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Inspection on 22/11/05 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 22nd November 2005.

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

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

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

What the care home does well

Residents at this home like and trust staff who are kind and patient. All residents speak highly of the staff; one resident described care provided as "very attentive", another said that they "could not praise them enough". Staff are on duty in sufficient numbers to ensure they can care for residents in an unrushed manner. The home staff ensure that residents get prompt access to health care. Most parts of the home are comfortable and benefit from ongoing investment. The manager is committed and works hard to ensure the home is run with residents best interests in mind.

What has improved since the last inspection?

Care planning has improved though further development is needed. Record keeping has improved with residents records now routinely being signed and dated as they should be.

What the care home could do better:

Care plans need to be developed to provide more detail about the care needs of residents. Procedures for managing medication need to be improved in some areas. The heating in one room needs improving, some radiators need to be covered, two fire doors need to be adjusted so that they fully close and bath water temperatures should be adjusted. Recruitment procedures are still not being sufficiently closely followed.The process of inducting new staff when first working at the home needs to be formalised and staff should be offered more training to ensure that they have the skills and knowledge to provide residents with a consistently high standard of care.

CARE HOMES FOR OLDER PEOPLE Alphington Lodge Residential Home 1 St Michaels Close Alphington Exeter Devon EX2 8XH Lead Inspector Stephen Spratling Unannounced Inspection 22nd November 2005 10:30 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.V259254.R01.S.doc Version 5.0 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.V259254.R01.S.doc Version 5.0 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 Susan Reynolds 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.V259254.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th April 2005 Brief Description of the Service: Alphington Lodge is a period property with large level gardens and an enclosed courtyard. It is situated in the centre of the Alphington within short walking distance of local shops, church, pubs and health centre. The home is registered to provide accommodation and personal care to up to 28 older people. The accommodation comprises of a main building, which has three floors, all served by passenger lift and a cottage annexe with two groundfloor rooms. All rooms provide single accomodation, 14 are ensuite. The home has three pleasant lounge/dining areas. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by one inspector, Stephen Spratling. During the day the inspector spoke with 9 residents, 4 members of the care staff, the homes administrator and the registered manager. He looked around some areas of the building and at some of the records kept by the home; including those written about people living at the home. Not all standards were assessed during this inspection and the reader should see the last inspection report for a fuller view of the service. What the service does well: What has improved since the last inspection? What they could do better: Care plans need to be developed to provide more detail about the care needs of residents. Procedures for managing medication need to be improved in some areas. The heating in one room needs improving, some radiators need to be covered, two fire doors need to be adjusted so that they fully close and bath water temperatures should be adjusted. Recruitment procedures are still not being sufficiently closely followed. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 6 The process of inducting new staff when first working at the home needs to be formalised and staff should be offered more training to ensure that they have the skills and knowledge to provide residents with a consistently high standard of care. 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. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. For further information please see previous reports. EVIDENCE: Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Care planning arrangements go some way to ensure that resident’s needs are met, but more work is needed to ensure they provide enough detail. By ensuring residents have prompt access to health care professionals; the staff at this home promote the good health of residents. Systems are in place regarding medication management though improvements could be made to ensure residents are fully protected. The homes assessment of residents wishing to manage their own medication potentially put residents at risk. EVIDENCE: Work to improve the care plans was seen by the inspector, this included regular weekly summaries of what had happened to residents. However those seen by the inspector still did not contain sufficient information to ensure care is provided in the best and most consistent way e.g. one resident needed support to manage their anxiety but the care plan available did not provide guidance as to how this support should be delivered by staff. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 10 Residents confirmed that their GP is called promptly when needed. Records seen showed evidence of residents being helped to access specialist health care services. One resident described being escorted to hospital by a “very attentive” member of the care staff. Medications managed by the home are securely stored and administration records seen had been properly completed. Though the manager confirmed that she checks medications when they are received by the home, records were not completed to confirm this, as they should be. The manager said that one resident manages their own medication but the homes risk assessment had not been completed in relation to this. A senior carer confirmed that staff administering medications had recently attended training provided by a pharmacist. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. For further information please see previous reports. EVIDENCE: Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. For further information please see previous reports. EVIDENCE: Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 The safety and comfort of some residents is put at risk by failure to suitably maintain and equip all areas of the home. EVIDENCE: Most areas of the home visited by the inspector were at a comfortable temperature, though one residents room was noticeably cool; this resident said that the room is rarely as warm as they would like in the winter. Other residents indicated that they are happy with temperatures around the home and content that the home is consistently well maintained. Many of the radiators are guarded to prevent residents burning themselves, though not all. The manager said some of the heating system has been upgraded and that plans to cover hot surfaces are in place. The temperatures of two baths were checked one was within recommended limits (around 43oC) though the other was too hot (48oC); the manager said that all hot bath taps have thermostatic valves fitted. Fire doors into two bedrooms did not close properly. Some carpets have been renewed around the home. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Residents benefit from being cared for by staff who are kind, caring and employed in sufficient numbers to help ensure their needs can be fully met. However the lack of a systematic approach to training means residents can not be reassured that all staff have the knowledge and skills they need to care for them to a consistently high standard. Recruitment procedures are in place but are still not sufficiently robust to maximise protection of residents. EVIDENCE: Residents spoke fondly of staff indicating that they provide prompt help, that they are kind and gentle. One resident that they “could not praise them enough”. Staff said that there are generally enough of them on duty to care for residents properly in an unrushed manner. The manager said that of the 28 care staff employed two staff are currently doing National Vocational Qualifications in care but no others have any formal care related qualifications. All four care staff spoken with had received training regarding safe moving and handling of residents and what to do in case of fire. Three who had been at the home for between 2months and 1year said they had not had any other training, a fourth carer said the home was funding them to do an NVQ and had done other care related training. Staff employed in the last year said they had been well supported when first working at the home, working with other experienced colleagues initially. The manager described an induction process for new staff but no records of induction are kept and so it is Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 15 not possible to see if induction is consistently applied or if it covers professionally recognised standards. There is no formal/recorded system for identifying staff training needs or plan as to how they should be met. Of three staff records seen two indicated that some pre-employment checks had not been done before the carers had started work as they should be to protect residents from people unsuitable to work with vulnerable people e.g. in both instances Criminal Records Bureau checks had been received several months after the member of staff had started work. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 37 The manager of the home works hard to ensure that the home is run in the best interest of residents. Improvements in the maintenance of records means resident interests are better protected. EVIDENCE: Sue Reynolds has managed this home since 2002. She has worked at the home in a care capacity since 1986 and she told the inspector that she has completed the registered managers award recently and has agreed to forward the certificate of confirmation to the commission. All residents and staff spoken with confirmed she is approachable and responsive to their concerns. The manager gave the inspector examples of occasions when she and her staff have advocated on behalf of residents. Questionnaires requesting feedback from visiting professionals were shown to the inspector; 12 briefly read Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 17 contained only positive feedback. All residents asked confirmed that the manger regularly checks if they are happy with everything and acts if they are not. The manager gave an example of changes to meals made as a result of resident’s feedback. Staff recording in residents daily records has improved with staff now routinely signing and dating entries. Records required by regulation requested by the inspector were available for inspection. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 18 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 X X X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 2 X X X X X 2 X 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 3 X 3 X X X X X Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 19 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 OP29 Regulation 19 (1) Requirement The registered person must not employ a person to work in the care home unless.. he has obtained in respect of that person all the information and documents specified in paragraphs 1 to 7 of schedule 2 (Criminal Records Bureau checks must be received before staff start work where exceptions are made Department of Health Guidance must be followed) (previous timescale for compliance not met) Timescale for action 22/02/06 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 OP7 Good Practice Recommendations Service users plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. DS0000037791.V259254.R01.S.doc Version 5.0 Page 20 Alphington Lodge Residential Home 2 OP9 Risk assessments should be completed and acted upon to minimise risk when residents wish to self-administer medication. Records should be kept of medications received into the home. 3 4 OP19 OP25 The building should comply with the requirements of the local fire services i.e. fire doors should close properly. Heating in resident’s rooms should meet their needs. Hot surfaces should be suitably guarded dependant on outcomes of risk assessments or have guaranteed low surface temperatures. Thermostatic valves on hot tapes should be regularly maintained to ensure that water is delivered at close to 43oC. 5 6 OP28 OP30 A minimum ratio of 50 of care staff should have achieved NVQ2 or equivalent. The registered person should ensure that the staff training and development program meets National Training Organisation (NTO) workforces targets… All members of staff should receive induction training to NTO specification (TOPPS) within 6 weeks of appointmentrecords of the induction undergone by each staff member should be maintained All staff should receive foundation training to NTO (TOPPS) specification within the first six months of appointment… All staff should receive a minimum of three paid days training per year and have an individual training and development assessment and profile. Alphington Lodge Residential Home DS0000037791.V259254.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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.V259254.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!