CARE HOMES FOR OLDER PEOPLE
Alma Rest Home 19-23 Alma Road Sheerness Kent ME12 2NZ Lead Inspector
Graham Cummings Announced 20/09/05 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. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Alma Rest Home Address 19-23 Alma Road, Sheerness, Kent, ME12 2NZ 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) 01795 665051 Mr Patrick Nicholas Pinagapany Registered Care Home 20 Category(ies) of Care Home for Older People with Dementia registration, with number of places Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service user whose date of birth is 15/05/1920 room 8 will be OP until they leave then will revert to DE Date of last inspection 13/01/05 Brief Description of the Service: The Home provides residential care for older people, all but one of whom have dementia. Recent alterations to the Home now mean that all service users have their own rooms, many of which are en-suite. The Home is on several floors and there is a lift access to all levels.The Home has a large lounge area in which there is plenty of space to wonder if that is what the service user want to do. The dining areas are also part of this space. There is also a conservatory and small courtyard garden where service users can relax or entertain family and friends. The Home is situated near the sea front in Sheerness, and is close to shops and many other amenities. Sheerness has a railway station and the Home is near a bus route. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Graham Cummings carried out the Announced Inspection on the 20th September 2005. The Inspector arrived at 09:30 and left at 15:00. The inspection consisted of speaking to the Manager, Deputy Manager and Assistant Deputy Manager, the Inspector also spoke to 3 members of the care staff, looked at 4 staff and 4 Residents files. The Inspector had also received the information supplied by the home in the Pre Inspection Questionnaire and 5 Relatives/Visitors and 2 Residents comment cards. The Inspector also toured the home. The Inspector found the home to be clean, tidy and well maintained. The staff files contained all of the required recruitment details and Residents care plans contained good clear information and comprehensive risk assessments. The home provided a good quality of choice regarding meals with the kitchen staff in the morning giving Residents a choice of 3 meals and puddings, if a Residents does not want any of the 3 choices they can request something different, staff and Residents were all complimentary about the high standard of food provided. The home is run to meet the needs of the Residents and the 4 Requirements from the last inspection have been addressed. The home has carried out a lot of improvements since the last inspection including replacing all of the windows at the front of the house and the front door. The Inspector left the premises with no concern for the health,safety or welfare of the Residents. What the service does well:
The home has a good training program and a new training facility has been adapted from the Hydro Therapy area in the back garden. The Manager said that the home has a good motivated staff team and communication system with fortnightly key-worker and regular team meetings. The homes care plans contain relevant information and are signed by residents or family member, daily recordings are of a good standard and entries are all initialled. The home has good relationships with family members and they are fully informed of activities and events within the home. The home have put a greater emphasis on taking residents into the local community more, this includes taking residents to the doctors instead of the doctor visiting, strolls out to the beach and shops. The home has purchased transport that allows for trips out of the local area. A singer is brought into the home at regular intervals to entertain the residents and have a sing song, other activities include playing skittles, domino’s, scrabble, snakes and ladders, soft ball and bingo. For residents who want to help around the home they can tidy and polish or wash up. The managers operate an open door policy for staff, family or residents to speak to them. Residents are given choices of meals and the clothes they want to wear. The home has a relaxed atmosphere and is clean, tidy and free from any offensive odours.
Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 7 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 Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 8 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) 3,6 Residents move into the home having been assessed that their needs will be met. The home does not cater for Intermediate care. EVIDENCE: The procedure for Residents to move into the home was inspected and found to be comprehensive. Following the initial telephone call from the care manager and the receipt of the care managers assessment, the home manager and deputy visit the resident to carry out their assessment to ensure that they could meet the individuals care needs and was an appropriate placement, Residents and or their family are invited to visit, normally without an appointment so that they can see how the home functions and nothing is hidden. If all parties are in agreement an admission date is agreed and a care plan drawn up and signed with input from all involved parties. Following admission a review is held after 4 weeks including the Resident, care manager, family and relatives. The home does not cater for placements that are for intermediate care. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 9 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) 7,8,9,10 Residents health, personal and social care needs are set out in an individual care plan. Residents health care needs are met. There are no Residents who self medicate. Residents feel they are treated with respect. EVIDENCE: The Inspector looked at 4 Residents care plans and found them to be comprehensive and informative. The care plans were signed by a member of the family and had a separate sheet containing evaluation dates and if changes were made. The Inspector and management staff discussed the use of a daily routine form that went through how an individual would like their routine to be when they got up in the morning or when preparing for bed. The daily notes were well written and contained relevant information, the use of different coloured pens was used to highlight if different areas of care had been provide, red pen was used to indicate personal care; green pen for toileting; blue pen for activities and black for other information. All of the Residents were registered with a local G.P and the home has started to take Residents to appointments whenever possible instead of the doctor being asked to visit. None of the present Residents are able to self medicate. During the Inspection it was noted that staff were polite and respectful when talking to the Residents and staff were seen to knock on Residents bedroom doors before entering. One Resident spoken to said they enjoyed spending time in their room.
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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) 13,14,15 Residents are encouraged to maintain contact with family and friends. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome and nutritious diet. EVIDENCE: Family and friends can visit anytime but are encouraged to avoid mealtimes also if they want to visit after 20:30 a telephone call is appreciated so that night staff can be informed. Residents who require assistance with dressing in the morning are asked and offered a choice of clothing to wear. Staff are encouraged to ask the Resident for their wishes and not make assumptions or decisions on their behalf, e.g ‘Would you like to go to bed’ and not ‘it’s time for bed’. The kitchen staff speak to individual Residents each morning and offer a choice of 3 main meals, if none of these are wanted the Resident is able to put in a request for a choice of their own. The Inspector saw the menu and both staff and Residents spoken to were very complimentary about the quantity and quality of the food. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 11 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) 16,18 Resident and relatives have their complaints listened to. Residents are protected from abuse. EVIDENCE: The Inspector noted that the complaints procedure was on display on the front door notice board and that a Service User Guide was available in each of the Residents rooms giving them access about who to complain to should they need to. The Inspector received 5 responses to the relatives and visitors comment cards, 2 of these indicated that they were not aware of the homes complaints procedures, the Manager is going to ensure that visitors will be made aware of the complaints information on the notice board. The home has had no complaints since the last inspection. Adult Protection training was last carried out in July 2004, the home has received the new Local Authority Adult Protection protocols, and these need to be checked against the homes policies and procedures to ensure they are consistent with each other. The Manager is to arrange Adult Protection training as soon as possible. Residents finances are kept locked in a safe in separate named wallets, there is an individual ledger sheet for each Resident, when money is withdrawn this is carried out by 2 staff, one being a senior, the transaction is recorded on the ledger sheet and signed by the 2 staff and wherever appropriate the Resident themselves. The Inspector spoke with 4 staff and established through discussions and scenarios that they were fully aware of the procedures to follow if they had any concerns regarding the financial and physical protection of the residents by either colleagues or management. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 12 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) 19,20,21,22,23,24,25,26 Residents live in a safe well maintained environment. Residents have access to safe and comfortable indoor and outdoor communal facilities. Residents have access to sufficient and suitable lavatories and washing facilities. Residents have access to specialist equipment to maximise their lifestyle. Residents own rooms suit their need. Residents live in safe comfortable surroundings. The home is clean, pleasant and hygienic. EVIDENCE: The Residents live in a home that is well maintained and safe, when the Inspector toured the home it was well furnished and decorated to a good standard. The home has adequate communal space both indoor and outdoors, after lunch Residents were taking advantage of a sunny day and sitting outdoors with staff having a cup of tea and biscuit. The home has 14 en-suite bedrooms, 6 toilets and 2 communal bathrooms and 1 shower room. The home has access to wheelchairs, walking frames, bath hoists and a lift to all floors of the building. The Inspector saw several of the Residents rooms and these were well decorated and appropriately furnished with personal belongings. The home was clean and tidy and there were no offensive odours.
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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) 27,29,30 Residents needs are met by the numbers and skill mix of the staff. Residents are protected and supported by the home recruitment process. Staff are trained and competent to do their job. EVIDENCE: The home employs 21 care staff and 9 ancillary staff, 9 of the care staff have an NVQ level 2 or above, 7 further staff are currently completing an NVQ with 3 more due to start in the near future. Training that has been carried out in the last year includes Moving and Handling, Fire, Health and safety, Food Hygiene, Dementia, Care Planning, Risk assessment, Supervision, Loss and Bereavement and First Aid. The home has currently got 12 staff with First Aid qualifications with a further 8 attending a course in November this year. The Inspector noted that the last Adult Protection training was carried out in July 2004 and suggested that another course be arranged for all new staff to attend and for others to attend as a refresher course. The Inspector looked at 4 staff files and found that they all contained the relevant information required in Schedule 2 of the Care Standards Act 2000. The home follows the process of advertising in the local press, sending out application forms, interview and a shadowed introduction visit, get references and CRB, if employed the person attends 4 introductory workshops that cover the induction process and they are shadowed whilst working until the Management and individual are confident to work as a member of the staff team. The Manager makes random telephone checks to referee’s to ensure the information given is legitimate. Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 14 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) 31,33,34,35,36,38 Residents live in a home that is managed by a person fit to be in charge and run in their best interest. Residents are safeguarded by the financial procedures in the home. Staff supervision needs to be improved. The health, safety and welfare of Residents are promoted and protected. EVIDENCE: The Inspector was satisfied that the home is run by a Manager that is fit to be in charge and of good character and that the service was run in the best interests of the Residents. The Inspector was satisfied that the Residents finances were protected by the procedures and practice of the home. The Manager was aware that the area of staff supervision needs to be addressed, Staff supervision is not being carried out at regular intervals and was quite sporadic, one staff spoken to did say that formal supervision was limited but the support from the management team was excellent and they were always available to answer any questions or queries regarding care. The Inspector had no concerns for the protection of Residents health, welfare or safety.
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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 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 3 3 2 x 3 Alma Rest Home H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 16 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. Standard 36 Regulation 18(2) Requirement That the Registered Person shall ensure that persons working at the care home are appropriately supervised - that is at least 6 times a year That the registered person shall not allow a person to work at the unless they have obtained in respect of that person the information and documents specified in (i) paragraphs 1 - 7 of Schedule 2 Timescale for action 30th November 2005 30th November 2005 2. 29 19(4)(b) 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 16 Good Practice Recommendations The complaints procedure was on display in the entrance hall, it is reccommended that the home makes relatives and visitors aware of the complaints procedure when entering. That all the homes staff are provided with Adult Protection training and that the new local authorities Adult Protection Protocols are checked against the homes policies and procedures.
H56-H05 S23899 Alma Rest Home V240978 200905 Stage 4.doc Version 1.40 Page 17 2. 18 Alma Rest Home Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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