Inspection on 09/06/08 for Alton House

This inspection was carried out on 9th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Alton House 05/11/07

Alton House 15/05/07

Alton House 23/11/06

Alton House 09/01/06

Alton House 29/09/05

Alton House 26/01/05

Alton House 15/07/04

Alton House 01/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Alton House 22 Sunrise Avenue Hornchurch Essex RM12 4YS Lead Inspector Harbinder Ghir Unannounced Inspection 08:25 9 & 12th June 2008 th 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 DS0000027828.V364944.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 DS0000027828.V364944.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alton House Address 22 Sunrise Avenue Hornchurch Essex RM12 4YS 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) 01708 451547 altonhouse@btconnect.com Mr Frank Barrs Mrs Patricia Lilian Barrs Jacqueline Ann Mitchell Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 19 5th November 2007 Date of last inspection Brief Description of the Service: Alton House is a privately owned care home registered to provide care and support to 19 older people. The home is situated in a quiet residential area of Hornchurch with access to local shops and transport links. The home is traditionally styled and in keeping with other properties in the area. It offers a warm, welcoming environment. The property has two separate lounges and 19 single bedrooms, 17 of which have en-suite facilities. As informed by the current registered manager of the home, the ranges of fees charged by the service are from £416 to £460 per week. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place over two days on the 9th June 2008 between 8.25 am and 5.35 pm and the 12th June between 9.30 am and 12.00 pm. The registered manager of the home was available throughout both days of the inspection and feedback was provided to the registered manager and the registered proprietor at the end of the inspection. During the inspection the inspector was able to talk to residents residing at the home and relatives who were visiting. Staff on duty during the day were also spoken to. A third day was spent at the Commision’s premises contacting relatives and professionals by telephone for further feedback; their feedback has been included in the report. The London Borough of Havering, who is the host authority for the service was liaised with during a strategy meeting regarding the service. Their feedback has been included in the report. An expert by experience was also used as part of the inspection who looked at daily life and meals at the home. The Commission for Social Care Inspection received a completed Annual Quality Assurance Assessment from the registered providers prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 12 requirements were made in the following areas; updating the Statement of Purpose, pre-admission assessments; care planning; risk assessments; the follow up of accidents and incidents; social Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 6 activities; meals; the recording of complaints; the need for increased staffing and the environment. At this inspection 10 of the 12 requirements have been complied with. What they could do better: 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 DS0000027828.V364944.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 Alton House DS0000027828.V364944.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): 1, 3, 4, 5, 6 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide are provided to residents already living at the home. However, the service needs to ensure that the documents are readily available to prospective residents, to ensure they have the information they need to make an informed choice about where to live. The service completes pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. The service does not provide intermediate care. EVIDENCE: Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 9 On touring the premises all residents were provided with a copy of the Statement of Purpose and Service User Guide, which was placed in their individual bedrooms. The latest copy of the Statement of Purpose and Service User Guide was requested by the inspector to view but was not provided by the home and therefore could not be inspected at this inspection. The service must ensure that these documents are also readily available to prospective residents to aid them in making a decision on whether they would like to live at the home. Therefore the Requirement made at the last inspection could not be tested and as a result will be repeated at this inspection. The Commission for Social Inspection also cannot satisfy itself that the providers are complying with the legal requirements to have an up to date Statement of Purpose and Service User Guide, which meets legal standards. Since the last inspection the service has introduced a new pre-admission assessment form, which is comprehensive and covers the health and social care needs of prospective residents, complying with the requirement made at the last inspection. Five pre-admission assessments were closely examined. It was evident that admissions to the home are not made until a full needs assessment has been undertaken. Care management assessments by the local authority had been obtained prior to admission. Assessments covered the health and personal care needs of residents and involved the individual and their family or representative. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. It was evident from the comments received from residents, relatives and representatives that they are given the opportunity to spend time in the home before making a decision on whether they would like to accept the care home placement. Friends of a recently admitted resident were spoken to, who were visiting at the time of the inspection. They informed, “We came to look at the home for X. We think the home is lovely and they’re so nice here. We know X is happy here. We have brought in personal things for X that she has put in her room. We were also provided with the Statement of Purpose, which is in X’s room, which we read. We think X’s room is lovely, its nice and bright.” “ I went to see the home, the management were very accommodating. They showed me around the whole home, even the kitchen. I had a chance to sit down afterwards and have a chat with the staff and the manager,” said another relative. “The care is very good at the home, the staff are excellent. We saw the home before our loved one moved in. There are no smells at the home and it is very nice and tidy. We were very impressed with it” commented a further relative. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 10 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, 11 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans set out the personal and social care needs of people who use the service, but information specified in care plans is not always followed by the care staff, to ensure the preferences of individuals living at the home are always met. The right for residents to exercise choice and control is not always promoted by the service, which does not always ensure that they are consulted about aspects of their daily life. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle and are updated according to residents’ changing needs. Medication practices at the home do not ensure the safety of residents. The service must ensure that procedures and guidelines are in place for any medication leaving the home, to ensure residents are safeguarded when not at the home. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 11 All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: Since the last inspection the service has introduced a new care plan format which is written in plain language, is easy to understand and looks at all areas of the individual’s life, complying with the requirement made at the last inspection. Reference is made to the personal care needs of the individual, their mental state and their likes and dislikes in regards to food. One resident had specified that they didn’t like sweet corn, but likes fish and chips and milk and coke. Another recently admitted resident had highlighted that they would like contact with a priest. Evidence was seen in the individual’s daily case recording notes of the home contacting local church services to arrange this service, which they are still in the process of doing. It was evident that information from care management assessments was being utilised in the care plan. For one resident their care management assessment highlighted that they had a history of falls, which was also highlighted in the care plan, and the individuals risk assessments. However, information in care plans was not always followed or put into practice by the home. Each resident has a preferences sheet which records the personal preferences of residents in regards to the likes of food, drinks and their preferred times of going to bed. However, staff did not always follow these preferences and recorded information in regards to daily routines on some forms was very limited. On speaking to one resident they informed that daily routines within the home are very regimental. “All the residents go to bed about 9.30 pm, everyone’s in bed by 10.00 pm. Some residents don’t want to go up. At about 7.00 pm we have a cup of tea and cake or something like that, then everyone start to get their night clothes on. All the women are put into their dressing gowns, who are taken to the bathroom one by one. We all again may have a cup of tea about 9.20 pm and then we all go to bed. They are all told to go to bed, especially the ones that don’t say much. They bring the wheelchairs and whiz them up” said a resident. Another resident informed “We all go to bed at the same time.” During the first inspection visit, the inspector arrived at the premises at 8.25 am and all residents were in the dining area eating their breakfast. Staff confirmed that all residents were in the dining room with no one in their rooms. On case tracking this information by examining the daily case recording sheets information did not include what times residents actually went to bed or got up. Good care recognises that individuals have the same rights as any other person to make decisions about their lives. It is Requirement 1a that care plans identify the preferred daily routines of people using the service and that they are followed to ensure practices at the home promote residents’ right to exercise choice and control Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 12 and ensure people who use the service are actively consulted on in all aspects of life in the home. It is Requirement 2 that daily case recording sheets are recorded in detail to reflect the actual care provided at the home. The service informed that the normal practice of the home is to check residents’ nails when delivering personal care and that the Chiropodist visits 8 weekly. Fingernails are also cut as required with the consent of residents. However, it was identified that personal care of residents was not always adequately maintained at the home. Two residents spoken to were seen to have black residue under their fingernails. It is Requirement 3 that the service makes proper provision for the health and welfare of people who use the service and ensure personal care is regularly attended to and maintained. Risk assessments were routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure care areas and were reviewed on a regular basis. Monthly weight checks were undertaken for all residents and appropriate action being taken where necessary. A district nurse who visits residents at the home was spoken to as part of the inspection. She spoke very positively about the service. She said, “The home is always clean and tidy and there’s always a smell of good cooking. I really can’t fault the service. I would certainly recommend the home. The rooms are always neat and tidy and everything is spotless. The home is geared towards the patients.” The accident and incident book was reviewed. Since the last inspection residents are receiving follow up checks to ensure there are no further healthassociated risks. The Commission for Social Care Inspection, in line with Regulation 37, of the Care Homes Regulations 2001, has been informed of accidents since the last inspection. Records indicated other health professionals such as the district nurses; optical, dental, General Practitioner (GP) and chiropody services saw residents. However, these were not always promptly contacted. During the inspection a resident was seen to ask her visitors “when the doctor was visiting” as she stated that she was in pain with her shoulder. On examining the resident’s daily case recording notes, the resident had complained of pain and asked for the GP three times in May 2008 and on another occasion the resident’s granddaughter asked if the (GP) could see to Y’s painful shoulder. It was only during the inspection when the friends of the resident spoke to the manager about this and the inspector highlighted it again to the manager that the home requested the GP to visit Y. It is Requirement 4 that healthcare professionals are contacted promptly to ensure the health needs of residents are attended to and met. It is a resident’s right to see a health care professional and not for the staff in the home to determine whether this is necessary. All care plans viewed contained information on the end of life wishes of residents and the contact details of relatives and representatives where appropriate. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 13 Residents and relatives spoken to spoke very positively about the care provided at Alton House. A resident spoken to informed, “The staff are alright, they’re friendly enough. I’ve got a television in the bedroom and I’ve got an armchair which I didn’t have before.” “I like it here. I know that in some places they couldn’t care less,” said another resident. Another resident informed, “The staff are alright and the food is ok.” There are policies and procedures for the handling and recording of medicines. A list of all signatures of staff trained to administer medication was kept on the medication file. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined. The following issues were identified; • • In excess of three handwritten amendments or additions to Medication Administration Records (MAR) sheets were not signed and dated by the person making the entry. On viewing the Medication Administration Records it was found that entries in excess of five were missing and appropriate codes for missing entries were not recorded. Medication in one instance had not been administered when audited and codes were not used on the Mar chart to indicate why medication was not given. The service did not have a policy on any medication leaving the home. In compliance with Care Homes Regulations 2001 and The Administration & Control of Medicine Guidance the home must produce a written policy that includes the procedures to be followed and the precautions to be taken, including a witness to the transfer, when transferring medication to be taken out of the home. There was also no record of signatures by family receiving the medication and staff accepting medication. As with any medication taken out of the home a signature of the person accepting receipt and any return is required. A member of staff had left her personal “over the counter medication” on the office desk, which residents could have access to, as the office is not kept locked. • • It is Requirement 5 that medication practices are reviewed to ensure the safety of residents. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 14 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 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A programme of activities has been introduced and residents are given the opportunity to take part in activities. But activities within the home need to be reviewed to ensure residents’ recreational needs are met to their preference. There is a choice of meals in the home, but this needs to be reviewed, to ensure it can meet the needs and choices of all residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: From examining the activities timetable and the activities record book which records the activities that have taken place, it was evident that there are Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 15 limited opportunities for residents to participate in social activities in and out of the home. Residents were observed throughout the days of the inspection sleeping on and off with the main social stimulation being the television. On speaking to residents, comments further evidenced the lack of stimulation provided at the home. One resident stated, “There’s not much that goes on here, residents are always asleep.” Another resident informed, “I wouldn’t mind going out if they assisted me.” “We don’t do anything here in the day. I would love to go out on a sunny day like this ” said another resident. A visitor spoken to at the inspection informed, “ I visit on regular basis and every time I’ve been here I haven’t seen any activities. I think they could definitely do with more stimulation.” A relative spoken to informed “ I know they have some sing a longs or musicals at the home but am not aware of any other activities taking place.” “I have actually been concerned about the lack of activities going on. They definitely need do more with them, as when I have been at the home, there is nothing going on,” informed a relative. An expert by experience contributed to the inspection by inspecting the daily life and activities and the meals provided at the home. Their findings were as follows; Activities “At present all members of staff undertake to lead the activities of the Home. I had great difficulty in finding just where the list of the weekly planned activities was displayed. I eventually had to be shown where it was – tucked in the furthermost corner of the dining area. The list is printed on A4 sheets, but you would have to remove the sheets from the wall to be able to read them. The activities offered are quite basic and include bingo, cards, sing-a-long, dominoes, puzzles, chair exercises, quoits and skittles. No crafts, no painting, no demonstrations. Visiting entertainers, choirs, appeared to be mainly at Christmas time. A hairdresser generally visits the Home once each week and the hairdressing is executed in the dining area. Manicure and hand massage is carried out by members of the staff. At present there are no church services in the home, nor do any of the residents go out of the home to any church service. At present none of the residents take part in any club or meeting outside the home. No outings are planned at the moment but the Manageress is trying to make plans for a joint venture with another care home. The main lounge was occupied by several residents and at approximately 11 a.m. no activities were in progress. The residents did not appear to talk to each other and several were asleep. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 16 Apparently the activities usually took place in the afternoon, after drinks had been served. By 14.00 hours still nothing was happening and the residents were dozing in their chairs. Although no mention had been made earlier in the day, the Inspector and I were then made aware that a staff emergency staff meeting had been arranged for today, and that no activities would be offered. The staff generally appeared to be very pleasant, caring, had a good attitude with the residents and talked to them frequently. The residents appeared to be very relaxed with the staff. All members of staff I spoke with were very helpful and happy to assist. On the day of my visit it was a very warm sunny day but not one of the residents had gone out to the garden. There are large sliding doors from the dining area to the garden but these were not opened. There was not a lot of shade in the garden and there were no seats, although I was informed that this was because the grass was going to be cut that day. By two thirty, no activities, no grass cut and most of the residents asleep.” The Commission for Social Care Inspection is concerned that the requirement from the last inspection has not been complied and will be repeated at this inspection as Requirement 6. The activities within the home must match residents’ expectations and preferences, meeting their recreational needs, at different times of the day. It is evident that limited activities are offered at the home. Failure to comply with repeated requirements will result in enforcement action by the Commission for Social Care Inspection. Visiting times were flexible and visitors could visit at any time convenient to residents. Relatives, family and friends were seen to visit residents throughout the time of the inspection and were made to feel welcomed by the staff at the home. The expert by experience also looked at meals at the home, her findings were as follows; The cook I spoke with had been employed there for the past nine years. The kitchen was clean, tidy and organised. At 11.15, the lunch was cooking in the oven, which for that day was shepherds pie or sausages with mashed potatoes and the vegetables were peas and broad beans. Rice pudding was also being cooked at that time. The meals were plated up in the kitchen and then served directly to the residents in the dining area. I was informed that lunchtime meals are generally cooked freshly each day but, as the cook finished work at 1.30 and another cook came on shift from 4.00 pm to 6.00 pm to prepare and serve the evening meal. The evening meals required little preparation and a fair proportion of these were from tins or frozen foods. These ranged from hot dogs, soup, spaghetti, sandwiches, fish fingers, fishcakes, etc. Cake is always Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 17 available at this time. The cook is at present attending a course on nutrition and seems to be enjoying the course. In the majority, the lunches for the week consisted of meat. Fish and chips generally were the main offer each Friday. Apart from tinned spaghetti, pasta and fish did not feature very often on the weekly menu, which I was looking at. I talked to several residents and everybody seemed content with their meals. The ones I spoke with said that they were not keen on fish or pasta and preferred meat. One comment was “I don’t like anything ending with an i” – spaghetti, macaroni, ravioli. When asked whether there were any residents who needed to have special diets or food, I was informed that there were none. None with any sensitivity to ingredients, allergies, or special needs, no vegetarians, none requiring pureed food. I was shown the chest freezer where the majority of the food is kept and although I did not move or touch anything in the freezer, I observed that there were not any marks or date labels on the items. I asked the cook about this and the explanation was that there was a rapid turnover of food from the freezer and the staff was aware how quickly the food rotated. The fresh vegetables were stored in the same storeroom. The outer leaves of two large cabbages were extremely yellowed, the swede appeared to be rather wilted and the carrots not the freshest I have seen. Apart from some cooking apples, I saw no other fresh fruit. The dining area runs on from the two lounge areas. The tables are set for four people. The table I sat at would have looked better if a fresh clean tablecloth had been in place but when lunch was about to be served, all cloths were covered by a plastic cloth. The dining area is rather cramped and on the day of my visit I counted six walking frames, which made accessing the dining table and chairs a little awkward for the residents. At least two of the dining chairs needed replacing. I also observed that there was not any dining chair with arms and in one particular instance, a chair with arms would have greatly assisted one resident. One resident who was having difficulty eating, did get assistance from the staff. This help was offered quietly and without fuss. The residents appeared to enjoy both dishes served for lunch that day. It was served efficiently and looked attractive. I heard no complaints. I also spoke to a few of the residents and the impression I received was that they were happy both with the food most of the time and with the service provided. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 18 There is sufficient evidence presented by the expert by experience and comments from residents that the meals with the home have improved since the last inspection complying with the requirement made at the last inspection. However, it is recommended that the registered person ensures all foods are adequately dated and labelled to reduce the risks of contamination and ensure all staff are aware when the foods were received into the home. They must also ensure a good variety of fresh fruit and vegetables are available at the home and foods that are no longer nutritionally useful are disposed of promptly. This will be stated as Recommendation 1. Since the last inspection the service has displayed two boards in the dining area to display the menu and activities for the day. Unfortunately the boards were blank throughout the days of the inspection. It is therefore Recommendation 2 that these boards are utilised and the menu and activities for each day are recorded on these to ensure the daily life and activities are communicated to residents living at the home. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 19 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 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The practices of the service do not ensure people who use the service are safeguarded from abuse or harm. Residents can be assured their views are listened to and acted on. EVIDENCE: On the commencement of the first day of the inspection, the registered manager informed the inspector that they had received a phone call on the 27/05/08 from an anonymous caller alleging that one member of staff was seen verbally abusing a resident and alleged another member of staff was seen using their mobile phone in the lounge and ignored a resident who was asking to use the toilet. The caller gave clear descriptions of both members of staff making them identifiable. On the 05/06/08 a letter written by the same anonymous caller alleged verbal and physical abuse against one of the members of staff discussed during the phone call, was received by the registered proprietor. The service had contacted and notified the London Borough of Havering the next day on the 06/06/08 of the allegations and informed that they had also contacted the Commission for Social Care Inspection that they were waiting further advise from the London Borough of Havering. The Commission for Social Care to date have not been formally notified of the incidents by a Regulation 37 notification. However, no action Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 20 had been taken by the management of the service to ensure the safety of its residents as the member of staff with the allegations of verbal and physical abuse made against them was still on duty working with the residents on the morning of the first day of the inspection. The service has not followed their own safeguarding protocols and did not take prompt action to safeguard the people using the service. The registered proprietor of the home was judgemental in her actions and claimed she suspected the allegations were malicious and was of the attitude that her staff would not do this. She was very reluctant to suspend the member of staff and the registered manager did this during the inspection to ensure residents were safeguarded. A strategy meeting was held on the 11/06/08 co-ordinated by the London Borough of Havering, which highlighted Alton House’s failure to protect its residents by not following safeguarding procedures promptly and in turn putting residents at risk. The Commission for Social Care is very concerned at the response of the service to the serious allegations made. The homes policy on responding to abuse clearly states, “When dealing with an abuse situation it is important that you do not be judgemental. The managers and staff should ensure that the operations of the service is centred on the needs of the residents and not on those of the institution and all allegations will be taken seriously.” Unfortunately the policy and the statements the service makes have not been followed and implemented. It is therefore Requirement 7 that safeguarding adult protection procedures are followed correctly to ensure the safety of people using the service and the service reviews its own safeguarding procedures and that the Commission for Social Care Inspection is promptly notified of any incidents at the home by a Regulation 37 notification. The anonymous complaint is being investigated by the London Borough of Havering. People who use the service are supplied with a complaints procedure, which is clear, concise and easy to follow and was displayed around the home. A complaints logbook is kept by the home, which was viewed. Evidence was also seen of verbal concerns recorded by the service and what actions they took to resolve the concerns, complying with the requirement made at the last inspection. One resident was observed speaking to the manager about his digital box and requested when it was going to be connected as he had changed his room. This was actioned for him within a few hours. Evidence was also seen by reading residents meeting minutes that this same resident was not happy with the room they were staying in, which the home resolved by moving the individual to a room of their preference which was viewed during the inspection. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 23, 24, 25, 26 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment and décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. But further maintenance would improve the environment of the home. EVIDENCE: Since the last inspection the service had a decoration programme implemented which has resulted in all radiators throughout the home being covered with pleasant wooden radiator covers. The windows at the front of the property have been replaced with new double glazed windows; dining room chairs have been replaced with the exception of two, which also have no arms on them. One resident observed by the expert by experience during lunchtime was extremely slumped in the chair and having difficulty in eating. Chairs with Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 22 arms would not only give support whilst sitting, but would greatly assist the residents rising from the chair. On speaking to a reviewing officer from Barking and Dagenham they informed that they have reviewed an individual who needs to be weighed regularly due to concerns regarding their dietary intake. The individual cannot stand on standard scales and needs seated scales due to variable mobility, which the borough is requesting are purchased by the home. The service must provide the necessary equipment to ensure the individual is weighed regularly or arrange for the individual to be weighed at a health care clinic where this equipment is readily available to ensure the healthcare needs of the resident are met; and that people who use the service have the specialist equipment required to maximise their independence. This will be stated as Requirement 11. There is adequate signage throughout the home making it easier for residents to identify rooms. The environment was clean and tidy and the home has committed to further improving the environment. It was evident that the dining room area is limited in space. To accommodate for this the home uses two separate entrances into the dining area to transfer residents safely to their chairs. The expert by experience noted that tablecloths were stained which the inspector also observed. The curtains in the main lounge were also hanging off their hooks on one side. The lighting in the lounge area was generally dull. The expert by experience also stated in their report “ that the two lounge areas and the dining area would benefit from a lighter coat of paint. These areas are dull and a little drab.” A number of toiletries belonging to residents were found in one communal bathroom. It is requirement 8 that all parts of the care home are maintained and residents’ toiletries are not kept in communal areas to reduce the risk of communal use and infection. Residents’ rooms were seen during the inspection. The rooms were comfortable with good quality furnishings and were also personalised by residents. Specialist equipment for residents was provided where required and bathrooms and toilets were fitted with appropriate aids and adaptations to meet the needs of people who use the service. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. staff are on duty to meet the basic personal care needs of residents. The service has a good skill mix of staff, which ensures adequate numbers of EVIDENCE: Three staff files were closely examined, which also included the files of two recently recruited members of staff, which were all in good order. References and Criminals Records Bureau checks had been obtained for all three members of staff. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 24 Staff rotas evidenced there are sufficient numbers of staff on duty to meet the basic personal care needs of residents. There are always two members of staff on duty during the day and two waking members of staff on duty during the night. However, the current staff ratio does not allow staff to meet the recreational needs of it residents, which has been highlighted in the report. Therefore it is Recommendation 5 that the service reviews its staffing complement to ensure the recreational needs of residents are met according to their preferences. The service has a permanent staff team and no agency staff are used. Staff were seen to interact and chat with the residents present positively. Since the last inspection the staffing complement has been reviewed complying with requirement made at the last inspection. The service has employed an extra cook who comes on shift from 4.00 pm to 6.00 pm to prepare and serve the evening meals and relieve floor staff of any cooking duties. Although this shift is only covered five days a week the service has also advertised for a weekend cook to cover these hours. During the inspection it was highlighted that the service is left uncovered if the registered manager is on annual leave or not available at the home. This became very apparent when an allegation of abuse was received by the service and the registered manager was on leave unable to deal with the situation. The registered proprietor did step in but had a lack of understanding of the safeguarding procedures and how they work which impacted on how the allegations were dealt with causing long delays in the homes actions to safeguard its residents. Therefore it is Recommendation 3 that the service reviews it management structure within the home ensuring adequate cover is provided by someone who is knowledgeable and qualified to sufficiently run the service and guide the staff team when the registered manager is not available at the home. This was discussed with the management of the home who informed that they will be looking into employing a deputy manager and they have the proprietor’s daughter-in-law in mind. The service must demonstrate that if they are going to recruit a new member of staff that they have a very good understanding of equality and diversity throughout the recruitment process, ensuring that Equal Opportunities Law is followed and that the successful candidate has the skills and competency to undertake the task. All staff have received relevant training which is focused on delivering improved outcomes for residents. The home has been very proactive since the last inspection and has put a high level of importance on care staff receiving training, which is specific in meeting the individual needs of people using the service. Staff files and the staff training matrix evidenced that staff have or are in the process of receiving training in Mental Capacity Advocacy Awareness; POVA Awareness; Managing Challenging and Aggressive Behaviour in clients who have dementia; Manual Handling; Fire Safety; Food Hygiene; Health and Safety; Infection Control; First Aid; Nutrition; Medication and Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 25 further training in dealing with complaints had been booked for 13/06/08. The service has not yet received a ratio of 50 of a NVQ qualified staff team but a number of staff have commenced the course whilst others are waiting for certificates. On speaking to relatives and representatives, very positive feedback was received in regards to the staff team at the home. “The staff are really helpful and are geared towards the patients,” said the district nurse. “The staff always make me feel welcome, they are very pleasant and welcoming. My relative told me that they are very happy at the home,” informed a relative. Another relative spoken to informed “The care is very good at the home. The staff are excellent and very caring.” Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 26 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, 36, 38 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that the staff team who care for them benefit from regular supervision. Service users’ financial interests are safeguarded. The systems for service user consultation are satisfactory and views are acted on, but must also include views from stakeholders to ensure the home is run in the best interests of residents. The health and safety of staff and residents is not always promoted by the home’s policies and procedures. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager is awaiting her Registered Managers Award certificate and has registered with the Commission for Social Care Inspection. She has the necessary skills to run the home. The manager trains and develops staff who are generally competent and knowledgeable to care for people who use the service. The service works in partnership with families or close friends, as appropriate and professionals. The manager is improving and developing systems that monitor practice and compliance with plans, polices and procedures but as the findings in this report have highlighted, more work is needed in this area. The service has comprehensive policies and procedures in place but there is no monitoring system to ensure that staff have read and understood these. Services users’ records of finances were viewed and the inspector tracked the amounts of money the service held for three service users. All amounts were accounted correctly and were in order. Staff supervision records evidenced that staff were supervised at least six times a year, ensuring staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Members of staff spoken to also commented that they were supervised regularly. Staff meetings are organised on a monthly basis. An emergency staff meeting was arranged on the first day of the inspection to discuss the allegations received by the home. Staff were observed being given opportunities to discuss issues or any concerns they had. Annual quality assurance systems are in place, and questionnaires completed by family and their representatives were seen. Survey formats for residents were simple and easy to read. The results of surveys that had been completed by people who use the service had been analysed and actioned and were planned to be discussed at the next relatives and residents meeting organised by the service. However, it was identified that stakeholders had not been included in the quality assurance programme. Health professionals, social services and any other stakeholders in contact with the home must also be involved in quality assurance surveys, to ensure their views are sought on how the home is achieving goals for residents. This will be stated as Requirement 9. Health and Safety records were inspected. The gas and safety certificate, gas safety inspection, fire system and emergency lights checks were all in good order and appropriately completed. The service had obtained insurance cover with the certificate from the company displayed in the main entrance area of Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 28 the home. However the certificate confirming the safety of electrical installation had expired on the 26/02/08, which the home had failed to renew. All documentation in relation to any health and safety checks must be up to date and renewed before expiring to ensure the health, safety and welfare of service users and staff are promoted and protected. This is Requirement 10. Water temperature checks throughout the home were completed weekly in line with the guidance from the Health and Safety Executive. The registered person has completed monthly regulation 26 visits and reports were examined at the inspection. The reports had been completed monthly but did not provide enough detail of the findings of the visit, or the audits completed or the views of residents that had been obtained during the visit. It is Recommendation 4, that the report format is reviewed to ensure the reports reflect the above information. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 29 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 1 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 2 Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 4, 5, Schedule 1 Requirement Timescale for action 30/07/08 1a OP7 OP10 12 (4) (b)15 (1) (2) ( c ) The registered persons must ensure that the Statement of Purpose and the Service User Guide are amended to provide the correct information required by the Care Homes Regulations and that the information content is a true reflection of the actual services provided by the home, to ensure that prospective residents or representatives have the information they need to make an informed choice about whether they would like to move into the home. Repeated Requirement. Timescale of 31/03/08 not met. The registered persons must 31/08/08 ensure that care plans identify the preferred daily routines of people using the service and that they are followed to ensure practices at the home promote residents’ right to exercise choice and control and ensure people who use the service are actively consulted on in all aspects of life in the home. The registered persons must DS0000027828.V364944.R01.S.doc 2 OP7 17 (1) (3) 30/07/08 Version 5.2 Page 31 Alton House (a) ensure that daily case recording sheets are recorded in detail to reflect the actual care provided at the home. The registered persons must ensure that the service makes proper provision for the health and welfare of people who use the service and ensure personal care is regularly attended to and maintained. The registered persons must ensure that healthcare professionals are contacted promptly to ensure the health needs of residents are attended to and met. The registered persons must ensure that medication practices are reviewed to ensure the safety of residents. The registered persons must review its activities programme within the home and consult residents about their social interests, and make arrangements to enable them to engage in local, social and community activities of their choice. Repeated Requirement. Timescale of 30/01/08 not met. The registered persons must ensure that safeguarding adult protection procedures are followed correctly to ensure the safety of people using the service and the service reviews its own safeguarding procedures; and that the Commission for Social Care Inspection is promptly notified of any incidents at the home by a DS0000027828.V364944.R01.S.doc 3 OP8 12 30/07/08 4 OP8 12 30/07/08 5 OP9 13 (2) 30/07/08 6 OP12 16 (m) 30/07/08 7 OP16 13 (6) 30/07/08 Alton House Version 5.2 Page 32 Regulation 37 notification. 8 OP19 13 (4) (c ) The registered persons must ensure that all parts of the care home are maintained and residents’ toiletries are not kept in communal areas to reduce the risk of communal use and infection. 24 30/07/08 9 OP33 10 OP38 23 13 (4) ( C) 11 OP22 12 (a) The registered persons must 30/07/08 ensure that quality assurance systems also seek the views of health professionals, social services and any other stakeholders in contact with the home to ensure their views are sought on how the home is achieving goals for its residents. The registered persons must 30/06/08 ensure that all documentation in relation to any health and safety checks must be up to date and renewed before expiring to ensure the health, safety and welfare of service users and staff are promoted and protected. The registered persons must 30/07/08 ensure that they provide the necessary equipment to ensure individuals are weighed regularly or arrange for individuals to be weighed at a health care clinic where this equipment is readily available to ensure the healthcare needs of residents are met; and that people who use the service have the specialist equipment required to maximise their independence. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 33 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 OP15 Good Practice Recommendations It is recommended that the registered person must ensures all foods are adequately dated and labelled to reduce the risks of contamination and ensure all staff are aware when the foods were received into the home. They must also ensure a good variety of fresh fruit and vegetables are available at the home and foods that are no longer nutritionally useful are disposed of promptly. It is recommended that boards in the dining are utilised, by the menu and activities for each day to be recorded on these to ensure the daily life and activities are communicated to residents living at the home. 2 OP24 3 OP27 4 5 OP38 OP27 It is recommended that the service reviews it management structure within the home ensuring adequate cover is provided by someone who is knowledgeable and qualified to sufficiently run the service and guide the staff team when the registered manager is not available at the home. It is recommended that regulation 26 visit reports provide enough detail on the findings of the visit and the views of service users during the visit. It is recommended that the service reviews its staffing complement to ensure the recreational needs of residents are met according to their preferences. Alton House DS0000027828.V364944.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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