Inspection on 10/12/07 for Aspray House

This inspection was carried out on 10th December 2007.

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

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

Other inspections for this house

Aspray House 25/06/07

Aspray House 29/03/07

Aspray House 22/02/06

Aspray House 25/08/05

Aspray House 17/03/05

Aspray House 19/11/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Aspray House 481 Leabridge Road Leyton London E10 7EB Lead Inspector Peter Illes Unannounced Inspection 10th December 2007 09:00 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 Aspray House DS0000044296.V356099.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. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aspray House Address 481 Leabridge Road Leyton London E10 7EB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8558 9579 0208 558 9052 burtonj@asprayhouse.co.uk Twinglobe Care Homes Ltd Ms Julie Burton Care Home 64 Category(ies) of Dementia - over 65 years of age (44), Old age, registration, with number not falling within any other category (20), of places Physical disability over 65 years of age (20) Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The `DE` and `PE` Categories specified relate to service users who are 55 years old and over. 8th November 2007 Date of last inspection Brief Description of the Service: Aspray House was purpose built in 2004 and is registered to provide dementia care for 44 older people and nursing care for 20 older people, including care for people with physical disabilities. The home is privately owned and is part of Twinglobe Care Homes Limited. The home has five floors. All 64 bedrooms are for single occupancy and have en-suite facilities. The ground floor, Emerald Suite, has twenty places for nursing care for older people; The first floor, Opal Suite, has twenty places for nursing care for older people with a diagnosis of dementia; The second and third floors, Sapphire Suite and Topaz Suite respectively, each have twelve places for residential care for older people with a diagnosis of dementia. The fourth floor consists of the manager’s office, staff facilities including a training room, the home’s main kitchen, laundry facilities and a hairdressing salon for people living at the home. All floors are linked by two flights of stairs and a passenger lift. The home has a pleasant garden and patio area at the rear and a paved car parking area at the front. CCTV is used as a security measure at the entrance to the home and does not infringe on the privacy of people living in the home. The home is situated in the centre of Leyton in the London Borough of Waltham Forest and is within easy access to public transport, shops and other community amenities. A stated aim of the home is to provide its customers and clients with the highest quality care services. The stated aim continues that the service will use its health and care knowledge, specialist skills and values to deliver as individual a service as possible to its residents. The provider organisation must make information about the service, including CSCI inspection reports, available to people living at the home and other stakeholders. The current weekly charge is from £600 per week depending on the person’s assessed need. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the last key inspection serious shortfalls were identified in the home’s staff recruitment procedures. Following this the Commission issued a statutory enforcement notice to the registered provider under the Care Standards Act 2000 requiring compliance and informing them that they may be prosecuted without further notice if compliance was not achieved. A random inspection was undertaken at the home on 8th November 2007 to verify compliance with the statutory enforcement notice and the results of that inspection are reported in the Staffing Section of this report. This key unannounced inspection took approximately ten hours. Ms Easbail Clements, an Expert by Experience, employed by Help the Aged, assisted me with the inspection and her findings are reflected within this report. The registered manager was present or available throughout the inspection. There were sixty-one people accommodated at the time of the inspection and three vacancies. Two people were in hospital at the time. The inspection activity included: meeting and speaking with the majority of people living in the home, a number of them independently; independent discussion with relatives and friends that visited on the day; independent discussion with a number of staff, including nursing, care and ancillary staff; detailed discussion with the registered manager and the senior administrator; independent discussion by telephone with a reviewing officer from the L.B. of Hackney and independent discussion by telephone with a contracts manager from L.B. of Waltham Forest. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection, a tour of the premises and documentation kept at the home. What the service does well: The home is working hard to provide good quality nursing and personal care to people with a range of complex needs. People living in the home, and relatives spoken to, were complimentary about the home and its staff. The home has a good quality training programme to help staff to keep their skills and knowledge up to date to assist meet people’s needs. The home is also proactive in informing the Commission and placing authorities of any significant events that effect people living at the home. The home itself is modern, purpose built and provides a clean and comfortable environment for people to live in. The Expert by Experience indicated that: My overall impression is that Aspray House is a busy home with lots going on. The staff were courteous and respected the residents and relatives. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 7 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 Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 8 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&3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a range of information available to help people make a decision about moving into the home. The needs of people are assessed by the home to assist staff to meet these needs when they are first admitted. Staff continue to reassess people’s needs in a range of key areas once people are living in the home to enable them to respond effectively to changing needs. EVIDENCE: I was given a copy of the home’s statement of purpose and service user guide, both of which had been revised in August 2007. These documents provided clear information for people living in the home and for people considering living there. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 9 At the last key inspection a requirement was made that staff undertaking a preadmission assessment of people’s needs are appropriately trained to do so. This was because the inspector undertaking that inspection was concerned that one person had been admitted to the home, from hospital, inappropriately and that a more robust pre-admission assessment may have identified this earlier. Evidence was seen at this inspection that the home had introduced a revised and more detailed pre-admission assessment format earlier in 2007. The preadmission assessment format covered both nursing and social care needs. Evidence was seen that senior staff that undertake these assessments had received appropriate training and direction regarding the new format. The files of ten people living in the home were inspected, three of these for people that had been admitted to the home since the last key inspection. There was clear assessment information on the files inspected, in the new format, for the three people admitted since the last inspection and the files indicated that the home was meeting these people’s needs. On files inspected for people placed by a statutory authority there was also pre-admission assessment information from placing authorities and health care professionals. Once admitted, people’s needs in key areas including, skin frailty, overall risk and moving and handling needs are reviewed on a regular basis by staff to assist them be aware of people’s changing needs. The home does not provide intermediate care. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has improved its systems to record people’s needs and to give guidance to staff on how to meet these needs, although people accommodated would benefit from some additional improvements in this area. People are supported to have their health needs addressed including by accessing a range of healthcare professionals. Effective medication policies, and procedures for its proper administration, safeguard people living in the home. Staff are working hard to treat people with respect and dignity, which is appreciated, although further information regarding the wishes of some people in the event of serious illness or death would improve this further. EVIDENCE: At the last key inspection a requirement from the inspection before that, in relation to care plans, was not inspected as the compliance date was beyond the date of the last inspection. The requirement was that care plans provide Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 11 sufficient detail to guide staff in the delivery of care. Care plans were seen on the ten people’s files inspected at this inspection and evidence was seen that this requirement was being met. All care plans seen had a guidance sheet attached to assist staff when drawing up and evaluating the care plan. This guidance sheet had three sections entitled: care plan factors, points to consider and assessment and monitoring tools. Each of these sections gave relevant bullet points to assist staff when writing and evaluating care plans. The plans inspected had a range of assessed needs including: personal care, communication, risk management, behaviour, nutrition, elimination and social well being/ activities. The plans also incorporated any specific nursing needs where appropriate for people receiving nursing care. The plans also gave sufficient guidance to staff on how to address the needs identified and staff spoken to were able to give examples of how the needs were addressed in practice. A number of the plans inspected had been signed by the person themselves or else by a representative. Evidence was seen that care plans were reviewed and evaluated monthly, with evidence seen that plans had been amended as a result of this review and evaluation. The Mental Capacity Act 2005 came fully into effect in October 2007 and this legislation gives a legal framework for how people are judged to have capacity to give consent to issues that effect their lives. It also gives a legal framework regarding how decisions may be made for people that are assessed as not having capacity to make decisions in a particular area. This has major implications for how people are cared for, especially for people with significant nursing needs and/ or with a diagnosis of dementia. The registered manager stated that she was aware of the implications of this legislation and that work would be starting soon to put this into practice in the home. Given the importance of the legislation and the vulnerability of people cared for in the home, a requirement is made regarding this. The registered persons must ensure that people’s care plans identify and record the areas that they are assessed as being competent in making decisions in and those areas that they are assessed as not being competent to make decisions in. This requirement is made to ensure that the home complies with current legislation and for the protection of both people living in the home and staff. A good practice recommendation is also made in the Staffing section of this report regarding staff training on the practical implications of the Mental Capacity Act 2005. It was noted that some files contained evidence of an annual review of need by the placing authority for those people so funded, to which relatives had been invited. The registered manager stated that other people’s overall needs were reviewed on a periodic basis, including those people that were self funded, but that relatives were not necessarily invited to those reviews. A number of relatives spoken to stated that they were satisfied with the care their person was receiving but that they had not been involved in any review meeting once the person has been admitted to the home. A good practice recommendation is made that relatives or other relevant stakeholders be invited to annual reviews of people’s needs to assist the home in the review Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 12 process. It was also noted that the home operates a named nurse and a key worker system, however there was little specific documentation available to record what work those staff members undertook. A good practice recommendation is made that named nurses and key workers produce a periodic written summary of the work they have undertaken to assist keep other staff informed of this work. Records were seen that people living in the home were registered with a GP and also had access to a range of external health professionals such as a dietician, chiropodist, optician and dentist. The registered manager stated that the home was currently having some difficulty keeping the continuity of dental support to the home but that this was being addressed. Evidence was also seen that the home address’s issues regarding skin fragility. This was from records inspected, staff spoken to and noting that the home had a range of suitable equipment such as ripple mattresses and cushions. Food and fluid intake is monitored to assist in this process. At the last inspection a requirement was made that people are supported to use appropriate chairs that are fit for purpose, this was because of a particular concern noted by the inspector that undertook the last key inspection regarding an identified person. Evidence was seen that this requirement had been complied with and that a new specialist chair had been purchased to resolve that problem. The inspector that undertook the last key inspection also made two other requirements relating to ensuring that other needs of the same person, and other people, were also met. A requirement was made that people must be responded in a timely manner when the call bell was used. The registered manager stated that following that requirement a revised procedure for answering the call system was put in place and a copy was given to me. Staff spoken to were aware of the revised procedure and were seen to respond appropriately to the call system when it was activated during this inspection. People living in the home that were asked indicated that staff usually attended within a reasonable time when they used their call alarm. The other related requirement made at the last inspection was that the moving and handling assessments for people living at the home are complete with the outcome recorded on the person’s care plan. The registered manager stated that all the moving and handling risk assessments had been reviewed as a result of this requirement and those I inspected were satisfactory. I observed the transfer of two people by staff during the inspection and these were undertaken in a safe way. The Expert by Experience raised a query with me regarding medication that that I subsequently explored with staff and was satisfied with the home’s medication procedures from the inspection activity on the day. Medication and medication administration record (MAR) charts were inspected for four people, two on a nursing unit and the other two on a residential unit. The medication corresponded to that recorded on the MAR charts and the charts were up to date. Each person had a medication profile including a photograph to aid safe Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 13 administration and a record of any known medication allergies. Controlled medication was also inspected for one other person on the nursing unit and this was properly stored in a controlled drugs cupboard. The controlled drugs register was up to date with two signatures seen to record administration of the medication. The home uses an appropriate contractor to dispose of unused medication as is required for a registered home with nursing. Records sampled of medication received into, and disposed of, by the home were up to date. On some files inspected there was a consent form regarding the home taking a photograph of a resident for that person’s medication profile, to assist the safe administration of medication and also for the use of bedrails where appropriate. Where those consent forms had been used it was not possible to differentiate whether the consent for was one or both of these issues. The registered manager stated that the identified forms should not have been used and that the home had separate consent forms for photographs and for bedrails, which I had seen on some files inspected. The registered manager stated that this would be addressed immediately. A requirement is made that the home must use separate consent forms for photographs, bedrails and any other identified actions the home has sought agreement to use with a person in order to protect that person and promote their welfare and dignity. A requirement was made at the last inspection that all people living in the home are offered a key to their private accommodation unless a risk assessment indicates otherwise. Evidence was seen on the files inspected of such risk assessments, including where a relative may hold a key to a person’s room. People spoken to, and relatives indicated that they were satisfied with access arrangements for their rooms. It was noted that one person, who chooses to spend a lot of time in their room had a gate fitted to stop other residents wandering in. This was properly documented on the person’s file and the person’s relative stated that they had requested the home to fit the gate. The person involved was unable to speak but indicated by gesture that they were happy with this arrangement. The Expert by Experience indicated the following: I spoke with service users and staff. I also had the opportunity to speak with several relatives and sought their views on the service. Two sisters who visit their mother on a regular basis explained they always found their mother clean and comfortable and on occasion a member of staff talking to her mother although the mother was unable to reply. Other relatives had no complaints about the food or their relatives care package. Some of the residents I spoke to were actually the first people to arrive at the home. I visited residents in their room on all three floors, and sat in the day rooms chatting to residents. They had no complaints about the home or staff. It was noted that there was a section on each person’s file to record their wishes or preferences in the event of serious illness or death and evidence was Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 14 seen that these were well recorded on the majority of the files inspected. However, on a few of the files inspected this section was blank and the registered manager stated that in some cases it was not possible to determine these wishes or preferences for some people. A requirement is made that the home must continue to endeavour to seek and respect people’s wishes and preferences in the event of serious illness or death and, where it has not been possible to obtain this information, this should be recorded on the person’s file to evidence this to placing authority’s and other stakeholders. Although a number of requirements and recommendations have been made in this section of the report it is my judgement that overall people experience good outcomes regarding their health and personal care. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 15 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 & 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from different activities being available within the home and within the community to meet their needs and preferences. Families and visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served good quality and appetising meals that they enjoy although further input is needed regarding an identified person’s nutrition. EVIDENCE: At the last key inspection a previous requirement that the individual social and leisure needs of people living at the home are planned for, was not inspected as the compliance date was beyond the date of the last inspection. Evidence was seen at this inspection that this requirement was being complied with. The home employs an activities coordinator and two assistants, the activities coordinator was spoken to independently. The home has a separate activities room where some activities including arts and crafts are undertaken. The home provides a range of other ongoing activities including: gentle exercise, softball Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 16 games, reminiscence work including in small groups, reading newspapers with people and bingo. The activities coordinator stated that the activities staff also endeavour to have individual sessions with people who may not be able to take part in group activities because of their specific needs, some evidence was seen from records to support this. I observed a gentle exercise group being held on one floor with some people from other floors being supported by staff to attend and join in. People seemed to be enjoying the interaction. The activities coordinator showed me photographs of people who had enjoyed trips out during the summer including a trip to Southend, Vestry House museum and Brook Lane Farm, a local town farm. The home also has entertainers visit the home on a monthly basis and was providing a Christmas activities programme during the time of this inspection. Evidence was seen from minutes of residents’ meetings that activities are discussed; it was noted from one set of minutes that people stated a preference for the majority of organised activities to be held during weekdays as many people received visitors at weekends. The Expert by Experience indicated the following: The first area I visited was busy with residents working with the activity staff. I was able to observe their inter action with the residents during a session of exercises that involved eye and hand co-ordination. Later in the day residents played musical bingo, which they all seemed to be enjoying with some of the residents singing along to the music. I could tell this was not the first time they had played the game as some were waiting to hear their favourite songs. I spoke to the activities manager and the two members of his staff, a worker and a co-ordinator. He told me they had a very busy two weeks ahead, children were coming from the local school to sing carols and other entertainment was planned leading up to the Christmas party, where each residents is given a present. It was noted that the activity coordinator held and was assisting to develop ongoing life history information on people, especially for those people with dementia. This is to assist develop more knowledge of what was important to individuals and helped in undertaking individual and small group exercises with people. This information was kept in the activities room and although the information was available for all staff it was not kept in the person’s main file, which is held with the care staff on the floor where the person is living. A good practice recommendation is made that copies of life history work are kept with the individual’s main file that is located with care staff on the floor that they are living. This is to ensure that information is as accessible as possible to all staff. Residents at the home include people from a range of ethnic minority communities and religions. The needs and preferences of some people from these communities were seen recorded on files inspected. It was noted that some had agreements recorded, including with relatives and other Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 17 stakeholders, about what activities and customs they wished to participate in and those they did not. It was noted that people were supported with their religious needs to the extent that they wished, including visits from representatives from different Christian churches including the Jehovah’s Witness church and an Imam from a local Mosque. One person living at the home originally came from Ghana and a member of staff who speaks Ghanaian interpreted for me when I spoke to the person. The interaction was relaxed and it was clear that the person very much appreciated being able to talk in their first language through the member of staff. Relatives and friends are encouraged to visit the home at any time during the day and evening. A number of relatives that visited the home were spoken to independently during the inspection. The majority expressed satisfaction with the home. One stated that they visited three or four times a week and were always made welcome by staff. They went on to say that their person was always well dressed, kept clean and the relative had no concerns about the person’s care. Another visitor stated that if they had any queries or concerns the staff would always see to it. One relative raised an issue in relation to their person’s room and this was fed back to the registered manager. At the last key inspection a previous requirement that staff receive training in how they can enable people living at the home to exercise more choice and control over their lives, was not inspected as the compliance date was beyond the date of that inspection. At this inspection evidence was seen that this requirement had been complied with and that staff were working hard to support people make as many decisions for themselves as they can. However, further documentary evidence of this is now needed following the introduction of the Mental Capacity Act 2005 and this is dealt with in the Health and Personal Care section of this report. The home has satisfactory systems for dealing with people’s finances with relatives or placing authorities being appointee for people when required. People are encouraged to bring their own possessions when they move into the home, one person living in the home was very proud of a bureau that they had bought from home and was keen to show it to me as a prized possession. Three requirements were made at the last inspection regarding the home’s meals. These were that the home ensures there is an alternative meal if a person does not like the existing choice of meals, that staff are available to support and supervise people at meal times and that food is available to meet the religious and cultural preferences of people. Evidence was seen to indicate that all three requirements were being met. The home has a four-week menu that is amended seasonally. The Expert by Experience and I were invited to have lunch, which we did on separate units. One person on the unit that I had lunch on did not like the pudding on offer on the day and was offered a banana instead, which they enjoyed. There were sufficient staff to support and assist people eat their meal and this was observed to be relaxed and unhurried. The home provides a range of culturally appropriate meals for people and the Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 18 registered manager stated that the home always has done. Examples on the menu included: fish stew, plantain and other Caribbean dishes, the home also provides Halal and Kosher meals for those people that require them. The home can cater for a range of dietary requirements such as diabetic and vegetarian diets. Feedback from people living at the home and from relatives was that people enjoyed the meals at the home. However, one person living at the home was observed asking for, and being given, a very large salt container and putting a significant amount of salt on his lunch. The person told me that they liked salt with their food. When I queried this with staff after the meal I was informed that the person’s family bought in the large salt pot and the person was persistent in asking for this. I checked the person’s care plan relating to nutrition and it stated that the person should be discouraged from eating too much salt and sugar, however, the care plan gave no further direction for staff on how this should be achieved given the person’s wishes and that the family had supplied the salt. A requirement is made that the person’s care plan and guidance to staff relating to the person’s salt intake is reviewed, including an assessment of the person’s ability to make an informed decision about salt intake, with the person and relevant stakeholders as deemed appropriate to assist promote the person’s physical health in this area. The Expert by Experience indicated the following: I went to the kitchen to speak with the chef. The kitchen was clean, the food being prepared looked well presented and appetising. The main meal was served at lunch time and supper was light either soup or sandwiches. The dining room where I had lunch had two servings. The first sitting was for those residents on soft diets who were fed in their rooms by staff. The second sitting had the choice of eating in their rooms or the dining room. I sat with two ladies I had spoken to earlier in the day, one of which was being fed by a member of staff. For lunch I had elected to try both options of the day. The first, chicken served in a sauce with mashed potatoes and broccoli, the second a stuffed baked potato both were very tasty and satisfying. The pudding however was a little tasteless and consisted of tinned pineapple and custard. I would have liked to have seen a selection of fresh fruit and instead of squash, fresh fruit juice. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 19 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 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home, and their relatives, have any concerns they raise taken seriously and acted upon appropriately. The home has clear policies and procedures for protecting people from abuse that staff are aware of. EVIDENCE: The home has a clear complaints policy that was seen. Four complaints/ concerns had been recorded at the home since the last inspection. Records of these were inspected and indicated that they had been dealt with in accordance with the home’s procedures. One of these complaints had been substantiated and the other three were not substantiated. People and relatives spoken to indicated that they were confident that any issues they raised with staff or managers would be promptly dealt with. No other complaints had been received by the home or by the Commission since the last key inspection. The home had a copy of the latest (2007) L.B. of Waltham Forest’s safeguarding adults policy and procedure, an in-house procedure that reflected current good practice. Staff receive training in safeguarding issues and staff spoken to were aware of how to respond should an allegation or disclosure of abuse be made to them. One safeguarding concern had been dealt with under Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 20 L.B. of Waltham Forest’s safeguarding adults policy since the last inspection. Minutes of the strategy meeting relating to this were sent to the Commission and the conclusion of the meeting was that the incident was not one of abuse. Another incident is currently being dealt with under L.B. of Waltham Forest’s procedures with a strategy meeting due to be held following this inspection. Full details of the incident and of the home’s response had been sent to the Commission at the time as is required under the Care Homes Regulations 2001. There had been no other disclosures or allegations of abuse made to the home or to the Commission since the last key inspection. The Expert by Experience indicated the following: I was rather worried about a lady who had bruising on her face. It looked as if she had fallen while wearing her glasses; I spoke to the manager who was in the room at the time and she explained what had happened. I did report this to the inspector and asked him to make his own enquiries. I subsequently followed this up with the registered manager and was satisfied that the incident had been properly reported and that action had been taken to minimise further risk to the person in question. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 21 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, 21, 22, 24,25 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a modern, purpose built home that is well equipped, well decorated, well furnished, well maintained and that meets their needs. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors EVIDENCE: The home was purpose built and opened in 2004. It is well furnished, well decorated and well maintained and meets the needs of people that live there. Accommodation at the home is on five floors. The ground floor, Emerald Suite, has twenty places for nursing care for older people; The first floor, Opal Suite, has twenty places for nursing care for older people with a diagnosis of dementia; The second and third floors, Sapphire Suite and Topaz Suite Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 22 respectively, each have twelve places for residential care for older people with a diagnosis of dementia. The fourth floor consists of the manager’s office, staff facilities including a training room, the home’s main kitchen, laundry facilities and a hairdressing salon for people living at the home. All floors are linked by two flights of stairs and a passenger lift. The home has a pleasant garden and patio area at the rear and a paved car parking area at the front. CCTV is used as a security measure at the entrance to the home and does not infringe on the privacy of people living in the home. Each of the four floors that people live on have kitchenettes, dining and lounge areas and suitably adapted toilets and bathrooms. The home also has a range of suitable specialist equipment such as hoists and grab rails to meet people’s needs. At the last inspection a requirement was made that bathrooms are not used to store equipment. No inappropriate equipment was seen stored in bathrooms during this inspection. Bedrooms seen during the inspection were comfortable and had been personalised to the taste of the person living in them. All floors are connected by lift and two flights of stairs. A number of notice boards were seen in communal areas throughout the home and these contained a range of useful and current information for people. There are a range of signs and pictures on doors to bedrooms and to other communal areas to assist people to find where they want to go and the building meets the needs of people living in it. The home was suitably decorated for Christmas. The Expert by Experience indicated: Aspray house is a fairly new purpose built care home, which provides all modern equipment and facilities for people living there. The environment within the home was clean and well organised. The laundry facilities are suitable to meet people’s needs and the home and the home had suitable infection control procedures that staff spoken to were aware of. The home was free from offensive odours, clean and tidy throughout during the inspection. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 23 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 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported by staff team with sufficient numbers to address their needs and who have a range of competencies. Staff have access to a wide range of training opportunities although people living in the home may also benefit from further staff training relating to a new piece of legislation related to giving informed consent. People accommodated are now better protected by improvements that have been made to home’s recruitment procedures. EVIDENCE: Staff at the home are currently deployed as follows: Ground and first floors (20 place nursing units) – I nurse and 4 care staff on the early shift, 1 nurse and 3 care staff on the late shift; on the second and third floors (12 place residential units) – 2 care staff early and late shift. In addition each of the 4 units has a full time housekeeper who undertakes a range of duties including assisting at meal times. At night the home employs 2 nurses and 6 care staff to cover as required. The registered manager is in addition to the above and the home also employs an activity coordinator, 2 assistant activity coordinators, a senior administrator, administrator, kitchen and domestic staff. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 24 At the last inspection a requirement was made that a staffing level review is undertaken for each of the 4 units and that there are sufficient numbers of skilled staff on duty to meet the residents’ needs. The registered manager stated that the home had reviewed its staffing levels and had introduced a more flexible system by which additional staff could be deployed if there was a need for more intense work with a person that required additional staff. The registered manager showed me written evidence of when additional staff had been deployed since the last key inspection. This was following a planned change in a person’s medication and where the person needed additional support during this process. The requirement about reviewing staff levels had been made by the inspector undertaking the last key inspection because of identified concerns at that time including feedback that sometimes people living at the home were having to wait for staff attention. I spoke independently to a reviewing officer from L.B. of Hackney who stated that she was satisfied with the care of people placed from L.B. of Hackney that she had reviewed. However, she went on to say that she had queried staffing levels at the home with the registered manager earlier in the year and had also been told about the flexible use of additional staff when required. From observation throughout this inspection and from feedback from people living at the home and relatives spoken to, the staffing levels appeared sufficient to meet the needs of the people living at the home at that time. However, the importance of continuing to keep staffing levels under review to meet people’s changing needs was reinforced with the registered manager who stated that she fully accepted this. The home’s staff training matrix record showed that 17, approx. 60 , of the care staff have achieved the national vocational qualification (NVQ) level two in care or above. At the last inspection serious shortcomings in the home’s recruitment process were identified including unmet requirements from the inspection prior to the last one. As a result of these shortcomings the Commission issued a statutory enforcement notice requiring the home to: • Obtain in respect of all persons employed at the home all the relevant information and documents as required by Regulation 19 (1) (b) and paragraphs 1 to 9 inclusive of Schedule 2 of the Care Homes Regulations 2001. Put in place arrangements at the home to ensure that persons are not employed at the home until such time as you have obtained all the relevant information and documents as required by regulation 19 (1) (b) and paragraphs 1 to 9 inclusive of Schedule 2 of the Care Homes Regulations 2001. • Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 25 • Put in place arrangements at the home to ensure that all employment history and references are adequately verified prior to any offers of employment being made. The notice also informed the registered person that if they failed to comply within the given timescale they could be prosecuted without any further notice or warning. I undertook an unannounced random inspection of the home on 8th November 2007 to test compliance with the statutory enforcement notice. I had previously received a copy of the registered provider’s response to the statutory requirement notice. This stated that the home had previously received a batch of application forms from Peninsula Services, a consultancy company the home uses, that had the dates for employment section missing and that the registered manager had subsequently removed this batch of application forms. The response stated that for one person concerned the dates of employment had been hand written into the box entitled Job Title and History. The response also stated that the home had introduced a new and formalised approach to show in detail how references are verified. The letter also confirmed that enhanced criminal record bureau (CRB) checks are now in place for all employees of Twinglobe Care Homes Limited. At the random inspection on 8th November 2007 the registered manager and senior administrator showed me current documentation relating to the home’s recruitment procedure. They also explained to me how the recruitment procedure was undertaken by the home, including the revised system for verifying references and in my judgment this was satisfactory. At the random inspection I also inspected the files of four of the latest staff members of staff to be employed at Aspray House, all of whom had started work at the home between July and October 2007. All of these files showed satisfactory evidence of the required documentation having been received by the home and that the home had operated a robust recruitment procedure in relation to these employees. Documentation seen on the files inspected included: proof of identity, including a recent photograph; a clear employment history, with dates, that was included on the application form; two written references including a last employer reference, with evidence that they had been verified using the newly introduced formal verification system; an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, that had been obtained by the home before the person had commenced work there; a contract of employment and evidence of a statement by the person as to their mental and physical health. At the last key inspection a requirement that further training in response to the skill gaps identified at the previous inspection, was not inspected as the compliance date was beyond the date of the last inspection. At this inspection Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 26 it was noted that the home was providing staff with a wide range of training. The home is currently part of a pilot scheme being run by City University, London, called “Relationships and Person Centred Care”, which is primarily about developing well being for people with dementia. The registered manager stated that 23 staff from the home were completing the 12 month programme. Staff are divided into 3 groups: the registered manager; senior nurses, nurses and senior carers and care assistants. Each group has a personal tutor that provides both group and individual input in relation to the work tasks and responsibilities the different groups are undertaking and the course includes elements of both practice and reflection. A number of staff spoken to independently stated that they found this course particularly helpful. Evidence was also seen that some staff at the home have are also undertaking training in palliative care to the National Health Service “gold standard” level. Both the above courses are aimed and providing better outcomes for people living at the home. In addition to the above a staff training matrix was seen to evidence that the home is implementing a rolling programme of induction for new staff and core skills training, including refresher training, for all staff. A registered nurse employed at the home stated that she was supported and encouraged by the registered manager to keep up to date with her nursing skills as part of her ongoing professional development as a nurse. It was noted during the inspection that staff in the home have not received formal training on the practical implications of the Mental Capacity Act 2005, which came fully into effect on 1st October 2007. This legislation is particularly relevant for assessing whether people accommodated have the capacity to give consent or make decisions about a range of areas that affect their lives and a requirement is made in the Health and Personal Care section of this report that more detailed recording in this area is needed. A good practice recommendation is made in this section of the report that managers and staff at the home receive training on the practical implications of the Mental Capacity Act 2005. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 27 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, 36 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from the service being managed by a competent, qualified and experienced registered manager. People accommodated and other stakeholders are regularly consulted to promote and monitor the quality of the service they receive. People’s financial interests are safeguarded while living in the home. Staff supervision is provided to support staff meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. EVIDENCE: The registered manager is a registered nurse and has many years experience working with older people both within the independent sector and with the National Health Service. The registered manager has also achieved her Registered Managers Award and has qualifications in both dementia care and Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 28 palliative care, she has managed the home since it was first registered in 2004. People living in the home, staff and relatives spoke highly of the registered manager and she presented as being knowledgeable and competent about the needs of older people and managing the home. The home has quality monitoring mechanisms in place that include regular questionnaires being sent out to people using the service and to other stakeholders, regular unannounced monthly monitoring visits to the home by the registered provider and prompt notification to the Commission and placing authorities of any significant incidents that take place in the home. An improvement plan was sent to the Commission following the previous inspection and I was pleased to be able to confirm compliance with the requirements made at this inspection. A contracts Manager from L.B. of Waltham Forest was spoken to independently by telephone. He stated that the Borough had a block contract with the home and that the Borough remained satisfied with the service provided by the home. At the last inspection three requirements were made relating to the home safeguarding money held for people living in the home. These were that the home must ensure that people’s money is only paid into bank accounts in their name and desist the pooling of people’s funds. (At that time money was paid into a single resident’s account that was separate from the home’s accounts but people were not receiving interest on their money); people were protected by detailing the role of staff in managing residents’ personal finances and the safeguarding measures in place and the management processes within the home are reviewed to ensure that people’s (finances) are adequately protected. The inspector that undertook the last inspection stated that the monitoring systems in place at that time for looking after people’s money appeared sufficiently robust but that the system of pooling money into one account must cease. The registered manager stated that since then the home has not held any money for residents, which is now held by placing authority’s, relatives or other stakeholders. Evidence was available, including from staff spoken to independently, that staff receive supervision at least every two months. Staff spoken to felt that this was useful. A range of satisfactory health and safety documentation was seen. This included: gas safety certificate, electrical installation certificate, portable appliance certificate and water tank maintenance to minimise the risk of legionella. The home’s fire log was inspected and showed: up to date servicing of fire fighting equipment, a record of fire drills being undertaken and an up to date fire plan and fire risk assessment. Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 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 3 4 X 3 3 X 3 4 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14 & 15 Requirement Timescale for action 31/01/08 2. OP7 17(1) 3. OP11 12(3) The registered persons must ensure that people’s care plans identify and record the areas that they are assessed as being competent in making decisions in and those areas that they are assessed as not being competent to make decisions in. This requirement is made to ensure that the home complies with current legislation and for the protection of both people living in the home and staff. The registered persons must 31/01/08 ensure that the home has in place separate consent forms for photographs, bedrails and any other identified actions the home has sought agreement to use with a person. This in order to protect that person and promote their welfare and dignity. 31/01/08 The registered persons must continue to endeavour to seek and respect people’s wishes and preferences in the event of serious illness or death and, where it has not been possible to obtain this information, this should be recorded on the DS0000044296.V356099.R01.S.doc Version 5.2 Aspray House Page 31 4. OP15 13(4) person’s file to evidence this to placing authority’s and other stakeholders. The registered persons must ensure that the care plan and guidance to staff relating to an identified person’s salt intake is reviewed, including an assessment of the person’s ability to make an informed decision about their salt intake, with the person and relevant stakeholders as deemed appropriate to assist promote the person’s physical health in this area. 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP7 OP12 Good Practice Recommendations Named nurses and key workers should produce a periodic written summary of the work they have undertaken in that role to assist keep other staff informed of this work. Relatives or other relevant stakeholders should be invited to annual reviews of people’s needs to assist the home in the review process. The home should make a copy of people’s life history work is kept with the person’s main file that is located with care staff on the floor that they are living. This is to ensure that information is as accessible as possible to all staff. Managers and staff at the home should receive training on the practical implications of the Mental Capacity Act 2005 to assist them in implementing this new legislation for the benefit of people living in the home. 4. OP30 Aspray House DS0000044296.V356099.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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