CARE HOMES FOR OLDER PEOPLE
Asmall Hall Nursing Home Asmall Hall Asmall Lane Ormskirk Lancashire L40 8JL Lead Inspector
Vivienne Morris Unannounced Inspection 8th August 2006 09:00 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 Asmall Hall Nursing Home DS0000025551.V302461.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. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Asmall Hall Nursing Home Address Asmall Hall Asmall Lane Ormskirk Lancashire L40 8JL 01695 579548 01695 579978 asmallmatron@aol.com 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) JenCare Homes Limited Mrs Jennifer Chapman Care Home 57 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (45), Physical disability (3) of places Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the overall total of 57 a maximum of 45 service users requiring either nursing or personal care who fall into the category OP - Old age not falling within any other category. Within the overall total of 57 a maximum of 3 service users requiring either nursing or personal care who fall into the category PD - Physical Disability (age 40-65 years). Within the overall total of 57 a maximum of 12 service users requiring nursing or personal care who fall into the category DE - Dementia. The registered person must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 8th March 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Asmall Hall has fifty-seven beds, the majority of which accommodate elderly service users who require personal or nursing care. Included within the total of fifty-seven, twelve beds are available, in a separate unit, for elderly service users with dementia care needs. Included in the registration are three beds that accommodate service users with a physical disability under the age of sixty-five years. A qualified nurse is on duty in the main part of the home and the specialist unit at all times. Mr and Mrs Chapman privately own Asmall Hall and Mrs Chapman is also the registered manager. The home is set in extensive well maintained grounds in a quiet residential area of Ormskirk. The grounds are accessible to wheelchair users and the less mobile and outdoor seating is provided to enable service users to enjoy the gardens. A number of aids are provided to assist service users with their activities of daily living and to promote and maintain their independence. The fees charged as at 8th August 2006 ranged from £399.50 to £600:00 per week. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced key inspection was conducted over a full day during August 2006. The key inspection involved a site visit to the service when the inspector toured the premises, viewing a selection of private accommodation and all communal areas. Some residents, staff and relatives were spoken to and all relevant records were examined. A range of other evidence was also gathered before the site visit in order to formulate this report, which included twenty comment cards received from relatives and nineteen from people living at the home. The home had also submitted a pre-inspection questionnaire prior to the site visit, from which some information has been included within this inspection report. The entire inspection process focused on the outcomes for people living at the home. Those living at the home who were spoken to were happy with the service provided and the care received. They felt that the management and administration of the home was good. The home was found to be clean, tidy and pleasant smelling, providing a comfortable environment for those living at Asmall Hall. One comment received from a relative prior to the site visit stated, “the mission statement ‘excellence comes as standard’ does not fully live up to its name. There is a lack of continuity and I do not believe that the agency nurses have the commitment to the patients that the regular staff have. I consider Asmall Hall to be very good, but falls short of excellence”. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection, although one allegation had been made against a staff member, which resulted in vulnerable adult procedures being invoked and referral to the Nursing and Midwifery Council and the Protection of Vulnerable Adults register. What the service does well:
Sufficient information is obtained about the needs of people before they move into Asmall Hall so that the home is confident that the staff team are able to meet individual assessed needs. Plans of care were in place for each person living at the home, which had been developed from the information obtained before admission so that staff were fully aware of the individual needs of people. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 6 A variety of risk assessments had been conducted in relation to the care of people living at the home so that any potential hazards were identified and reduced as far as possible. A variety of external professionals visited the home at regular intervals to ensure that the health care needs of the residents were fully assessed and appropriately met. The management of medications in general was satisfactory ensuring that those living at Asmall Hall were adequately protected against any potential for drug errors or drug mishandling. The routines of the home are planned around the resident’s needs and wishes so that people are able to enjoy a flexible life style and if they choose are able to utilise the services of a local advocate to act on their behalf. Meal times are generally well managed with residents being assisted, where required in a dignified manner or supported to maintain their independence as far as possible. A relaxed environment was evident at lunchtime, providing people with an enjoyable dining experience. Where residents have particular interests every effort is made by staff to help the resident maintain their interests and keep up any community involvement, including maintaining contact with family and friends. Complaints were well managed and those living at the home were confident that their concerns would be listened to and appropriately investigated. The home was generally well maintained, clean, tidy and free from offensive odours, providing a comfortable environment for residents to live in. The grounds of the home were found to be well-maintained providing pleasant outdoor sitting areas for residents to enjoy. The ratio of care staff to residents was calculated in accordance with their assessed needs to ensure that the skill mix and number of care staff was appropriate. A wide range of training was completed by staff, including National Vocational Qualifications and in depth induction programmes were provided so that those working at the home were given sufficient information and training to enable them to do their jobs in looking after the people within their care. The registered manager has relevant qualifications and is adequately experienced to run the home and to meet the stated purpose, aims and objectives. The registered manager has systems in place to demonstrate continuous monitoring of the services provided by conducting periodic audit trails and by
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 7 obtaining feedback from residents, relatives and other stakeholders in the community, who have some involvement with the care of those living at the home. The policies, procedures and systems adopted by the home in relation to residents’ money and valuables were thorough enough to safeguard their financial interests. What has improved since the last inspection? What they could do better: Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 8 The care planning process could be improved so that a person centred approach is adopted by the home, which involves the service user or their representative in the development and review of their care plan so that they have some input into the care delivered. The plans of care should be followed in day-to-day practice to ensure that all assessed needs are appropriately met. The medication policies and procedures of the home should be reviewed and updated in line with the current Waste Regulations. Staff must refrain from displaying personal information about residents to ensure that their privacy and dignity is consistently maintained and so that there is not a breach of confidentiality. Liquidised meals should be presented in a manner, which is attractive and appealing in terms of texture, flavour and appearance, in order to maintain appetite and nutrition. The policies and procedures of the home should be periodically reviewed and up dated to reflect any changes in current relevant guidelines. A few of the bedrooms were in need of decoration and some carpets needed replacing in order to provide a homely environment for the people living in these rooms. The results of service users’ surveys should be published so that prospective residents are able to get a general picture of what living at the home is like. Cot sides must be protected at all times when in use in order to minimise the potential for residents becoming entrapped whilst in bed resulting in injury. The home should either employ sufficient appointed first aiders or provide appropriate training for identified staff to obtain an appointed first aider certificate so that accidents requiring first aid intervention are appropriately managed. 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. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 9 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 Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. Sufficient information had been provided to people to enable them to make an informed decision about moving into the home. EVIDENCE: The care records of four service users were examined at the time of the site visit. Admissions had not been made to the home until a full assessment had been undertaken to ensure that individual needs could be sufficiently met by the staff team. The home confirmed with service users that they could meet the needs of the individuals through the service they delivered as detailed within the statement of purpose. For those people who were self-funding and without a care management assessment, a skilled and experienced member of staff had consistently undertaken the assessment in a professional and sensitive manner so that individuals were confident that their needs would be fully met. Where an assessment had been undertaken through care management arrangements the registered person had obtained a summary of the assessment and a copy of the plan to ensure that staff were aware of the needs of each individual.
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 11 A plan of care had been developed for each service user, which had been generated from the information gathered prior to admission so that all assessed needs were incorporated into the home’s plan of care. Staff spoken to were able to discuss the care of people living at the home, demonstrating that they were aware of the individual needs of people. Service users and relatives spoken to on the day of the site visit stated that they had been provided with sufficient information to enable them to make a decision about living at Asmall Hall and that someone from the home had visited them to find out what their needs were before entering the home. The pre-inspection questionnaire showed that policies and procedures were in place in relation to the admission process providing staff with guidance about the correct procedure to take when admitting someone to the home. One relative commented, “I sought advice before my relative was admitted and having made contact with matron and her staff had no hesitation in placing my relative in their care”. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. The health and personal care needs of people living at the home were not consistently met. EVIDENCE: Each resident had a care plan in place, which had been developed from the information gathered before admission, so that all assessed needs were recorded. However, practice of involving residents in the development and review of their plan, so that they had the opportunity to be involved in their care was not evident. The plan in most cases included the basic information necessary to plan the individual’s care and included a risk assessment element so that any potential hazards were identified and removed or reduced as far as possible. Evidence of updating information and changing actions appeared on care plans and input by external professionals into the care of service users was evident in most cases. However, the plans of care were standardised documents, which were not individualised and did not promote a person centred approach. The instructions contained within the plans of care were not Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 13 consistently followed in day-to-day practice to ensure that assessed needs were fully met. A comment card received from an external professional stated, “I am very happy indeed with all aspects of dealing with this home on behalf of my patients. I have no concerns, only praise for the caring attitude of the staff and gratitude for their helpful and professional approach”. Comments submitted by relatives prior to the site visit included, “my relative has always received excellent care and attention from the matron and her staff” and “in my opinion Asmall Hall is an excellent care home and I have no complaints about the way my relative is looked after”. The home had a medication policy which was accessible to staff. However, the policies and procedures of the home should provide staff with clear instructions about the disposal of waste medication in line with current Waste Regulations. Medication records were in general up to date for each resident and medicines received, administered and disposed of were recorded so that the safety of those living at the home was adequately protected. The home understood the need to comply with the policies and procedures in relation to the management of controlled drugs so that the possibility of any mishandling of drugs was reduced as far as possible. Staff were aware, through induction training, of the need to treat service users with respect and to consider privacy and dignity when providing personal care. The home arranged for residents to enjoy the privacy of their own rooms and provided screens in shared rooms for added privacy should the need arise. Residents were happy with the way that staff delivered their care and promoted their dignity, which showed that a good rapport existed between service users and staff and that those living at the home were respected at all times. However, a notice displayed by the door in the dining room disclosed the special dietary needs of one service user, which did not protect this individual’s dignity and was a breach of confidentiality. Two comment cards received from residents indicated that their nurse call bells were not always answered promptly and one resident spoken to informed the inspector that this was a particular problem during the night. Asmall Hall Nursing Home DS0000025551.V302461.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents find the lifestyle experienced in the home matches their expectations and preferences, and generally satisfies their social, religious and recreational interests and needs. EVIDENCE: Care records of people living at the home contained a detailed social history, which was well recorded and which the inspector found to be good practice enabling staff to meet social care needs of individuals. A social care plan showed that people were offered the opportunity to continue their leisure interests whilst living at the home. Those service users spoken to had all really enjoyed the recent summer fayre organised by the home. Asmall Hall has a chapel on site and clergy of various denominations visit the home to provide those wishing to participate with mass or holy Communion. Service users dietary needs were recorded in the care records showing that their preferences had been discussed. A programme of activities was prominently displayed within the home so that people could decide which activities they preferred to take part in. The daily progress notes for each person included reference to participation in activities.
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 15 One comment card from a relative suggested that more 1:1 activities could be provided for those who were poorly, bedfast or confined to their rooms because of physical frailty in order to prevent isolation and to promote some form of stimulation. Another suggested the possibility of photographs of staff being displayed, so that new residents and relatives could easily identify the people working in the home. Those spoken to were satisfied with the activities provided by the home. Some stated that they were not interested in activities and were pleased that they were not pressurised to participate. However, one comment card received indicated that although activities were provided, these were ‘old fashioned’, and not suitable for all residents. It is recommended that the registered person conduct an audit of the activities provided, particularly for the younger people living at the home to ensure that suitable activities are available for all residents in order to promote equality within the home. A detailed policy was in place in relation to the freedom of choice for people living at the home and the inspector noted that freedom of movement around the home was evident. Service users were seen to make requests to staff, which were honoured, showing that their wishes and preferences were addressed. Although one comment card received indicated that people could not visit service users in private, the statement of purpose and policies of the home showed that service users were able to receive visitors within the privacy of their own rooms, if they so wished and those spoken to confirmed this. Relatives were observed visiting people in private and a quiet visitors room was available at the home. Relatives’ comments indicated that they were made to feel welcome when visiting the home and those spoken to said that staff at the home were very approachable. One comment received was, “the atmosphere is good, helpers are friendly, welcoming and kind” and another was, “when my relatives visit they are impressed with the welcome and kindness they receive from the staff and also the cleanliness of the home”. The Pre-inspection questionnaire received prior to the site visit showed that one service user had an advocate and the statement of purpose, policies of the home and leaflets available informed people about local advocacy services, should they choose to utilise an independent person to act on their behalf. Residents’ personal possessions were seen in service users bedrooms, which made their accommodation individualised and homely. Residents were able to eat their meals in the dining areas of the home or within the privacy of their own bedrooms, enabling them to choose and change their dining arrangements. Meal times, in general were well managed and treated as an occasion and something to be looked forward to, providing people with a relaxed setting in which to dine. Some people were sitting at dining tables in their wheelchairs. However, those spoken to informed the
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 16 inspector that this was their choice, which was recorded within individual care records. Staff were seen to be supporting those requiring assistance in a gentle and courteous manner, allowing them to eat at their own pace, sitting with them and chatting to them whilst providing encouragement, in order to promote independence. Staff were observed anticipating residents’ needs well and any requests were attended to promptly so that people did not have to wait unreasonable periods of time for assistance. The different flavours of the main course served at lunchtime for those receiving liquidised diets were mixed together in a bowl, which did not look attractive for these residents and did not provide them with equal opportunities in relation to the provision of food. The regular diets were well presented in order to maintain appetite and nutrition. Mixed comments were received from residents in relation to the food served. Three comment cards indicated that meals were sometimes enjoyed, others indicated that meals were always enjoyed and some indicated that meals were usually enjoyed. Verbal feedback from service users on day of site visit included, the meals are good at weekends, but a bit iffy during the week, I always enjoy my meals, they are very good, the food is generally enjoyable and the meals are always good. Due to the range of comments received in relation to the quality of food, it is recommended that the registered person conduct audits to obtain an overview of people’s views of the food provided. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. Service users are adequately protected from abusive situations and they are confident that their complaints will be listened to, taken seriously and acted upon. EVIDENCE: The pre-inspection questionnaire showed that no changes had been made to the complaints procedure since the last inspection, at which time it provided clear information. The written procedure was included within the service users’ guide and was prominently displayed within the home at the time of this site visit so that people were aware of how to make a complaint should they so wish. However, out of the 20 comment cards received from relatives, 6 showed that they did not know how to make a complaint. Any complaints received by the home were clearly recorded showing that a thorough investigation had been conducted in order to address the issues raised in a timely fashion. The policies and procedures in relation to the protection of vulnerable adults had been reviewed and updated since the last inspection to ensure that correct procedures would be followed should an allegation of abuse be received by the home. New policies and procedures had been implemented so that any valuables or money held by the home on behalf of residents was adequately safeguarded.
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a generally well-maintained environment, which is clean, pleasant and hygienic. EVIDENCE: The registered person had implemented a routine maintenance plan, which demonstrated that work was continuing on a rolling programme and it was evident that some carpets had been replaced and some areas of the home had been decorated. However, although on the day of the site visit the home was found to be pleasant smelling, clean and tidy, a few bedrooms were looking ‘tired’ and ‘worn’ and in need of decoration and a few bedroom carpets were now in poor condition and needed replacing in order to promote a more homely atmosphere for all the people living at the home. Residents spoken to said that they were comfortable and that the home was clean, warm and well lit. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 19 The grounds of the home were very well maintained, providing pleasant outdoor areas for residents to enjoy during the better weather. The pre-inspection questionnaire showed that no changes had been made to the infection control policies and procedures, which were satisfactory at the last inspection. The laundry department was found to be satisfactory, providing sufficient equipment for the needs of the home. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff employed are trained, skilled and in sufficient numbers to fulfill the aims of the home and robust recruitment procedures are in place to adequately protect residents. EVIDENCE: Prior to the site visit the registered person had submitted information to the Commission in relation to staffing levels within the home, which demonstrated that the ratio of care staff to residents was calculated in accordance with the assessed needs of the people living at the home to ensure that the skill mix and number of staff on duty was appropriate at all times. Some agency staff were being utilised to cover staffing deficits. However, it was seen that where possible the same agency staff were being used in order to provide continuity of care. One comment card received indicated that the agency staff were not as caring as the regular staff employed by the home. Another comment submitted by a relative stated, “the staff are always present, pleasant and helpful”. The pre-inspection questionnaire received prior to the site visit demonstrated that 41 care staff were employed at the home, 21 of whom had achieved a National Vocational Qualification at level 2 or above, providing 50 of adequately trained care staff. The inspector examined the records of four staff members who had been recruited since the last inspection and found that the recruitment procedures
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 21 adopted by the home had improved to ensure that people were adequately protected. The pre-inspection questionnaire showed that a wide range of training was provided for staff working at the home and that future planning had been arranged. The inspector examined relevant training records and found that care staff routinely completed the ‘skills for care induction standards’, which showed that they received detailed information and in depth training during the first six weeks of employment. Individual training and development assessments had been completed and staff spoken to felt that a lot of training was provided, which was funded by the home, so that people working at Asmall Hall were kept up to date with current practices. Certificates of training were retained on staff files, confirming that a good amount of training was provided for staff employed at the home. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified and competent person, who ensures that residents’ financial interests are safeguarded and that safe working practices are in place. However, care practices were not always thorough enough to consistently protect those living at the home from potential risks. EVIDENCE: The manager of the home, Mrs Chapman is also one of the owners. She is a first level registered nurse and has been registered with the Commission for Social Care Inspection, meeting all the standards applying to the registered manager. Training records show that Mrs Chapman has completed a National Vocational Qualification at level 4 and that she updates her own knowledge and skills regularly to ensure that the home is well managed. The job description of the registered manager enables her to take responsibility for fulfilling her duties.
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 23 Staff spoken to stated that they felt well supported by the management structure of the home and were able to discuss any concerns with the senior staff. One relative commented, “I have complete confidence in the management and have received good practical advice from members of the senior management team” and another comment submitted was, “the deputy matron’s prompt and immediate response to a concern was very satisfactory”. The registered person had not consistently given notice to the Commission of the death of any service whilst they were in hospital, therefore required information was not being provided in accordance with the Care Homes Regulations. An annual development plan had been produced, but was currently under review for future planning. This plan reflected the aims and outcomes for residents, who were able to provide formal feedback to the managers about the quality of service provided. However, the results of residents’ surveys had not been published so that people considering a placement at the home were able to determine what life was like at Asmall Hall. The home had achieved an external quality award showing that a recognised professional body had assessed the service. A variety of audit trails had been conducted, demonstrating that the registered person periodically monitored the quality of systems adopted by the home and their effectiveness for people living there. Surveys had been conducted, which included feedback from residents and their relatives about the quality of service provided and the views of stakeholders in the community had been sought on how the home was meeting goals for residents. Some of the policies and procedures of the home had not been reviewed and updated periodically to ensure that they were in line with current good practice guidelines. The policies, procedures and systems adopted by the home in relation to residents’ money and valuables were thorough enough to safeguard their financial interests. The pre-inspection questionnaire showed that systems and equipment within the home had been appropriately serviced and the policies and procedures in relation to safe working practices and health and safety were detailed so that staff were provided with clear guidance about health and safety issues. Accidents had been appropriately recorded in line with current data protection guidelines and although 48 staff members had completed a basic first aid course no appointed first aiders were on the staff team to ensure that any accidents requiring first aid intervention would be appropriately managed.
Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 24 A variety of risk assessments had been conducted in relation to safe working practice topics to ensure that people living at and those working at the home were adequately protected. However, some bed rails, which were in use at the time of the site visit, were not protected with covers to reduce the possibility of residents becoming entrapped whilst in bed. Although risk assessments for those using cot sides had been conducted and the manager informed the inspector that covers were available for all cot sides, one service user was seen in bed with unprotected cot sides. The resident confirmed that they were unable to move alone whilst in bed. However, this had a potential to place people at risk. All staff had received a wide range of training courses and all new staff had been provided with in depth induction training programmes within the first six weeks of appointment and had subsequently completed foundation training so that they were able to provide the care required by those living at the home. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 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 X X 2 Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 26 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) Timescale for action The registered person shall, after 31/08/06 consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. (Timescale of 15.10.05 and 31.03.06 not met). The registered person shall 31/10/06 ensure that the care home is conducted so as to promote and make proper provision for the health, welfare and care of service users by ensuring that the plans of care are consistently followed in day-to-day practice. The written policies and 30/09/06 procedures of the home must be in line with current Waste Regulations. Once amended this policy must be forwarded to the Commission for Social Care Inspection. The registered person shall make 31/08/06 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service
DS0000025551.V302461.R01.S.doc Version 5.2 Page 27 Requirement 2. OP8 12(1)(a)( b) 3. OP9 13(2) 4. OP10 12(4)(a) Asmall Hall Nursing Home 5. OP33 37(1)(a) 6. OP38 13(4)(c) users. The registered person shall give notice to the Commission without delay of the occurrence of the death of any service user, including the circumstances of his death. The registered person shall ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated, including adequate protection from risks associated with the use of cot sides. 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP10 OP12 Good Practice Recommendations The plans of care should be individualised in order to promote a person centred approach to care planning. There should be a formal system for prompting medication reviews in line with National Service Framework for Older People. The registered person should assess staff response times to the nurse call bells. It is recommended that the registered person conduct an audit of the activities provided, particularly for the younger people living at the home to ensure that suitable activities are available for all residents. Liquidised meals should be presented in a manner, which is attractive and appealing in terms of texture, flavour and appearance. The registered person should conduct audits to gather the views of people living at the home in relation to the quality of food provided. The registered person should conduct an audit of the standard of private accommodation for all residents and where identified as necessary decorate bedrooms and
DS0000025551.V302461.R01.S.doc Version 5.2 Page 28 5. 6. 7. OP15 OP15 OP19 Asmall Hall Nursing Home 8. 9. 10. 11. YA20 OP33 OP33 OP38 replace carpets. Consent to the administration of medication for the younger adult should be recorded in the care plan. The policies and procedures of the home should be periodically reviewed to ensure that any changes in legislation and good practice guidelines are up dated. The results of service users’ surveys should be published. The home should either employ a number of appointed first aiders or provide relevant training for identified staff to become appointed first aiders. Asmall Hall Nursing Home DS0000025551.V302461.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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