CARE HOMES FOR OLDER PEOPLE
Alston House 380 Aylestone Road Leicester Leicestershire LE2 8BL Lead Inspector
Helen Abel Unannounced 22 August 2005, 1:45pm
nd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Alston House Address 380 Aylestone Road Leicester Leicestershire LE2 8BL 0116 2915601 0116 291 5611 None Mrs M Madden Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Carol Smith Care Home 19 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (19), Sensory Impairment over 65 years of age (2) Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: No person falling within categories MD(E) or DE(E) may be admitted to the home when 6 persons of categories/combined categories MD(E), DE(E) are already accommodated within the home. No person falling within category SI(E) may be admitted to the home when 2 persons of categories/combined categories SI(E) are already accommodated within the home. Date of last inspection 22nd November 2004 Brief Description of the Service: Alston House is a registered for older people and can accommodate up to nineteen older people, including up to six older people with dementia, up to six older people with mental disorder and up to two older people with sensory impairment. The home is situated off a main road, along a tree-lined road and approximately 15 minutes away from city centre. There are shops within five minutes walking distance from the home and a small park nearby.The home provides two-storey accommodation with communal areas and conservatory on the ground floor. Bedrooms are located on both the ground floor and first floor that can be accessed by the stairs or the passenger lift. A large parking area is to the front of the home. There is a well-maintained garden to the rear of the home with seating and mature plants and shrubs. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced during a week day afternoon over a four hour period. I spoke with residents, visitors, staff and the Registered Manager. A part tour of the premises took place and some staff and care records were inspected; as well as some records, policies and procedures relating to the management of the home. What the service does well: What has improved since the last inspection? What they could do better:
Update the risk assessment for an identified resident and provide the appropriate equipment to meet their health care needs. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 6 Obtain the appropriate weighing equipment to meet the needs of residents with mobility difficulties; and for all residents ensure regular monitoring of weight gain or loss, with records held of any action taken. Obtain new carpets on the hallways and passageways due to wear and tear. A review of the recruitment procedures around Criminial Record Burea Checks (CRB’s) to be undertaken to further safe guard residents. Provide for all new staff - a basic staff induction; followed by the National Training Organisation for Social Care (TOPPS) induction to ensure staff are competent to do their job. Ensure the cleaning cupboard is kept locked; and the use of bleach is reviewed in line with Control of Substances Hazardous to Health Regulations (COSHH) 1988. This will further ensure the health and safety of residents and staff. Review and update the Statement of Purpose ensuring this remains available to prospective and current residents. For accuracy ensure the correct spelling of an identified residents name is recorded on their care plan. Develop a nutrition section/sheets as part of the care plan to ensure food and fluid intake is monitored and health care needs are fully met. Provide alternative floor covering for an identified residents room to assure a more pleasant and comfortable environment. 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. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3, Assessment systems are fully implemented, which ensures that the service meets prospective resident’s needs. EVIDENCE: The Statement of Purpose was available in the office area. Suggestions for developing and updating the document were given to the Registered Manager. The Registered Manager has undertaken a needs assessment for a new resident prior to entering the home. This involved close working with the resident, family members and social worker. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, Resident’s personal and social care needs are generally satisfactory. Generally residents health care needs are met, however not all are fully met. EVIDENCE: One residents care plan did not reflect her assessment of health and care needs around the prevention of pressure sores. There was some uncertainty around the correct spelling of the resident’s first name. Not all resident’s records for weight gain and loss had been undertaken. Staff confirmed more appropriate weighing equipment was needed and would be beneficial to support residents with mobility difficulties. Other care plans were examined and found to hold the appropriate and relevant information. The medication records were examined and found to be of a good standard. All senior staff had received training in medicine management. The Registered Manager confirmed the medication area door would receive a new sign to reflect its purpose. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12,13,14,15 There are sufficient, social, cultural, religious and recreational interests to meet the expectations and preferences of residents. EVIDENCE: Residents have opportunities for exercise to music, sing a longs, dances and watching staff dance, listening to music. Staff felt residents would enjoy a game recently purchased called memory lane bingo. One resident said, “I prefer to stay in my room and look at the view outside”. Relatives were observed visiting throughout the inspection day. A visitor told the Inspector, “The staff are quite approachable. Staff will listen to you. All members of our family come and visit frequently”. Staff were observed serving fried eggs and homemade chips for tea. One resident refused the meal served and was promptly offered an alternative meal. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, Resident’s complaints are listened to and taken seriously. EVIDENCE: A clear complaints procedure is included in the home’s Statement of Purpose. A visitor confirmed, “ There had been difficulties in the past with the care for my mother but we had a meeting and the issues were dealt with. I would come to the Managers if I had any further problems”. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24 The premises are generally well maintained, safe and comfortable. EVIDENCE: Rooms viewed were, personalised, tidy, safe, and comfortable. It was agreed with the Registered Manager one identified room would require an alterative floor covering to ensure a more pleasant and comfortable environment. The carpets in the communal hallways and passageways were worn and soiled and need replacing. The bathrooms areas were clean and tidy and well presented. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29,30 Recruitment procedures do not safe guard residents; new staff members have not received all the relevant training, which would enable them to be competent to do their jobs. EVIDENCE: There were good levels of staff observed during the unannounced inspection, with staff being friendly and warm in their approach with residents. A new staff member was employed with no proven experience and there were concerns around the recruitment and selection process. It was agreed with the Registered Manager immediate action would be taken to resolve this. A review of the recruitment procedures around Criminial Record Burea Checks (CRB’s) must also be undertaken. One new staff member had not completed a basic staff induction; or undertaken the National Training Organisation for Social Care (TOPPS) and was not equipped with the skills to do the job. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health, safety and welfare of residents and staff are generally promoted and protected. EVIDENCE: Some safety checks and associated records were viewed and were in order. The outcomes for this Standard will be inspected again at the next inspection. It was noted the cleaning cupboard was not closing properly and needs repair. Bleach is used in the home for some cleaning procedures. Guidance was given around obtaining alternative cleaning materials. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 2 3 x 3 3 x x STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 16 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 13 Requirement Unnecessary risks to the health and safety of the resident are identified and so far as possible eliminated: Update risk assessment for new resident and ensure approiate equipment is provided to meet health care needs. Timescale for action Immediate 2. 8 12 To promote and make proper Immediate provision for the health and welfare of residents: For the identified resident monitor food/fluid intake; Keep a record of weight gain and loss and any appropitae action taken. To promote and make proper provision for the health and welfare of residents: Obtain suitable weighing equipment; and regularly weigh all residents with written records held. To obtain new carpets in the communal hallway/passage ways. 22nd September 2005 3. 8 12 4. 20 23 22nd November 2005 Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 17 5. 29 19 6. 30 12 The Registered Person shall not employ a person to work at the care home unless - the person is fit to work at the care home; This is subject to full and satisfactory information being made available: To review recruitment procedures around Criminial Record Burea Checks. The Registered Person shall ensure that the care home is conducted so as; to make proper provision for the care and where appropiate, treatment, education and supervision of residents: To provide a basic staff induction followed by the National Training Organisation for Social Care (TOPPS) induction The Registered Person shall ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety: Ensure the cleaning cuboard is kept secure; Review the use of bleach in the home under COSHH regulations. Immediate Immediate 7. 38 13 Immediate 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. 2. 3. Refer to Standard 1 7 7 Good Practice Recommendations To review and update the Statement of Purpose. Check out and ammend care records with the correct spelling of an indentified residents first name. Update risk assessment format .
C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 18 Alston House 4. 5. 8 24 Produce and maintain food/fluid intake formats as part of individual residents care plans. It is strongly reccommended an alternative floor covering is obtained for an identified residents bedroom. Alston House C51 C01 S6408 Alston House V242436 220805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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