CARE HOMES FOR OLDER PEOPLE
Aspen Court Nursing Home 17 Dod Street Poplar London E14 Lead Inspector
Seka Graovac Unannounced Inspection 12th December 2005 09:20 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 DS0000007350.V270432.R01.S.doc Version 5.0 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. DS0000007350.V270432.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Aspen Court Nursing Home Address 17 Dod Street Poplar London E14 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) 020 7538 9789 020 7515 0938 Southern Cross Healthcare Services Limited Mrs Mary Kenny Care Home 75 Category(ies) of Old age, not falling within any other category registration, with number (75) of places DS0000007350.V270432.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 25 BEDS FOR ELDERLY FRAIL PERSONS - NURSING 50 BEDS FOR ELDERLY FRAIL PERSONS OF WHICH 26 BEDS WILL BE FOR DEMENTIA NEEDS - RESIDENTIAL MINIMUM STAFFING NOTICE To provide accommodation for Two (2) named service users aged under 65 years. 22nd August 2005 Date of last inspection Brief Description of the Service: Aspen Court is registered with the Stratford East London Commission for Social Care Inspection Area Office as a care home for older people that also provide nursing. It is owned and managed by Southern Cross Healthcare that is one of the largest care providers in the UK. In its statement of purpose, the home underlines its commitment to individualised care and provision of an environment that service users regard as their home. The premises are purpose built and have their own parking facilities. All rooms (69 single and 3 double) have en-suite facilities and are fully furnished. Various communal areas are available, including a garden. DS0000007350.V270432.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out as a part of the annual statutory cycle. It lasted approximately five and a half hours. The main aims of the inspection were to check the home’s compliance with six requirements that had been made at the previous inspection and also to assess the service against the core National Minimum Standards that had not been covered at the inspection in August 2005. The inspector was accompanied by Linda Bowdell, a business services support senior administrator working for the Commission for Social Care Inspection. Apart from the manager’s office, the inspector and the administrator spent most of their time on the top floor, nursing unit. They also visited a dining room on the ground floor. They spoke to a number of service users and staff and looked through a number of records. What the service does well: What has improved since the last inspection?
The manager stated that the home continued to improve its care planning for service users and also the general administration in the home. Out of six requirements that had been made at the previous inspection, the home resolved three. Service users’ care and support needs were assessed. Staff stopped using care plans for daily recording. Food was available when service users’ needed it and they were not brought to the dining tables too early for their meals.
DS0000007350.V270432.R01.S.doc Version 5.0 Page 6 The inspector and the Commission’s administrator were told that several service users’ individual bedrooms had been redecorated since the previous inspection. The manager monitored falls on a monthly basis and stated that they significantly decreased in the months recent to the inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. DS0000007350.V270432.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000007350.V270432.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000007350.V270432.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Service users’ support and care needs were assessed by the home. EVIDENCE: The inspector examined three service users’ individual files. Each of them contained comprehensive support and care needs assessments. DS0000007350.V270432.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. The service users were not always adequately supported by the home’s care planning, monitoring of their wellbeing, medication and recording procedures. EVIDENCE: The inspector viewed care plans for three individuals who lived and received care at Aspen Court. Some of the statements found in them were generic and appeared in all three cases. The inspector felt that the care plans could be much more individually tailored, taking in account all the information available in the files. None of the examined care plans had records of the service users’ wishes in respect of cardio-pulmonary resuscitation. The inspector was also concerned that no records were available of the wound found on the forehead of one of the service users. The only related records stated that the wound was healed a while ago. The nurse in charge of the unit at the time of the inspection told the inspector that the service user would be seen by a General Practitioner, but no related records were available. DS0000007350.V270432.R01.S.doc Version 5.0 Page 11 The inspector enquired with a care staff about a growth approximately one inch diameter that she noticed on one service user from the nursing ward. The staff member stated that it had always been there, but did not know what it was or anything about it. The nurse stated that it was a glioma (tumour of non-nervous cells called glia in the nervous system). Both the inspector and the nurse scrutinised this person’s individual notes and could not find it being recorded anywhere. The inspector noted that the examined service users’ files contained professional visitors records and medical services sheet. However, these did not always match. The inspector was further concerned that some sprays and creams found on the trolley in the medication room were not labelled. The nurse told the inspector that she did not know who they belonged to. An open packet of what had been a sterile dressing was also left on the same trolley. The home did not have any controlled drugs at the time of the inspection. However, the inspector checked the controlled drugs register and discovered that not all the pages were cross-referenced in the index. The register also contained filled in pages that did not record the name of the person for whom the controlled drug was offered as prescribed. The inspector and the administrator found that the nurse was not confident in answering some simple questions regarding medication. Despite the inspector’s findings outlined above and apart from one person, all other service users spoken to were satisfied with the care given to them at Aspen Court. DS0000007350.V270432.R01.S.doc Version 5.0 Page 12 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): 15. The service users were satisfied with food. However, the refrigerated food was not always labelled and dated as required. EVIDENCE: The inspector spoke to several service users about food in the home. They were satisfied with it. Food was available when the service users’ needed it and they were not brought to the dining tables too early for their meals. However, the inspector was concerned to find several food items of perishable food in the fridge that had been taken out of their original packaging and were not dated or labelled. This had been identified as a hazard at the previous inspection. The requirement had to be repeated. DS0000007350.V270432.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The service users were protected by the procedures regarding complaints and allegations that the home followed when it was needed. EVIDENCE: The home had the appropriate written procedures that outlined how to deal with complaints or identified protection issues. The inspector was informed that there have been no new complaints raised with the home since the previous inspection. At the inspection, one service user expressed his dissatisfaction with some aspects of the service. The manager stated that this ongoing and complex situation was dealt with appropriately with the involvement of other professionals. The home also appropriately dealt with a major protection issue in liaison with the Social Services. The inspector was informed that all permanent staff received training in protection of vulnerable adults. A suggestions box was available in the lobby. DS0000007350.V270432.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. Apart from inappropriately stored wheelchairs, the home was well maintained and fit for its purpose. EVIDENCE: The areas of the home that the inspector and the Commission’s administrator saw were either well maintained or in the process of improvement. The home was adequately furnished and the bedrooms were individualised. The maintenance worker kept redecoration records that indicated that several bedrooms had been repainted since the previous inspection. The requirement made at the previous inspection, for the equipment not to be stored in en-suite bathrooms thus creating a tripping hazard, hadn’t been resolved and the requirement had to be repeated. DS0000007350.V270432.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. Due to a number and seriousness of requirements related to health and personal care made at this inspection, it is recommended that the organisation consider employing a clinical lead sister. EVIDENCE: A current duty roster was displayed on the wall in the nursing floor. It indicated that there was always one qualified nurse in charge of that unit. The nurse was supported by five care staff morning time, four in the afternoon and evenings and six staff night-time. Previous rosters were kept in the manager’s office and were available for inspection. Issues identified at this inspection, regarding health and personal care of the service users on the nursing unit, were discussed with the manager and the above stated recommendation was agreed as a possible way forward for the home. The service users talked positively about staff in their conversations with the inspector. Some of the comments they made: “It is lovely here. Everybody is nice to me”, “I am well looked after”, “Good girls”… DS0000007350.V270432.R01.S.doc Version 5.0 Page 16 It was noted at the inspection that many staff did not have identification badges. The manager explained that she was in process of issuing them to all the staff. The inspector recommended that these were regularly worn by staff. DS0000007350.V270432.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The manager was competent and motivated. However, the identified issues with service users’ money, risk assessments and fire safety must be remedied. EVIDENCE: The manager was a very experienced nurse and competent in management of care services. She informed the inspector that she completed a Registered Manager Award. She was also highly motivated to provide a quality service at Aspen Court. She told the inspector and the Commission’s administrator that she had been working since 6am that morning after returning from leave. She was available to see service users, relatives and friends in her office every Friday. Separate service uses’ and staff meetings were regularly held. Regulation 26 visits by the provider were also done as required. The manager also stated that a monitoring officer from the Local Authority visited on a regular basis.
DS0000007350.V270432.R01.S.doc Version 5.0 Page 18 Some service users kept their money in the home’s safe. The inspector and the Commission’s administrator viewed the related records and randomly chose one person’s money to check. The actual count and the record did not match. There was 10 pence more then recorded. The management must ensure that correct records are kept of individual service users’ money at all times. In response to a service user claiming that he could not get his money out of the safe while the manager was on leave, the manager stated that her deputy did have access to the home’s safe in her absence. The inspector and the administrator from the Commission viewed the health and safety records for the home. They were very well organised and in date. However, no written risk assessment regarding storage of wheelchairs, that had been identified as hazardous at the previous inspection, was available. The related requirement was made. The control measure (to store them folded) intending to minimize the risks was not implemented. The manager monitored falls on a monthly basis and stated that they significantly decreased in the months recent to the inspection. The last fire-drill was recorded in July 2005. At the inspection, the fire-door between the servery and the dining room on the top floor was found propped open with a wedge although there was nobody in the servery at that time. The Registered persons must ensure that the fire doors would shut freely in case of the alarm sounding. DS0000007350.V270432.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 DS0000007350.V270432.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The Registered Persons must ensure that each service user has a comprehensive care plan that is individually tailored and based on the assessment of that particular person’s individual support and care needs The Registered Persons must ensure that service users’ health and welfare are monitored and that the records are available to confirm any identified issues. The Registered Person must make the appropriate arrangements for the recording, handling, safekeeping and safe administration of medicines. The previous target expired on 24/11/05. The Registered Persons must ensure that service users or their representatives are asked about CPR and that their wishes are recorded. The Registered Persons must ensure that stored food is labelled and dated. The previous target expired on 24/11/05.
DS0000007350.V270432.R01.S.doc Timescale for action 31/03/06 2 OP8 12 26/12/05 3. OP9 13 19/12/05 4. OP11 12 31/03/06 5 OP15 16 19/12/05 Version 5.0 Page 21 6 OP19 13 7 OP35 17 8 OP38 13 9 OP38 13 The Registered Persons must ensure that Service Users have access to hazard free parts of the home and that equipment is not stored in en-suit bathrooms. The previous target expired on 24/11/05. The Registered Persons must ensure that correct records are kept of the individual service users’ money at all times. The Registered Persons must have a written evidence of a risk assessment regarding storage of wheelchairs being completed and ensure that all the identified control measures to minimize the risks are fully implemented at all times. The Registered persons must ensure that the fire doors would shut freely in case of the firealarm sounding. 19/12/05 31/12/05 31/12/05 14/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations Due to the seriousness of a number of requirements related to health and personal care made at this inspection, it is recommended that the organisation consider employing a clinical lead sister. The inspector recommended that all the staff wear the identification badges while working. 2 OP27 DS0000007350.V270432.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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