Inspection on 09/08/06 for Alston View Nursing & Residential Home

This inspection was carried out on 9th August 2006.

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.

Other inspections for this house

Alston View Nursing &... 08/11/05

Alston View Nursing &... 26/04/05

Alston View Nursing &... 12/10/04

Alston View Nursing &... 06/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Alston View Nursing & Residential Home Fell Brow Longridge Preston Lancashire PR3 3NT Lead Inspector Mrs Janet Proctor Key Unannounced Inspection 08:45 9 & 14th August 2006 th X10029.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 Alston View Nursing & Residential Home DS0000022500.V303348.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 and Care Homes for Adults 18 – 65*. 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 View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alston View Nursing & Residential Home Address Fell Brow Longridge Preston Lancashire PR3 3NT 01772 782010 01772 785649 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) MPS (Investments) Limited, Green & Co Mrs Patricia Dixon Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (44) of places Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A max of 44 service users requiring nursing care who fall in either the category of OP or PD A max of 15 service users requiring personal care of the category OP Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 12 May 2000 8th November 2005 Date of last inspection Brief Description of the Service: Alston View provides long and short stay care for a maximum of 44 service users who are elderly and need personal care, or who are elderly and have physical needs for which they need nursing care. The home can also accommodate adults aged 18-64 for nursing care. The registered persons are MPS (Investments) Limited, Green & Co. The day-to-day management of the home is undertaken by a Registered Manager, Mrs Patricia Dixon. The home is located within the village of Longridge in a residential area. Access to shops, a Church and other facilities is within walking distance. The building is a modern purpose built home, which overlooks landscaped grounds to the side and rear of the home. All bedrooms, except for one, are single rooms. All of the rooms are en-suite, with the exception of two single rooms. There are separate lounge areas and dining areas located on each floor of the home. Service users have access to garden and patio areas to the side and rear of the home and a small car parking area is located to the front of the home. Information for prospective residents is given in the form of a brochure when they express an interest in the home. Prospective residents received a brochure that contained the Service User’s Guide. Information from the home at the time of inspection showed that there is a range of fees. Those who are funded through the local authority for residential care are charged £366-00. Residential residents who pay privately are charged £400-00. Those residents receiving nursing care are charged between £432-00 to £546-00 if they pay privately. Those funded by the local authority are charged £471-00 plus a £15-00 top up fee. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection was unannounced and took place over one and a half days on the 9th and 14th August 2006. The previous inspection was done on 8th November 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk . No additional visits have been made to the home since the previous inspection. Two complaints have been received by CSCI and forwarded to the home for them to investigate using their own procedures. These investigations have not yet been completed. On the day of the inspection there were 41 residents at the home. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to residents, the Deputy Manager, the Acting Manager, the Administrator, staff members and visitors. Information was also received from 8 surveys completed by residents and 4 from relatives. Wherever possible the views of residents were obtained about their life at the home and their comments are included in this report. What the service does well: The residents were provided with bedrooms that were clean and nicely decorated and they had a choice of sitting and dining areas. They could bring small items of furniture to make their bedroom more homely. They could use their bedrooms as and when they wished. Residents spoken to said,” I generally stay in my room” and “It’s clean and they look after your clothes and bedding well.” Four of the resident surveys said that they thought the home was always fresh and clean. Residents were informed of what the menus for the week were. They received a meal sheet to fill in and kept a copy for themselves. This meant that there was plenty of time to arrange a different item if they did not like what was on the menu. The food was to the liking of the residents spoken to and they were pleased with the meals served. Residents said, “The food’s good. If there’s nothing you like on the menu you can have something else” and” The food’s good, you can tell from the taste that it’s home cooked and not from the freezer.” Visitors were encouraged and made welcome. Residents said, “I get a lot of visitors. They come up and see me in my room” and “My son comes every night to see me.” All except one of the resident surveys returned all said that the staff listened and acted upon what they said. A resident said, “I feel safe and it’s nice to know there’s always someone there – better than being on your own.” Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: All residents should receive a copy of the home’s terms and conditions of residency. This would ensure that there were no misunderstanding s about what would be provided. Resident must receive confirmation in writing that the home can meet their needs. This is so they can be assured that the home has the necessary equipment, staff and expertise in place to enable them to receive the care they need. Every resident must have a plan of care, including those people who come for day care. This is so that there are directions to staff about their needs and how to meet them. The plans should always be discussed with the resident or their relative so that they have some control over the care they receive. The plans should be amended when care needs change so that the information is accurate and current. There should be some record of what progress is being made to meeting goals. This is so that it can be seen whether the actions being taken are right. The means of moving and handling residents must be done in a safe way. This is so that no injury occurs to either the resident or the staff. If relatives are involved in the moving and handling of a resident this must also be done in a Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 7 safe way. One survey returned said that relatives were worried about an injury from moving and handling practices. The District Nurses must either provide the full nursing care for a resident or this be the responsibility of the staff at the home. This is so that the nursing care is given in an accountable way. Residents should be assessed as to whether they are able to manage their own medication. A resident said, “My only grumble is that they won’t let me manage my medication. I was capable of doing this at home and in hospital so why not here.” Staff must ensure that they use the medications prescribed for each resident and not ‘borrow’ from other residents. The range of activities on offer should be increased. This is so that the social and recreational needs of residents are met. Of the resident surveys returned only two said that they thought there were always suitable activities. In order to ensure continued protection of residents all staff must receive regular training in the protection of vulnerable adults and be aware of whom to contact should such an incident occur. Training for staff must cover all aspects of care, health and safety, moving and handling and fire procedures. This is in order to ensure that all staff are competent to do their work and to protect residents and staff. Some of the bedroom doors did not fit correctly. This meant that they did not offer full protection in the event of a fire. The windows to parts of the home require attention to ensure that they are not ‘fogged’ up. This is so that residents have a clear view from their windows. All staff must have two written references before they start work and one of these must be from their last employer. This is so that that the Manager ahs sufficient information to make a decision about whether they are suitable to work at 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. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not every resident received a contract from the home, which meant there was the potential for misunderstandings to occur about what would be provided. Residents could not be confident that the home could meet their needs, as they did not receive written confirmation of this. EVIDENCE: Only those residents who paid their fees themselves received a copy of the terms and conditions of residency. Local Authority funded residents had a copy of the service level agreement between the local authority and the home. There were items and information included in the terms and conditions of Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 10 residency that were not covered in the service level agreement. For example, the total value of items that could be lodged with the home for safe-keeping. A range of fees were charged. Those who were funded through the local authority for residential care were charged £366-00. Residential residents who paid privately were charged £400-00. Those residents receiving nursing care were charged between £432-00 to £546-00 if they paid privately. Those funded by the local authority were charged £471-00 plus a £15-00 top up fee. Of the four residents who were case tracked three had appropriate assessments prior to admission. One resident’s pre-admission assessment was dated the date of admission. A letter confirming that the assessed needs could be met at the home was only seen for one resident. Intermediate care was not given at Alston View. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans were clear and well written. Not all of these were up to date which meant that staff may not have information they needed to satisfactorily meet residents’ needs. Moving and handling practices meant that residents and staff were not safeguarded. Medication practices ensured that residents were safeguarded. Residents’ privacy and dignity were respected. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 12 EVIDENCE: The records for four residents were viewed. Each resident had an individual plan of care. Each plan of care followed the same format and all records relating to the resident were kept together in one folder. There was a full assessment of the residents’ needs and a plan of care formulated for those areas of personal, health and social care that needed staff intervention. Two of the plans seen had evidence of consultation with either the resident or their relative. The directions to staff on how to meet the needs were written in good detail. Carers spoken to said that they read the plans of care and were able to understand the information in them. The plans had been reviewed monthly but there was no indication of the progress being made. The plans of care were not always amended when care needs changed. For example, a resident’s catheter had been removed but there were no directions about how continence was then to be maintained. The details in the plan of care were not always followed. For example, the plan of care directed that a resident’s weight, blood pressure and urinalysis were to be recorded monthly but there were no records of this. Two people came for day care one day each week. There were no plans of care for these residents. There were a variety of assessments that covered: pressure sore risk; nutrition; moving and handling; and falls. The falls risk assessment did not state how the score of High, Medium or Low had been arrived at and did not include strategies for reducing the risk. A resident was seen to be moved by an ‘under arm’ lift despite there being explicit instructions to staff about this not being done. A resident was seen to be moved by her husband in a fashion that was potentially harmful for both parties. Plans of care were prepared if the resident was seen to be at risk of pressure sores or nutritional deficit. The details in the plan of care were not always correct, for example, details about the type of mattress to be used to reduce the risk of pressure sores. A resident had a wound but there was no record of this in the plan of care and no current record of the treatment being given and the progress being made. There was evidence that health professionals such as District Nurses, GPs, Chiropodists, and Psychologists were consulted about the needs of residents. One resident was receiving residential care and the District Nurses administered his insulin. However, due to the instability of his diabetes he required 4 hourly checking of his blood sugar levels, which was being done by the Registered Nurses at the home who then made a decision about what action to take. This means they were in effect giving him nursing care. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 13 The medication storage area was clean and tidy and the temperature of the room and fridge were recorded daily. The temperature of the room had risen above 25 degrees Celsius on some occasions. The trolley and oxygen cylinders were secured correctly. Creams were seen on open display in one of the bedrooms. There were policies and procedures for staff to refer to about the control of medications. There were records of medications received into the home, administered and disposed of. Some medication belonging to residents were being administered to others who were on the same medication. Hand written annotations to the Medication Administration Records were signed and witnessed. The copy of the British National Formulary was dated September 2002. This meant that staff could not look up information on medications issued since that date. One resident queried why she was not allowed to administer her own medication when she had been able to do this satisfactorily at home and in hospital. Privacy and dignity were respected and noted in the directions to staff in the plans of care. The resident’s preferred term of address was recorded. There were some communal toiletries – shampoo and conditioner – seen in the bathrooms. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities being done on a daily basis needed to be extended in order to meet the recreational needs of more residents. Residents were encouraged to keep contact with relatives and friends and visitors were made to feel welcome. Residents were happy with the meals served at the home. EVIDENCE: Social Therapist hours were provided on 3 half days each week. There was a programme of activities displayed on the notice board. This was not being Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 15 followed as on the day of inspection it was supposed to be gentle exercise, skin care and pampering. Instead dominoes were played. Records of activities were not available at the time of the inspection. Some residents spoken to said that they were able to occupy themselves and preferred to do this than join in the organised events. There were notices displayed informing residents and visitors of forthcoming activity events. There were photographs of events done previously on display. The preferred rising and retiring times were noted in the plans of care. The issue of giving residents choice about aspects of their lives was also indicated in plan of care. Staff spoken to said that they asked residents what they wanted. If residents were unable to make a choice then they tried to be aware of their past preferences and routines. Some residents spoken to said that their choices about their daily routines were respected by staff. One resident said that he was sometimes put to bed early because of staff shortages, which was not his choice. Religious services were held at the home and details of how to contact relevant ministers were displayed on the notice board. The plan of care for one resident stated that she was a practising Catholic and her Priest visited her each Sunday. Visitors were welcome and invited to attend any social events at the home. Residents spoken to were happy with the meals at the home. They were offered a choice of food at mealtimes and could have alternatives to this if they wished. They were issued with two menus each week. One to make their choices on and return to the kitchen and one to keep to remind themselves of what was to be served. The kitchen was clean and tidy and sufficient stores of food were seen. Records were kept of food served and fridge and freezer temperatures. There was a cleaning schedule. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were confident that their complaints would be listened to and acted upon. The lack of staff training in protection of vulnerable adults may result in abusive practices being unrecognised and unreported. EVIDENCE: There was a complaints procedure displayed on the notice board. This gave clear directions on who to make a complaint to and that a response would be made within 28 days. The procedure also had the address and telephone number of the Commission. A record of complaints made was kept at Alston View. None had been recorded since the previous inspection. Two complaints had been made direct to CSCI in this period and forwarded to the home for them to investigate under their own procedures. These investigations had not yet been finished. Residents spoken to said that they’d no complaints about the way they were looked after. There were policies and procedures for the Protection of Vulnerable Adults. A copy of this had been given to staff and was also available on each floor of the home. Residents spoken to said that they felt safe at Alston View. All new Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 17 employees received Protection of Vulnerable Adults training in their Induction session. Not all of the other staff had yet received training in Protection of Vulnerable Adults. This meant that the Manager could not be assured that they would be aware of and implement the correct procedure should a situation occur. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were happy with their accommodation at the home and lived in a safe, clean, well-maintained environment. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 19 EVIDENCE: A tour of the building showed that all areas were clean, tidy and well maintained. Some bedrooms were newly decorated with matching bedding and curtains. One resident had recently moved to a bigger room and was happy with this. Residents were able to bring in small items of furniture so that they had their own possession around them. Locks were not fitted to bedroom doors. The admission documents recorded that residents had been offered the opportunity to have a lock provided to their bedroom door if they wished. Each resident had a lockable drawer for storage. Repairs were recorded and done as identified. A new ceiling had recently been fitted in the kitchen. A number of double glazed windows were ‘fogged up’ meaning that the view from these was reduced or spoiled. There were obvious gaps at the bottom of some bedroom doors. This compromised the fire safety of the doors, as smoke would be able to pass through the gap. There were aids and equipment, for example, Grab rails, bath hoists, and hoists. The temperatures of the hot water to the baths was checked. One of these was 49.0 degrees, which is too hot for safety. Records of hot water temperatures were not routinely taken. There was a separate laundry that had 2 washers and 2 dryers. One of the washers had a sluice programme. Red alginate bags were seen to be used for safe laundering of soiled items. Liquid hand soap and paper towels were available to staff for good hand hygiene. Plastic gloves and aprons were used when giving personal care. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were enough staff on duty to meet the needs of the residents. Recruitment procedures were not thorough enough to fully ensure the protection of residents. Staff were not provided with sufficient training to ensure they had the skills and knowledge to do their work. EVIDENCE: There was a rota on display. This was inaccurate as it showed the Registered manager to be on duty when she was actually on annual leave. The staffing levels were usually two Registered Nurses and 6 carers on duty during the day and one Registered Nurse and 3 carers at night. The staffing levels were reduced on the day of the inspection as a staff member was off sick. Some Agency staff had been used to fill any gaps in the rota. Staff spoken to said that they felt that there were sufficient staff to meet residents’ needs. One Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 21 resident made a comment about being put to bed early due to staffing shortages. The files for four new members of staff were examined. These showed that a CRB check was done and no new member of staff started work without the POVA First clearance being received. Two files had only one reference and this was not from the most recent employer. This meant that there was no information about their past work performance, attendance and attitude. A recent photograph and proof of identity of the staff member was available in each file. Staff were issued with a copy of General Social Care Council’s code of conduct and practice. They received a contract of employment after their probationary period of 3 months. A new application form had just been introduced that obtained more precise details about dates of previous employment and the reasons for leaving. New employees now received an induction to the home that included Protection of Vulnerable Adults and fire safety training. They were issued with an induction pack that included the topics specified by Skills for Care. Evidence that they had completed this was kept in their personal file. Other training was available for staff. Recent sessions included catheter care and administration of creams. Training was recorded in the staff member’s personal file. However, not all staff had yet received training in all aspects of safe working practice. 47 of the care staff had the NVQ qualification. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was managed in a manner that showed that residents and relatives were offered an opportunity to make comment about how the home was run and whether this was being done in their best interests. All staff had not yet Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 23 received training in mandatory subjects. This meant that the health, safety and welfare of residents and staff might not be fully promoted and protected. EVIDENCE: The Registered Manager of the home was a Registered General Nurse with many years experience of working with elderly and disabled people. She was appointed Manager of Alston View in September 2004. Internal auditing of the home against the National Minimum Standards for Older People had been implemented. This included topics of the care plans, record keeping and facilities provided. This was to ensure that these met legal and good practices requirements and were in the best interests of residents. Resident and relative questionnaire sheets had been sent out for the annual survey. Once these had all been received the results would be made available for people to read. A staff meeting had been held in July 2006. Residents meetings were no longer held due to lack of attendance. Residents and relatives could meet with the Manager on a one to one basis to discuss any concerns that they might have. The Administrator collected the benefits for 2 residents. There were records to show the receipt of this. There was a record of the personal allowance allocated each week. The recording system showed the amounts deposited, withdrawn and the balance. The money held for these residents and one other randomly selected was checked against the records. These were correct. Any money held at the home was securely stored in a safe. Receipts were issued for any money or valuables left with staff. There were records to show testing and servicing of equipment. The Portable Appliance Testing was overdue, as this should have been done in April 2006. There were no records to show that the hot water temperatures of baths were routinely monitored. Accidents were recorded. Not all staff had yet received training in safe working practices. Some staff had received instruction in some topics and this was in the process of being arranged for the remainder. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 24 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 X 2 2 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 2 Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 25 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 2 Standard OP2 OP3 Regulation 5(b) 14(1)(d) Requirement Each resident must be provided with a copy of the terms and conditions of residency. Following their assessment the resident must receive written confirmation about whether the home can meet their needs or not. Each and every resident must have a plan of care that sets out their personal, health and social care needs. The use of the ‘under arm’ lift must be discontinued. The level of care being given to a specific resident must be discussed with the District Nurses. Appropriate arrangements must be made for either the District Nurses to monitor his health care or for him to receive nursing care from the home. Medications belonging to individual residents must be used only for that person. Sharing of medications must not occur. All staff must receive training on protection of vulnerable adults. (Previous timescale of 31/07/05 not met) DS0000022500.V303348.R01.S.doc Timescale for action 30/09/06 31/08/06 3 OP7 15(1) 31/08/06 4 5 OP8 OP8 13(5) 13(1)(b) 31/08/06 31/08/06 6 OP9 13(2) 31/08/06 7 OP18 13(6) 31/12/06 Alston View Nursing & Residential Home Version 5.2 Page 26 8 9 10 11 OP19 OP19 OP27 OP29 12 OP38 13 OP38 23(4)(c)(i) The fitting of all bedroom doors must be checked to ensure that fire safety is not compromised. 13(4)(a) The hot water temperature of baths must be maintained at around 43 degrees Celsius. 17(2) The duty rota must be an Schedule accurate record of the hours 4(7) worked by staff. 19 There must be two written references for each employee. One of the references must be from the current or most recent employer. 23(2)(c) Portable Appliance Testing must be done annually to show that the equipment provided at the home is maintained in good working order. 18 (c)(i) All staff must receive training in: fire safety; moving and handling; infection control; basic food hygiene; and first aid. 31/08/06 31/08/06 31/08/06 31/08/06 30/09/06 31/12/06 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 2 3 4 5 Refer to Standard OP7 OP7 OP7 OP7 OP8 Good Practice Recommendations There should be evidence of consultation with the resident or their representative. If this cannot be done there should be a record as to why. There should be some indication of the progress made to meet the goals when the care plan is reviewed. The details in the plan of care should be correct and amended as and when the care needs change. The directions in the plan of care should always be followed or a record of the reason why this can’t be done made. The falls risk assessment should indicate how the level of risk has been arrived at and what strategies are to be used to reduce the risk. DS0000022500.V303348.R01.S.doc Version 5.2 Page 27 Alston View Nursing & Residential Home 6 7 8 9 10 11 12 13 14 15 16 OP8 OP9 OP9 OP9 OP9 OP10 OP12 OP14 OP19 OP28 OP38 Any wounds should be included in the plan of care and direction given to staff on how to treat these. There should be an assessment to show the progress of the wound. Action should be taken when the temperature of the medications storage rises above 25 degrees Celsius. Creams and ointments should be stored securely in individual residents’ bedrooms. There should be a recent copy of the British National Formulary Residents should be assessed for their competency to administer their own medications if they wish to do this. Communal toiletries should not used for residents. The range of activities offered to residents should be increased so that the programme meets the social and recreational needs of residents. The rising and retiring times of residents should be in accordance with their wishes and not to meet staff routines. An audit should be done of all double glazed windows and attention given to any where the view from them is obscured. Training in NVQ should continue in order that 50 of the care staff have this qualification. The temperature of the hot water to baths should be monitored routinely. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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. Alston View Nursing & Residential Home DS0000022500.V303348.R01.S.doc Version 5.2 Page 29 - 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. 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