Inspection on 12/03/08 for Alphington Lodge Residential Home

This inspection was carried out on 12th March 2008.

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.

Other inspections for this house

Alphington Lodge Residential Home 10/03/09

Alphington Lodge Residential Home 23/08/06

Alphington Lodge Residential Home 22/11/05

Alphington Lodge Residential Home 08/04/05

Alphington Lodge Residential Home 02/11/04

Alphington Lodge Residential Home 02/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Alphington Lodge Residential Home 1 St Michaels Close Alphington Exeter Devon EX2 8XH Lead Inspector Ms Rachel Fleet Unannounced Inspection 12th March 2008 9.45 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.V360328.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.V360328.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 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.V360328.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 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 £400 - £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.V360328.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. This inspection took place as part of our usual inspection programme. The inspection site visit was made unannounced on the 12 March 2008 and completed on 14 March 2008, lasting just over 10 hours. This included time spent with Julie Smith, the acting home manager, discussing our findings. A CSCI questionnaire on the home (the Annual Quality Assurance Assessment, or AQAA) had been returned prior to this visit, completed by the previous registered manager. This included current information about the service, staff and people living at the home, some assessment of what the home does well, and any plans to improve the service. We had also sent out 13 questionnaires to people living at the home, 13 for their relatives/supporters and 7 to relevant community-based health or social care professionals, seeking their views about the service. Completed questionnaires were returned from eight people living at the home and nine from relatives/supporters; two were received from professionals, after the first day of our visit. There were 25 people at the home at the time of our visit. During the course of the inspection we spoke with 11 people who lived at the home, four members of care staff and the cook. We looked closely (‘case tracked’) at the care of three men and women who lived at the home, reading their various carerelated records, looking at their accommodation, talking with three care staff, and observing care generally. We also looked at other documents/records e.g. recruitment records, quality assurance information, policies and procedures. Our tour of the building included the kitchen, where we spoke with the cook, and laundry. Information gained from all these sources and from communication with the service since the last main or ‘key’ inspection (on 23 August 2006) is included in this report. The Commission has not received any complaints about the service since the last inspection. What the service does well: Relatives’/supporters’ surveys included the following comments about what the home does well: Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 6 “It gives my father 24hour care and independence.” Encouraging independence was mentioned by another person, who thought the home was “Very good at treating the residents as individuals and providing considered care.” This was identified by another respondent also. “General care is very good” and “The staff are kind, considerate and very patient for the needs of the elderly.” Another also said they were gentle, and very helpful to relatives. “They have a high standard of care and cleanliness”, “My mother’s room is attended to very well. It is bright and homely”, and “Provides a basic level of care in a clean and comfortable environment.” “Events and outings are in manageable groups.” We found there are good systems for informing prospective residents about the home for prospective residents. A professional’s comments on what the service does well included ‘Staff who were always polite, cheerful and very caring’ – a view also reflected by people living at the home. One person wrote, “I have been resident at this home for many years. I would like to recommend it to anybody seeking such accommodation. During those years I have received kindness, understanding, love and tolerance from the staff.” Another wrote, “Everyone is very kind – nothing is too much trouble.” People can be confident that they will be treated with respect; they get support they want, from a caring staff team. Social activities, and links with the community outside the home also ensure most people enjoy variety, as well as beneficial relationships, in their daily lives. Action is being taken to ensure everyone has the same opportunities for such fulfilment. The home is generally being run in the best interests of those living there, although a manager is yet to be registered with us to ensure good management in the long term. People living at the home can be confident that their concerns or complaints will be listened to and acted upon, and action will be taken to protect them from abuse. They receive the personal or health care they currently need, and enjoy a balanced, varied diet that caters for their preferences. A relative said, “The food is of a high standard,” and a community-based professional commented positively about the ‘home-cooked meals’, when asked what the home did well. People have clean, homely, and well-maintained accommodation. Regular attention to health and safety helps to protect everyone at the home from harm. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There were three suggestions from relatives/supporters, as to what could be better, relating to staffing. One person felt ‘the wonderful staff are put under pressure’. Another wrote, “I feel the ratio of staff to residents is less than ideal. I rarely see any interaction on a personal level between staff and my parent.” One person hoped the excellent recent investment in the services and fabric of the building would be continued, ‘so that good standards may be maintained and improved on.’ The registered providers have assured us that this investment will be ongoing, several improvements having been made in recent years. The home’s admission procedures must ensure that anyone admitted to the home can be cared for properly, especially in the long term, with regard for the home’s registered categories of care. And the assessment of individuals’ needs should include social aspects, for the same reason. Medication must be managed properly, to avoid risks to peoples’ safety. Choice must be properly promoted for each individual, safeguarding them, their rights and control of their life. Although the views of people living at the home and of their relatives are sought in order to improve the service individuals receive, systems for monitoring and improving the service overall could be strengthened. The staff training programme should include training relevant to the needs of people living at the home, to ensure that all their needs – including changing needs - will be met. And be such as to ensure the staff team can offer a safe level of care at all times. Recruitment procedures have been improved, although one aspect could be more robust, to better protect people from unsuitable staff. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 8 An application to register a manager must be submitted as soon as possible, to establish that someone who is fit to do so is managing the home. 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.V360328.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.V360328.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): 1 & 3. Quality in this outcome area is adequate. The home’s admission practices are appropriate for most prospective residents, with the individual and the home usually adequately informed, but they do not ensure the needs of everyone admitted to the home can be met. This home does not offer an intermediate care service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Seven people living at the home who replied in the surveys we sent them confirmed that they or their family had received enough information before moving in, to help them decide if it was the right place for them. Two people we spoke with said the previous manager had visited them, at their previous home to discuss what help they needed, etc. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 11 One person knew about the home before they moved in because they knew someone already living there. Another said they had gone for a meal there and looked around; on moving in, they had found everything was as they expected from the information they had been given before their admission. A relative said their mother had settled in well and ‘been made very welcome’. The Statement of Purpose and Service User Guide have been combined into one readable, helpful document. It emphasises that Alphington Lodge is individuals’ home; two people we spoke with referred to, this adding staff told them this again since they moved in. The information can be provided in large print. We saw assessments for three people, in their care records, detailing the person’s routines prior to admission (such as their sleep pattern) and some of their needs. The template used included all the areas included in our minimum standards, although levels of recorded information varied. Social histories were absent, with little about peoples’ interests, hobbies, etc.; no social care plans were in the care plans subsequently written based on these assessments. One person’s records said their main health problem on admission was dementia. The home had spoken with a health professional who knew the person, and who thought the home was suitable for the individual. But the home is not registered to care for people with a main diagnosis of dementia, and we had not been consulted about this matter. Alphington Lodge Residential Home DS0000037791.V360328.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 can be confident that they will be treated with respect, and they receive the personal or health care they need. However, current practices do not ensure medication is managed properly, creating potential risks to peoples’ safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three care plans we read generally reflected individuals’ needs, although peoples’ social needs were not as well recorded. The acting manager said staff were working to remedy this, by getting more information from individuals about their personal histories, etc. Care plans were detailed as to what help people needed from staff for personal care, drinking/eating, skin care, mobility, etc. related risk assessments were also recorded. Staff we spoke with knew people’s general needs and individual preferences well, describing their possible daily routines - which we had observed during Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 13 our visit and individuals told us about. They described peoples’ preferences, which we saw noted in their care records. There was evidence of regular care reviews. We saw a letter inviting a relative to the next review or to speak with staff next time they were visiting. An interpreter had attended Social service reviews for someone with particular communication difficulties. The person has lived at the home a long time and we saw staff were able to communicate with them, as well as advising us as to how we could speak with them. One person who lived at the home though that staff cared for people well if they were ill. The majority of surveys from people living at the home said they always got the medical support they needed, with one saying ‘usually’. Care records showed staff were observant about changes in peoples’ health, regularly seeking advice from GPs. Weight charts we saw for each person showed their weight had been stable or had increased in the last year. A survey from one healthcare professional said care staff usually met peoples’ health and social care needs. One person we spoke with seemed to have a skin condition that was not reflected in their recent care notes; the acting manager agreed to follow this up. Another professional felt they were not always informed in good time about people whose health was deteriorating, only being contacted when the home needed nursing equipment for the person, for example. The acting manager said she would speak to district nurses, etc. to clarify when they wished to be contacted. We looked at the medication systems in use. Peoples’ allergies were very clearly highlighted in their medication records. We saw a notice saying agency staff were not to administer medication. The acting manager said she would keep a list of administering staff signatures, with their full names, as good practice. She also agreed to ensure that all medication administration records had information on them about various codes used by staff. One of three peoples’ medication charts was hand-written. Two people had not signed and dated the entries, to verify their accuracy; quantities of their medication received by the home were not recorded. There were some gaps on the administration chart where signatures should have been recorded. There was a suitable storage cupboard for controlled drugs. But their use was not being properly recorded, with two unsuitable books in use concurrently, showing inconsistent recording of doses, times of administration and balances. We could not ascertain from these what stocks should have been held. The acting manager agreed to address this urgently, to ensure clear records were kept of what individuals took, etc., whilst obtaining a suitable register. We saw a tea trolley was used to take medication round the home on medicine rounds. This was not safe, since medication could not be locked up if the Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 14 administering staff had to leave the trolley. The manager agreed to urgently review this and take steps to obtain a lockable facility for transporting medication. All the people we spoke with confirmed that staff were polite and kind, and said their privacy was respected. Two health care professionals who returned our surveys confirmed that peoples’ privacy and dignity was respected by staff, one adding staff take people to their room without being asked, so that the professional is able to see them in privacy. We saw staff knocked before entering bedrooms. Toilets, bathrooms and some bedrooms had privacy locks. There were few male care staff; the gentlemen we asked said they did not mind being helped by female staff. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 15 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 – 15. Quality in this outcome area is good. Social activities, and links promoted with the community outside the home ensure most people enjoy variety and beneficial relationships in their daily lives. And people enjoy a balanced, varied diet that caters for their preferences. However, choice is not properly promoted for some individuals, affecting their rights and control of their own lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person told us, ‘I’m doing exactly what I used to do at home except I don’t have to wash up.’ People told us they had played Bingo the day before, and that the home had a library that included large print books. Several people said they enjoyed reading. Others enjoyed visiting singers, and flowerarranging activities. A staff member was coming in later the week of our visit to play scrabble with some people. We saw a poster of the week’s activities, which included an exercise class. One person said, ‘There’s always something going on.’ Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 16 The acting manager said a tea party was planned at Easter, outings were arranged (although support was variable), and a special event was being planned for the summer. Surveys from one person living at the home and one professional said they felt the home could improve their entertainments and activities, although the professional added the acting manager was already addressing this. The curate from the church of some of the people living at the home visited to give communion. The acting manager said a Catholic deacon also visited, and staff told us a minister from a society for the deaf visited one person, as seen from their care records. People living at the home confirmed there was ‘open visiting’, and care records we saw reflected this. The Service User Guide said peoples’ visitors could join them for a meal, if the home were given notice. We saw the home had a ‘post box’, which staff said was for anyone to use, with senior staff ensuring letters were posted. Records for someone who was poorly showed the family had been kept informed, and a relative also confirmed they were kept informed of important matters affecting their family member. One person said senior staff told them that Alphington Lodge was their home and they should do exactly as they liked. They said the home was ‘a very happy place to be, with no strict and fast rules.’ A professional commented that night staff got some people up, and we saw a notice asking night staff to get an individual up whilst another person was away. A similar issue was raised at our last inspection. However, no-one we spoke with (including this individual) on this occasion was unhappy with their rising or bedtime. The professional also commented people were not helped to bath in the mornings, suggesting also that this meant people with wound dressings didn’t get a bath, and when people were bathed in the afternoon they were put into their night clothes. The professional said they had raised these issues with the home several times. All three suggestions for improvement on relatives’ surveys were that more staff were needed sometimes. Senior staff said that although mornings were usually too busy to help people bathe, two people had had morning baths on the day of our visit. And we were shown that someone with dressings had had a bath recently. The acting manager agreed to speak to community nurses responsible for dressings to clarify care plans, including bathing arrangements, with them. Although we were told that families’ permission had been obtained about individuals wearing nightwear in the afternoon, we discussed that such practices are still ultimately to suit staff or the service, rather than the people Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 17 living at the home. The acting manager was very willing to review these practices. The cook said she visited new residents to check their dietary preferences or requirements. She also said fresh and frozen vegetables are used; we saw home-baked cakes in the kitchen. The day’s menu was in the hallway. One person living at the home told us there were 2 roast dinners a week. We saw main meals were plated for people, but a pudding trolley was taken round from which people were served. One person living at the home told us there was always someone to help cut food up. Others confirmed staff knew their dietary dislikes, or that alternative choices were available. Most surveys completed a few weeks before our visit, said people usually or always liked the meals provided; one said ‘sometimes’. On our visit, most people were very happy with the meals. The acting manager said menus had been revised recently, to increase variety. One person thought the food wasn’t as good, referring to vegetables for a recent lunch. However, the same person also said, ‘Everything is very nicely done’ regarding teatime, especially that crusts were cut off sandwiches and they were covered to keep them fresh, with any filling available. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 18 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 good. People can be confident that concerns or complaints will be listened to and acted upon, and action will be taken to safeguard them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we asked said they would feel able to complain if something weren’t right, and thought they would be listened to. This was reflected in surveys returned to us by relatives/supporters – who said their concerns if any had been dealt with appropriately - and people living at the home. A new staff member told us there were complaints forms in the entrance hall, as seen near the visitors’ signing in book. The complaints procedure was also displayed there. One professional said the service always responded appropriately if they or people living at the home raised concerns about care. Another said this happened sometimes (see section on ‘Daily life and social activity’), in that they had raised certain concerns several times in the past but practice had not changed. The acting manager agreed to look at the issues raised, which also had potential safeguarding implications. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 19 When asked if they felt safe at the home, one person said, ‘I go to bed at night and feel as safe as can be.’ Records showed all staff had had training on safeguarding, except for new staff. However, a new staff member we spoke with could identify various forms of abuse and knew they should report abuse, if they witnessed it, to senior staff. One staff member we spoke with had some ideas but was not certain which outside agencies they could report concerns to if necessary. The acting manager said she would discuss this again with staff. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. People benefit from well-maintained, clean and homely accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bedrooms were personalised with peoples’ possessions. One person was very pleased that they had been able to bring some of their own furniture. Those we asked were satisfied with hot water supplies, general warmth, the lighting in their bedroom and shared areas, etc. One person told us they enjoyed the garden in better weather. One person said that although there was a bath in their en suite, they used another bath that had a fixed hoist facility for getting in/out. We saw grab rails and raised toilet seats around the home. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 21 Décor, fittings and furnishings around the home were generally in a good state, with painting going on during our visit. The kitchen had recently been re-fitted and upgraded. Some people confirmed the fire alarms were tested regularly. People surveyed and whom we spoke with were satisfied with the level of cleanliness maintained at the home. When we visited, everywhere looked clean and orderly, yet homely. There were no malodours. Staff described some appropriate practices for controlling spread of infection. Care plans included that disposable gloves and aprons were to be worn when helping people with personal care. The laundry had hand-washing facilities. Washing machines had recommended programmes for thorough cleansing of laundry, and the care staff we asked also described suitable programmes. The acting manager agreed to seek advice from specialist staff as to whether particular bags should be used for transporting soiled washing, rather than the current system used. She was also going to ensure one bathroom was restocked with soap, towels and a pedal bin, since the toilet opposite had no handwash facilities. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 22 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 – 30. Quality in this outcome area is good. People currently get the support they want, from a caring staff team. However, the current staff training programme does not help to ensure that all their needs – including changing needs - will be met or that they are in safe hands at all times. Improved recruitment procedures are in place, although one aspect is not sufficiently robust to ensure people are protected from unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with were positive about staffing generally across the whole week (including weekends), as well as day, night and agency staff. Two surveys from relatives/supporters said there was a core of loyal, dedicated care staff. The acting manager said they request the same few agency staff, to ensure people are cared for by familiar staff, who know what help they need. When we first arrived, there were 5 care assistants, the acting manager, a cook, and a cleaner on duty, with 25 people at the home that day. Half of those we spoke with indicated they were relatively independent. Staff appeared very pleasant, cheerful and unrushed during our visit, although they were continually occupied except when on their break. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 23 People living at the home who completed our surveys said staff were always or usually available when they needed them. Three relatives suggested more staff as an improvement. Care staff said they were responsible for cleaning part of the home. We discussed with the acting manager whether non-care duties might affect time that care staff had for people. We looked at recruitment files for three care staff who had been employed since our last inspection. All had the necessary pre-employment checks, including timely police checks (as required at our last inspection), except that application forms only asked for a three-year employment history. We discussed this with the acting manager, since a full employment history is required. The induction programme we saw for a new staff member was very specific about a range of practical care skills. The person also confirmed their induction had included fire safety training, infection control, manual handling, how to talk to people, etc. They were going to be doing medication training and commence a higher care qualification within a few weeks. We suggested that individual staff signed their record as well as their assessor, as good practice. Where one person told us they felt one staff member was more abrupt than others, the acting manager said she would address this through supervision. The induction programme was also used in staff supervision sessions. We discussed how these record might be developed, to ensure further training needs were also considered, etc. Several staff had worked at the home for some time. Of 22 care staff, one had a recognised care qualification, one had a nursing qualification from overseas and seven were undertaking care qualifications. The staff training programme included health and safety topics, but little about topics more relevant to peoples’ care needs. Alphington Lodge Residential Home DS0000037791.V360328.R01.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 good. The home is generally run in the best interests of those living there, although a manager is yet to be registered with us to ensure good management in the long term. Systems used to monitor and improve the service that people receive could be strengthened, to show people that their views are valued and responded to. A systematic approach to health and safety helps to protect everyone at the home from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We had been notified that action was being taken to recruit a manager for the home. Julie Smith, the acting manager, assisted us; by the second day of our visit, she had made an action plan and was addressing issues raised on the Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 25 first day. One person living at the home singled out her for praise, whilst others said she was very approachable. They were satisfied with the ongoing running of the home. Julie Smith said Mr Mike Beard, representative of the registered providers, visited weekly, sometimes unannounced, requesting action to be taken about issues he identified on these visits. One person we spoke with knew that he visited and that they could ask to speak with him. People told us there were no residents’ meetings. The acting manager said that care plan reviews were used to get peoples’ views about the service they received, for quality assurance purposes. Surveys were also used; however, issues raised in these were addressed individually, with implications for anonymous completion of surveys. No report of overall findings was produced, which could be shared with groups consulted and show what action would be taken in the light of their contributions. In view of comments we received, the acting manager agreed it might be useful if the home’s own surveys went to a wider range of professionals. The home’s staff did not act as appointees for anyone. The acting manager said only one person living at the home had no relatives to help them with their finances so Social Services had taken on this role. The home held personal monies for some people. Records we checked had two signatures to verify entries; recorded totals matched the individual cash balances held, etc. People who used walking aids told us they felt safe getting around the home, and they did not encounter any hazards or environmental problems. Hot bath water we checked was safe, at 46°C. Upper windows that we checked were restricted. The AQAA showed that certain equipment and facilities, such as gas and electrical systems, had been serviced recently. Accident records showed a low level of accidents. Where someone appeared to have had more falls than their peers, the acting manager showed that the GP had been consulted. Peoples’ care records had individual fire safety risk assessments that included what help they might need, etc. in the event of fire. One person’s notes included foods they should not eat because it would react adversely with medication they were on. The cook was aware of the latest food safety guidance, monitoring temperatures of fridges, freezers (which were in recommended ranges when we checked) and certain hot foods, for example. We saw environmental risk assessments, and that they had been reviewed in December 2007. We discussed with the manager that more garden areas might be included, to ensure pathways, etc. were safe and easy for people to use independently, since the garden could be a great asset to the home. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 26 A professional said they thought the service could improve through better adherence to the manual handling policy, a concern we discussed with the acting manager. The cook and care staff we spoke with confirmed they had had manual handling training within the last year. Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 27 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation National Care Standards Commission (Registration) Regulations 2001 Requirement People whose primary needs are other than those shown on the home’s registration certificate must not be admitted to the home until the Commision has been consulted and reassured as to how their needs will be met - Timescale for action 11/04/08 2. OP9 13(2) To ensure people are only appropriately admitted, to a home that is able to meet their needs. The registered person shall make 11/04/08 arrangements for the safekeeping and safe administration of medicines in the home 1) Stock levels & administration of controlled drugs must be properly & clearly recorded; 2) There must be safe delivery/transport systems for medication administered to people living at the home To ensure people are protected from risks due to maladministration of medicines. The registered person shall - so far as possible - enable people DS0000037791.V360328.R01.S.doc 3. OP14 12(2)&(3) 30/04/08 Page 29 Alphington Lodge Residential Home Version 5.2 living at the home to make decisions regarding the care they are to receive, taking into account their wishes and feelings, especially in relation to their daily routines In order to provide personcentered care for them, and safeguard their rights. The registered person must not employ a person to work in the care home unless he has obtained all the information and documents specified in paragraphs 1 to 9 of Schedule 2 about that person, including a full employment history together with a satisfactory written explanation of any gaps in employment – To ensure people living at the home are protected from unsuitable staff. 4. OP29 19 (1) & Schedule 2 30/04/08 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 OP3 Good Practice Recommendations For each prospective resident who is self-funding and without a Care Management assessment/care plan, you should carry out a needs assessment that includes social interests, hobbies, religious needs, carer or family involvement, and other social contacts/relationships – To ensure no-one moves into the home without having had all their needs assessed, so that they can be assured that their needs will be met if they move in. Each person’s care plan should set out in detail the action which needs to be taken by care staff to ensure that all DS0000037791.V360328.R01.S.doc Version 5.2 Page 30 2. OP7 Alphington Lodge Residential Home aspects of the health, personal and social care needs of the individual are met – 3. OP9 To ensure they receive person-centered, holistic care. Where handwritten entries are made on medication administration records, each entry should be signed and dated by two staff members – To verify the accuracy of each entry. Medication administered to individuals must be signed for on the individual’s medication administration records, in a timely way – To keep an accurate record showing that they have taken medication prescribed for them. At least 50 of care staff (excluding the registered manager) should be trained to NVQ Level 2 in care, or equivalent – To ensure people living at the home are in safe hands at all times. There should be a staff training and development programme which includes training relevant to the particular needs of people living at the home – To ensure staff fulfil the aims of the home and meet peoples’ changing needs. An application to register a manager must be submitted as soon as possible – To establish that the home is being managed by someone who is fit to do so, and so that the manager is not committing an offence through managing a care home whilst unregistered. 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 – So quality assurance systems, based on the views of service users, are in place to measure how well the service has met the aims, objectives and statement of purpose of the home. 4. OP9 5. OP28 6. OP30 7. OP31 8. OP33 Alphington Lodge Residential Home DS0000037791.V360328.R01.S.doc Version 5.2 Page 31 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.V360328.R01.S.doc Version 5.2 Page 32 - 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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