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Inspection on 10/03/09 for Alphington Lodge Residential Home

Also see our care home review for Alphington Lodge Residential Home for more information

This inspection was carried out on 10th March 2009.

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

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

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

CARE HOMES FOR OLDER PEOPLE Alphington Lodge Residential Home 1 St Michaels Close Alphington Exeter Devon EX2 8XH Lead Inspector Vivien Stephens Key Unannounced Inspection 10th March 2009 09:30 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 Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alphington Lodge Residential Home Address 1 St Michaels Close Alphington Exeter Devon EX2 8XH 01392 216352 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) Nicola Hitchcott Anna Hitchcott Mrs Julie Ellen Smith Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 28 12th March 2008 Date of last inspection Brief Description of the Service: Alphington Lodge is registered to provide accommodation and personal care to up to 28 older people. It is a period property in the centre of Alphington, within short walking distance of local shops, church, pubs and health centre. The accommodation comprises of the main building, and a separate cottage annexe with two ground floor bedrooms with office rooms above. The main building has three floors, including a new extension, served by a passenger lift. All bedrooms are for single occupancy, 14 being en suite. The home has three pleasant lounge/dining areas, and large level gardens, with an enclosed courtyard for the extension. Current fees are £450 - £500 per week, depending on the accommodation (en suite, etc.) and level of care required. Fees include activities but do not include hairdressing, chiropody or newspapers for individuals. The latest inspection report by the Commission for Social Care Inspection (CSCI) is available in the home’s entrance hall. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment (AQAA). They completed the form and returned it to us by the date we requested. It gave us useful information about the way the home is managed. We also sent out survey forms to some of the people who live in the home, and to some of the staff and other professionals who provide care or treatment to people living in the home. We received 7 completed survey forms from people living in the home, 8 from care staff, and 6 from health and social care professionals. The responses we received helped us to form the judgements we have made in this report. On the day of this inspection we arrived at the home at approximately 9.30am and left at approximately 6.30pm. During the day we talked to the manager, 10 people who live in the home, 1 care worker, 1 relative and one District nurse. We looked at four care plan files and talked to the manager and care workers about how the information is organised and used. We looked at other records the home is required to keep including staff recruitment and training records, medicine administration, and health and safety records. We also carried out a tour of the home. What the service does well: The responses we received from the people who completed a survey form before this inspection, and the comments we received from people we met during our visit showed that people living in the home were happy with the services and the care they received. Comments included “Alphington Lodge is a very caring home and my mother has been as happy as she could be while there.” People told us they enjoy the meals. The menus were varied and balanced and people were given plenty of alternatives to suit all individual preferences and dietary needs. The home has produced a laminated card for each person giving care staff information about the person’s preferences for breakfast, for example, how many cups of tea, what time they wanted their drinks or breakfast, and what they liked to eat. A card was placed on the breakfast trays Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 6 as a checklist for the care staff. They demonstrated good practice and provide clear evidence of individual choice and personalised care The house and gardens have been well maintained and provide comfortable and attractive accommodation. What has improved since the last inspection? What they could do better: Information in the care plan files should be improved to give an easy to follow guide for staff to follow on a daily basis that clearly sets out how each person wants to be assisted. The plans must be drawn up with each person (and/or their representative where appropriate) and they should be asked to sign the plan to show that they agree it is correct. While medicine storage and administration is generally good, some aspects of the home’s recording systems must be improved to make sure people are protected from potential errors. The home must improve the way they administer creams and lotions by giving care staff clear instructions on how, where, when and why creams or lotions should be applied, and how the condition must be monitored, and any action they should take if the condition changes. A record must be maintained each time a cream or lotion is applied. Creams and lotions should be dated when opened to show when they must be discarded. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 7 We could not see evidence to show how the home had gathered information during people’s initial assessments and care plan reviews to help plan the range of activities in the home. We found that activities are often provided, but it was not easy to see exactly what was planned for each day. We recommended that they improve the information they gather from each person, and they use this to draw up a plan of activities so that people know what is planned, and when. All of the people we talked to said the meals were always tasty and enjoyable, but a few people said sometimes the meals weren’t hot enough. We asked the manager to investigate this and take any action necessary to ensure people receive meals at a temperature that suits them. The home must keep a record of all complaints they receive, and the actions they have taken to investigate the complaint and address each issue. This is necessary to provide evidence to show that all complaints have been addressed satisfactorily. When staff are busy in the home they often cannot hear the front doorbell. We have recommended that they take action to ensure staff know when there is someone at the front door, they open the door promptly, and they check on visitors to the home to ensure the people living in the home are safe from harm. We received several comments from people living in the home and from some of the staff and health professionals about staffing levels. Some people thought that the home was often short staffed. We heard that there have been some staff changes recently, and while these had clearly caused some upset, new staff had recently been recruited and Julie Smith was confident that there was now a full staff team and she felt staffing levels were now good. However, there were some areas where she agreed staffing levels could be adjusted, especially in relation to cleaning tasks. We recommended that all staffing levels should be reviewed. Many of the staff have not received regular updates on important health and safety related topics. A plan has been drawn up to show the future training and development needs of the staff team, including health and safety and relevant care and health related topics. Action is now necessary to identify training dates and methods of providing this training. A record must be kept in the home of all visits made by the registered provider and/or the Responsible Individual. A report of the visit must be completed to show that they have talked to people living in the home, and they have inspected the premises and all records, and that they are fully aware of all issues relating to the management, staffing and daily life in the home. The results of quality assurance surveys should be made available to current and prospective residents, their representatives and other interested parties, Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 8 with consideration given to anonymous completion of surveys. This will ensure people know that their views and comments have been listened to and acted upon. Records should be completed to show that regular checks and maintenance of all fire safety equipment, and regular staff training and/or drills have been carried out in accordance with the guidance laid down by the fire authority. The records should provide evidence to show that the home has taken all necessary precautions to prevent the risk of fire. 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. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 9 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 Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 10 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): 2, 3, 6 Quality in this outcome area is good. People can be confident their needs will be assessed before they move in and the home will be able to meet their needs. People are offered good information and opportunities to visit the home so that they can be certain that Alphington Lodge is the right place for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the way people’s needs have been assessed before they moved in. We found that the home uses a number of different forms that guide them to gather a good range of relevant information about the person’s social, personal and health needs. They included a risk assessment checklist. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 11 The forms had been completed for those people who had moved in over the last year. We talked to 10 people during our visit, some of whom had moved in recently. They were all happy with the information and opportunities to visit the home before they moved in. Some talked about the happy atmosphere in the home and said they were certain they made the right decision. At the last inspection we told the home they must take care when assessing new people to ensure they do not admit anyone whose needs are outside of the categories the home is registered to care for. During this inspection we talked to the manager, Julie Smith, about the people who have moved in since the last inspection. We found that they had taken care to ensure each person’s needs could be met. All of the people who completed a survey form before this inspection told us they had received a contract of residence, either from the home or from Social Services depending who was funding the care. Alphington Lodge does not provide intermediate care. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 12 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. People’s health and personal care needs have been provided by a dedicated and caring staff team, although some weaknesses in the care planning system may result in care not being provided in a consistent manner. While medicine storage and administration is generally good, some aspects of the home’s recording systems may place people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at four care plan files to find out how the home had used the information they gathered about people during the initial assessment to draw up a care plan that explains to the care staff how each person wants to be assisted each day. We found that the home had a number of forms in place with some basic information about each person’s needs. We found evidence in Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 13 some of the records of good practice, such as an awareness of each person’s preferred time to get up or go to bed, and how often they wanted a bath or shower. However, the way the information was presented was not always easy to follow, and this may prevent care workers from following the care plans on a daily basis. We talked to the manager, Julie Smith, about the care needs of the people whose files we had read. We heard some examples of the care they provided, including details of the way they assisted one person who needed to be moved by using a hoist. Some care workers had found particular ways of reassuring the person and making them feel safe and comfortable when they were using the hoist, but this important information had not been explained in the care plan file. There was a reference to an injury in the care plan, but no explanation of how this might affect the person when they were being moved or assisted, or any special care the staff should take. We also found that the care plans did not clearly explain exactly what personal care tasks they should help each person with (for example, cleaning teeth or brushing hair). The plans did not explain how each person wanted to be assisted with personal care tasks to protect the person’s privacy or dignity, or to ensure they were offered choices in all aspects of their daily lives. We talked to a senior member of staff about the way the staff help people choose what they wanted to wear, and we were assured that all staff had been given training on how to offer choice and respect privacy and dignity. We could see evidence to show that the information in the care plan files had been reviewed regularly to make sure it was still up-to-date. However, there was no evidence to show that people had been given a copy of their care plan, or that they had signed to agree that all of the information in the files was correct. We heard from some of the people who live in the home and some of the care staff about the way that care is provided. While most people living in the home said they received the care they needed, a few people said the staff were sometime too busy to help (see also Staffing section). Two care workers told us that communication in the home was good, but the information they needed could not always be found in the care plans. A GP commented “Lots of staff changes recently make continuity of care less easy.” We looked at the daily care notes completed by the care staff. We found that the notes contained a great deal of information, and the notes had generally been used as a guide for the care staff on the daily care needs of each person, rather than using a care plan. The notes explained any changes to the person’s health or well-being each day. However, they did not always give evidence to show that all care tasks had been carried out. The home was Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 14 planning to introduce new daily report sheets in the next few days that would improve the way the daily notes are presented and we suggested ways of adjusting the forms so that the daily notes provide a good monitoring tool that the manager and senior staff can use to check that all important care tasks have been carried out. Julie Smith agreed to use the information in the care plan files to draw up an easy to follow guide for staff to follow on a daily basis that clearly sets out how each person wants to be assisted. The plans must be draw up with each person (and/or their representative where appropriate) and they should be asked to sign the plan to show that they agree it is correct. Each care plan file contained a print out from the local health centre showing the medication, visits and treatment provided by the GP’s and District Nurses. We talked to a District Nurse who was visiting the home on the day of our visit. She assured us that the home has worked well with the local health professionals to ensure each person has received good health care. We looked at the way the home cares for people with skin problems. We found that the care staff had not recorded when they had administered creams or lotions. We also found that the care plan files did not contain an assessment of the risk to each person of developing a pressure sore. We talked to Julie Smith about the importance of monitoring people’s skin, and also of recording the use of creams or lotions to make sure they are effective. She agreed to implement a system for recording creams that also provides care staff with clear instructions on the type of skin problem the person has, how and where the creams should be applied, and how the condition should be monitored. Creams and lotions have not been dated when opened to indicate when they should be discarded. We looked at the way the home stores and administers medications. In the last year the home has introduced a new system of storage. Each person now has a secure lockable cupboard in their bedroom to hold their daily medications. This has also addressed the requirement we made at the last inspection to improve the security and recording of controlled drugs, and to improve the way medicines were transported around the home when they were being administered. It demonstrated good practice as it helped people to retain as much control over their own medications as possible, and enable care workers to provide assistance to each person that had been tailored to their individual needs. The medicines administration record could not be stored individually in each person’s medicine cabinet. Therefore the care workers had to return to the medicines trolley stored in the corridor in the lower ground floor to pick up the correct chart for each person. We looked at the administration records and Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 15 found there were a number of gaps. We could not see any evidence to show the gaps had been investigated to find out if the medicines had actually been administered. There was no accounting method for the amount of each medicine held in the home at the end of each month and therefore there was no way of double checking to find out if the medicines had actually been given. Medicines have been supplied in bottles or packets rather than in weekly or monthly monitored dosage packs. While this method of supply of medicines suited the individual cabinets (the cabinets were not large to hold monthly blister packs) it was very important that medicines were recorded each time they were administered, and to ensure there were regular checks on the stocks held in order to ensure all medicines have been correctly administered. The home has a medicines administration policy in place, and this had recently been reviewed. However, a copy of the policy was not held in the medicines trolley, or in a convenient place where care staff could check the policy quickly if they were concerned that a mistake may have occurred. We heard that all care workers have received training on the safe administration of medicines during their induction. We recommended that the home checks the quality of the training each care worker has received this subject to ensure they are fully competent, and to ensure they have a clear understanding of the home’s policy on the safe administration of medicines. The training should cover all areas recommended by the national training organisation known as Skills for Care. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 16 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. People are offered a range of activities to suit many interests, although more could be done to tailor the range of activities to suit each person, and better information could be provided to people so that they know what activities are planned each day. People enjoy a variety of healthy and tasty meals to suit their individual preferences and dietary needs, although meals may not always be hot enough. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the entrance hallway and in the corridor on the lower ground floor we saw notice boards giving information about various activities that were planned, including visiting entertainers. We also talked to people to find out what they enjoyed doing every day. Some people told us they found plenty of things going on in the home that interested them, and some people said there were Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 17 often things going on but they chose not to join in. However, one member of the staff told us they felt the home could provide more varied activities and more outings. Some of the activities provided by the home have included pub trips, flower arranging, cooking, and outings during the summer months. The parish church is just across the road and there are good links between the home and the church. We saw evidence in the care plan files to show that the home has found out about people’s faiths and denominations. We talked to the manager about using the information gathered before people move in to help them plan to meet all individual social needs. We also suggested they look at ways of improving the information about forthcoming activities so that everyone can see clearly what is planned for the coming week and/or month. We talked to people and to a senior member of staff about the way staff help people to make choices about every aspect of their daily lives. We heard examples of how staff help people to choose what they wear every day, how they help people choose new clothes, and how they help people decide what they want to do. The daily menus have been clearly printed and the menu was displayed on the wall outside each dining room. The menus offered a main meal or a salad or omelette. We talked to the care staff about other choices people could have if they did not like the main meal, or salads or omelettes. We heard that people could ask for whatever they liked and the menu was there just as a guide. The care staff went around to each person every day to let them know what was on the menu and to find out what they wanted. They gave assurances that people can, and do, make special requests and many people often had meals not displayed on the menu. We saw the lunchtime meals being served. The home has two hot trolleys, one for the ground floor dining room and one for the lower ground floor. The care workers plated meals individually for people straight from the trolley and in this way people could have the food or portion that suited them. The people who completed a survey form, and the people we talked to during our visit told us that the meals are usually very good, and they confirmed that they are always offered a good choice of foods to suit their dietary needs. One person told us the meals are “Especially good when the main chef is on duty.” A few people commented that the meals were sometimes not hot enough. We talked to Julie Smith about this. She said they had been aware of this and had recently made some changes to address this, so she was surprised people were still saying there was a problem with food temperature. We suggested she looks at this issue again to find out why some people were still finding their meals were not hot enough. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 18 The home has produced a laminated card for each person giving care staff information about the person’s preferences for breakfast, for example, how many cups of tea, what time they wanted their drinks or breakfast, and what they liked to eat. A card is placed on the breakfast trays as a checklist for the care staff. They demonstrated good practice and provide clear evidence of individual choice and personalised care. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 19 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. People can be confident that senior staff will listen to concerns and complaints, and actions will be taken to protect them from abuse. However, systems for recording complaints and ensuring they are heard are not robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has received three complaints. We asked the manager if we could look at the records of these complaints to see how they had investigated them, and to find out what actions they had taken. However, the complaints had been dealt with by the providers and no records were available in the home. We talked to Julie Smith about the need to maintain a record of all complaints and to provide evidence to show what action had been taken. She had been made aware of the complaints and she was able to tell us about some of the actions taken. We heard that there has been some discontent among some members of staff and that some staff may have felt they could not raise concerns either with the manager, the Responsible Individual, or with the providers. We suggested that the management team should look at ways of listening to the views and Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 20 concerns of all staff so that they can investigate all issues promptly and effectively. The home has a written complaints procedure in place and a copy was clearly displayed on the wall in the main entrance hallway. All staff have received training on the protection of vulnerable adults during their induction training. However, this training has not been followed up with more detailed information and guidance on how to recognise signs of abuse and what to do about it. We recommended that the home looks at the level of information all staff need to know on this subject and considers the best way of delivering the training (either in-house or through an external specialist training provider). Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 21 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, 20, 23, 26 Quality in this outcome area is good. People live in comfortable and well-maintained surroundings to suit their needs. While the level of hygiene and cleanliness is generally good, some areas would benefit from more regular cleaning and vacuuming. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Alphington Lodge stands in large well-tended and attractive gardens in the residential area of Exeter called Alphington. A gardener and maintenance person have been employed to keep the gardens tidy and to carry out minor repairs and routine maintenance around the home. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 22 When we arrived at the home the doorbell was not answered for several minutes despite ringing a number of times. The door was eventually answered by one of the people who lived in the home. We found that when the staff were busy elsewhere in the home they could not hear the doorbell ringing. We advised the manager that they must ensure the staff can hear the doorbell and answer it promptly to ensure that visitors are not left waiting on the doorstep, and are to ensure that visitors checked by staff when they enter to make certain that they have a valid reason for visiting. This will protect people from unwanted visitors who may not have a valid reason for visiting the home. During our visit we carried out a tour of the home. We looked at approximately half of the bedrooms (these were chosen randomly), and all of the communal areas including the bathrooms and toilets. We also looked at the laundry. We found it was attractive and homely throughout. All bedrooms were of a good size, and had been comfortably furnished and decorated. People have been encouraged to bring items of furniture, pictures and personal effects to make their room feel homely. During our tour of the home we found that a number of carpets were in need of vacuum cleaning. We heard that a domestic person is employed in the mornings, and in the afternoons the care staff were expected to carry out any vacuuming or cleaning tasks that the domestic had been unable to complete. It appeared that the carpets had not been vacuumed for several days. We discussed the allocation of cleaning hours with the manager. She agreed that the care staff usually put the care of people living in the home at a greater priority than cleaning, and this may have been the reason why rooms had not been vacuumed. At the last inspection we asked the home to seek advice on handling soiled laundry. We found they had taken action and now use laundry baskets when handling washing. They have a one colour of basket for soiled washing and a different colour for clean washing. The home told us in their AQAA that all staff have received infection control training, and that they have an action plan in place to deliver best practice in prevention and control of infection. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 23 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 good. The home has followed good recruitment and induction procedures that ensure people are cared for by competent staff who are entirely suitable for the work they are employed to do. Staffing levels may need to be adjusted to ensure people’s care needs are met at all times, and to ensure the home is always clean. A satisfactory number of staff have achieved a relevant qualification and a plan has been drawn up to meet future training needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection there were 26 people living in the home. Most people had medium or low care needs. On arrival there was a manager, 2 Senior Care staff, 2 care workers, 1 cook and 1 domestic on duty. We were also given a copy of the previous week’s staff rota to provide evidence of the staff who had been on duty. Some people who completed a survey form, and some of the people we met during our visit told us they thought the home was often short staffed. An anonymous complaint received by the Commission in October 2008 related to the staffing levels. They said that during the mornings there was only 1 care staff on duty to provide care to Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 24 the people on the ground and top floors, and that the workload was too much for 1 person. We talked to the manager about the staffing levels. She said she had previously worked on the care team and therefore fully understood the care tasks the staff had to perform. She felt the staffing levels were correct, although agreed that the rotas may need to be adjusted to make sure that all necessary cleaning tasks are carried out. During our visit we found that the care staff were bright and cheerful, and appeared relaxed and able to provide most care tasks in a timely manner. However, we recommended that the staffing levels are closely monitored to ensure needs set out in each person’s care plans are met. We checked the recruitment records of four staff employed since the last inspection. We found that all required checks had been carried out before the staff had started work. This meant that the home had taken care to ensure that new staff were entirely suitable for the job. We were given a copy of the training plan that has been drawn up to meet the training needs of the staff over the next year. We found that staff had not received regular updates as recommended on health and safety related topics. Julie Smith said she had recognised that some training was out of date and had therefore drawn up a plan to address this. We were told that 15 care staff have either obtained, or are close to achieving a nationally recognised qualification known as NVQ level 2. 5 care staff have also achieved NVQ level 3. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 25 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, 36, 38 Quality in this outcome area is adequate. While there have been improvements in the management of the home in the last year there are still some of areas that need further action to ensure all staff are working together effectively to provide a safe and happy home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our last inspection Julie Smith has been registered as manager of the home. She holds a nationally recognised qualification known as NVQ level 3 and is working towards the leadership and management course recommended as the minimum level of qualification for a registered manager. A new member of staff has recently been appointed as Head of Care and Julie said Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 26 she was confident they would be able to work together well to provide good management cover. The staff who completed a survey form before this inspection gave varying opinions about the management of the home. Some staff praised the home and the way it is managed. Comments included – “I believe Alphington Lodge is a very happy and efficient care home. Also I thoroughly enjoy all aspects of the job and working environment.” “It provides excellent service in relation to all aspects of care.” “My last manager never met with me. I get a lot of support with Julie my new manager.” Other staff told us about aspects of the home and management they were unhappy about “I feel I have not been given the relevant training or information I need to do my job to me best ability. Staff always feel under pressure and it is assumed we can cope being short staffed, despite some staff informing management.” (The service) – “Needs to improve in all areas.” “Myself and my colleagues work hard with no support from management. When bad practice is brought to management attention this is not acted upon.” A GP told us “Major changes in personnel in the home have caused upheaval for patients.” We talked to Julie Smith about the different views within the staff team. She told us she had already been aware of some of the feelings within the staff team. She felt that the appointment of a new Head of Care would provide greater support for staff. We looked at the way the providers oversee the management of the home. The owners have appointed a person to act as the Responsible Individual to visit the home at least once a month to ensure it is running smoothly. The Commission require providers or their appointed Responsible Individual to complete a report after each visit to provide evidence of the areas they have checked and any actions they have taken. No reports have either been forwarded to the Commission and none were held in the home to be made available during our inspections. Therefore we could not see if the providers were aware of the views of the people living in the home or the staff, and we could not see what support they had given to the manager or any actions they had taken to address any issues or problems that had arisen in the home. We looked at the way the home holds cash on behalf of those people who do not wish (or who are unable) to handle their own cash. We found the money was held securely and there were good records in place to clearly show how the money had been spent. Good accounting systems were followed that ensured balances were regularly checked. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 27 We saw records in individual staff files to show that some supervision sessions have taken place. Julie Smith said that the level of regular supervision has improved since her appointment as manager, and since a new Head of Care has been appointed. She told us that all staff now receive supervision every two months. We looked at the way the home checked the quality of the services they provide. We saw questionnaires they had given out to the people living in the home to seek their views on all aspects of daily life in the home. We found that they had a low response rate, but some of the replies gave them useful information that could be used to help them plan future improvements. The questionnaires were not anonymous and we suggested they should consider giving people the option to reply anonymously as this might encourage more people to respond to the questionnaires. It might also help people to speak out about any negative aspects of the home they may be afraid to say if they could be identified. We also suggested that they should consider ways of gathering the views of the staff team, and also of other professionals who regularly visit the home. The responses should be collated and the results of the surveys should be made known to everyone so that people could feel confident that their views had been listened to and acted upon. We also talked to Julie Smith about the evidence we look for in the AQAA (Annual Quality Assurance Assessment) we ask the home to complete each year. The document submitted to the Commission before this inspection gave some useful information on parts of the service, but there were many parts of the National Minimum Standards that had not been covered and therefore did not give us the evidence we needed to show that all aspects of the home were well managed and running smoothly. We advised Julie Smith to look at the guidance provided by the Commission and to use this form to help develop their quality assurance systems. We looked at the reports completed after each accident or incident. We found that these had been completed satisfactorily and reviewed regularly to ensure there were no patterns of accidents that might indicate further preventative action might be needed. We also looked at the fire log book to find out how the home has checked all fire safety equipment and how they have trained the staff to make sure they know exactly what they have to do if a fire breaks out. The fire log book was on display in the main entrance. We found there had been no entries since January 2009, and therefore there was no evidence of the checks and training they should have carried out on a weekly or monthly basis. We talked to Julie Smith about the action she must take to make sure these checks and training sessions are carried out as required. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 28 The home told us in their AQAA that they have policies and procedures in place on all aspects of the management of the home, including health and safety topics. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 x x 3 x x 2 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 2 x 3 3 x 2 Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Information in the care plan files should be improved to give an easy to follow guide for staff to follow on a daily basis that clearly sets out how each person wants to be assisted. The plans must be drawn up with each person (and/or their representative where appropriate) and they should be asked to sign the plan to show that they agree it is correct. Timescale for action 01/09/09 2. OP8 12 3 OP9 13(2) 01/09/09 The home must show how they have checked the risk of each person developing a skin conditions (for example, pressure sores). They should provide clear instructions to care staff on the use of creams and lotions, and how the condition should be monitored. A record should be maintained each time a cream or lotion is applied by the care staff. Safe systems of storage and 01/05/09 administration of medicines must be followed 1) Stock levels & administration of all medicines held in the home DS0000037791.V374345.R01.S.doc Version 5.2 Page 31 Alphington Lodge Residential Home 4 OP16 17 (2) Sch 4 5 OP31 26 must be properly & clearly recorded; 2) All care workers who are responsible for administering medicines must be well trained and their competence should be checked. 3) Any gaps in the medicines administration charts must be investigated immediately and the home must be able to demonstrate they have taken appropriate action to ensure the person is safe from any potential harm if an error has been made. This will ensure people are protected from risks due to maladministration of medicines. A record of all complaints 01/04/09 received by the home must be maintained and held in the home. These must give clear evidence to show how the complaints were investigated and any action taken in respect of the complaint. Visits by the registered provider 01/04/09 or their appointed representative (referred to as the Responsible Individual) must be carried out at least once a month and a written report of the visit must be completed. A copy of each report must be given to the registered manager, and a copy of the report must be made available to the Commission when requested. These reports will provide evidence to show how the manager is supported, and demonstrate that the providers have a good knowledge of how the home is managed on a day to day basis and any possible problems or issues. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 32 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 OP9 Good Practice Recommendations Creams and lotions should be dated when opened to indicate when they should be discarded. The home should check that the training given to all care workers who administer medicines meets the levels set down by the national training organisation known as Skill for Care. Information about the activities provided by the home should be improved so that people know what is planned for each day. The home should improve the way they consult with each person about the things they would like to do, and to tailor the regular activities in the home to meet all interests and needs. The temperature of hot meals should be regularly checked before serving to ensure they are the correct temperature. All care workers should receive suitable training and information on the protection of vulnerable adults. All staff should be able to hear the front doorbell when it rings and the door should be answered promptly by a member of staff. This is to ensure that visitors are welcomed into the home, and to ensure their reason for visiting the home is checked in order to safeguard the people who live in the home. Cleaning routines should be reviewed to ensure that all areas are kept clean at all times, and to ensure that carpets are regularly vacuumed. Staffing levels in the home should be reviewed to ensure people receive the assistance they need in a timely way, and to ensure there are sufficient staff to carry out cleaning and domestic tasks. The plan recently drawn up to address the training and development of the staff team should be implemented to ensure the staff receive regular updates on all health and safety related tasks, and any topics relevant to the particular needs of people living at the home. DS0000037791.V374345.R01.S.doc Version 5.2 Page 33 2 OP12 3 4 5 OP15 OP16 OP19 6 7 OP26 OP27 8 OP30 Alphington Lodge Residential Home 9 OP33 10 OP38 The results of quality assurance surveys should be made available to current and prospective residents, their representatives and other interested parties, with consideration given to anonymous completion of surveys. This will ensure people know that their views and comments have been listened to and acted upon. Records should be completed to show that regular checks and maintenance of all fire safety equipment, and regular staff training and/or drills have been carried out in accordance with the guidance laid down by the fire authority. The records should provide evidence to show that the home has taken all necessary precautions to prevent the risk of fire. Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Alphington Lodge Residential Home DS0000037791.V374345.R01.S.doc Version 5.2 Page 35 - 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. 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