CARE HOMES FOR OLDER PEOPLE
Alton House 37 St Leonards Avenue Hayling Island Hampshire PO11 9BN Lead Inspector
Clare Hall Key Unannounced Inspection 7th February 2007 08.00 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 Alton House DS0000061683.V323938.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. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alton House Address 37 St Leonards Avenue Hayling Island Hampshire PO11 9BN 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) 023 9246 2910 Alton House Partnership Mrs Elaine Herridge Care Home 18 Category(ies) of Dementia (18), Dementia - over 65 years of age registration, with number (18), Mental disorder, excluding learning of places disability or dementia (18), Mental Disorder, excluding learning disability or dementia - over 65 years of age (18), Old age, not falling within any other category (18) Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. All Service Users must be aged at least 55 years. Date of last inspection 16th August 2005 Brief Description of the Service: Alton House is a large, detached property set in a quiet residential area of Hayling Island and provides accommodation for a maximum of eighteen older people, including those with dementia and/or mental health needs. Accommodation is provided with ten single bedrooms, five of which have ensuite facilities, and four double bedrooms, of which two have en-suite facilities. The home has a large lounge/dining room and a smaller, quieter lounge. The layout of the communal areas is open-plan with archways leading into each area. Outside is an attractive, well-maintained garden that is accessible to service users. The rates for accommodation are between £385 and £510 a week. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced site visit to Alton House took place on 7th February 2007 and was undertaken by one inspector over one day. Throughout the visit the manager was available and the staff assisted the inspector in general. The judgements made in this report were made from information gathered pre-inspection from previous reports, the service history, Regulation 37 notices received and reports sent to the CSCI by the provider. Also considered were correspondence with the home, contact sheets, reports and feedback relayed to the commission by staff. The managers assisted the audit process by handing out relevant comment cards pre inspection to service users other stake holder’s, health and social care professionals and staff. The management team completed the pre inspection evidence and this was used to inform the inspection. The environment was audited and a tour of the premises undertaken. The inspector had the opportunity to sit in the main lounge and dining areas and observe the routines and care practices in the home. As a result of this audit 5 requirements have been raised. What the service does well:
In total the inspector received comment card responses from ten relatives, two doctors, two community nurses, three care managers and four staff. All comment cards received reported that the homes staff always made visitors feels welcome and stated categorically that visitors could visit their relatives in private. Everyone asked stated they were kept informed and agreed unanimously that their relative was able to make decisions and they were consulted about their care. 80 of service users relatives said they were aware of the complaints procedure. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 6 !00 of responses stated they were satisfied with the overall care provided by the home. Healthcare professionals reported that the home always communicated clearly with them. Medical personnel also felt there was always a senior member of staff in the home to confer with and that they could always see their patients in private. Medical personnel further reported that the homes staff demonstrate a clear understanding of the care needs of service users and that any specialist advice is incorporated into the care plan. Health professionals were unanimous when stating the service users medication was always appropriately managed and that staff take appropriate decisions when they can no longer manage the care needs of the service users. One relatives survey response was, “Having visited my father at a variety of times over the last few years I have never experienced anything but care, kindness and affection both to my father and myself.” What has improved since the last inspection? What they could do better:
The home provides support to service users who have mental health needs. The current records of the service users emotional, psychological and mental health is not being assessed and recorded. It cannot therefore be determined whether all their needs are being met. One area of concern is the management of service users records as these are very fragmented and do not allow for a smooth audit tracking of care needs and interventions. Staff do not record how needs are met or give a detailed account of the service users well being. Service users must also be supported during decision making. When decisions are made regarding sharing rooms records need to identify what consultation has taken place. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 7 The manager’s processes for recruitment must be improved. The information given by potential employees must be scrutinised for the necessary details and accuracy. Identification must be established and all necessary information provided. The provider must look to improve the bathing facilities if one bathroom is not fit for purpose. Only 60 of the relatives felt there is always sufficient staff on duty. This will need to be looked at by the manager as it was not evident there was any staff shortages. 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. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 8 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 Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information regarding the home is very detailed. The majority of files have agreements regarding residents stay but they are not consistently held on all files. All service users should be provided with terms and conditions regarding their stay. Despite this the service is ensuring the staff receive appropriate training suited to the needs of individuals. The mental health needs of individuals are not assessed. The majority of service users are very happy at Alton house. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 10 EVIDENCE: The service does provide good information for prospective residents and their representatives informing them of all the general aspects of the home. One of three files audited did not have a copy the terms and conditions /contracts regarding the residents stay completed on the individual files. Service files did identify needs assessments and the manager confirmed that assessments are undertaken pre admission to ensure the suitability and compatibility of individuals accommodated. These records do not give a detailed account of the individuals mental health needs. It was established that the majority of service users accommodated are having their needs met but there was a question regarding one lady who may not be having her needs fully met. An area of concern regarding this has been relayed to her care manager. This particular lady felt isolated and could not relate to the other service users. She explained how she had no one to talk with. Her pre assessment identified that she was a lady who enjoys contact with others and was sociable. Despite this, all other service users were clearly having their needs met. It was further established that staff are currently receiving training in dementia care, communication, behaviours which may challenge, and medication. The majority of relatives reported that they felt informed by the staff. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care is informed by comprehensive assessments but need to reflect service users psychological, emotional and mental health care needs. Staff are respectful and sensitive to the needs of individuals. EVIDENCE: Overall the care records were good but need to be developed to identify the emotional and psychological needs of individuals. The records held are fragmented. Records case tracked for one lady did not adequately reflect any mental health assessment or how the needs identified were being met. The care staffs daily records are not reflection of what care needs were met or how they were met. Daily records were written as “All Ok “ and not reflecting the well being of the individuals.
Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 12 Records lacked psychological, mental health, emotional and social needs and heavily weighed on the physical needs. One staff member was observed giving medications. She was observed doing this sensitively and seeking consents where possible. Medication trolleys were stored safely. Drug reference materials were available to staff. Throughout the visit staff were generally seen assisting service users in a kind considerate, respectful and sensitive manner, seeking consent and assisting discreetly when and where necessary. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 13 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The visit to the home confirmed what comment cards reflected. The home meets the expectations of the majority of the service users accommodated. EVIDENCE: Records held and on display showed that activities included quizzes, reminiscence chats, sing along, ball games, skittles and trips out. During the visit there was a music work-shop taking place and the service users were participating alongside their relatives. Two visitors were made welcome by staff, who laid up a tray of tea and biscuits for them. Residents confirmed that they bring their own possessions, such as furniture, pictures etc. with them when they move in, as long as they meet fire regulations. Inventories were seen on files.
Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 14 Records were seen being completed for people who are not eating well. Staff were observed offering one service user a supplement and regularly offering cups of tea/coffee. One relative reported, “ When my aunt arrived she was in a neglected state. Since she has been at Alton house the staff have sorted out her leg problems, dress her daily, bring her down stairs to the lounge and take care in trying to get her to eat and drink properly.” Service users were observed getting up through out the morning and coming to the dining room for breakfast as they preferred. Staff were observed consulting service users throughout the day. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures in the home protect vulnerable persons. EVIDENCE: Eight out of ten relatives asked knew what the homes complaints procedure was. Two general practitioners who regularly visiting service users in the home stated they had never received any complaints about the home. No complaints have been received by the commission regarding the home. The staff survey identified that staff are aware of the protection of vulnerable adults procedures. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 16 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, 21, 25, 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 well-maintained,clean, comfortable, safe and suitable for the needs of service users. EVIDENCE: The home employs a maintenance man and he was observed through out the day responded promptly to all maintenance issues. The gardens were safe and accessible and there had been improvements made to the height of the fence to ensure it was safe. The communal space in the home was adequate for the number of service users and was well laid out. Furnishings in the communal areas were comfortable and the rooms were light and well ventilated.
Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 17 All rooms had suitable locks so that service users could maintain their own privacy and these could be opened from the outside by staff in the event of an emergency. Shared rooms had screens to maintain privacy. One service users did express that she was not happy with who she was currently sharing a room with. There was no documentary evidence that she had made an active decision to share. Adequate lighting was provided in each room and the heating could be adjusted in each room according to the wishes of service users. The inspector did ask the manager to address the locking of the side gate with the fire authority as this would prevent residents getting away from the building should their be a fire. The home currently accommodates 18 service users but only has one suitable bath. The step in bath down stairs was said by staff to be unsuitable and was not in use. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not ensure that residents are always protected through their recruitment processes. This has been raised previously. EVIDENCE: Case tracked staff employed by the homehad Protection of Vulnerable Adults (POVA) check or Criminal Records Bureau check in place. Of the three recruitment files audited there was a poor standard of employment history noted in staff records. Application forms were not completed with all the necessary information, concerns regarding health had not been followed up and two forms of identification were not available for all staff. One staff member had a gap of five years and no record of undertaking courses and further training. Staff surveys and records demonstrate the home provides good standards of staff induction, training and supervision. One comment received stated, “When I started work they gave me full support and training to help me
Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 19 Four of ten relatives indicated in survey responses that the staff work very hard and that the home could do with more staff. The manager will need to monitor this as during the unannounced visit the numbers of staff employed was observed to meet the needs of residents at that time. Staff comments did not indicate there were any staffing issues. Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are very good outcomes for service users and the home is well managed. EVIDENCE: The home does have a quality assurance system in place, which is based on finding out the views of service users and their families. Evidence was seen of a recent questionnaire sent to all service users and their families. The manager also discussed the home’s new quality audit tools and documents, which are just being implemented.
Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 21 Most service users maintain their own finances with support from their families where necessary. The home is currently managing the day-to-day finances of one service user. A policy for this was in place and comprehensive records were kept of all transactions. Hairdressing records are not held individually and this could now be done through providing individual receipts to service users. Records showed that all staff had regular supervision from the manager and staff spoken with confirmed this. All feedback received in respect of the service from staff, service users, their relatives, care managers, health and social care professionals was very complimentary. One doctor said, “ I feel this is a clean well run establishment with good quality staff and a very good care manager. I always joke I will be admitted there but that’s because I do think they manage the patients well.” One relative said, “I chose Alton House because 1st impressions – a very warm & cosy home and the staff are very helpful.” Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 2 x x x 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 23 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 OP2 Regulation 5 Requirement The registered person must ensure all accommodated service users have been provided with the terms and conditions in respect of the accommodation provided. The registered person must ensure service users emotional, psychological and mental health needs are being met. The registered manager must ensure that service users sharing double rooms have been consulted regarding whether they prefer not to share. The registered person must provide adequate bathing facilities. The appropriate checks and employment history must be on the application forms with the supporting references. These records must indicate an audit trail of the employees work history. Identification and other documents which show that the candidate is who they say they are and that fit to undertake the position. This must be in place
DS0000061683.V323938.R01.S.doc Timescale for action 08/05/07 2 OP4 OP7 12 08/05/07 3 OP10 OP14 12 08/05/07 4 5 OP21 OP29 23 19 (1)(b)(i) 08/06/07 08/03/07 Alton House Version 5.2 Page 24 prior to a new staff member starting work. This was raised previously with a compliance date of 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alton House DS0000061683.V323938.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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