Inspection on 31/05/06 for Aspen Court Care Home

This inspection was carried out on 31st May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aspen Court Care Home 20/09/07

Aspen Court Care Home 14/06/07

Aspen Court Care Home 25/07/06

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

CARE HOMES FOR OLDER PEOPLE Aspen Court Care Home Hope Corner Lane Taunton Somerset TA2 7PB Lead Inspector Caroline Baker Key Unannounced Inspection 31st May 2006 09:25 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 Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 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. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Aspen Court Care Home Address Hope Corner Lane Taunton Somerset TA2 7PB 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) 01823 346000 01823 346001 N Notaro Homes Limited Mr Nicholas Lawson Warner Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate up to 27 service users in category DE(E) who require nursing care. Including 3 service users from the age of 55 years. The manager to have supernumerary of at least 25 hours a week. Date of last inspection NA Brief Description of the Service: Aspen Court is a purpose built care home found on the same site as its sister home Cedar Lodge. The home is registered with the Commission for Social Care (CSCI) to provide nursing care for up to 27 persons over the age of 65 years with a dementia with the conditions listed above. All private rooms are single with en-suite facilities. There are communal areas and a secure garden for resident use. The current scale of charges range from £537 - £637 per week. Hairdressing, private chiropody, dental care, optical treatment, clothing, toiletries and newspapers are not included. Since February 2006 part of the 42 bed premise was registered separately – the ‘Roma Unit’ - to accommodate up to 15 younger adults. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is Aspen Court’s first Inspection since it was registered under the Care Standards Act 2000 in November 2005. In line with Inspecting for Better Lives (IBL) all newly registered care services receive a ‘Key’ inspection within the first 6 months to ensure compliance with legislation. 36 of the 38 National Minimum Standards (NMS 6 does not apply to the home) were assessed. This Key Inspection was Unannounced and took place over one day and was conducted by two inspectors, which amounted to 18 inspector hours. The inspectors felt welcomed by the registered manager, the registered provider, the regional manager, staff and residents. There were 20 residents living at the home at the time of this inspection. Two rooms were booked and the manager was assessing two more prospective service users during the afternoon of the inspection. The CSCI sent comment cards to all of the service users and their relatives and GP’s for their views on the conduct of the home. 12 service users one relative and two GP’s responded. Comments were generally positive as reflected throughout the report. A tour of the premises took place where a selection of bedrooms and all communal areas were seen. The inspectors consulted with at least 14 service users, two visitors and 8 staff during the inspection. The registered manager was available for the majority of the inspection until he left to assess prospective residents. The regional manager was available throughout. During the inspection the inspectors observed interactions between staff and service users. Selections of records were examined relating to care, health and safety, and staff. What the service does well: Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 6 Prospective residents and their representatives are able to visit the home before making a decision to move into the home and residents benefit from being assessed by the home before admission to see if it can meet their needs. Residents are able to have visitors at any time and keep links with the local community. Visitors seen during the inspection were satisfied with the provision of care at the home. Residents are able if they choose to continue to handle their own finances and are able to access their personal records should they wish to do so. Comments received from residents and relatives via comment cards and during the inspection included: ‘I like living here’, ‘the food is good’, ‘the staff are kind and helpful’ ‘the manager is nice’, ‘staff are very caring and alert to symptoms’ (relative), ‘well cooked varied and interesting meals’ (relative) and ‘staff are attentive and have positively responded to a number of comments’ (relative). Residents and staff spoken to were aware of the complaints procedure, which forms part of the service user guide. The home had responded appropriately to a complaint from NHS Direct in regard to the way staff responded to a fall at the home, and detailed records had been kept. Residents are able to vote in local elections and have been registered to vote according to the manager. The building and gardens are well maintained. The environment is designed with dementia care needs in mind with contrasting colours and signage. Residents benefit from adequate lavatories and specialised showering and bathing facilities. Residents’ benefit from the aids and adaptations provided at the home to include mobile hoists and grab rails throughout. Residents’ benefit from having airy light well sized single rooms, which suit their needs, and being able to bring personal items in to the home to personalise their rooms. Residents benefit from staff undertaking their laundry needs, one resident told an inspector that ‘they look after our clothes nicely’. Residents also benefit from the homes infection control systems – a recent outbreak, which affected many residents and staff, was managed very well by the home with guidance from the Health Protection Unit. Residents benefit from being able to trust the home to look after their personal finances should they be not able to look after their own monies. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection? What they could do better: If the homes Statement of Purpose and Service User Guide were up to date prospective residents and/or their families would be able to make an informed choice as to whether they would want to move in to the care home. On moving into the home 75 of residents indicated via comment cards that they had not received a contract. On assessing and sampling residents personal files 2 out of 6 assessed did appear to have a contract. Residents would benefit from knowing what their fees include. Residents would benefit if all care staff at the home had the appropriate skills and training to meet their specialist needs. Residents would benefit from staff understanding their past life histories and social care needs so that social interaction as well as task orientated interactions can take place on a regular basis throughout a residents day. Also regular activity and occupational provision would be beneficial with involvement of all staff. The activities co-ordinator was not available on the day of inspection therefore the notice board had not been completed with the date and the weather. Residents would benefit if action was taken when loss of weight was identified and nutritional assessments were completed and care plans adjusted to have detailed actions written for care staff to take to meet the residents’ individual nutritional needs. Residents would benefit more from always being treated to ensure their dignity is maintained, with particular regard to basic care needs and mealtimes. Two male residents were in need of a facial shave and two other residents seen had dirty fingernails. At lunchtime tables were not laid, there were no condiments or serviettes available. Residents were cramped into a small dining area upstairs and two residents were being assisted to eat by one member of staff. Another member of staff was seen putting plastic aprons on residents whether they wanted them or not. Residents would benefit if staff had been made aware of the policies of the home in particular the death and dying policy and the Whistleblowing policy. Also the policy manual at the home contained policies that were incomplete and not individualised to the home. Residents would benefit from being given a choice of meal at lunchtime to include desserts. Staff told inspectors that residents were not given a choice. It was a warm day and there was a choice of roast beef or egg salad, all residents were given roast beef. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 8 Residents would benefit and be at less risk of harm if the home tightened up its recruitment procedures and ensured staff received training in abuse and know the local adult protection policies which explain steps to take should they suspect any form of abuse. Residents would benefit if they were given a choice of dining area and of whom to sit with in more congenial settings. Also if there were more staff available over mealtimes then the 8 residents requiring assistance may not have to wait for their meals. Residents would benefit if more staff at the home had a care qualification. 27 have a National Vocational Qualification (NVQ) in care and it must be 50 at least to be able to ensure that collectively staff are trained and competent to undertake the job they are employed for and meet the needs of the residents. Overall the home was very clean and tidy 75 of residents indicated through comment cards that the home was always fresh and clean. Of all the rooms assessed only one room had a stained carpet and stains on chairs. The indoor laundry was being overused and must be reviewed for health and safety and infection control reasons. Residents would benefit more if the registered provider and manager had through quality monitoring ensured that staff were supervised to ensure their competencies, and if the manager had commenced the required management qualification and had received regular 1:1 supervision. Staff spoken to felt lack of leadership and a comment received was ‘we direct ourselves’. Residents spoken to liked the manager. This inspection was disappointing considering the home has only been open since November 2005 and has only had 27 beds since February 2006. Given the content of the report CSCI will be asking the provider to attend a meeting to discuss an improvement plan for the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 9 contacting your local CSCI office. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 10 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 Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 11 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): 1; 2; 3; 4; and 5. NMS 6 does not apply to this service. Quality in this outcome group was poor. Prospective residents and their representatives are able to access information and visit the service to enable them to choose whether the home would meet their needs. The Statement of Purpose however, does not reflect what the home provides. Not all residents had been provided with a statement of terms and conditions before admission to the home. The service undertakes pre-admission assessments to see if they can meet the prospective residents needs. The care staff at the home had not received any specialist training in dementia or challenging behaviour. The home does however employ RMN staff. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 12 EVIDENCE: The home updated a Statement of Purpose/Service User Guide during the inspection process and gave a copy to the inspectors. It reflects the current registration for 27 clients however states it has ‘42 bedrooms’, three sitting rooms and three dining rooms, and ‘Fees are between £519 -£620 per week’ which is incorrect and must be amended. Nine of the twelve comment cards received from residents indicated that they had not received a contract with the home. Further evidence of this was noted when individual resident files were assessed through case tracking. One resident had a contract with Somerset County Council but appeared not to have a contract for their contribution made. A further file seen did not contain a contract. All residents must receive a contract on moving into the home in line with legislation. There was little evidence found that the service user guide to the home had been provided to residents and/or their representatives. Evidence was found in individual care plans sampled of pre-admission assessments being carried out prior to admission to the home. On the day of the inspection the manager had to leave after lunch to assess prospective residents. Prospective residents and their representatives are able to visit the home prior to admission to allow them an informed choice. The Statement of Purpose states: ‘the home manager will encourage family members to participate in the assessment and invite them to view the home’. Staff training records and care staff spoken evidenced that training to meet the specialist needs of the current resident group had not been provided at the home. Registered Nurses trained in mental health (RMN’s) are employed at the home however the lack of competencies in the care staff group in dementia and challenging behaviour evidences that the home is not fully meeting the specialist needs of the resident group. Training must be provided to the staff team without delay. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 13 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; 10 and 11. Quality in this outcome group was poor. Each resident had an individual plan of care; those seen were detailed with clear actions for staff to take to deliver care. There was evidence of input from the resident and/or their representative. Some care plans lacked adequate risk assessments and residents with significant weight loss had not had a care need plan recorded and there was little evidence that monitoring of nutritional needs were taking place. Medication administration and recording practise put residents at a potential risk of harm. Staff showed respect towards residents and allowed their privacy and dignity to be maintained in regard to personal care, however at mealtimes there was evidence that staff treated residents in a way that did not respect their dignity. The home had policies and procedures, which inform staff how they should handle dying and death, however staff spoken to were not aware of these. The wishes of residents about arrangements after death were not always recorded. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 14 EVIDENCE: Eight individual care plans were assessed. Overall care plans specified clear actions for care staff to take to enable them to deliver the care required. Current care needs were reflected. They had all been reviewed with input from the resident and/or their representative. Four of the care plans did not contain a social care profile. Three recorded the residents’ cultural beliefs. Care plans should be more person centred in regard to social care needs and cultural needs. Residents have access to health care services. The CSCI received comments from two GP’s via surveys, which asked some of the following questions: Do staff demonstrate a clear understanding of the care needs of service users? One GP indicated Yes and one No If you give specialist advice is this incorporated into the service plan? One GP indicated Yes and one Sometimes Do management/staff take appropriate decisions when they can no longer manage the care needs of the service user? Both indicated Yes Are you satisfied with the overall care provided to service users within the home? One indicated generally and one this is a new home and we do not have enough experience of it yet to have fully formed an opinion. Other comments received from GP’s included: It is difficult to get through to nursing staff on the phone. Often if they request telephone advice from a doctor it takes 4 or 5 attempts to speak to someone, which can be frustrating. All the above comments were passed on to the manager of the home. All residents had profiling adjustable beds and pressure relieving equipment where needed, which was being used appropriately. Wound care plans were detailed and evidence was seen of a pressure sore almost being at the healing stage according to the notes and the staff spoken to. Six of the eight individual care records assessed had records of significant loss of weight since admission. This was very concerning and brought to the attention of the manager and regional manager at the time of the inspection. For example: one resident had lost 10kg in 2 months, another had lost 6kg in 2 months and one person who had recently passed away had lost 9kg in 3 months. Even more concerning was that there had been no action taken according to the records to monitor and act upon any loss of weight. There were no nutritional assessments completed apart from one, which indicated the resident was ‘high risk’ and should have 1 x supplement drink daily. No action had been taken according to the records. Action must be taken without Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 15 delay to monitor weight loss and act upon it. Staff asked told inspectors that they always reported any weight loss to the nurse in charge. The regional manager telephoned the lead inspector on 2nd June 2006 to alert her to the fact that he had informed a GP of our findings and comments in regard to the weight loss. The inspectors discussed the fact that the negative mealtime experience seen at the home during this inspection could potentially contribute to a loss of weight (see ‘Daily life and Social Activities’). Comments were received via surveys and during the inspection from residents and relatives, which included: ‘I like living here’, ‘staff are very caring and alert to symptoms’, ‘they are all kind and caring’, ‘the overseas staff are especially very helpful’, ‘ and ‘its a nice, lovely place’ and ‘night nurses check on you often enough’. On assessment of the homes medication systems Medication Administration Records (MAR) were examined and the following noted: 6 MAR sheets identified good practice 10 MAR sheets assessed had gaps in signing for administration of prescribed medication. 6 MAR sheets assessed had ‘O’ used as a sign of not being given – there was no reason as to what the meaning of ‘O’ was and in 6 of the bedrooms assessed during a tour of the premises and through the case tracking process creams (for example: sudocrem or conotrane cream) were found in rooms inappropriately stored and not named for the individual service user, or dated when opened. An immediate requirement notice was issued in regard to poor medication administration records. Evidence was seen through direct observation that staff treated residents kindly and with respect overall. Service users spoken to indicated that staff were always respectful towards them. Dignity issues were identified in regard to personal care and at lunchtime. When speaking with residents two were noted to have dirty fingernails and two men were unshaven. At lunchtime when one member of staff was sat assisting two residents to eat at the same time, one resident was sat at a table alone looking towards a wall. Residents were having plastic aprons put on whether they wanted one or not with no interaction from the member of staff. Tables were not laid and some residents were left waiting for at least 40 mins before they had their meal. Other Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 16 residents were seen having food in the area by the lift, which is a thoroughfare (also see ‘Daily life and Social Activities’). Staff spoken to were not aware of the homes policies on death and dying. There have been 10 deaths at the home since it was opened in November 2005. Staff also told inspectors that they supported each other, when it meant coming to terms with a resident dying. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 17 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 for this outcome group was poor. There was little evidence of individualised social care. Individual residents social care profiles were not completed on occasions. There was no social activities record available. Staff interaction with residents was mainly task orientated. Residents are able to maintain links with their families and friends. The home was managing individual residents finances on their behalf where they were unable in an appropriate way. Residents are able to access their records. Menus are available and appear nutritious with a specified choice. Residents were not given a choice. The dining area was not adequate or a pleasant environment to eat a meal. Policies and procedures were not being followed. EVIDENCE: Eight care plans were assessed as part of the case tracking process. Social care needs and life histories were not always completed. Person centred social care was not evident. Surveys received from residents indicated that 50 thought that they could sometimes take part in the activities arranged by the Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 18 home,, 41 thought they could take part and 8 that they could always take part. The activities co-ordinator was on sick leave at the time of the inspection therefore activities records were not available. The notice board had not been completed with the date or the weather because she was off sick. It seemed that very little individual social care takes place in the absence of the activities person. One resident was unable to go on their weekly trip in the absence of the activities co-ordinator and told the inspectors that this was disappointing. One resident told inspectors that they would like to go in the garden but because they are upstairs and their chair is too heavy, they cant. Three more independent residents accessed the garden during this inspection. The registered person should consider increasing social care provision at Aspen Court to allow for all residents needs to be met. When staff interacted with service users the majority was task orientated for example when someone needed the toilet or someone was given a cup of tea. There were long periods where service users were not spoken to and left to sleep during the morning and afternoon. It was pleasing to see two staff chatting with residents however for a short time, during the morning, in the lounge area reminiscing about the past. Visitors were seen at the home and told inspectors that they felt the care provision was satisfactory and that since the home opened ‘its getting there, slowly – it’s a new home’. The inspectors observed the lunchtime meal being served and briefly observed the teatime meal being served. The mealtime experience for residents was negative. The dining room upstairs seats up to twelve residents and there was not much space between tables. One resident had to face a wall. Residents were mainly sat in pairs. There was no recorded evidence of preference where residents would like to sit or with whom. Residents from the floor below were also expected to eat their meals in the upstairs dining area. The home’s dining area on the ground floor was not used. Staff confirmed these details with the inspectors. Other residents (3-4) were seen having their meals in the area outside the nurse’s office, which is a thoroughfare for visitors, residents and staff. There were no tablecloths/tablemats, condiments or serviettes available for the tables. Knives and forks were eventually given to residents just before or as their meal appeared. Dessertspoons were given with the dessert. There was one member of staff seen assisting two residents at the same time to eat their meal. One member of staff served food from a hot trolley. One member of staff gave teas, coffees or cold drinks before the meals were served. Some residents waited up to 40 minutes for their meal to be served. One member of staff was Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 19 placing plastic aprons over resident’s heads whether they wanted them or not. There was no interaction or conversation. The nurse in charge was administering medications from outside the dining area and heard calling a resident who was sat in the dining room to see if they needed analgesia. Staff told inspectors that eight residents required assistance with their meals and there were only three/four care staff on duty with the trained nurse. The six other persons needing assistance, who were in their rooms would have had to wait for their meals it appeared. Menus were available and posted up on a notice board outside the dining room for residents to see. Those asked did not know what they were having for lunch, one stated ‘it is always a surprise’. All the residents spoken to stated that the food was generally good at the home especially the ‘cooked breakfasts’. Comments from surveys sent to residents indicated that 66 always liked the meals at the home, 25 usually liked the meals and 8 sometimes liked the meals. Menus reflected a choice of roast beef or egg salad on the day of the inspection. When asked if anyone had ordered egg salad as all there seemed to be on the trolley was roast dinner the staff told inspectors that residents were not given a choice. This is very concerning. It was a warm sunny day and inspectors did not know how the home knew without asking them that all the residents wanted roast dinner. This must be reviewed and a choice given at mealtimes without delay. Soft diet was well presented. Meals were presented in large amounts to many of the residents. Plate guards were not used where needed and there was no provision of adapted cutlery, which would have aided one particular resident to help themselves to their food. Their individual care plan stated that they needed assistance with meals and this was not available. A lot of food was being left to go cold in front of at least 6 residents and some residents were left to sit and watch another resident eat whilst they waited for their meal. Desserts were handed out before the main meal had been eaten and evidence was seen of at least 2 residents leaving a large amount of food on their plate. This could be contributing to the loss of weight of 6 of the 8 residents case tracked (see ‘Health and Personal Care’). One resident being assisted was heard to say ‘its cold now’. The home was not following its Serving of Meals Policy, which states: meals are plated up in the kitchen and delivered to the residents. One of the inspectors spoke to the catering staff that also cook for 15 residents in the Roma Unit. The staff told the inspector that they understood dementia care but did not appear to think that there was anyone with dementia at the Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 20 home. They saw the home as one and both units received the same meals. The inspector discussed ways of offering choice as stated on the menu and the staff appeared to believe that it would cause too much waste and that they were working to a tight budget. They were concerned that staff were not offering a choice, however stated that if they knew a week in advance it would be helpful. The inspector explained that people with a dementia would probably not remember what they had ordered. Evidence of breakfast choice was seen and all residents had an individual card of what they had ordered. The chef told the inspector that they are reviewed on a regular basis. At teatime soup and sandwiches are available and on the day of inspection quiche was also available. There is no choice of dessert and all residents are given the same even persons with diabetes as saccharin is used. The inspector discussed provision of a ‘sweet trolley with a choice of dessert’ and this will be recommended. There was no fresh fruit seen in the home but the chef told the inspector it is available but always comes back to the kitchen. The inspector suggested to the regional manager that all staff including the kitchen staff see CSCI’s Infocus booklet ‘Highlight of the Day’ – improving meals for older people in care homes. The inspector’s observations evidenced that the home is not following its own standard set in their Statement of Purpose, which states: ‘Mealtimes are a focal point in the days routine and are generally social occasions……..our emphasis is on creating a relaxed, social setting’. And the menus in the Statement of Purpose given to the inspectors are not the same as the menus displayed in the home. The registered person must ensure that all staff employed at the home have an awareness of person centred dementia care. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 21 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; 17 and 18 Quality for this outcome group was adequate. Residents and visitors to the home have the information to enable them to make a complaint or raise concerns. There was provision to allow residents to have their legal rights protected. Arrangements for protecting residents from harm or abuse were poor. EVIDENCE: The home has a complaints procedure, which can be seen on request according to the Statement of Purpose given to the inspectors. There have been no complaints recorded at the home. The CSCI received one concern from NHS direct in regard to the way staff dealt with an emergency overnight. This was thoroughly investigated by the regional manager and appropriate records kept. Residents spoken to and able knew who to raise concerns with and staffs were aware of the complaints procedure. The manager informed inspectors that residents are registered to vote in local elections. The home has a Whistleblowing policy however staff spoken to were not aware of the steps to take or the local multiagency policies for Adult Protection. The homes Whistleblowing policy has not been completed and is not personal to the home and must be updated. Staff must receive formal abuse awareness Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 22 training without delay. They had seen a video on induction but this did not cover local policies. Staff recruitment gaps were evidenced (see ‘Staffing’). Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 23 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): 19; 20; 21; 22; 23; 24; 25 and 26. Quality in this outcome area was adequate. The homes provision of a safe environment for residents was good. Arrangements for the control of infection were compromised by the over use of the small internal laundry. Residents are able to individualise their private rooms. Shared facilities were not being used to their potential. Residents are able to have access to a secure garden, however restrictions were evident if residents lived upstairs. EVIDENCE: Aspen Court has 27 single rooms with en-suite shower facilities. There are two dining areas and two sitting rooms it is split into 2 units. There is a secure garden available for residents. The home and garden is well maintained and Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 24 complies with the local fire service. There are adequate parking facilities outside the home. The home was purpose built and completed in November 2005. Residents upstairs and not mobile told inspectors that they could not access the garden and would like to (see ‘Daily Life and Social Activities’) On the day of the inspection one dining room was in use only (see ‘Daily life and Social Activities). Residents from downstairs were using the upstairs dining area. As discussed both dining rooms should be in use to give more choice and space to residents. Many residents were seen accessing all parts of the first floor. Some were in the lounge upstairs and others were in the sitting area outside the nurse’s office. The regional manager contacted the inspector on 2nd June 2006 and informed her that both dining rooms and lounges were being used since the inspection; this was very pleasing to hear. The environment has been designed with dementia care in mind, for example there is signage on toilet doors and doors to toilets are contrasted to the rest of the décor. Bathing and toilet facilities are adequate at the home. All corridors are wide with grab rails to aid with mobility. The home has adapted baths for disabilities. There are two mobile hoists available and the regional manager agreed to monitor whether this was enough for the current residents dependency levels. A nurse call system is available throughout the home. At lease 10 individual residents bedrooms were assessed as part of the case tracking process and through a tour of the premise. All rooms meet NMS space and furniture and fitting requirements. Residents spoken to liked their rooms and many contained personal items including pictures and photographs. Rooms were well ventilated and windows were restricted in line with HSE requirements. All radiators conformed to HSE guidelines. Hot water temperatures were tested regularly and records maintained. All baths and wash hand basins were fitted with thermostatic controls. There were no malodours in the home and it was generally very clean. One room seen had stains on the chairs and carpet and this was brought to the attention of the regional manager. Infection control systems and equipment are in place and staff asked understood the importance of infection control and what actions to take. The home recently had an outbreak of diarrhoea and vomiting which affected many residents and staff, the Health Protection Unit took the lead in monitoring the situation and within 4 days the home was clear and the manager and staff should be commended for their hard work of stopping the outbreak in such a short time. The home has two laundries, both shared facilities. One, which is outside, is shared with Cedar lodge and one inside (solely for personal items the CSCI Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 25 were told on registration), which is now shared with the Roma Unit. It was concerning to see on the day of the inspection that all items of laundry from Aspen Court, including bedding and towels were being undertaken in the small inside laundry. The laundry room was overloaded with wet and dry laundry and was hanging or piled up over the sluice next to it. This not only compromises infection control it is a health and safety and fire hazard. This was brought to the attention of the regional manager and the manager of the Roma Unit. Comments received via surveys to residents indicated that 75 always felt the home was always fresh and clean 25 felt the home was usually fresh and clean. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 26 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 for this outcome group was poor. Staffing levels appeared inadequate at the time of this inspection. The service does not encourage the development of a competent staff team; therefore residents are not always in safe hands. Training provided is limited with areas not being identified or targeted at relevant individuals. The services recruitment procedures were poor with shortfalls that put residents at risk of harm. EVIDENCE: At the time of this inspection there were 20 residents living at the home. The registered manager was on duty in a management role. There was an Enrolled Mental Nurse (EMN) on duty and in charge of the shift from 8-8pm. There were three care staff on duty during the morning with one carer who had been at the home for 2 weeks and was classed as supernumerary the manager told the inspectors. During the afternoon there were three care staff plus the new carer. Minimum staffing levels were being met at this time however at mealtimes when 8 out of 20 residents required assistance the staffing level was not adequate and this must be monitored and action taken to ensure residents needs are met at mealtimes (see ‘Health and Personal Care’ and ‘Daily Life and Social Activities’). Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 27 According to duty rotas sent in to the CSCI as part of the pre-inspection data from 10th to the 23rd April minimum staffing levels have been maintained. Agency staff were used to cover any shortfalls. Overnight there were three waking staff including an RGN and RMN. According to the Duty rotas some days there are three care staff all day and other days there are four not including the trained nurse. This must be more consistent to meet residents personal and social care needs. There are 5 registered nurses employed (including the manager) at the home, which includes 2 RMN’s and 2 RGN’s and 1 EMN. According to the duty rotas there has consistently been an RMN/EMN on duty each day and this should continue. The new staff member, undergoing induction, was from overseas and from inspectors observations and feedback would benefit from a mentor to enable them to settle in to their new place of work. Communication was difficult at times. One resident told inspectors that overnight ‘they speak in their own language and I don’t understand’ this must be monitored and duty rotas completed with this in mind to have a balance of staff. There are 11 care staff employed at the home and only 27 have gained an NVQ in care. This should be 50 in line with NMS. Staff have not received any specialised accredited training in Dementia Awareness, Nutrition and assisting people with dementia with meals, and Challenging Behaviour and this must be provided to allow staff to be competent to meet the needs of the residents currently at the care home. Staff spoken to told inspectors that they felt they needed more training and wanted to do NVQ training. Records seen and speaking to staff evidenced that all staff had received mandatory training and induction over a 2-3 day period (See ‘Choice of Home’). On assessment of 4 staff files of recently employed staff the following were noted: One staff file contained only one reference and identified a Nursing PIN Number expiry date of 11/05. Two files evidenced that staff had commenced employment at the home before receipt of a CRB disclosure or POVAFirst check. An Immediate Requirement Notice was served in this regard. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 28 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; 32; 33; 35; 36; 37 and 38. Quality for this outcome group was poor. The manager has the necessary experience to run the home but has not gained the required management qualification. The manager had not supervised, trained or developed the staff team to the necessary competencies to look after older people with a dementia. Staff morale was low. The manager had not encouraged a person centred approach to meeting the needs of the residents therefore not enabling equality and diversity. The manager has not implemented the systems to monitor compliance with the homes plans, policies and procedures. Residents have an opportunity to manage their own finances if they wish and facilities are provided for security. Where the home manages money on residents’ behalf a good system is in place to record all transactions. Service users are protected by the health and safety checks in place. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 29 EVIDENCE: Mr Nicholas Warner was the registered manager for Aspen Court at the time of the inspection and had been since it was registered in November 2005. Mr Warner is a Registered Mental Nurse (RMN) and has had experience caring for persons with dementia and mental health problems. He had not managed a care home before. Part of Mr Warner’s registration agreement was that he commences the Registered Managers Award (RMA/Level 4 NVQ in management) in line with legislation. Mr Warner informed inspectors that he hadn’t enrolled yet. Mr Warner had only received 1to1 supervision once, in May 2006, since taking up his management post at the home. Staff spoken to during the inspection thought that Mr Warner was approachable and kind, however staff felt that they lacked leadership and direction, one stated ‘we direct ourselves’. Residents spoken to indicated their fondness of the manager one stated: ‘couldn’t wish for a nicer man for the job he is doing’. Staff supervision had not taken place and individual training needs had not been identified. New staff in particular those from overseas do not have a mentor and are expected to commence caring for persons with specialist dementia care needs after 3 days of induction. It was evident on the day of inspection through observation and speaking to staff that they lacked direction and would benefit from of 1to1 supervision to determine their needs and allow them to air their views. On 2nd June 2006 Mr J Caine regional manager telephoned the inspector and informed her that Mr Warner had been asked, and had agreed to step down as manager of the home. The CSCI awaits a letter of confirmation from Mr Warner. Quality monitoring systems and policies were in place however, apart from Regulation 26 visits undertaken by the operations manager, no quality monitoring had commenced to ensure the home was being run in the best interests of its residents. A Policies and Procedures Manual is in place at the home. Staff spoken to were unaware of some of the policies for example, whistleblowing, adult protection and death and dying. Policies and procedures were not complete or personalised to Aspen Court. There was no evidence recorded that staff had seen the policy folder. Finances kept on behalf of residents were assessed as part of the case tracking process. Evidence was seen of a robust system being in place to protect Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 30 resident’s personal finances and record all transactions. All records are computer based. All health and safety checks were in place and up to date. Fire Risk Assessments for the building were not seen and will be followed up at the next inspection. All resident accidents are recorded, there had been 29 recorded since November 2005; one had resulted in a fracture. Staff accidents are recorded; one lead to a back problem through manual handling, however the residents profile stated that two persons should always be used to move the resident and the staff member attempted a move alone. According to staff spoken to and staff training records all staff had received mandatory training including manual handling. The home must ensure that all staff follow individual residents manual handling risk assessments. Staff had not received training that equips them to meet the assessed specialist individual needs of the residents accommodated at the home in line with the National Training Organisation (NTO) and Skills for Care (see ‘Choice of Home’) Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 31 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 1 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 2 2 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 2 2 Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 32 Are there any outstanding requirements from the last inspection? NA 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(1) (2) 5(1) (2) Requirement The registered person must reassess and produce an up-todate Statement of Purpose and Service User Guide with particular regard to current fee charges and menus, to allow for prospective residents and /or their representatives to have an informed choice. A copy must be sent to the CSCI. The registered person must ensure that all residents are provided with a statement of terms and conditions and/or a contract if funded privately. Timescale for action 01/08/06 2 OP2 5(1)[b] 01/08/06 3 OP4 12(1) 18(1)[a] [c]{i} The registered person must 15/07/06 produce and implement a training plan to ensure that staff individually and collectively have the skills and experience to deliver a person centred approach to care for persons with the specialist needs the home offers to provide. This must include accredited Dementia Awareness, Nutrition and assisting people to eat and drink and Challenging Behaviour training (Also under OP30). DS0000066159.V290699.R01.S.doc Version 5.1 Page 33 Aspen Court Care Home 4 OP8 14(2)[a] [b] 17(1)[a] The registered person must 01/07/06 ensure that individual residents nutritional needs are monitored and any weight loss recorded acted upon and a care needs plan implemented. The registered person must ensure that all staff responsible for the medication records and systems follow the Royal Pharmaceutical and NMC medicine administration guidelines. An Immediate Requirement Notice was issued. 31/05/06 5 OP9 13(2) 17(1)[a] 6 OP10 12(3) (4) [a] The registered person must 01/07/06 ensure that at all times residents dignity is respected and maintained with particular regard to personal basic care needs and at mealtimes. The registered person must 15/07/06 ensure that all staff are aware of the homes policies on death and dying. The registered person must 01/08/06 ensure that social care is person centred on the individual service users choice and life history. Staff must provide occupation for individual residents in line with their social needs and use the times in between tasks for social interaction. 7 OP11 18(1)[a] 8 OP12 16(2)[m] [n] Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 34 9 OP15 12(2) (3) 18(1)[a] The registered person must ensure that residents are given a choice of main meal at the time of the meal given their specialist needs, and a choice of deserts. Meals must be taken in a congenial setting and tables must be laid, with cutlery, tablecloths/tablemats and condiments must be available for use. Staff must be available to assist residents who need help on a 1to1 basis and residents must be given a choice of where and who they would like to sit with at mealtimes. 01/08/06 10 OP18 13(6) The registered person must 01/07/06 ensure that the Whistleblowing Policy is individualised to Aspen Court and ensure all staff are aware of local adult protection guidelines for the Protection Of Vulnerable Adults. Also arrangements must be made for all staff employed to receive formal training in abuse awareness. The registered person must 01/07/06 ensure that all residents are able to access the gardens at the home in line with their individual needs and choices. The registered person must 01/07/06 ensure that residents are given a choice of communal areas in particular dining areas. The registered person must 01/07/06 review the use of the internal laundry and systems at the home. Also all areas must be kept clean and stains identified, removed from seating and carpets. 11 OP19 23(2)[o] [n] 12 OP20 23(2)[h] [g] 13 OP26 13(3) (4) [c] Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 35 14 OP27 18(1)[a] 15 OP28 18(1)[a] [c]{i} The registered person must 01/07/06 ensure that the ratio of care staffing levels meet the individual specialised needs of the residents with particular regard to social care and mealtimes. The registered person must 15/08/06 ensure training is implemented to ensure a minimum of 50 trained members of care staff (NVQ level 2 or equivalent) is achieved excluding registered nurses. The registered person must 31/05/06 ensure that all fitness checks are received before a person commences employment at the care home to protect vulnerable service users from abuse. An Immediate Requirement Notice was issued. The registered manager must 15/07/06 work towards gaining a qualification to NVQ level 4 in management. The registered person must 01/07/06 ensure through 1to1 formal supervision of the manager that there are strategies in place for enabling staff, service users and other stakeholders to affect the way in which the service is delivered. The registered person must ensure that quality assurance and monitoring systems are implemented and that staff demonstrate a commitment to lifelong learning and development for each service user, linked to their individual needs plan through person centred care. DS0000066159.V290699.R01.S.doc 16 OP29 17(2) 19 17 OP31 9(1)[i] 18 OP32 24(1) (2) 19 OP33 12(1) 24(1)(2) (3) 01/07/06 Aspen Court Care Home Version 5.1 Page 36 20 OP36 18(2) The registered person must ensure that all staff employed at the home receive 1to1 formal supervision which covers: all aspects of practice the philosophy of care in the home career development needs. And to ensure care staff are working in line with the General Social Care Council (GSCC) Code of Practice. The registered person must review the homes policies and procedure manual and individualise the policies to Aspen Court. Also all staff must be made aware of the policies of the home and a system developed to record staff awareness. 01/07/06 21 OP37 12(1)[a] 01/07/06 22 OP38 13(4) (6) The registered person must 01/07/06 ensure that all care staff are trained to follow the individual residents manual handling risk assessments and not move residents on their own when it clearly states ‘two staff needed’. 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 OP7 Good Practice Recommendations The life histories of residents should be available in their individual plans of care. This will allow all staff to begin to understand the individual social care needs of the service users. All staff including the kitchen staff and domestic staff DS0000066159.V290699.R01.S.doc Version 5.1 Page 37 2 OP15 Aspen Court Care Home should have training in dementia awareness with particular regard to mealtimes, social care and choices. Also a sweet trolley with a choice of desserts and fresh fruit should be implemented. Aspen Court Care Home DS0000066159.V290699.R01.S.doc Version 5.1 Page 38 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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