Inspection on 19/11/07 for Allonsfield House Care Home

This inspection was carried out on 19th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Allonsfield House Care Home 13/01/09

Allonsfield House Care Home 07/02/07

Allonsfield House Care Home 07/02/06

Allonsfield House Care Home 04/07/05

Allonsfield House Care Home 15/03/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Allonsfield House Care Home Allonsfield House Campsea Ashe Woodbridge Suffolk IP13 0PX Lead Inspector Mary Jeffries Unannounced Inspection 19th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Allonsfield House Care Home DS0000062861.V355207.R02.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. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Allonsfield House Care Home Address Allonsfield House Campsea Ashe Woodbridge Suffolk IP13 0PX 01728 747095 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) jill@kingsleycarehomes.com Kingsley Care Homes Ltd Manager post vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (23) of places Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Bedroom 9 may be used as a shared bedroom only for those persons whose name was made known to The Commission For Social Care Inspection on 25th January 2005. The home can provide care for 18 people with dementia in Ashefield unit and 1 named older person with dementia in Allonsfield House as set out in letter dated 19/12/05. 7th February 2007 Date of last inspection Brief Description of the Service: Allonsfield House, situated in Campsea Ashe, is registered to provide care for 41 people aged over 65 years, including nineteen people with dementia. The home is owned by Kingsley Care Homes, who took over the running of the home in December 2004. Campsea Ashe is a small village in a rural location, close to the town of Woodbridge. The home is located opposite the village church and 400 metres from the local train station, which has direct trains to Lowestoft, Ipswich and London. Woodbridge offers a range of amenities that include, restaurants, garden centres, shops, a Library, banks, a post office, Riverside Theatre and swimming pool. The home, a former farmhouse, has been refurbished and adapted over the years. In December 2006 a large extension to the home was also completed enabling the home to increase its registered numbers from to 23 to 41. The main house is located on two floors and accommodates up to 23 older people, including one named person with dementia. The extension provides ground floor, purpose built accommodation for up to 18 older people with dementia, and this unit is called Ashefiled. The home has appropriate communal areas throughout the home including dining, lounge and comfortable ‘quiet’ areas. There are also safe, enclosed and attractive grounds to the rear & side of the premises and a visitors cark park. The current fees detailed in the Service User Guide are £495-£730 per week, depending upon accommodation and care required. Newspapers and magazines, toiletries, clothes and dry cleaning are not included in the fee, nor are hair dressing, private chiropody, or opticians services. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. An annual quality assurance assessment (AQAA) was sent to us by the service. Pre inspection Surveys were returned to us by two relatives / visitors and eight members of staff. The inspection took place on one day in November and took nine hours. Additionally a second inspector also undertook a short observational framework inspection, (SOFI) over a two hour period on Ashefield Unit. This involved close observation of four residents for a two-hour period, monitoring their wellbeing and engagement. The manager facilitated the inspection, and other staff participated. The home was full, one resident was in hospital. Four residents were tracked. Three of these had dementia and live on Ashefield, one did not and lives on Allonsfield unit. The plan to track two residents on each unit was changed because after tracking one resident on each unit, it was decided to track the care of two other residents on Ashefield who had bruises. A tour of the communal areas and some bedrooms was undertaken. In addition to the SOFI, there were periods of observation of staff and residents on Allonsfield, in the lounge and in the dining room, and administration of medication was observed and inspected. One resident who did not have dementia was spoken with in some depth. A relative visiting the home was also spoken with. A number of documents were examined including residents’ care plans, medication records, training records and records relating to health and safety. The homes Quality Assurance exercise was inspected. The manager was telephoned following the inspection to seek further clarification on some points. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home should have a Registered Manager. The Service User Guide needs to be updated, so that prospective residents have accurate information. All allegations of abusive behaviour, including between residents, must be reported in accordance with safeguarding procedures to ensure that residents are protected from harm. Medicines should not be touched during administration. If the carer is wearing protective gloves and medications are touched, them these must be changed each time. Any changes to the MAR sheets must be signed and dated. There must be a hot water supply to the washbasin outside of the staff toilet, and also for the basin to a residents’ toilet where this had been turned off. This is necessary to maintain acceptable standards of infection control. A significant number of staff require training in moving and handling and in Fire safety as a matter of priority. Staff working with residents with challenging behaviour must receive training for this. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive information about the home, although they cannot be assured it is up to date. Residents can expect to have an assessment of their needs undertaken before they are admitted into the home. EVIDENCE: A copy of the home’s Service User Guide was provided. This had been reviewed in November 2006.The fees for the home were included. The Service User Guide stated that in addition to the 18 places for people with dementia on Ashefield unit, that there are two places on Allonsfield unit for people with dementia. There was only one place for a resident with dementia on Allonsfield unit, as shown on the homes certificate of registration dated 5/12/06 which was correctly displayed in the home. This one place was occupied. A second resident with dementia who used to live on Allonsfield unit was living on Ashefield. The address of the CSCI was out of date. There were Service User Guides in residents’ bedrooms. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 10 The two relatives who returned pre inspection surveys to the CSCI both stated that the home usually provided them with enough information about the home to help them make decisions. One of the residents tracked had moved to the home, following a diagnosis of dementia, from another care home. The home had received a fax confirming the resident’s diagnosis, and a carer advised that they had visited the person and their relatives in the other home. An assessment had been carried out prior to admission. This resident has challenging behaviour. The resident had been admitted for a trial period. The other three residents tracked all had pre admission assessments, one of these who had a Social Care Services assessment also had a preadmission assessment conducted by the home. The home does not provide Intermediate care. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a care plan but cannot be assured that this will be agreed with them or a relative. Residents can expect their care needs to be met most of the time but residents with dementia cannot be fully assured that they will always be protected from other residents with challenging behaviour. EVIDENCE: There were up to 11 residents in the lounge during the two hour SOFI observation; all looked well groomed. The two relatives who returned pre inspection surveys both stated that they felt the home usually meets the needs of people, and always keeps them up to date with important issues affecting their relative. One stated that the home always provides their relative with the care and support, which they expect; the other noted that sometimes it did. The home’s quality assurance exercise asked residents if they receive the service that matches what is in their care plan. Thirty out of thirty-one who responded stated that they always or usually did. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 12 All four of the residents tracked had recently reviewed care plans. The plans of one resident had not been signed to show whether it was agreed with the resident or their relatives. It was recommended at the last inspection that this should be achieved. The basic care plans were adequately detailed and included areas such as personal care, sensory needs, mobility, nutrition, medical/physical conditions and social support. There were personal profiles on the files of residents with dementia. Plans included assessments on skin quality and risk of pressure areas developing. One of the residents’ plans had been reviewed on the day of the inspection and there was a note on file to state that the carer plan needed updating for August, September October and November in respect of activities. The sheet on history of falls was blank, although the accident book showed that they had had a fall leading to accident and emergency admission four days earlier. They did have had a risk assessment stating that staff must ensure that they wore appropriate footwear. The resident was seen to be wearing sturdy well fitting slippers. The other residents’ plans had been regularly reviewed. One resident had a significant bruise. From records and discussions with the manager and staff, it was found that this was believed to have been caused by another resident was seen leaving their room in the early hours of the morning. However, there was no clear evidence of this. Although, the manager advised night staff were being vigilant and that this resident could lock their door, this was not the first occasion on which the other resident had entered their room and hit them. There was no specific risk assessment on the care plan of the resident with the bruise to evidence that all consideration had been given to steps that might be taken to protect them from this reoccurring, which in these circumstances would be advised. Another residents care plan recorded a number of other incidents in September when they had struck or tripped other residents and staff. Other than this recent incident, the last of these occurrences recorded was in September. There was a risk assessment on file regarding wandering, and they have now been referred for a medication review. This resident also had a large bruise, this had been incurred whilst they were ill during the night and was adequately accounted for in their records, Family had been notified. Staff had not received training in working with challenging behaviour. The care plan noted that staff were to take the resident out of a situation if they were aggressive. Other than in the context of Safeguarding training, staff had not received specific training in working with challenging behaviour. Daily records also evidenced that the home ensures residents have access to health care services such as GP’s, community nurses and hospital outpatient services. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 13 Lunchtime administration of medication was observed. This took place immediately after lunch, and therefore residents were not disturbed during their meals. The medication trolley was used, and the carer locked it each time they left it unattended. The AQAA states that this is now used for all rounds and the carer confirmed this. The carer wore gloves to give out the medications. They changed their gloves when they had administered tablets to a resident in their room, however, in the dinning room several lots of medications were given and touched by the carer who did not change their gloves between touching different medicines. The manager was advised of this; they agreed that it would should not happen and advised it would be taken up. The carer had a good manner with the residents; they were patient and communicated well. The Medicine administration records (MAR) contained specimen signatures and photographs of residents. The records were inspected. They commenced on 5th November and during the fortnight since then there was one gap, only. There were two instances where a medication had been changed by the GP or prescribed by the GP after the MAR sheet had been printed where the MAR chart had been amended but the entry was not signed by the person who had made the amendment; this practice leaves residents vulnerable to unauthorised changes. Pre inspection comments had been received by one worker and by one relative that some staffs’ English language was not sufficiently good. One resident spoke about the staff from Europe; “ Some of them are very good, they work very hard and are beginning to settle down.” The manager advised that many staff had undertaken English language courses, and some were currently undertaking it. This resident also said; “I pressed my buzzer at 6am this morning – I was in a mess, they came pretty quickly. I’ve had them out a number of times, they don’t complain and they always knock before they come in. I’m pretty comfortable really”. Although the home’s own quality assurance report noted that there was room for improvement with respect and dignity, the only evidence on the day that this was so was that in one room a large packet of incontinence pads were not stored discretely. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy the meals served in the home and to have choices in their daily lives. They may not receive the level of individual attention and activity that they would hope for or expect. EVIDENCE: A relative who visits the home frequently advised that they considered Allonsfield to be a very nice home. During the SOFI on Ashefield unit, atmosphere in the lounge was warm, calm & relaxing. Initially the TV was on in the background but for most of the time there was a variety of music on. Three of the residents were asleep for part of the two hour period, which was before lunchtime, one for just twenty-five minutes and one for well over an hour. However, the majority of the time most of the residents were awake, and they were engaged with a member of staff, a visitor or another resident or an object or task. None of the residents were seen to be withdrawn or unhappy at any time. Eighty percent of the observations made of these residents found them to be in a positive state of being, rather than negative, withdrawn. The rest of the time they were passive. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 15 During this exercise, several residents in the same area were asked if they wanted to have their hair done with the hairdresser and one was given a manicure. A relative responding to the pre inspection survey commented; “Ashefield help to stimulate and also comfort the residents when they are stressed”. The relative who had indicated on their pre inspection survey that the home only sometimes provided the care and support they expected had commented; “I think that quite often the staff are hard pushed to see to everyone’s needs. If attention is needed by one resident the others are left waiting. More staff would enable residents to have more time and attention or even give them enough time to go out on outings and trips and have time to talk or organise occupational therapy”. One member of staff had written on their survey response; “Allow extra staff on shifts for activities!!! We need to get some stuff for activities, which would be interesting for our residents. Allow 4 people on the morning instead of 3.” Another commented, “ they should consider to take at least two residents out every week so residents don’t feel like they are in prison & stop asking staff for the way to go out.” At noon, one resident on Ashefield was seen sitting alone in another area, a small lounge. They advised, “I’ve been here all morning.” With encouragement they choose to walk down to the main lounge where there were other residents. A carer advised that activities occurred during the afternoons, but that staff can no longer take people out which they used to do. Another carer advised this was because one resident needed two carers to assist them during the day to go to the toilet, and that would only leave one on the unit. A programme of activities was provided which included bingo, flower arranging, light exercises, sales of shoes etc. and watching specific programmes. The carer said that there is time in the afternoon to sit and talk with residents if every thing else is done. One of the files of the residents tracked had some participation in activities recorded, but this was less than once a week. Holy communion is offered in the home once a month, and the home has organised for Roman Catholic priest to visit residents upon request. The relatives spoken with advised that they and other family members visited frequently and were always made welcome. Two residents spoken with on Allonsfield advised that they could get up and go to bed at whatever time they liked. Residents could have baths and showers as they wanted, a carer advised one resident chooses to have a shower, with some assistance, three times a week. There is a coffee machine in the lounge on Allonsfield that was stocked with supplies of fresh coffee and cups. During the morning coffee and tea was provided to residents on Ashefield in china cups and saucers, everyone managed to use them successfully. Everyone Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 16 was individually, and nicely, asked what they wanted to drink and were offered a biscuit which they were able to help themselves to. At the previous inspection there were some concerns expressed that the food was not consistently good. The home had included enquiries into residents satisfaction with food on the most recent resident’s survey; all residents indicated that they now think the food is always or usually good. On the day of inspection the lunchtime menu was displayed in the dining area. The main choice on the day of the inspection was Minestrone or garlic bread, followed by sausages or meatballs with vegetables, and jam pudding or apricots and cream. Meals could be taken in the dining areas or in the privacy of the resident’s own rooms. The dining areas in both units were very warm and comfortable and pleasantly furnished and decorated. Tables were nicely laid with tablecloths, napkins, place mats and condiments. Residents had a choice of soft drinks or wine with their meals and tea was served afterwards. A relative spoken with said that they have a meal at the home sometimes and that they thought the food was fine, but sometimes a little dry. They advised that they had been visiting for a number of years, and that if there was any dissatisfaction it was probably because the previous chef was hard to beat. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have access to a clear complaints procedure and that should they require to use it, complaints will be dealt with properly and within a suitable time. They cannot be assured that agreed county procedures will be followed in the event of them being abused, so cannot be guaranteed that the risk of this happening again has been minimised. EVIDENCE: Both relatives’ pre inspection surveys stated that they knew how to complain to the home if they needed to. One stated that in the event of them raising a concern or a complaint the home always responded appropriately, the other stated that it usually did. A relative visiting the home on the day of the inspection said that they did not know the “official route” to complaining but that they would have no problem speaking to the manager if they had to. All seven care staff who responded to the survey stated that they knew how to respond if a resident had a concern about the home. The home’s own quality assurance exercise asked how easy it was to speak to staff about anything that concerned them. Thirty of the thirty-two responding indicated that they could always or usually do so. As noted earlier in this report, residents all had a Service User Guide, which include information on how to complain. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 18 The home had received two complaints in the previous twelve months and both had been responded to within the twenty-eight day timescale. A complaint received by the CSCI in April was referred to the home to investigate. The home provided full information to the CSCI, and also evidence that they had worked with the complainant to resolve issues with them directly. Both staff files inspected had evidence of safeguarding training on them, however this was not dated. As noted under the health and personal care section of this report, it was noted that one resident had a significant bruise caused by another resident who can exhibit challenging behaviour. The incident had not been referred to Adult Safeguarding. This was discussed with the manager. After checking records within CSCI it was established that it had not been reported to the CSCI either, as it should have been under regulation 37. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a clean and comfortable environment. EVIDENCE: Communal areas on Ashefield, which is home to eighteen people with dementia includes two lounges, a dining room and a large sun lounge. All communal areas were carpeted, furnished and decorated to a good standard. There was an “orientation board” on the wall that had the wrong day & date on, which is unhelpful for people with dementia. There was an attractive display of memorabilia and old photos on a corridor wall. Some, but not all of the bedrooms had signs on the doors to assist residents recognise their own rooms. A corridor joins the Ashefield to the main house and give access to a shaft lift and the managers and deputy managers’ office. Allonsfield has a large Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 20 comfortable lounge with a smaller area next to it. There were other small areas where residents could choose to sit, and a dinning room. The kitchen was clean and well maintained. Records were kept of the temperatures of cooked meals. Food in the refrigerator was covered. With the exception of one bedroom all bedrooms were for single occupancy and had en-suite facilities. One resident advised that they complained that he kept falling out of bed, and as soon as they did, “ They got on the phone and got me a nice big bed, ¾ size, with rails just at the top.” It was brought to the manager’s attention that in a hallway, the doors to two linen cupboards marked “fire doors, keep locked”, were not locked. They were locked when this was pointed out. There was no hot water supply to two sinks. The hand basin for the staff toilet at the end of the dining room for older people had no supply, nor did the hand basin in a communal toilet near by. This was pointed out to the manager who was unaware of this, and who advised they would attend to it immediately. Hot water was checked at several other outlets and found to be at safe temperatures. On the day of inspection the home was clean, tidy and hygienic with no offensive odours. It had suitable laundry facilities with commercial washing machines and appropriate procedures in place to handle soiled articles and linen. Staff were equipped with disposable gloves and aprons. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be protected by the homes recruitment procedures and find that staff relate well to them, but cannot be assured staff have all of the required training to do their jobs safely. EVIDENCE: At the time of the last inspection care workers were still regularly covering kitchen duties and there was concern that there may be times when resident’s needs were not fully met. The CSCI was subsequently informed that that this had been addressed, and that the kitchen was fully staffed, leaving care workers free to attend to service users at all times. The home subsequently undertook to monitor staffing levels and dependency levels on an ongoing basis. On the day of the inspection, an increase had been made in the care hours available. An additional care had been timetabled to work on Allonsfield on the morning shift, of the day of the inspection, between 8am and 11am. . The manager advised that the level had been increased in accordance with ongoing monitoring of levels of need, and the company have subsequently clarified that the additional member of staff was on duty because of resident’s external appointments. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 22 One carer spoken with said, “I like it here, but not with (only) three on in the morning. Another carer spoken with advised that it was hard to be patient when there were other pressures, like making beds and tidying rooms, and on the two days a week when the cleaners are not in, when bells were ringing repeatedly. The cleaner’s scheduled showed that there was cleaning cover every day. This was discussed with the manager who advised that during holidays one cleaner did overtime to cover the other, so at these times there was only one cleaner across the home. On Allonsfield unit staff were observed responding to call bells in a timely manner. The staff deployment on this unit was four staff for twenty-three residents, in the first past of the morning, then three staff. One of the residents has dementia and one requires double assistance. The carers also make beds and tidy room, although there are also domestic staff, and the kitchen was fully staffed. Only half of the staff surveys received by the CSCI stated that there were always or usually enough staff on duty to meet the individual needs of all the people who use the service. One commented that on Allonsfield the staffing level had been cut from 4 to 3 staff on morning shift. They stated that they had 22 residents, and one of them required two carers to wash & dress them. “I feel I cannot give all that is needed as a carer as most of the time we are rushing to get all the jobs done (making beds, laundry etc.)” During the inspection it was noted that not all of the beds were made by mid morning. In the home’s own survey of residents, twenty out of thirty two responded that staff always attend them at the time they want, and another nine stated that they usually do. Three stated that they never came at a time that suits them. However, twenty-nine out of thirty who responded to the enquiry, “If you ask for changes in your care, are those changes made?” stated that they always or usually were. The rota for Ashefield showed three staff on duty every morning of the forthcoming week, but four scheduled on one day. At the last inspection there were two care staff on this unit, and the manager had advised that the staffing level would increase as the unit became full. One of the two relatives who responded to the pre inspection survey commented that they did not consider three to be enough for residents with dementia. It is noted under the section on daily life and social activities, that a significant amount of sleeping occurred by the residents who were observed on Ashfield. Staff interaction with the four residents with dementia was observed during the SOFI. The carers were also attending to other residents during the period, but our observation was focussed on four. The quality of the carers’ interaction with these residents, when they were not sleeping, was consistently good. A relative spoken with advised that the staffs’ manner was, in their opinion, very good and was the most valuable thing about the home. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 23 The AQAA showed that only 25 of staff hold National Vocational Qualifications. Previously the home had reached the 50 target, but eleven out of a staff group of 34 had left during the previous twelve months. The AQAA stated that four staff were currently working towards NVQ 2 and one of the two staff files inspected evidenced that they were undertaking this. The company have subsequently provided evidence that the percentage of staff with NVQ two or above has risen. Seven of the eight staff pre-inspection surveys indicated that they were being given appropriate and relevant training, except for one who had been waiting to undertake NVQ3 for some time. The home had a training analysis that showed that less than half of the care staff had received manual handling training, and that some of those who had received it staff had not had an update since 2004. New staff had received this as part of their induction. The files for two carers on duty that day were inspected. One of these cares had recently had manual handling training and the other had received it as part of their induction. This was discussed with the manager who advised that it would be taking place early in the New Year, however this was not entered in the AQAA as an area needing improvement. Both carers had certificates to show that medication training had been received. No training in challenging behaviour was evidenced. All of the eight staff who provided a pre inspection survey indicated that the appropriate reference and CRB (Criminal Records Bureau) checks were carried out before they began employment, and that they had received induction when they commenced work. The staff files of two carers who had been recruited in the last twelve months were inspected. Both had all of the required documentation and pre employment checks. There was evidence of a roper recruitment process. Both carers had received a full induction including manual handling training. The manager had provided the manual handling training, and evidence was seen that they had been trained to deliver this. Approximately half of the staff had received Fire training in June 2007; eight were detailed on the training plan as not having had this since 2006. The homes fire risk assessment states that fire training will be delivered to staff every six months. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect for their views to be sought and for these to influence the way in which the home runs. EVIDENCE: It was recommended at the last inspection that the manager should ensure a complete registered managers application be submitted to the Commission. The manager advised that she intended to apply to become the Registered Manager, and would be doing so within the next couple of weeks. They advised that they were undertaking their Registered Managers award, and evidence of this was seen. Quality Assurance visits are undertaken by a senior manager, and a customer satisfaction survey had been undertaken. The home had addressed residents Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 25 concerns about meals and noted areas to improve upon as a consequence of this consultation. Discussion with the manager confirmed that the home does not handle resident’s monies. Residents that are not able to manage their own finances are supported by their relatives or representatives. Residents are invoiced on a monthly basis for items, such as newspapers and toiletries that are supplied by the home but not included in the fees. A number of good health and safety practices were evidenced. The bath chair was due to be serviced next in December 2007. The fire alarm was tested regularly. The home had a current fire risk assessment, dated within the last 12 months. This document, however, said that refresher training was to be given every six months; not all staff had received this within the time period. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 26 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The Service User Guide must be kept under review and revised as required so that it accords with regulation 5, to ensure that residents and prospective residents have all of the information they require. Any changes to Mar sheets must be signed and dated to prevent unauthorised changes being made to the medications. Any suspicion that a resident may have been harmed by another must be referred to Adult safeguarding to determine a way forward. There must be a hot water supply to hand basins servicing staff and residents toilets to promote proper hygiene and prevent the spread of infection. All staff involved in personal care must have moving and handling training that is regularly updated, to ensure that they can meet the needs of residents safely. Timescale for action 31/01/08 2. OP9 13(2) 19/11/07 3. OP18 13(6) 19/11/07 4. OP25 OP38 23(1)(a) 30/11/07 5. OP30 18(1)(c) (i) 30/01/08 Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 28 6. OP30 18(1)(c) (i) 7. OP31 37 8. OP38 23(4)(d) Staff working with people with challenging behaviour must have appropriate training for them to de escalate aggressive behaviours and protect other residents from abuse. Any event in the care home which affects the well being or safety of any service user must be reported to CSCI, this is to ensure that the home can be properly regulated and that the regulator has the opportunity to determine whether the management of such an incident has been satisfactory or whether further action is required. Fire training must be provided in line with the homes fire risk assessment. 30/01/08 22/11/07 30/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations Management should continue to monitor staffing levels against dependency needs of residents. Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Allonsfield House Care Home DS0000062861.V355207.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!