Inspection on 26/11/08 for Aspen Lodge Care Home

This inspection was carried out on 26th November 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aspen Lodge Care Home 07/05/09

Aspen Lodge Care Home 13/09/07

Aspen Lodge Care Home 21/02/07

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aspen Lodge Care Home 222 Weston Lane Weston Southampton Hampshire SO19 9HL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Richard Slimm     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: Aspen Lodge Care Home 222 Weston Lane Weston Southampton Hampshire SO19 9HL 02380421154 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aspen Care Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Aspen Lodge is a registered home providing care and accommodation for up to twenty 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 lawned garden area to the rear and side of the premises. Although not registered for people with a physical disability the Care Homes for Older People Page 4 of 39 20 20 0 Over 65 0 0 20 Brief description of the care home home does have level or ramped access to the front or rear of the property. The home provides private accommodation in twenty single bedrooms and a number have ensuite facilities, some bedrooms are on the ground floor and others on the first floor accessible via a shaft lift. Communal 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 manager had applied for registration with the Commission for Social Care Inspection. Fees are dependant on assessed needs. Members of the public may wish to obtain up-to-date information regarding fees from the care home. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was an unannounced Key Inspection of the home, a Key Inspection being part of the CSCI inspection Programme, which measures the service against the key National Minimum Standards, and outcomes for people using the service as part of a process known as Inspecting for Better Lives (IBL). This report incorporates information gained from people using the service and/or their advocates / relatives, staff, including managers and comments from external stakeholders who completed professional comment cards. Care Homes for Older People Page 6 of 39 We were also provided with the services annual quality assurance assessment (AQAA) completed by the manager and other relevant information gained by the inspector via such processes as observations, interviews, inspection of documents and records and case tracking, during a site visit to the home. The visit to the home was undertaken by 2 inspectors and lasted 5 hours. What the care home does well: What has improved since the last inspection? What they could do better: Aspen Lodge needs to make a number of improvements in order to meet the Care Home Regulations 2001, and to ensure that quality of life outcomes for people using the service are improved. We noted that systems of care planning needed further development in order to ensure information gathered during assessments is available to guide staff in their daily Care Homes for Older People Page 8 of 39 interventions with people. Daily recording systems and care plans need to be developed further, and improved in order to ensure that staff are able to implement, report, monitor and review care and support effectively, and where needed make changes to peoples support plans. In addition to this risk assessment needs to be improved across all areas of service provision so that service users are actively protected from harm. Aspen Lodge needs to put in place appropriate storage arrangements for drugs and medications held on behalf of residents accommodated at the home. This is in specific respect of controlled dugs. Aspen Lodge needs to improve the quality of activities, entertainments and outings for people living at the home, in order to improve quality of life for people living at the home. People need to be provided with better support to enable them to remain in control of their lives as far as possible. This needs to be based on clearly agreed plans of care and support, informed by good quality assessments of needs, risks as well as wishes and aspirations. Where needed people should be supported to use the complaints procedure and to access advocacy externally to the home if appropriate. There should be more appropriate signage to peoples rooms, and other facilities such as communal WCs, so as people who suffer from age related mental health problems, can maintain greater independence. This also applies to the provision of handrails to long corridors and additional handrails to steep stair wells. So that people can be supported to move around their home more independently. The home needs to sustain the recent improvements to staff training, development and support, and management need to ensure this training is transferred to daily practice to the benefit of service users. The provider and the manager need to carry out a full audit of the service using the Care Home Regulations 2001 to identify those areas where the home fails to meet regulations, and to inform a plan of action to remedy such shortfalls. Where charges are levied on individuals by the provider for additional items such as toiletries individual receipts must be maintained to provide proof of purchase on an individual basis. So that people are safeguarded by transparent financial procedures. In order to ensure the home is run in the best interests of the people living there, the Responsible Individual must carry out a formal visit under Regulation 26, at least each month, and must provide a report about the conduct of the home to the manager. Given the number of concerns currently a copy of these monthly reports must be provided to the Commission for Social Care Inspection. The provider and the manager need to ensure that the environment is safe and any area that is deemed unsafe is risk assessed and action taken to minimise risks to all concerned. Care Homes for Older People Page 9 of 39 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed prior to admission. The current arrangements for assessments do not fully consider all areas of risk. Evidence: We case tracked three peoples records. We found a number of different assessments held on these files. Assessment information was broken down into differing areas of daily living and other relevant areas. These included - mobility; self-care; medications; night-care; communication; continence and mental health. Other assessment formats had been added in areas such as dementia; sleeping; risk assessments for falls, as well as additional assessments for mental health; behavioural and nutritional needs. In addition to this we found other forms of assessment usually used in nurse care settings such as the Barden Scale Guidance, linking to Barthell Index assessments. There were no risk assessments for a number of areas where risks were clearly evident for people as set out below. This put people at risk where important needs may not be Care Homes for Older People Page 12 of 39 Evidence: assessed fully, identified and met. We found evidence of pre-admission assessment in one case. The two other people we case tracked had been accommodated some time, and their admission assessments were not on the files we saw. There were specific issues identified in assessment and plans that outlined a residents choice to use the garden area, and we found evidence that unsupervised access to this area would currently be unsafe for this person. There were also other concerns in the area of risk assessment in regard to the use of stair gates that appeared to create tripping hazards, and one stair gate was found to be broken so did not function as designed and was consequently hazardous. During a tour of the premises we were shown up a steep stair well. At the top there was a stair gate. This stair when opened came away from its fittings leaving a tripping hazard. The upper stair lobby was dark. The light bulb was broken. The stair well had only one Bannister. In the homes own health and safety statement we saw later in the visit, it said that stair wells will be well lit, and will be provided with two Bannisters, one each side for the safety of service users. Consequently we found samples of care related assessment that appear to have been carried out over recent months at the home, but these assessments did not always take full account of risk issues. The service needs to work to improve this to ensure people are appropriately assessed. We found evidence that people are not being listened to fully or their views and wishes taken fully into account at the home. In one case the views and aspirations of the resident had not been assessed accurately in respect of her choice of home, or recorded into a plan of care and support. We gained the permission of the resident concerned and then we brought these matters to the attention of the manager in order that a review of placement could be arranged with all relevant people concerned. Four Service user surveys returned to us earlier in the year indicated that those people had been provided with a contract and sufficient information in order to decide if Aspen Lodge was going to be the right place for them. Care Homes for Older People Page 13 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care and support needs are not fully set out in individual plans, to ensure their care needs are met. People are not fully supported and/or encouraged to make decisions about their lives, with support and assistance where this is needed. People are supported to manage their medications safely. But the arrangements for the storage of controlled drugs are not currently suitable. The degree to which people are treated with dignity and respect is not fully promoted and protected, by providing staff with improved training, support and leadership. Evidence: We looked at case records for three people. It was unclear how information gathered in the various forms of assessment identified linked or informed plans of care and support, especially in the area of risk taking. Peoples plans contained differing Care Homes for Older People Page 14 of 39 Evidence: amounts and quality of detail. Consequently there were variations in the quality of guidance for staff in respect of how people were to be supported. The manager advised us this was due to the changes that the home is making with social services to care planning and recording systems. As identified above in one case it was evident that a resident was not being actively listened to. The issues likely to be causing behaviors that are presenting direct challenges to the home are not fully acknowledged in either assessment or care planning, and daily notes of these challenges are not acted on in any structured or helpful manner. We passed our concerns back to the manager at the time of our visit with the permission of the resident concerned. We found in another case that a medical condition had been identified at the home, staff had tried to treat this rather than referring the matter to a GP immediately. This led to the resident having to be in discomfort before the matter was referred appropriately to the community medical team. The condition became worse and we were advised by the manager that the duty doctor arranged an ambulance. The home sent the elderly frail resident to hospital unsupervised. She was returned to the home as the hospital could not treat her condition. Records of events had not been clearly recorded at the home, and copies of hospital admission forms sent with the resident were not available to us at the home. In a third case we found recordings that failed to satisfy us that the home had a clear understanding of how to meet the needs of older persons who have multiple disabilities. We identified activities recorded in the plan of care and support related to the garden area that was found to be unsafe for the individual concerned, and there were no risk assessments in place either. We identified that when issues had been identified in assessments, it was unclear what action was needed or was going to be taken by whom, when or how in plans of care and support to meet those needs and wishes on a daily basis. There was no clear system for monitoring outcomes for, or with people in respect of their care and support needs. Daily recording notes did not always capture important details of peoples lives. There did not appear to be a system that checked records of care and support arrangements on a monthly basis to monitor progress or changes. As a result there was a lack of good quality information to inform practices, monitor changing needs at the home or inform the annual review of care and support. In general we found people told us they were quite happy, but in at least one case we found a resident who was unhappy. We found information in care plans that said the resident liked to walk in the garden. Because of the state of the garden at the time of Care Homes for Older People Page 15 of 39 Evidence: our visit if the resident had been left to do this he could potentially have been put at risk. One survey comment from an external professional stated - Risk assessments generally are unfinished, the home does not use an accredited tool, and information appears NOT to be used pro-actively to minimise risks identified and does not always link to individual plans. Other professionals have told us in survey responses that In my professional view if care plans fail to recognise abilities as well as needs, this leads untrained staff to treat people in institutional ways that potentially fail to recognise individuality, or respect peoples status as customers. In my experience there is an institutional approach that often fails to see diversity issues for, or with individuals. In respect of one of my patients behaviour recently had not been reported to me. Another of my patients had become unwell had been seen by a GP and also had a hospital admission, this had not been reported to me a the patients cummunity nurse - this seems to show a lack of good communication. There was some information found in assessments in respect of peoples health and psychological needs. As identified above there was little evidence of how this information informed and linked to pro-active plans of care and support on a daily basis. We found evidence that medical conditions were not being routinely reported to the community health care professionals, and in one instance there had been a delay in reporting a medical problem leading to poor outcomes for the person concerned. We saw recorded evidence that staff initially attempted to treat this condition without any external consultation. People we spoke to said they could see their doctors if they wished, but given the particular needs and frailties of the residents this was difficult to validate in records such as care plans and daily notes, and we also found evidence that doctors were not being called when they should be, and concerns from other exteranl health care professionals that they were not being kept informed of development affecting their patients. We found comments in plans of care and support that failed to identify what people could do, as there appeared in at least one case to be a focus more on what the person could not do, not interested in much, that appeared to be based on Care Homes for Older People Page 16 of 39 Evidence: assumption as opposed to quality assessment. Other survey feedback comments from external professionals included I have offered support and guidance about improving and developing care plans, and Im aware social service colleagues have been working with the home in this area, but Im not sure this has had much effect. I noted the other day the home was serving liver for lunch, but had not checked health issues such as gout that could be adversely affected. In my view staff need training in all areas as well as more specialist areas. Since my involvement with the home in April 2008 I find there is a lack of specific health care information recorded in any quality in plans of care and support. The local GP surgery staff say they are often contacted inappropriately, and I understand they feel the home is over cautious about some things. I understand information is often not shared with important support professionals such as community psychiatric nurses. Sometimes information is not shared with me either. There was no evidence that the home assesses the abilities of individuals to self medicate or to assess risks prior to taking over this element of people lives when they move to the home. Once more we were told by an external professional - The service fails to risk assess or assess ability to self medicate to my knowledge. This fails to enable more able people to maintain control in this area of daily living if they wish. The home adopts a monitored dosage system for the storage, administration, handling and recording of people drugs and medications. The home is holding medications that need to be stored as controlled drugs. We pointed out that the law concerning the storage of controlled drugs has recently changed and the home was reminded that if there is a need for any controlled drugs to be held at the home, they must be stored in a proper Controlled Drugs Cupboard. Current arrangements for the storage of controlled drugs do not meet the following requirements - Metal cupboard of specified gauge; Specified double locking mechanism; Fixed to a solid wall or a wall that has a steel plate mounted behind it; Fixed with either Rawl or Rag bolts. On entering the home there were two drug trolleys. One was secured safely to the wall in the corridor where it is sited when not in use. The other was not secured as Care Homes for Older People Page 17 of 39 Evidence: required, and we requested that the trolley be moved to a secure room in order to promote safe storage of medicines. External professionals who have had regular input at the service told us in response to surveys There have been many noted omissions in the recording of administered medications since my involvement with this service in April 2008. During our visit we noted no omissions to medication records. In the past there has been a history of poor practices in respect of medication administration, but more recently I have noticed some improvements here. We observed staff giving out medications, and the staff member involved showed us the process and procedure she followed. The practices observed appeared to be safe, and follow the homes procedures. There was no appropriate controlled drug storage cupboard in place. As part of our case tracking we inspected a sample of medicine administration records (MAR sheets) and found them to be completed properly, and practices were to complete MAR sheets as medicines are given out in line with the procedures. The staff involved in medication administration said she had received training. People spoken to said they were happy with the arrangements made at the home in respect of their medications. An external professionals who has had regular input at the service told us in response to a survey During a visit a lady who was wheelchair dependent was being assisted to use a communal WC without adequate room or facilities to do this. The door to the WC could not be fully closed by the staff member so the resident was visible using WC from the corridor where I was stood. We passed this information onto the manager in order that she could look into this breach of privacy. Another professional shared with us that - I feel staff have not always been trained, supported and supervised well. On one occasion Id come to give one of my patients an injection and staff, who were trying to be helpful, were calling the resident to come Care Homes for Older People Page 18 of 39 Evidence: and get her injection, along a corridor in formt of everyone else. We have also, as identified above been advised of other incidents where privacy has not been fully promoted and protected at the home. We did see staff knocking on bedroom doors before entering the room, but we also saw staff that did not knock before entering private rooms. Two staff interviewed were able to demonstrate an understanding of the core values of privacy, dignity and respect when we spoke to them. Care Homes for Older People Page 19 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lack mental and physical stimulation. The home does not provide the range of activities, entertainments and outings needed to fully promote a good quality of life for all the people living at Aspen Lodge. People are encouraged and supported to have visitors and to maintain links with relatives and other people important to them from outside of the home. The home fails to fully support people to exercise choice and control over their lives with appropriate support/advocacy where needed. People enjoy a full varied diet, and food is served at times suitable to service users and in pleasant surroundings. Evidence: The homes AQAA states - The home provides a variety of activities and additional services programmed to meet the likes and needs of residents. - We were unable to substantiate this claim, Care Homes for Older People Page 20 of 39 Evidence: and found that activities and stimulation were lacking. People told us there was a lack of activities, including the manager. There is an activities display in the hall area of the home, it is unclear what events and activities are to take place on a daily basis from this display. There were no activities provided during our visit. Plans of care to identify peoples wishes and preferences for interests and activities and their support needs were not in place due to what we were advised was the introduction of new systems. The manager said she is finding it difficult to access the necessary resources to improve things. She told us she had asked for a set of carpet skittles recently, but this had been declined on the grounds of health and safety. Currently there is no single staff member allocated the duty of consulting residents or co-ordinating and providing activities in a structured way. People told us there was not much going on at the home, but they usually found their own entertainments. Two people spoken to said they were happy with the current arrangements, but would like to go out more often when the weather was good. We observed less able people being left to their own devises even though it was evident they needed stimulation and support. Visiting professionals told us in response to our surveys - I do not feel confident in the outcomes for people living at Aspen Lodge. I have reviewed the care of seven people living at the home recently and have found that people lack stimulation, 6 of these people have specifically asked for more activities and opportunities to travel out from the home. The home has a clear visiting policy that appears to place service users at the centre of these arrangements. The homes AQAA states visitors are always welcome and there are no restrictions. People told us they had regular visitors and that they could always see them in private if they wished. Two people told us their relatives visit regularly and take them out as well. We were unable to speak to any visiting relatives during our site visit, but did speak to three visiting professionals. We also spoke to the regular hairdresser who told us she felt the home was better than some she visited in the area. There is a statement regarding visiting displayed in the home. Information in respect of visiting is available in the statement of purpose. People living at the home knew they could have visitors at any reasonable time. Care Homes for Older People Page 21 of 39 Evidence: Given the lack of clear care and support plans, and poorly organised daily notes/reports, it was difficult to assess how people are actively encouraged and supported to be autonomous, and make choices and decisions in respect of their daily lives. In one case we found evidence that the contrary was true for one person living at the home. Some people told us they were happy with their home, and felt there was enough going on for them. Other people were less able to communicate lucidly during our visit, and appeared to be a little withdrawn. These people were unable to tell us how things were for them, and due to a lack of clear records it was not possible to assess the kinds of inputs being made to promote good outcomes for/with people. People did tell us they thought the staff were very helpful and that they were grateful for the support they provided. Food menus for the day of the visit included one choice of a roast chicken meal. When we asked the cook about menu options and choices she told us that people usually eat what was on offer, as they liked what was on the menu. She did say that if a person requested something different she would do this, but once more there did not appear to be any clear linkage to likes/dislike/needs/ wishes etc within plans of care and support, given that these were incomplete. We ate with residents who appeared to enjoy their meal and some people also said the food at the home was very good, and that they enjoyed what was provided. People told us they liked the food at Aspen Lodge, and looked forward to their meals there. People could not remember if they had ever disliked anything or what would happen if they wanted another option. The cook had many years experience of working in care service for older people, and confirmed that she was able to go and speak to people regularly to see if the menus were meeting with people likes and needs. There was no apparent documentation to show how people who were unable to say what they liked and wanted to eat, received the food they liked. The cook confirmed that she had enough resources to ensure people received a good varied well balanced diet. We noted a standard monthly additional fee being levied across all service users. We were unable to see specific receipts for this additional charge. An external professional told us in a response to our survey - The home needs to improve the quality and amount of choices for people living there in such areas as food, activities, outings, the daily running of the home and types of toiletries. Care Homes for Older People Page 22 of 39 Care Homes for Older People Page 23 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that is available to residents and/or their advocates. The home had two differing ways to record complaints and concerns. Some people were aware of how to make a complaint. Some people were not being actively listened to in respect of their concerns. There are current safeguarding concerns about Aspen Lodge, and the way people are being cared for at the home. The home has copies of the protocols and local authority arrangements for the safeguarding of vulnerable adults. Staff receive training in adult protection. The provider and the manager co-operate with agencies investigating safeguarding matters. Evidence: We inspected Aspen Lodges complaints log. There were no recorded complaints since the last key inspection in March 2007. We noted that there were currently two systems for recording complaints/concerns at the home. The home has a complaints procedure that is displayed. This procedure is also part of the contract given to all residents and/or their relatives. Surveys returned to us in August 2008 indicated that people know how to make a complaint. We spoke to people and some knew who to speak to if they had any concerns, but some people were not so aware of such processes due to their special needs. Care Homes for Older People Page 24 of 39 Evidence: There have been a number of concerns about the quality of provision at Aspen Lodge, and there has been significant involvement from the local authority who place and fund some residents at the home. The home has a safeguarding adults policy and procedures were evident in the office to guide staff/management. Staff interviewed were able to demonstrate an awareness of what might constitute abuse in respect of vulnerable adults/older persons. The manager was able to demonstrate an awareness of what to do in the event of suspecting, and/or identifying abuse in the home. The local authority are currently looking into safeguarding concerns at the home, and are currently not commissioning services at Aspen Lodge. The manager and the Responsible Individual have been involved in strategy meetings, and have been cooperating with local authority staff who have been reviewing care at the home. Care Homes for Older People Page 25 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Areas of the home that may pose an element of risk to people, inside and out have not been fully risk assessed. So that people are protected from harm. Action is not routinely taken to provide specialist equipment and facilities to promote peoples independence. The home was cleaned to a good standard. Some areas of the home needed some refurbishment and did not provide service users with a homely environemnt in which to live. Evidence: The home is laid out over two floors, the ground floor consists of a lounge, 2 dining rooms, office, kitchen, laundry, 2 bathrooms and 3 WCs. There are a total of 11 bedrooms on the ground floor 6 of which are part of a new addition to the home and all of these new rooms are en suite and are well equipped with suitable furniture and fittings. The other 5 bedrooms on the ground floor are existing rooms. The new building also contains a well equipped bathroom with a specially adapted bath and there are 2 new WCs which are wheelchair accessible. There is small dining room and the new building has enabled the lounge area to be extended. Care Homes for Older People Page 26 of 39 Evidence: Upstairs there are 9 existing rooms and 1 new en suite bedroom. It should be noted that the new bedroom on the upper floor (unoccupied) contains a cupboard, which is currently being used as storage for some of the homes equipment and for this room to be used by a resident all of the homes equipment would need to be removed from the room and cupboard. The homes new rooms were well presented, however a number of the existing rooms were in need of decoration and would benefit from new furniture. Residents rooms had a number of different locking mechanisms, the new rooms had suitable locks, however the mechanisms on some existing rooms could be confusing for users of the service who have dementia and it would be beneficial if the locking mechanisms on all rooms were appropriate to peoples needs. It was also noted that rooms were poorly numbered and it was not always clear which rooms were bedrooms. Other communal rooms such as WCs were not clearly marked for people with dementia either. Whilst touring the home it was noted that there were no hand rails situated in any areas of the home apart from stairways that had one handrail, Residents were seen to be mobilising around the home and hand rails in corridors were not in place to promote safer, independent mobility for people. At one point of our visit we saw an elderly man having to support himself with his hands on the wall of a corridor while he walked along as there were no handrails. Access to the upper floor is via 2 separate sets of stairs or via a small passenger lift. When we toured the home it was found that there were stair gates fitted at the top of both sets of stairs. The gate at the top of the front steps was not securely fitted and the stair gate had a bar across the bottom of the gate even when open and this presented a tripping hazard for residents. When we toured the home the lighting at the top of the front stairs was not working, also the hand rails on the stairs was only on one side and did not continue to the top of the stairs. The homes own health and safety policy regarding stairs stated, Stairs should be properly maintained, well lit with hand rails provided on both sides of the stairways. There were risk assessments in place for the stair gates but these were hand written and illegible, the last review date for the risk assessment was December 2007. There was an enclosed rear garden and also a paved area to the sides of the house. The garden has a small lawn to the rear and other areas were paved, with a patio to one side of the house. We noted that the garden had a number of walking aids left outside down the side of the house and also there was steep edging to the side of the garden, which presented a potential hazard to residents. In a care plan for one resident who has no sight it stated that the resident liked to access the garden Care Homes for Older People Page 27 of 39 Evidence: independently and enjoyed walking in the garden. Given the current layout of the garden this could pose a significant risk to this person and other residents. The home has a laundry, which is situated in the downstairs part of the home. This is equipped with an industrial washing machine and tumble drier. There are no hand washing facilities in the laundry and we discussed the need for clear signs to be in place to direct staff to the nearest hand washing facilities. The home does not employ dedicated staff to do residents laundry and care staff members carry out these duties. All residents had named laundry baskets where clean clothes were placed so that staff could deliver washed items back to individual rooms. Laundry is collected by staff and brought down to the laundry in bags with any soiled items clearly identified. All staff have received training with regard to infection control and the home was generally clean and tidy. All WCs had hand washing liquid and paper towels and disposable gloves and aprons were available for staff. Staff spoke with told us and said that they were aware of infection control procedures and that they had received training in this area and each member of staff is issued with alcohol gel to help prevent the spread of infection. Care Homes for Older People Page 28 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples do not have their needs are met fully by the number and skill mix of the staff team. The staff team have recently received increased training and support. Staff training has recently been increased and improved. Staff recruitment checks are carried out. Staff induction and support has recently been increased. Evidence: The homes staff rota showed that there are 2 care staff members on duty between 0800 & 2000 and 2 staff members on duty between 2000 and 0800. One of these staff members is able to sleep between 2300 and 0600 while the other staff member is awake throughout the night. There is also a cook who works between 1000 and 1300 6 days per week, and who works solely as a cook, and a cleaner who works 16 hours a week at the home. On the day of the visit staff were seen to be working well to support residents and the atmosphere in the home was relaxed and friendly. All residents and staff spoken to said that they felt that staffing levels were sufficient and residents told us that - the staff are very good - there is always someone around and I am well looked after. Care Homes for Older People Page 29 of 39 Evidence: Recruitment records were seen for three members of staff. All of the files contained all of the required information. Staff confirmed that they were subjected to the appropriate checks as part of their selection and recruitment to work at Aspen Lodge. Staff training records were looked at and these showed that training has recently taken place in Reporting and Recording, half day dementia training, food hygiene, infection control, moving and handling and half day medication training. The manager has completed the train the trainer course in moving and handling and infection controls so is able to keep staff up to date with this training, other courses are run by an outside training organisation. Staff told us that recently training had improved. The home will need to keep up this commitment to providing training for staff, which enables them to carry out their roles effectively. One external professional told us in a response to our survey - I am advised staff have had half day dementia and other training since September 2008, but to date I have not seen improvement to practice from the training input. Given the issues identified above we have to question the degree to which recent staff training has directly affected pratices and outcomes for people living at the home. The home has an induction based on skills for care and we saw completed induction forms for staff, these forms were signed off by the manager. We discussed induction with the manager who told us that for each section of the induction standard staff were expected to write up notes to show that they understood and knew what was expected of them, however the manager had not kept these notes so it was not clear if the induction was effective. Staff on duty told us that training and induction had recently improved since the new manager had been in post. However, this needs to be reflected in practices at the home. Care Homes for Older People Page 30 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not currently have a registered manager who supported by the Responsible Individual, can imporve outcomes for people living in the home. The home has a quality assurance system, but it is unclear how this is based on the views of service users, or is effective in maintaining good outcomes for people living at the home. It was unclear how accounting and financial arrangements safeguarded residents individual financial interests. The health, safety and welfare of service users and staff are not fully promoted and protected at the home. Evidence: The manager has been in post for 3.5 months she has completed the RMA and has Care Homes for Older People Page 31 of 39 Evidence: NVQ4 in care, her background is mainly in community based care and support services (domiciliary care agencies) that provide support to people in their own homes, and she told us that she is in the process of applying for registration with CSCI as the manager of Aspen Lodge. As part of the registration process the applicants suitability and fitness will be assessed. Currently information is spread over numerous files. There is a computer in the office but at the time of our visit there was not access the Internet at all times and the CSCI professional web site. The manager told us that she has a small amount of petty cash but has no budget responsibility so everything has to go through the Responsible Individual. The home has a quality assurance system in place and staff and residents meetings are held monthly. We saw a file of surveys that had been returned by staff, service users and health care professionals. Some of the surveys were not dated so it was not always clear when they had been completed and also there was not always evidence that concerns or suggestions raised in the surveys had been addressed or considered. One visiting health care professional commented that she felt that when she visited staff did not greet her or escort her to residents. The manager told us that this issue was discussed at a recent staff meeting to rectify this issue. The Responsible Individual carries out Regulation 26 visits to the home, however records showed that these are only carried out every two months and this is not in line with the Care home Regulations which state that visits must be conducted monthly. The home does not keep any money on behalf of service users and we were informed that the Responsible Individual pays any bills that are incurred such as chiropody or hairdressing and then invoiced to residents or their relatives/advocates. We spoke to the hairdresser who was visiting on the day of our visit and she told us that she makes out an itemised list of all residents who have had their hair done and this also states what service they have had. The provider then pays this to her. We looked at a file, which contained invoices, and these were not always clear. There was headings and costs for chiropody and hairdressing and there was also what appeared to be a regular monthly charge of 4.95 (pounds Stirling) for personal items. There were no individualised receipts for such items as toiletries. So the charges were not itemised so it was not clear what the charge was for and each service users appeared to pay the same amount each month. The manager told us that she went round each week to see what items each resident needed but it was not clear if residents had any choice or control in what was purchased for them or what the actual cost was. It was not clear Care Homes for Older People Page 32 of 39 Evidence: how the home supported peoples preferences when they were not able to express wishes. The homes fire logbook was inspected and there was an up to date fire risk assessment for the building. Records of fire drills and the testing of equipment were up to date and there was a defect book where any problems were recorded and these were signed off as they were completed. Staff spoken to told us there were regular fire tests and drills at the home, and that they had received fire training. There were a number of risk assessments in place for the environment, however all of these were hand written by the previous manager and were not clear or easy to follow, some of the writing was illegible and when discussed with the current manager she was unable to fully understand what the actual risk was and how the risk could be minimised. The most recent review of any of the risk assessments seen was December 2007. Care Homes for Older People Page 33 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must 26/12/2008 ensure service users health and welfare needs are assessed and identified by a suitably qualified and trained person prior to admission. To ensure the needs, wishes and any risks are identified and action taken to meet those needs. 2 7 15 The registered person must 26/12/2008 after consultation with the service user, or a Representative of his/her, prepare a plan as to how the service users needs and wishes in respect of his/her health and welfare are to be met. In order that people accommodated have their needs and their wishes met. 3 9 13 The registered person must make arrangements for the recording, handling, safekeeping, safe 26/12/2008 Care Homes for Older People Page 35 of 39 administration and disposal of medications received in the care home. In order that drugs and medications are stored and looked after safely and the well-being of residents promoted and protected. 4 12 12 The registered person must 26/12/2008 make arrangements for suitable activities to be made available at the home. So that people have access and choice in areas such as - leisure, social activities and outings. Food menu choices. Routines of daily living at the home. Increased opportunities need to be provided that promote greater mental and physical stimulation for people accommodated. 5 18 13 The registered person must ensure that people are protected from harm or suffering abuse. This is to ensure vulnerable people living at the home have the protection they need to prevent them being subjected to any form of abuse. 6 22 13 The registered person must ensure the environment is safe for people living at the home. In order that people living at the home have safe access 26/12/2008 26/12/2008 Care Homes for Older People Page 36 of 39 and have their independence promoted by the provision of aids and adaptations as identified by assessment by a competent and trained person. 7 33 26 The registered person must 28/12/2008 make arrangements for the responsible individual to visit the home under paragraph (1) or (2). These visits will be at least monthly, will be unannounced and a written report on the conduct of the home will be provided to the manager and the Commission for Social Care Inspection. In order to ensure the home is run in the best interests of the people living there, and that the responsible individual provides a report about the conduct of the home to the manager and the registration authority. 8 35 12 The registered person must make arrangements to ensure the home is conducted in the best interests of residents, that their financial interests are safeguarded and their wellfare promoted. In order to ensure people are only charged fees for things they receive, it is essential that all receipts of item purchased on behalf of or for each individual are maintained for inspection. 28/12/2008 Care Homes for Older People Page 37 of 39 9 38 13 The registered person shall 28/12/2008 ensure that - all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In order to ensure the wellbeing and welfare of people in your care is promoted and protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The Misuse of Drugs (Safe Custody) Regulations 1973 gives full details and suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. We recommend that care homes request formal confirmation when purchasing a CD cabinet that it complies with current legal requirements. The registered person should make available increased choice and control to people accommodated at the home. People need to be provided with better support to enable them to remain in control of their lives as far as possible. This needs to be based on clearly agreed plans of care and support, informed by good quality assessments of needs and wishes/aspirations. The provider/manager need to ensure that people are actively listened to, and action taken to ensure people wishes and aspirations are fully respected. If a resident complains about living at the home they should be advised of how to use the complaints procedure. The provider should introduce more appropriate signage to peoples rooms, and other facilities such as communal WCs, so as people who suffer from age related, confusional mental health problems can maintain some independence. The provider and the manager should carry out a full and thorough audit of the service using the national minimum standards, in order to clearly identify those areas where the service falls below the standard. 2 3 12 14 4 16 5 19 6 33 Care Homes for Older People Page 38 of 39 Helpline: 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 We want people to be able to access this information. 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