dementia and Activities with questions to check knowledge at the end. Staff found them very good. Cooling fans were bought to help maintain an appropriate temperature throughout the home, including some service users’ bedrooms for those who wanted fans in them. 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.
Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 The home ensured that only properly assessed service users whose needs could be met moved into the home. EVIDENCE: The home changed their assessment format to ensure the admission assessment was carried out covering all details of the needs of the assessed potential service users. The form addressed their physical needs in detail, covering mobility, dressing, bathing, food management, oral and dental care, challenging behaviour, social needs, communication abilities and risks. The home used different but supplementary forms, one to record contacts and basic details, the other to assess abilities and the third to identify potential risks. In addition they obtained comments from previous care providers, families and health professionals. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 10 The home kept assessments under review on a monthly basis, since May this year, opposed to previous two monthly assessment reviews. The assessment was updated whenever there was a need, as in one inspected example after 16 days. An example was seen in another assessment too, where the service user’s food intake was re-assessed from “normal diet” to soft diet. The service user stated: “I find it easier to swallow this, soft food.” This was supported by nutrition and weight charts, to ensure the outcome of the change was beneficial to the service user. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 Care plans were very good documents and demonstrated how health care needs were met. Service users were supported in the way they preferred and felt dignified when preferences were respected. Medication process, policies and recording must change to ensure accuracy and the protection of service users. EVIDENCE: The home introduced a new format for care plans in April. This format was much better as it clearly presented the needs, one per page. The form addressed all main areas that might require care, such as personal hygiene, dressing, eating and diet, toileting, medical conditions, mobility, challenging behaviour, social interactions, communication, religious aspects, burial arrangement and skin care. Additional charts were kept based on individual needs. A related risk assessment was drawn up and covered risk of falls, skin conditions and individually addressed hazards; in one of the checked examples MRSA was addressed and managed before it was cleared and recorded appropriately. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 12 Medication procedure and storage was observed and was appropriate. However, records showed that it was very difficult to audit the amount of Calcihew tablets against records due to not recording transferred amounts from one MAR sheet to another. Although there was a signed consent for and it was addressed in care plan, there was not a separate risk assessment drawn up for service users that were self-medicating. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not inspected. EVIDENCE: The manager stated that quality assurance review showed satisfaction with the activities provided in the home. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home’s financial procedure and staff awareness of protection procedures were appropriate to ensure service users’ protection. EVIDENCE: The home implemented BUPA’s financial procedure. The checked statements of service users’ money were accurate and corresponded to the transaction records and amounts recorded. There were 3 service users who kept their personal allowances with them. Families acted as the representatives for the majority of service users. Three service users wanted to and had their finances managed by BUPA’s finance department. The manager was not the representative for any service user. The home kept small amount of personal allowances for three service users and records and amounts checked were correct. There was no allegation of POVA in the home. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not inspected. EVIDENCE: The inspector walked through the home and found it clean, bright and free from offensive odours. When records were inspected, there were documented checks of the equipment (hoists, bed sides rails and electrical portable appliances) with appropriate certificates. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29.30 The staff had the skills, knowledge and experience to meet all service users’ needs and used their knowledge to appropriately care for service users. EVIDENCE: The home used the master rota to draw the daily rota two to three days in advance, ensuring that all shifts are properly covered. Busy morning times were covered by 10 staff on duty. In the quieter afternoons 6 staff worked, and the number was increased in the evening to 7 staff. This ratio was determined by assessing service users’ needs. The staff were encouraged and keen to obtain the NVQ qualification that resulted in 20 staff out of 38 being qualified already. The home exceeded the expectation to have 50 of staff qualified to the NVQ level. The recruitment process was carried out with full respect of policies and procedures. The files checked contained all required documents: an application form, references, Criminal Records Bureau disclosure, proof of identity, induction check list and signed terms and condition. Training records were kept in 11 files, covering plans for training, attendance records, certificates issued, tests materials, learning resources etc. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35,37,38 The home was run in the best interests of service users. EVIDENCE: The home’s operation, working practices and an independent quality assurance reviewer audited policies. An action plan was drawn up from the results, fed back to the originators of information and monitored continuously through “customers satisfaction” comments. As a result, the home arranged regular meetings of service users and catering staff. The budget demonstrated careful planning and appropriate allocation of financial resources to cover budget subheadings. Financial planning was carried out each September. Three service users kept their personal allowances and records and transactions were accurate. The organisational financial system ensured full protection of service users’ financial interests and money. Individual
Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 18 statements were available to service users and appropriate individuals. The small amounts of personal allowances held in the home were accurately recorded and kept safe. The home’s records were in order, accurate and up to date. Staff stated that they discussed records with service users that they key-worked. The manager stated that relatives interested in seeing the records were provided with the opportunity to check the records if service users agreed to that. The Health and Safety and welfare of service users were ensured through safe moving and handling practices, fire safety, infection control and regular checks and inspections of other relevant authorities: water board, gas, electrical and maintenance professionals. Accidents/incidents were accurately recorded and reviewed. Risk assessments were regularly reviewed. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 3 3 x 3 3 Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 9 9 Regulation 13 13 Requirement Amount of medication transferred from one month to another must be recorded A risk assessment must be drawn up for service users who are self medicating. Timescale for action 20/09/05 20/09/05 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. Refer to Standard 7 Good Practice Recommendations Admission assessment and risk assessments should be signed and dated for all service users including short stay users. Allison House I51 s14875 Allison v242815 090805 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Clifton House Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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