Inspection on 21/02/07 for Aspen Lodge Care Home

This inspection was carried out on 21st February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Aspen Lodge Care Home 07/05/09

Aspen Lodge Care Home 26/11/08

Aspen Lodge Care Home 13/09/07

Aspen Lodge Care Home 11/10/06

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Aspen Lodge Care Home 222 Weston Lane Weston Southampton Hampshire SO19 9HL Lead Inspector Janet Ktomi Unannounced Inspection 21st February 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aspen Lodge Care Home Address 222 Weston Lane Weston Southampton Hampshire SO19 9HL 023 8042 1154 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) Aspen Care Ltd Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number disorder, excluding learning disability or of places dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13), Old age, not falling within any other category (13), Physical disability (2), Physical disability over 65 years of age (2) Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the categories DE, MD and PD must be at least 55 years of age. A maximum of two service users in the categories PD and PD(E) are to be accommodated at any one time. 11th October 2006 Date of last inspection Brief Description of the Service: Aspen Lodge is a registered home providing care and accommodation for up to thirteen older people. The home is situated in Weston, close to a park and local shops. Public transport bus stops are located nearby. The property is an extended older detached house with car parking to the front and a patio and large garden to the rear. Although registered for people with a physical disability the home does not have level or ramped access to the front or rear of the property. The home provides private accommodation in thirteen single bedrooms (one en-suite), some on the ground floor and others on the first floor accessible via a shaft lift. Bathrooms and WCs are located around the home. The home was purchased in March 2006 by Aspen Care Ltd, responsible individual being Mr C S Meepegama. At the time of this key inspection the home had recently appointed a new manager who has yet to complete the registration process. Weekly fees range from £327.04 to £385.21 dependant on assessed needs. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows the second key inspection of the service since it was purchased by Aspen Care Limited in March 2006. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 20th February 2007. All core and a number of additional standards were assessed. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately seven hours commencing at 10.00 a.m. and being completed at 5.00 p.m. The inspector was able to spend time with the provider, newly appointed manager and care staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and service users. As part of the information gathering process questionnaires were sent to external professionals who have regular contact with the home. Comment cards were returned from three GP’s and two visiting nursing professionals. Service user and relative comment cards were sent to the home. Three service user and three relative responses were received. Eight care staff also returned comment cards. Information was also gained from the link inspector and the home’s file containing notifications of incidents. Following the previous inspection undertaken in October 2006 the provider was invited to the CSCI office to discuss the findings from the first key inspection of his service. During the visit to the home the inspector was able to meet with and talk to all the service users and two visitors. What the service does well: Being a smaller home Aspen Lodge is able to provide an individualised service with staff knowing service users individual likes and dislikes. Service users and relatives state that their needs are met and that staff are all kind and caring. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 6 The provider has made vast improvements to the homes environment and invested in the homes fixtures and fittings since purchasing the home in March 2006. Visitors stated that they are welcomed at the home and able to visit at all reasonable times. What has improved since the last inspection? The provider and newly appointed manager have worked hard to meet many of the thirty requirements and two recommendations made following the previous inspection of the service. The statement of purpose and service users guide now accurately reflects the service provided and is available in standard and large print versions. The service users’ guide states that smoking is only permitted in the designated smoking room. All service users now have a contract which clearly states the terms and conditions of residency. All new admissions will now be assessed using a comprehensive pre-admission assessment document to determine if their needs can be met at the home. Where possible potential service users will be invited to visit the home prior to admission. The care planning and risk assessment process has been reviewed by the new manager and once all care plans have been re-written the care plans will be appropriate working documents. Staff have received medications training and medication is appropriately managed within the home. The proprietor has continued the programme of improvement to the environment and whilst some work continues many areas are completed. A new bath hoist has been fitted in the ground floor bathroom and new non-slip flooring provided. The laundry area has been altered and now provides improved working conditions for staff and has also received now non-slip waterproof flooring. Carpets within all bedrooms and hallways have been replaced. Bedrooms have been redecorated and new vanity units incorporating wash hand basins installed. The manager stated that new soft furnishings, curtains and bed linen has been ordered. A portable ramp is now available for use at the front and rear doors for service users with limited mobility. The home was clean and had no offensive odours at the time of the unannounced inspection visit. The home now has a comprehensive staff training programme with all care staff commenced on their NVQ level 2 in care. Staff have received training in infection control, manual handling, challenging behaviour and medications. Further training is planned throughout 2007. An induction programme, which meets the General Social Care Councils common induction standards, is now in use. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 7 The proprietor has appointed a new manager who has been in post approximately one month. The new manager demonstrated a clear understanding of service users needs and has a commitment to providing a quality service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 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 Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 is not applicable, as the service does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users guide now accurately reflects the service provided and is available in standard and large print versions. All service users now have a contract which clearly states the terms and conditions of residency. All new admissions will now be assessed using a comprehensive pre-admission assessment document to determine if their needs can be met at the home. Where possible potential service users will be invited to visit the home prior to admission. EVIDENCE: The provider showed the inspector the statement of purpose and service users guide that have been revised as required following the previous inspection. The inspector read these documents and found that they contained appropriate Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 10 factually accurate information and were available in both standard and large print versions. The provider confirmed that these could be translated into other languages if required, however at the time of this inspection the English language version was appropriate for all service users living at the home. One service user does not have English as her first language, however she is fluent in English and the new manager speaks her native language if this were necessary. Following the previous inspection it was required that all service users have a contract/terms and conditions of residency. This has been complied with and signed, either by the service user or their representative, terms and conditions of residency were seen in service users files. The inspector read a sample contract document and this is written appropriately to include all the necessary information for service users. As with the statement of purpose and service users guide this could be made available in alternative languages if required. The provider was required to ensure that a full pre-admission assessment has been undertaken on all new admissions to ensure that their needs could be met at the home prior to an offer of a placement being made. This was discussed with the provider and new manager during the inspection. The home now has a comprehensive pre-admission assessment tool (seen during the inspection) which will be completed by, initially, the provider and manager and once the manager has gained more experience by the manager. Discussions with the provider and manager indicated that they had a good understanding of the importance of correctly identifying if the home was able to meet potential service users needs. The provider stated that many referrals come via social services and assessment information from social services as well as other professionals and family carers would be sourced as part of the assessment process. Discussions with the new manager indicated that she has a good up to date knowledge about dementia and mental health, the service user groups that the home is registered to provide a service for. Discussions with the manager and provider indicated that where-ever possible potential service users would be invited to visit the home prior to admissions. Where this is not practicable relatives or representatives would be invited to visit the home and view potential bedrooms and communal areas of the home. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning and risk assessment process has been reviewed by the new manager and once all care plans have been re-written the care plans will be appropriate working documents. Individual risk assessments must be held within the relevant service users folder and not in a general risk assessment file. Staff have now received medications training and medication is appropriately managed within the home. Health and personal care needs may not always have been fully met, however the new manager demonstrates a clear knowledge of mental health and dementia and is working with staff to improve standards of care. A staff training programme has commenced. Service users feel they are treated with respect and their rights to privacy and dignity are upheld. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 12 EVIDENCE: The inspector viewed care plans for three service users and discussed health care needs with the new manager. Comment cards were received from three GP’s and two community nurses who regularly visit the home. Comment cards from service users, staff and relatives were also received. Following the previous inspection in October 2006 the home was required to ensure that all service users have a care plan and risk assessments. The new manager has revised the care planning process and showed the inspector one of the newly completed care plans. The manager stated that she intends to complete the same format with the remaining care plans although acknowledges that this may take some time. The new format clearly identifies service users health, social and care needs and how these should be met. Care plans are reviewed monthly by the manager or key-workers. The new manager has completed some individual risk assessments, however these must be stored in the service users individual folders and not held all together. Comment cards were returned by three GP’s and two nursing professionals who have contact with the service. The responses were mixed however they did indicate that visiting health professionals had concerns that staff did not always have a clear understanding of residents needs and that they were not always satisfied with the overall standard of care provided to service users in the home. One cited poor standards of personal hygiene care to residents. During the inspection all service users looked clean and their personal hygiene needs appeared to have been met. The inspector spoke with two visitors neither of whom identified problems with the level of care received by their relative. Three relative comment cards were received and these were all satisfied with the overall care provided at the home. Three comment cards were returned by service users and two stated they always received the care they required and one usually received the care they required. During discussions with service users none identified concerns with their health or personal care needs not being fully met. Discussions with care staff and the new manager indicated that the new manager is spending time working with care staff to improve the knowledge and skills of care staff. The home now uses the common induction booklets supplied from the General Social Care Council with two new staff currently completing these with the new manager. The home has commenced a staff training programme with all care staff now undertaking NVQ level 2 in care. A requirement is not made in respect of personal care as the newly appointed manager who has been in post only one month is addressing these issues. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 13 The home now retains records of visits to/from health professionals however as with the risk assessments these must be held within individual folders and not in a general file. All records must comply with the Data Protection Act 1998 and ensure residents confidentiality. Care staff have received infection control, manual handling and challenging behaviour training as required following the previous inspection in October 2006. Following the previous inspection the home was required to ensure that all staff had medications administration training and that medications were appropriate managed and recorded within the home. On the day of the inspector’s unannounced visit the pharmacist who supplies medications for the home was undertaking a training session for staff at the home. Staff off duty at the time of the training were also attending as did the homes new manager. The inspector viewed the medication administrations records and these were fully completed. The inspector did not view the lunchtime medications administration however as all staff have now received training this should be appropriate. Medications are stored in a suitable secure medications trolley, which is attached to the wall when not in use. Service users stated that they felt they were treated with respect by all staff and that their privacy and dignity is maintained. The inspector spoke with two relatives who are regular visitors to the home who stated that all service users are treated with respect and that the staff are very caring. Recently the commission was contacted by a visiting professional who expressed some concerns with the way that one resident was spoken too, however this was not raised as a concern in comment cards from other professionals, relatives or service users. During the inspectors visit there was an NVQ assessor in the home undertaking observations as part of the proprietors NVQ level 2 in care. The NVQ assessor did not identify any concerns in respect of the service users. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices and have control over their lives. The home provides a variety of activities and the new manager is developing an activities programme to meet the likes and needs of the residents. Visitors are welcomed at the home. Residents told the inspector that the food in the home is generally very good, however the home must ensure that it has the necessary supplies for people on special diets (diabetic hot drink sweeteners). EVIDENCE: Three service user comment cards were received, two stated that the home always provides activities that they could take part in one stated that these did not occur. During the inspection the new manager showed the inspector the recordings she has undertaken of activities provided in the home and the Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 15 responses and involvement of service users. The manager stated that she is identifying what activities residents like and those they don’t like and will then plan an activities programme to meet these needs. The new manager is a qualified social worker with a background in dementia and older persons mental health and had a number of ideas about activities and how to involve people. During the inspection service users stated they enjoyed some activities and care staff showed the inspector the activities equipment they have. A range of games and craft items as well as videos are available. The manager hopes to arrange some outings in the summer and one service user identified that he/she would like to go out in a coach on the comment card. On the day of the inspection a bingo session was held in the afternoon with the manager and staff stating that bingo is very popular. The home has purchased large number size wipe off bingo cards and has random number selection equipment. On a Monday the home has a music session provided by a visiting musician. The inspector was able to meet with two relatives and one service user had gone out with a family member during the inspectors visit. Relatives stated to the inspector, and on the three comment cards received, that they were able to visit at any time and that they were welcomed into the home. As previously stated the manager aims to organise some external activities such as coach trips and visits to the nearby park in the warmer months. During the previous inspection concerns were identified in respect of the safety of the patio and garden. The specific concerns have now been resolved and the provider informed the inspector that a portable ramp is now available to support service users with mobility needs who which to access the rear garden. Service users informed the inspector that they were happy with the meals provided at the home. On the day of the unannounced visit the main lunchtime meal being roast chicken with potatoes and vegetables. The home employs a cook six days per week. The cook is also responsible for the food shopping and informed the inspector that she is able to spend whatever she likes to provide the meals requested by service users. The home does have a menu plan, which was seen by the inspector, however the cook will vary this depending on the wishes of the service users. The cook stated that where possible fresh fruit and vegetables are provided with supplies seen in the home. Throughout the day service users were seen being offered and provided with hot and cold drinks. The inspector joined the residents for the after lunch cup of tea. One service user requested sugar and was reminded that she was diabetic and could not have sugar. The inspector asked care staff if a suitable diabetic alternative sweetener was available, they stated that they had had one but it had run out. The inspector suggested a new supply be purchased. The resident did not drink her tea. The home must provide suitable alternatives to people with special diets including sweeteners, if wanted, in hot drinks. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 16 Care staff were observed asking service users what they wanted for their tea during the afternoon with service users confirming that they were always asked and were given what they had requested. The home has a good sized dining room with space for all service users to eat. Care staff confirmed that they encourage service users to eat lunch and evening meals in the dining room. On Sundays the home does not have a cook and care staff prepare meals as they do the evening meal every day of the week. Following the previous inspection it was required that care staff who prepare meals have food hygiene training. The provider has contracted with an external trainer and provided a timetable of booked training to the inspector. Food hygiene training is due on the 5th April 2007. Although not yet met, this requirement will not be repeated as it is acknowledged that the provider has made the necessary arrangements to meet the requirement. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users or their relatives are able to complain if they are unhappy with the service received at the home. Service users are protected from abuse, however the proprietor and manager must be clear as to the action they must take should they suspect that abuse may have occurred. EVIDENCE: Comment cards from service users indicated that two were always aware of how to make a complaint and the other did not answer this question. Discussions with service users during the inspector’s visit indicated that they had no complaints or concerns and that they would probably say something to a member of care staff. None could recall having being provided with the home’s complaints procedure however this may due to age related memory loss. The complaints procedure is included within the service users’ guide. Relatives stated that if they had concerns they would say something to a member of staff or the manager if it was serious. Care staff stated that they would try to sort out a complaint if they could and if not would pass it onto the manager for her to resolve. Comment cards from professionals stated that they had not made any complaints or had any complaints about the service passed to them. Observations of interactions between service users and staff Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 18 and the manager indicated that service users would feel able to state if they had concerns or complaints. The inspector discussed the home’s adult protection procedure with care staff manager and the provider. In discussion with care staff they stated that they would inform the manager if they had any concerns that might indicate that a service user was being abused. Care staff have now received challenging behaviour training with adult protection training booked for 3rd May 2007 and abuse and neglect training for mid August 2007. The proprietor and manager did not identify all the correct action that they should take in the event of a suspicion of adult abuse. They correctly identified that they should ensure the persons safety and if necessary seek medical attention and that CSCI should be informed, however they did not identify that they should contact social services before commencing an investigation. The provider stated that he had not yet got a copy of the Hampshire adult protection procedure but had been promised a copy by one of the care managers. The manager had information from the department of health protection of vulnerable adults guidelines and the inspector drew her attention to a flow chart in the document, which states the actions service providers should take in the event of abuse being suspected. Although staff have not yet receive protection of vulnerable adult training this requirement is not repeated as the provider has taken the necessary action to book the training. Overall the homes recruitment practises should prevent unsuitable people working in the home however the home must ensure that it is able to demonstrate that two written references are received on all new staff. At the time of the inspection two references were not available for the two staff recruited since the previous inspection, the proprietor stated that these were at his home and was requested to fax these to the inspector the next day. Only one was received with other information requested. The arrangements in respect of service users personal finances were viewed and found to be appropriate. This will be discussed in greater detail in the management section of this report. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Since purchasing the home the proprietor has commenced a programme of redecoration and refurbishment. This work is continuing. The home now provides a clean, pleasant environment for residents. Some outstanding issues remain however the proprietor is addressing these. EVIDENCE: The home is situated in a residential area of Southampton, close to a public park and with bus links to other areas of Southampton. The home is an extended detached house with a large garden to the rear and parking to the front. A shaft lift provides access to the first floor bedrooms. The new owner has commenced a programme of redecoration and refurbishment and on the day of the inspectors visit new floor coverings were being laid in the ground Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 20 floor bathroom, laundry room and the main ground floor hallway was being recarpeted. The home has a communal lounge located at the rear of the property and a dining room to the front. Both are of a suitable size to accommodate all service users at one time if required. The home also has a small smoking room separate to the other communal rooms for service users who smoke. The home does not have a separate room for private visits however the dining room could be used outside of meal times. The home has a large rear garden with patio area. As identified in the previous report there are some access concerns with the garden. The garden is accessed via the lounge and by sliding patio style doors, which have a raised lip at the bottom through which the doors slide as opposed to one which is flush to the floor. A portable ramp is now available for use at the front or rear of the home for service users with limited mobility. Furnishings within communal rooms are domestic in style and appropriate for the service users. Lavatories and bathrooms are located around the home close to bedrooms and communal areas. The home has an assisted shower on the first floor and a bath with hoist on the ground floor. The ground floor bathroom has been retiled since the home was purchased by the new owner. The bath hoist has been replaced since the previous inspection. As previously stated on the day of the inspectors visit the flooring in the bathroom on the ground floor was being replaced with new non-slip flooring. One relative identified a need to have a place within the bathroom for clean items to be placed whilst the service user is in the bath and getting dressed. The manager stated that this will be organised. Due to the work being carried out the inspector did not fully view the ground floor bathroom. During the previous inspection the inspector noted service users struggling to open the heavy fire doors from the lounge and dining room and the service was required to fit suitable devises such that the doors could be held open and close automatically in the event of fire. The provider has researched various options and showed the inspector the automatic door closures, which have now been purchased and would be fitted once the new carpet had been laid in the hall. As previously stated the home has a new hoist in the ground floor bathroom. Most of the people who live at the home are mobile however the home is registered for up to two people with a physical disability and some existing service users use walking frames and one a wheelchair. The home now has a portable ramp for use at the front or rear doors for people with limited mobility. All bedrooms in the home are single, one with en-suite facilities. Since the home was purchased by the new owner all bedrooms have been redecorated and new carpets laid. New vanity units incorporating wash hand basins have been fitted. Although some remedial tiling is outstanding arrangements are in hand for this and therefore a requirement is not made. The manager informed Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 21 the inspector that the proprietor has arranged for soft furnishings, curtains and co-odinating bed covers. As part of the refurbishment programme all radiators in the home have been covered with radiator covers to prevent the risk of service users burning themselves should they fall onto hot surfaces. Service users stated they were happy with their private accommodation. The inspector was concerned during the previous inspection that a service user who uses a wheelchair had a bedroom, which had a step down into it. The inspector noted that this room had been fitted with a ramp to ensure staff do not injure themselves or the service user. The proprietor confirmed that all the necessary checks have been undertaken on the homes electrical, gas and water services with the inspector viewing relevant certificates. At the time of the unannounced inspection visit the home was found to be clean and no offensive odours were detected. The home employs a part time cleaner who has been given clear instructions as to what tasks must be undertaken on a daily and weekly basis. Care staff stated that the new cleaner is very efficient and they subsequently have less cleaning to do allowing them more time to devote to the residents. Care staff have attended infection control training in November 2006. Care staff confirmed they have supplies of disposable aprons and gloves with new boxes of gloves seen in the laundry room. As previously mentioned the proprietor has removed a wall, which divided the laundry and this room has been redecorated and new flooring laid. Care staff stated that the laundry is now much easier to work in and provides adequate space for soiled and clean laundry in separate areas. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides adequate numbers of care staff and has commenced a training programme. The homes recruitment procedures are appropriate, however the home must ensure that it can demonstrate that all preemployment checks have been undertaken. New staff now undertake an appropriate induction programme. EVIDENCE: A number of requirements were made following the previous inspection in October 2006 in relation to staffing issues. These have largely been met. Comment cards were returned from eight care staff. The inspector viewed duty rotas, which stated that two care staff are on duty during the day with one awake and one sleepin at night. Care staff and relatives confirmed that this is the usual number of staff. The manager works six days per week and in addition to the care staff a cook is available six days per week and a cleaner most days. The proprietor is spending a large part of the week in the home at present but stated that he will reduce the time he spends in the home once the manager is settled into her post. The home is currently registered for a maximum of thirteen people and the staffing numbers would appear appropriate especially as the manager is involved in Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 23 care and activities as well as management. Service users and relatives spoken with stated that they felt there were sufficient staff to meet their needs. Care staff stated that they are now doing less cleaning and this enables them to spend more time with service users in meeting care and activities needs. One of the new staff recruited since the previous inspection has an NVQ level 2 in care, however none of the other care staff has an NVQ in care. The proprietor has registered all care staff on the NVQ level 2 in care and care staff confirmed this during discussions and on comment cards returned. Although the home falls far short of the required number of care staff with an NVQ a requirement is not made as the proprietor has taken the necessary steps to ensure that staff achieve this qualification. Since the previous inspection the home has recruited three new staff, the manager, a carer and a cleaner. The recruitment records for the carer and cleaner were viewed and the homes recruitment procedures discussed. The home had undertaken an appropriate recruitment process, with evidence of POVA and Criminal Records Beuro checks having been undertaken. However the proprietor could not provide evidence that two references had been received, stating that these were at his home in London. The proprietor was requested to fax these to the inspector and if received these could be accepted as evidence. The proprietor faxed the second reference for the carer but the inspector did not receive the second reference for the cleaner. It was not clear why the references were not at Aspen Lodge. The proprietor must ensure that either originals or copies of evidence of pre-employment checks are available in the home. The home now has an appropriate induction process involving workbooks obtained from the General Social Care Council and overseen by the manager who is a qualified social worker with a background in dementia and older persons mental health care. Following the previous inspection in October 2006 the home was required to ensure that all staff undertake mandatory and other training to meet service users needs. The proprietor has contracted with an external training provider and supplied the commission with a training plan for 2007. Prior to this inspection staff have received, infection control, manual handling and challenging behaviour training as well as commencing NVQ level 2 in Care. Further training is planned to meet health and safety, food hygiene, protection of vulnerable adults, first aid, risk assessment, COSHH, abuse and neglect. On the day of the unannounced inspection visit staff were receiving medications training from the homes pharmacist. The new manager is a qualified social worker and has previously worked with dementia and people with mental health needs and should be able to provide some in house training in these areas. The proprietor informed the inspector that fire awareness training is to be included with the COSHH training. The inspector suggested to the proprietor that he contact the homes district nurse and request training in relation to Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 24 diabetes and pressure area care as these would be other relevant training considering the current service users. A comment card from one community nurse stated that in the past the home had been reluctant to accept education/additional support but senior staff have now agreed to this. Whilst it is accepted that staff have not yet attended all the necessary training no requirements are made in respect of staff training as the proprietor has demonstrated a commitment to providing a comprehensive training programme for staff. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The proprietor has appointed a new manager who has been in post approximately one month. The new manager demonstrated a clear understanding of service users needs and has a commitment to providing a quality service. The manager is clear about quality assurance and has commenced some work focusing on activities and meals. Service users financial interests are safeguarded. Staff must receive regular formal supervision at least six times per year. Records must be held in compliance with the Data Protection Act 1998. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 26 Generally the home is a safe place for service users, staff and visitors however the proprietor must consult with the local environmental health officer to determine the correct actions which must be taken in to prevent the risk of legionella in the homes shower head. EVIDENCE: The proprietor has appointed a new manager who is a qualified social worker and has a background in dementia and mental health. Throughout the inspectors visit to the service the manager demonstrated an enthusiastic approach with a clear focus on the service users and a commitment to providing a high quality of service. Care staff confirmed that the manager is approachable and is involved in care as well as management tasks. The proprietor is aware of the registration process and the manager will apply for registration once her induction period is completed. The manager has commenced some quality assurance work focusing initially on the meals and activities. The manager showed the inspector the work undertaken so far and this is very detailed and comprehensive. This has focused very much on service users and what they like and dislike with a view to ensuring that meals and activities meet service users needs. The manager has undertaken a service user meeting with minutes held and seen by the inspector. Although the quality assurance standard is not fully met no requirements are made in respect of this as the manager is new in post and the inspector is confident that service users views are paramount to the way she intends to run the service. The manager undertakes checks of the rooms and call bells each week. The proprietor is currently at the home for a large part of the week and stated that when the manager is settled into her role he will spend less time at the home. The proprietor is aware that he will then have to undertake visits and provide reports as outlined in Regulation 26 of the Care Standards Act 2000. The proprietor stated that the home does not become directly involved in the management of service users’ personal finances. The inspector was shown the invoices sent to service users or their representatives, these detail what additional services are being charged such as for chiropody and hairdressing. If additional personal items are required, such as toiletries or clothing the proprietor stated he will contact the service user’s representative and arrange to either purchase these on behalf of the service user and add to the invoice or for the representative to purchase the items and send to the home. The arrangements would seem appropriate. Comment cards were returned by eight of the care staff. These indicated that staff were not receiving regular formal supervision at least six times per year. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 27 Discussions with the manager indicated that she will undertake formal supervision in the future and that she is currently working with care staff and supervising them informally. During the inspectors visit the manager was observed to make suggestions and advice to staff in a positive manner about care and health and safety matters. Overall the homes record keeping was much improved however the manager must bear in mind the Data Protection Act 1998 and ensure that individual records such as risk assessments and visits to/from health professionals are held in individual service users files and not a general file. Care records are no longer held in the homes kitchen but now in a lockable cabinet in the dining room. This also reduces the need for care staff to enter the kitchen whilst meals are being prepared. Following the previous inspection a number of concerns in respect of health and safety were identified which indicated that the home was not a safe place for service users, staff and visitors. Many of these issues have been addressed. The proprietor has addressed the staff training concerns and although staff have not yet received all the necessary training a comprehensive programme is in place and some training has already been undertaken. Steps have been taken to address previous concerns in respect of the environment and appropriate routine checks on the homes gas, electric and water services have been undertaken. Weekly checks of the homes fire detection equipment are undertaken by the manager. The proprietor was unsure about the correct procedures to reduce the risk of legionella in the homes showerhead and must consult the local environmental health officer to determine the correct solution that should be used to and frequency that showerheads should be disinfected. Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 2 Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 29 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 17 Requirement All records must comply with the Data Protection Act 1998 and ensure residents confidentiality. Individual risk assessments and visits from health professionals must be held within the individual service users folder and not in a general file. The home must provide suitable alternatives for people with special diets specifically sweeteners, if wanted, in hot drinks. The home must have a clear adult protection policy and procedure which links to the locally agreed procedures for reporting concerns. The proprietor must ensure that either originals or copies of evidence of pre-employment checks are available in the home. A similar requirement was made following the inspection in October 2006. Care staff must receive formal supervision at least six times per year. DS0000066715.V328468.R01.S.doc Timescale for action 01/05/07 2. OP15 16 (2)(i) 15/03/07 3. OP18 13(6) 01/06/07 4. OP29 13 (6) 15/03/07 5. OP36 18 (2)(a) 01/06/07 Aspen Lodge Care Home Version 5.2 Page 30 6. OP38 13 (3) The proprietor must consult the 01/04/07 local environmental health officer to determine the correct solution that should be used and frequency that showerheads should be disinfected to prevent the risk of legionella. 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 Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aspen Lodge Care Home DS0000066715.V328468.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!