CARE HOMES FOR OLDER PEOPLE
Aspen Court Nursing Home 17 Dod Street Poplar London E14 Lead Inspector
Seka Graovac Unannounced Inspection 20th April 2006 11:20 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 Aspen Court Nursing Home DS0000007350.V290151.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 Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 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 Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 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. 12th December 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. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted approximately seven hours. Its main aim was to assess the Aspen Court’s compliance with the key National Minimum Standards for Older People and the Care Homes Regulations. At the previous inspection that was conducted in December 2005, nine breaches of legislation were identified and the provider agreed to take the actions to secure full compliance. At this inspection, the related home’s progress was assessed. Usual inspection methodology was used, such as: talking with service users, their visitors, staff and management, general observation and looking through various records. The inspector spent most of her time on the nursing unit, on this occasion. What the service does well:
The service users who spoke to the inspector were satisfied with the care they received at Aspen Court Nursing Home. Some of the words they used to describe it: “They really look after me here”, “I’ve got everything I need”, “They treat me really well, here”… Two relatives that the inspector spoke to were also positive about the home. The service users were supported to lead fulfilling lifestyles and enjoy their meals in accordance with their needs and wishes. The programme of activities was displayed in the home. The inspector saw several service users enjoying drawing, painting and colouring in the afternoon of the inspection. One service user was engaged doing a puzzle. A party to celebrate St George’s Day was planned for later in the week, and also a trip to Hackney Empire to see “Music Hall” in May. There were several visitors to the home and some of them spoke to the inspector. Apart from some issues with the laundry that the Manager was trying to resolve, they were very positive about the care their relatives and family members received at Aspen Court Nursing Home. The inspector noted that many service users were smiling and had relaxed and contented expressions on their faces. Some of them were joking and laughing with the inspector and the staff members. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 6 One service user told the inspector that he felt horrible. However, he added hastily: “The home is fine. Everybody is really nice. It is just where I am at the moment.” The inspector overheard a service user telling the manager how much she enjoyed Roast Beef with Yorkshire Pudding that she had for lunch. One service user told the inspector: “I don’t feel like eating most of the time. But the staff put so much effort to prepare it that I try to eat a little bit.” The home’s updated Statement of Purpose and Service User’s Guide were available for inspection. All three examined individual service users’ files contained comprehensive assessments of their support and care needs. The home had appropriate procedures for dealing with complaints and protection issues that were followed when it was needed. The staff were appropriately vetted. The staffing levels were appropriate. The service users and relatives made only positive comments about the staff in their conversations with the inspector. The Registered Manager is qualified and experienced, both in management and nursing care. She is highly motivated to provide quality care to the people who live at Aspen Court and help her staff further their competences and careers. The home was well run and in the best interest of service users. One of the staff members who spoke to the inspector was very positive about the ethos and the working atmosphere in the home. She stated that the Manager was very supportive in many ways. The home had a service agreement with Tower Hamlets and was regularly monitored by their staff as well. The Manager was committed to monitoring and tried to use some innovative ways to audit the quality of the service, such as asking staff to imagine being an inspector visiting the home and then giving a feedback. The home was well run and in the best interest of service users. What has improved since the last inspection?
The home has successfully dealt with all the requirements that had been made at the previous inspection. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 7 The service users had comprehensive individual care plans and their health and welfare were appropriately monitored. They and their representatives were asked to make decisions regarding resuscitation if a need arose and these were recorded. The service users’ medication was appropriately stored, administered and recorded, following good professional guidance and legislation. The service users’ individual money was securely kept together with satisfactory records. Food was also appropriately stored and labelled in the home. The manager said that a new food-trolley has been purchased. A new activities co-ordinator and a person responsible for laundry have been recruited since the previous inspection. The environment was safe. No uncontrolled health and safety hazards were identified at this inspection. Fire-doors were free to shut. New wooden flooring has been fitted to the dining rooms on two floors and also a carpet on the ground floor. The home also continued its rolling redecoration programme. The Registered Manager told the inspector that all policies and procedures had been reviewed and were reissued. What they could do better:
The sluice room on the nursing unit was in need of attention. The ventilation point on the ceiling appeared to be broken. The walls were dirty, and the cupboard doors were broken. This was discussed with the Manager and a related requirement was made. The Registered Persons must ensure that all areas of the home are kept in the reasonable state of repair and appropriately ventilated. The inspector was informed that only two (half percent) of permanent care staff have completed their National Vocational Qualifications (NVQ). The Manager explained that this was due to a training provider suddenly pulling out of the programme. However, the inspector was reassured that a new provider was found and seventeen carers continued to progress towards NVQ level 2 award. The Registered Persons must ensure that at least 50 of care staff have the appropriate care qualifications (NVQ level 2). Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 8 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. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 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 Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 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): 1 and 3. The appropriate information was available about the home and the prospective service users were assessed prior to a placement being offered. EVIDENCE: The home’s updated Statement of Purpose and Service User’s Guide were available for inspection. All three examined individual service users’ files contained comprehensive assessments of their support and care needs. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 appropriately supported in respect to their health and personal care. EVIDENCE: The service users had comprehensive individual care plans and their health and welfare were appropriately monitored. They and their representatives were asked to make decisions regarding resuscitation if a need arose and these were recorded. The service users’ medication was appropriately stored, administered and recorded, following good professional guidance and legislation. The service users who spoke to the inspector were satisfied with the care they received at Aspen Court Nursing Home. Some of the words they used to describe it: “They really look after me here”, “I’ve got everything I need”, “They treat me really well, here”… Two relatives that the inspector spoke to were also positive about the home. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 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): 12, 13, 14 and 15. The service users were supported to lead fulfilling lifestyles and enjoy their meals in accordance with their needs and wishes. EVIDENCE: The programme of activities was displayed in the home. A full time activities co-ordinator has been appointed since the previous inspection. The inspector saw several service users enjoying drawing, painting and colouring in the afternoon of the inspection. One service user was engaged doing a puzzle. A party to celebrate St George’s Day was planned for later in the week, and also a trip to Hackney Empire to see “Music Hall” in May. There were several visitors to the home and some of them spoke to the inspector. Apart from some issues with the laundry that the Manager was trying to resolve, they were very positive about the care their relatives and family members received at Aspen Court Nursing Home. The inspector noted that many service users were smiling and had relaxed and contented expressions on their faces. Some of them were joking and laughing with the inspector and the staff members. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 13 One service user told the inspector that he felt horrible. However, he added hastily: “The home is fine. Everybody is really nice. It is just where I am at the moment.” The inspector overheard a service user telling the manager how much she enjoyed Roast Beef with Yorkshire Pudding that she had for lunch. One service user told the inspector: “I don’t feel like eating most of the time. But the staff put so much effort to prepare it that I try to eat a little bit.” The inspector visited the kitchen that was clean and well organised. Food was appropriately stored and labelled. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 14 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 home had appropriate procedures for dealing with complaints and protection issues that were followed when it was needed. EVIDENCE: The inspector viewed the home’s complaints log and Regulation 37 notices file that contained information regarding protection issues. All documentation seen and the discussions that the inspector had with the Registered Manager indicated that the home was dealing appropriately with complaints and protection issues. All permanent staff had training in Protection of Vulnerable Adults. One staff member told the inspector that she appreciated the training very much and became much more sensitive and skilful in her work since then. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 15 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 and 26. Apart from a sluice-room, the environment was well maintained and fit for its purpose. EVIDENCE: The service users seemed comfortable in their bedrooms that were personalised in accordance with their wishes and in the communal areas that were tastefully furnished. New wooden flooring has been fitted to the dining rooms on two floors and also a carpet on the ground floor. The home also continued its rolling redecoration programme. The environment was clean, tidy and safe. No uncontrolled health and safety hazards were identified at this inspection. Fire-doors were free to shut. However, the sluice room on the nursing unit was in need of attention. The ventilation point on the ceiling appeared to be broken. The walls were dirty,
Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 16 and the cupboard doors were broken. This was discussed with the Manager and a related requirement was made. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 17 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. The staff were appropriately vetted. The staffing levels were appropriate. Care provided was good. However, the staff must obtain the appropriate qualifications as required. EVIDENCE: The manager stated that there were sixty-eight service users on the premises at the time of the inspection. The home employed five permanent Registered Nurses (RGN) and thirty-six care assistants. The inspector was informed that only two (half percent) of those have completed their National Vocational Qualifications (NVQ). The Manager explained that this was due to a training provider suddenly pulling out of the programme. However, the inspector was reassured that a new provider was found and seventeen carers continued to progress towards NVQ level 2 award. The Registered Persons must ensure that at least 50 of care staff have the appropriate care qualifications (NVQ level 2). One Registered Nurse was always in charge of the nursing unit. She was supported with care assistants. Duty rosters were displayed on the units and the staffing levels appeared appropriate. In addition to care staff, one activities co-ordinator, two chefs, one maintenance staff, one housekeeper, two cleaners and one person working in laundry were on duty at the time of the inspection.
Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 18 The examined staff files (three randomly selected) contained the appropriate staff records indicating a thorough recruitment procedure being followed. The service users and relatives made only positive comments about the staff in their conversations with the inspector. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 19 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 home was well run and in the best interest of service users. EVIDENCE: The Registered Manager is qualified and experienced, both in management and nursing care. She is highly motivated to provide quality care to the people who live at Aspen Court and help her staff further their competences and careers. She is supported by her line manager who conducted Regulation 26 visits and subsequently produced the related monitoring reports. During Manager’s absence, one RGN was acting-up and the inspector was shown her Acting-Up Programme written having in mind this person’s Personal Development Plan. The service users’ and the staff meeting were separately held. The Manager held open door surgery every Friday.
Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 20 The home was in process of collating information regarding various stakeholders’ satisfaction with the service. One of the staff members who spoke to the inspector was very positive about the ethos and the working atmosphere in the home. She stated that the Manager was very supportive in many ways. The Manager was committed to monitoring and tried to use some innovative ways to audit the quality of the service, such as asking staff to imagine being an inspector visiting the home and then giving a feedback. The home had a service agreement with Tower Hamlets and was regularly monitored by their staff as well. The inspector checked individual money and valuables for three service users that she was case-tracking and found that the records were satisfactory. No health and safety issues were identified at this inspection. Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23 Requirement The Registered Persons must ensure that all areas of the home are kept in the reasonable state of repair and appropriately ventilated. This includes sluicerooms. The Registered Persons must ensure that at least 50 of care staff have the appropriate care qualifications (NVQ level 2). Timescale for action 30/06/06 2. OP28 18 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aspen Court Nursing Home DS0000007350.V290151.R01.S.doc Version 5.1 Page 23 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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