Inspection on 31/01/07 for Altham Care Home

This inspection was carried out on 31st January 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Altham Care Home 28/05/09

Altham Care Home 02/10/07

Altham Care Home 15/11/05

Altham Care Home 24/05/05

Altham Care Home 25/01/05

Altham Care Home 03/09/04

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

CARE HOMES FOR OLDER PEOPLE Altham Care Home Burnley Road Clayton-le-moors Lancashire BB5 5TW Lead Inspector Mrs Susan Hargreaves Unannounced Inspection 31st January 2007 10:00 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 Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Altham Care Home Address Burnley Road Clayton-le-moors Lancashire BB5 5TW 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) 01254 396015 0254 871335 Mr Rajinder Singh Mrs Mary Fell Care Home 36 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (13) of places Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 13 service users requiring personal care who fall into the category of OP. A maximum of 23 service users requiring personal care who fall into the category of DE(E) The registered provider, must, at all times, employ a suitably qualified and experienced person who is registered with the Commission For Social Care Inspection as Manager of Altham Care Home. 15th November 2005 Date of last inspection Brief Description of the Service: Altham Care Home offers 24 hour personal care for up to 36 older people including 23 people with dementia. The property is purpose built with a car park and garden. It is located in Clayton-Le-Moors close to local amenities and public transport. Accommodation is provided on two levels in thirty single and three twin-bedded rooms. Twenty of these rooms have en-suite facilities. Communal rooms include two separate lounge areas with television, and two dining rooms. One dining room has a kitchenette for residents to make their own drinks and snacks. Toilets and bathrooms are conveniently located close to communal rooms and bedrooms. The current fees charged at Altham Care Home are £325 to £395 per week. Additional charges are payable for hairdressing, newspapers and extra toiletries. A statement of purpose and service user guide was available to prospective residents and their relatives on request. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Altham Care Home on the 31st January 2007. No additional visits have been made since the last inspection. At the time of this inspection 33 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and a visitor were spoken to. Discussions also took place with the registered person and the home manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Urgent action must be taken to ensure care plans address all the identified needs of each resident including the management of problems associated with dementia and diabetes. Where a risk assessment identifies the resident is at risk of developing pressure sores or falling a care plan giving clear guidance about how the risks are to be managed must be developed. It is important to ensure medication is managed correctly in order to prevent errors. A record of all medication received into the home must be kept. Members of staff must sign their full name on records relating to the administration of controlled drugs. A record of the amount of all controlled drugs stored in the home for individual residents must also be kept. All members of staff responsible for the administration of medication must receive formal training in the management of medication. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 6 It is of serious concern that residents are getting up early without any reason for this recorded in their individual care plans. Action must be taken to ensure residents are not getting up as early as 5.45am if they do not wish to do so. If a resident wishes to have breakfast in bed appropriate assistance should be given. Although the meal served at lunchtime looked wholesome and appetising it was of concern that all residents were served with sugar free custard because this was suitable for the diabetics. The drink of tea was served to all residents in the dining room from a large teapot to which milk had been added. These practices are institutional and do not take into consideration the likes and dislikes of individual residents. Action must be taken to ensure recruitment procedures are thorough. Two written references, one of which should be from the applicant’s last employer, must be obtained prior to appointment. To promote the health and safety of residents action must be taken to prevent the spread of infection especially food poisoning. The temperature of cooked food must be checked and recorded. Records of the food provided for individual residents must be kept to ensure they are having a nutritionally balanced diet. To ensure all members of staff have regular fire drills attendance records should be kept. Urgent action must be taken to ensure all members of staff receive training in fire prevention and know the procedure to follow in the event of a fire. It is important that CSCI are notified of all incidents listed in regulation 37 of the care homes regulations 2001. It is of serious concern that members of staff continue to use the inappropriate underarm lift. All members of staff must be trained to use correct moving and handling techniques. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 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 Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission procedures were thorough. EVIDENCE: The individual records of three residents were inspected. These records contained a detailed pre-admission assessment. This assessment provided important information for the care plan. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Privacy and dignity was promoted for all residents. Care plans did not contain detailed information relating to all aspects of care. Procedures for the management of medication need to be improved. EVIDENCE: The individual care plans of three residents were inspected. These plans did not identify and address all the care needs of each resident. Information about how to manage diabetes was not included in the care plan for one resident. Care plans about the management of problems associated with dementia were not in place for two of these residents. Care plans about incontinence did not give clear guidance for staff to follow about how to manage this problem. Appropriate risk assessments for falls, nutrition and pressure sores had been carried out. However, where a risk had been identified a care plan to manage the risk had not been developed. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 10 Records of the visits of other healthcare professionals e.g. GP, chiropodist, etc. were included in the care plans. A report about the care and condition of each resident was written during each shift. Care plans were reviewed monthly and residents or their relatives were invited to be involved in this process. Policies and procedures for the management of medication were in place. Records of the amount of unused medication returned to the chemist were seen. However, a record of all medication received into the home was not kept. The medication administration records of three residents were inspected. These were up to date and clearly stated the times when medication had been given. Members of staff were only writing their first name on the records relating to the administration of Temazepam. Moreover, the number of tablets in stock was not recorded. Medication was stored in a locked trolley inside a locked utility room. The temperature of this room was checked and recorded daily. A member of staff who was responsible for the administration of medication had received some training from the assistant manager and the supplying pharmacist but had not received any formal training in the management of medication. Personal care was carried out in private. Members of staff were observed attending to residents in a friendly and professional manner. Two members of staff explained in detail how they promoted privacy and dignity for all residents. One resident said, “The staff are nice, they look after me very well.” Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A range of leisure activities were organised for residents. Visitors were welcomed into the home at anytime. The daily routine was not sufficiently flexible to meet the needs of individual residents. Meals were wholesome but institutional practices were used for serving drinks. EVIDENCE: Social activities were advertised in the home. These included aromatherapy, dominoes, bingo, movement to music, watching films and trips out. An outside entertainer visited the home every two or three months. It was evident from discussion with staff that the daily routine wasn’t flexible. A member of staff explained that on the day of the inspection all the residents were up, dressed and ready for breakfast to be served in the dining room at 8.00am. One resident said staff got her up at 5.45am and she was served breakfast in the dining room at 8.00am. She explained that she used to have breakfast in bed and would still like to do this but due failing eyesight she was taken downstairs for breakfast. This resident also said that she went to bed Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 12 between 7.45pm and 8.00pm because she got up so early. Only three of the other residents asked were able to express an opinion, they said they chose when to get up and go to bed. Visitors were welcomed into the home at anytime and offered refreshments. Local clergy regularly visited the home and gave communion to residents who wished to practice their religion. Residents were encouraged to personalise their rooms with photographs, ornaments etc. The meal served at lunchtime looked appetising and consisted of minced beef, dumplings, mashed potato, broccoli and swede. The cook explained that chicken was on the menu as an alternative and residents had been asked for their choice on the previous day but all had requested minced beef. As a result chicken had not been taken out of the freezer and was not available. Another member of staff said that residents had not been offered a choice of meal for lunch. A resident also said she had not been offered chicken for lunch. She also explained that she was given a choice when she was able to stay upstairs for meals but not downstairs. The dessert was sponge cake and custard and bananas and custard for the diabetics. The custard served to all residents was sugar free because this was suitable for diabetics. A drink of tea was served to all residents during the meal. This was poured from a large teapot to which milk had also been added. A member of staff and the manager said this was to ensure the tea was cooled and prevented residents from being scalded if they spilt it. This practice is institutional and does not take into consideration the likes and dislikes of each resident or their right to choose. Members of staff offered assistance to residents in a sensitive and patient manner. Lunch was unhurried allowing residents time to chat and enjoy their meal. All the residents asked said they had enjoyed their lunch. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and investigated. Appropriate policies and procedures were in place to ensure the protection of residents at the home EVIDENCE: A copy of the complaints procedure was included in the statement of purpose and service user guide. Three complaints have been made to the home since the last inspection. Written records of all complaints and the action taken were kept. Policies and procedures for the safeguarding of vulnerable adults were in place. This issue was discussed with three members of staff. They were aware of the procedure and said they would report any concerns immediately. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and provided a homely environment for the residents. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. This provided a safe and comfortable environment for the residents. The grounds and gardens were well kept and accessible to all residents. Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to meet the assessed needs of the residents. Training was actively encouraged. More than fifty percent of care staff had an NVQ qualification in care. Recruitment procedures need to be improved. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. The files of six members of staff appointed since the last inspection were examined. Four of these files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. One of the other files contained two written references from a friend. There was no evidence to suggest that a reference had been requested from a previous employer. The other employee had been re-employed after a gap of a few years. Only one reference had been obtained. The manager said he would obtain further references for these two employees. It was evident from discussion with members of staff and the manager that training was encouraged. This included induction training for new employees, moving and handling, first aid, basic food hygiene, fire safety and dementia care. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 16 Nine members of staff (56 ) had obtained NVQ qualifications in care including one at level 4. A further seven members of staff were working towards NVQ level 2. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager. Residents and their relatives were consulted about the quality of the care and services provided at the home. Procedures to safeguard the health, safety and welfare of residents require further development. EVIDENCE: The registered manager has completed the NVQ Registered Manager’s Award. She maintains an up to date knowledge of current practice by attending relevant training courses and reading articles in various care publications. The home has achieved the nationally accredited Investors in People award. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 18 Anonymous satisfaction questionnaires were given out annually in March to residents. An evaluation of the 2006 survey was available. An annual business plan to help monitor the quality of the service and further improve outcomes for residents was in place. Transactions involving resident’s money were seen to be well maintained and up to date. Records kept in the home did not include details of the food provided for individual residents. Discussions with the manager confirmed that she was not notifying the commission of all incidents when residents had needed to see their GP, district nurse or attend accident and emergency as a result of an injury. Policies and procedures for safe working practices were in place. Fire alarms were tested weekly and a fire risk assessment had been carried out. Although fire drills were held regularly staff attendance records were not kept. The manager said that fire training had taken place on 13 November 2006. However, one member of staff had not received this training and was unable to explain the procedure to follow in the event of a fire. Records of the routine servicing of equipment were seen. These included up to date gas safety and electrical installation certificates. The annual testing of small electrical appliances was carried out in February 2006. Not all members of staff had received training in moving and handling. One member of staff explained how she used the inappropriate underarm technique. Records maintained in the kitchen included fridge and freezer temperatures. The temperature of cooked food was not checked and recorded. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 19 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 16/03/07 2. OP8 12(1)(a) (b) 3. OP9 13(2) To ensure all members of staff are fully informed about the care needs of each resident care plans must identify and address all care needs. To ensure the healthcare needs 16/03/07 of all residents are met care plans must provide clear guidance for staff to follow about how to manage identified risks. Where a risk assessment indicates that a resident is at risk e.g. of developing pressure sores or falling a care plan must be developed explaining how the risks are to be managed. Timescale of 30/12/05 not met. 31/01/07 To ensure medication is managed efficiently a record of all medication received into the home must be kept. Members of staff must sign their full signature on all records relating to controlled drugs. The number of all controlled drugs in stock must be kept. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 21 4 OP9 13(2) 5 OP12 12(3) To ensure medication is managed safely and administered correctly to residents all members of staff responsible for the administration of medication must receive appropriate formal training in the management of medication. To ensure the rights of all residents are promoted their preferred time of getting up and going to bed must be respected. If residents get up before 8.00am the reason for this must be clearly recorded in their individual care plan. If a resident requests to have their breakfast in bed they must be assisted to do so. To ensure residents are protected by thorough recruitment procedures two written references, one of which should be from the applicant’s last employer, must be obtained prior to appointment. Records of the food provided for individual residents must be kept to ensure they are having a nutritionally balanced diet. In order to promote the health and safety of residents CSCI must be notified all incidents listed in regulation 37, including when a resident requires medical attention resulting from an accident. To promote the health and safety of residents all staff must receive training in fire safety and prevention. To prevent the spread of infection especially food poisoning the temperature of cooked food must be checked and recorded. DS0000009438.V323105.R01.S.doc 20/04/07 16/03/07 6 OP29 19(1)(b) Schedule 2 31/01/07 7 OP37 17(2) Sch 4 37 31/01/07 8 OP38 31/01/07 9 OP38 23(4)(d) 20/04/07 10 OP38 13(3) 31/01/07 Altham Care Home Version 5.2 Page 22 11 OP38 13(5) To promote the health and 20/04/07 safety of all residents and ensure that correct moving and handling techniques are always used all staff must be given training in moving and handling. 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 OP38 Good Practice Recommendations To ensure all members of staff have regular fire drills attendance records should be kept. Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Altham Care Home DS0000009438.V323105.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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