Inspection on 25/06/07 for Aspray House

This inspection was carried out on 25th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Aspray House 10/12/07

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 Zita McCarry Unannounced Inspection 10:00 25th and 29th June 2007 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.V343574.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.V343574.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.V343574.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. 29th March 2007 Date of last inspection Aspray House is a registered care home for 64 older people. The home is registered to provide dementia care for 44 people and nursing care for 20 people including care for people with physical disabilities. The home was first registered as Twinglobe Care Home and subsequently changed the name to Aspray House. The home is part of Twinglobe Care Homes Limited. The home is situated at the heart of Leyton in the London Borough of Waltham Forest. The home is within easy access to public transport, shops and other community amenities. The home was registered with the Commission for Social Care Inspection (CSCI) on 13.8.04, providing 64 beds with en-suite facilities in four suites: Emerald and Opal with 20 beds each, and Sapphire and Topaz, each with 12 beds. Aspray house is a purpose built care home, which provides all modern equipment and facilities for service users. The bedrooms are spacious, light and airy. All have en-suite facilities, and assisted bath and shower rooms are close by. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report of an unannounced inspection undertaken over two visits at the end of June 2007. The purpose of the inspection was to test the service’s compliance with requirements made at an earlier inspection in March 2007. The inspector spoke with service users and staff. The inspector spoke with 4 relatives and sought their views on the service. She read records relating to the management of the home and records pertaining to the care delivered to service users. The inspector undertook a tour of the home and was assisted in the process by the registered manager and administrator. The inspector would like to thank everyone at Aspray house for their assistance in the process. At the inspection in March 2007, 20 statutory requirements were made as a result of findings. Of these 20 the timescales had not been reached on 4 of these so they were not tested at this inspection. Of the 16 tested 12 of these statutory requirements were found to have been met so there was good evidence that the service was working toward improving outcomes for service users. What the service does well: What has improved since the last inspection? In a relatively short period of time the service has put in place many key improvements. Revision work has begun on the development of service users life histories. The service has introduced a comprehensive pre admission assessment although staff now need to be trained in its use. The service has improved the recording of complaints and could evidence the appropriate implementation of safeguarding processes. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 6 The service keeps the Commission advised of occurrences in line with regulation. 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.V343574.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.V343574.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): Quality in this outcome area is adequate. However for prospective service users to be confident that their needs will be appropriately assessed staff will need to have further training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had only been one admission into the service since the last inspection so the inspector reviewed the process. In response to requirements made that the last inspection the service has introduced a new assessment format. The document is comprehensive and addresses all aspects of needs as detailed in the standards. It was evident that as a new process staff may not feel confident in its completion. Crucial areas to be completed went unaddressed. For example the documents asks questions about the prospective service users dementia, type of dementia and if under the care of mental health service. These questions were unanswered. Similarly the assessment seeks information Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 9 on the state of the service users wellbeing but the person completing the assessment recorded only “spoke well”. Despite the lack of information the service user was admitted to the home. The initial incomplete assessment of need was counterbalanced by an extremely thorough and detailed assessment that was undertake after admission. The assessment detailed the service users cognitive ability and the history of his life. The outcome of the assessment was that at this stage in the service users life he would not be appropriately placed in Aspray House and the inspector was very pleased to note the service was advocating on his behalf to be transferred to a more independent environment. The service user actually left the home on the day of the inspection. It could be said that the preadmission assessment should have indicated the inappropriateness of Aspray as a placement for the service user however the assessment took place in hospital where he was recovering from a bout of ill health and this may have presented a different picture. However in this instance the inspector was satisfied the service responded appropriately to new information in relation to the service users changing needs. Aspray House DS0000044296.V343574.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): Quality in this outcome area is poor. Service users are not consistently provided with prompt assistance and support when in discomfort or distress. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the last inspection the service was required to improve upon it care planning arrangements. The timescale had not expired at this inspection so the standard was not tested. It will be tested thoroughly at the next inspection. It was noted that the service is currently reviewing the life history work it undertakes with service users but this will be more fully assessed as part of the next inspection. The inspector reviewed accident and incident records there was a notable improvement in the recording of these. Most of the accidents involved falls and there was a management review of these. The service was able to demonstrate that it took prompt and appropriate action in response to accidents. The Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 11 manager reported that no service user in the home had pressure sores although on occasion service users are admitted from hospital with these. The inspector was concerned to note the apparent lack of attention given to a service user. The service user who was in her bedroom called to the inspector asking for assistance as she reported she was very uncomfortable in the chair she was sitting in. The service user was clearly uncomfortable she was grimacing and her feet were not supported on the floor or a stool. The inspector sought the attention of a member of staff and reported to her the service users complaint. The inspector returned to the unit an hour and a half later and the distress of the service user had increased, she told the inspector: “I’m all aches and pains and no-one will take any notice……I’ve been like it all day and all day yesterday…nobody takes any notice”. The service user was very uncomfortable her legs were hurting and her body was very poorly supported in a chair that was not suitable for her needs. The inspector spoke with the sister in charge she had not been advised of the service users/inspectors early request for attention and none was provided. It was explained to the inspector that the service user usually sits in a more appropriate chair which is she reportedly finds very comfortable. Whilst the bedroom door was open the service user was isolated in her room with nothing to distract her from her discomfort. It was explained that the service user usually spends her day in the lounge. The explanation as to why she was not using her appropriate chair in the lounge was unacceptable to the inspector. The inspector was told the service user had slept poorly the night before and was tired which is why she was in her bedroom. It would be expected in such an event the service user should have been supported to remain comfortably in her bed to rest. It is of serious concern that a service user of should be left in this level of discomfort and distress for such a period of time. The inspector reviewed the service users moving and handling assessment which was over a year old it failed to give staff clear instruction on the correct moving and handling for the service user comments such as “correct hoist to be used” and “enough staff when attending” is inadequate strategies to direct staff in transferring the service user. The inspector undertook a random audit of medications within the home. The medication system is a well organised and stored securely in rooms with temperature controls. Six service users medications were audited and all of these records evidenced the service was recording them being received into the home, administered as prescribed and recorded when removed. One of the service users who the inspector spoke with reported that staff were respectful and always knocked before entering his room. However later in the day when he invited the inspector to speak with him in the privacy of his room another service user was in his bed. He confirmed to the inspector that he had Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 12 not been provided or offered a key to his room. The service user stated he was unaware that he could have a key to his room and said that other service users coming in uninvited to his personal space was one of the most annoying aspects of his stay at Aspray House. He confirmed to the inspector that it was a very frequent occurrence. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 13 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): 13, 14, 15 Quality in this outcome area is good. Service users living at Aspray house can be assured that staff and management will advocate on their behalf. However not all service users are satisfied with the variety, choice and presentation of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last inspection a requirement was made in relation to the social and leisure needs of service users. At this inspection the timescale on the statutory requirement had not expired so the standard was not tested. The requirement will be carried forward and tested at the next inspection. The service has no restriction on visiting within the service and there are a number of spaces on each floor where service users can receive their visitors in private. One relative described to the inspector how the service was supportive and prompt in finding a resolution to her concerns. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 14 There were several examples obtained during the course of the inspection where service users were supported to exercise autonomy and choice over their daily lives. As noted earlier the manager of the service demonstrated herself as strong advocate in supporting a service users choice in where he lived. Where there was restriction on autonomy this was supported by a risk assessment. One service user complained that he could not get access to his belongings which he indicated were stored in a locked cupboard in his bedroom. Staff caring for the service user confirmed this to be the case and reported that this was as a result of a risk assessment. The inspector tracked the service users records and noted the risk assessment and the strategies that infringed the service users autonomy were considered and well documented. There was very mixed commentary on the food provided. One service user described his lunch of home made chicken pie as “disgusting” sliding the plate to the inspector he challenged her to tell him with it was. The inspector was unable to do so, his lunch appeared unappetizing and not well presented There were no care staff around and the service user was not provided with an alternative. The service user qualified his judgement by stating that whilst he didn’t enjoy the meal the food was “usually alright”. The ancillary staff described to the inspector how service users make a choice about their food and it is based on these choices that food is prepared in the kitchen. On the unit the inspector visited the meal was a rather functional process. There were 2 service users sitting at separate tables with no staff visible other than ancillary staff washing up in the kitchen next door. The worker reported that on that particular unit there were 11 service users who needed assistance with feeding and the three care staff were busy undertaking that task in individual service users rooms. Another service user told the inspector that the food was “OK” and a third reported that he is always provided with the same food with little variety saying “I get the same food every day – mash”. It was noted that another service user logged a formal complaint about the quality of food provided in the home. The menu does provide for alternatives and choice however on the service users selection sheet completed by staff before it was sent to the kitchen service users unanimously choose only one option. The service will need to review the menu planning to ascertain how appealing the alternative dish is. It has been noted from the service’s annual quality assurance assessment that the service only purchases Halal meat for consumption within the home. This information has been provided as an example of how the service promotes equality and diversity. The provision of Halal meat for service users who require a Halal diet on grounds of their religious need is indicative of a service respecting the diversity within the home. However the provision of Halal meat for all service users who do not require this diet is indicative of a service failing to address the diversity within the service user group. Whilst the inspector did not survey the service user group it may well be that there are service users Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 15 living in the home who having information and opportunity may object to being provided with meat that was sacrificed. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. Service users living in Aspray House and their advocates have their concerns and complaints logged and responded to appropriately. The service demonstrates its ability to respond appropriately to suspicions of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the complaints received in the service since the last inspection. There had been seven complaints logged which ranged form the hairdresser failing to arrive and domestic cover. Six of these complaints were responded to within timescale. One complaint in relation to the care provided was investigated by the managing organisation. The complaint was not upheld and there was evidence that the service responded appropriately in relation to the incident. There was evidence obtained by the Commission that the service acted promptly and appropriately in notifying the local authority about a safeguarding concern within the home. There was evidence that staff promptly reported their concerns to the manager who in turn notified the Commission and Waltham Forest Adult Protection team. The matter was satisfactorily resolved. The service has in place adult protection procedures in line with local protocols. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 17 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, 22, 26 Quality in this outcome area is excellent. Service users live in a clean and homely environment that is very well maintained and comfortable. The service will however have to ensure that bathrooms are not used as storage areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Aspray House is a purpose built home which is accessible and well maintained. The service complies with all the local fire and environmental departments. CCTV is used as a security measure only at the entrance to the home and does not infringe on the privacy of service users. The home is well maintained, it is decorated and furnished to a high standard. The service is well equipped with specialist equipment that meets the individual and collective needs of the various service user groups. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 18 A tour of the home evidenced an apparently clean service that was free from malodours, which is indicative of good continence management. However the service will have to find an alternative to the bathrooms as storage facilities. The inspector noted 2 hoists, a linen trolley and a clinical waste bag stored in bathrooms. The service has in place infection control policies and procedures and the laundry is appropriately equipped. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. Service users cannot be assured that the management of the service have taken steps to ensure their safety by undertaking adequate pre-employment checks that are designed to protect them from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home consists of 4 group living areas one on each floor of the home. This report comments on the staffing levels of a floor registered for 20 service users. On the day of the inspection there were three staff which included a nursing sister leading the shift. The vast majority of service users spent the day in their private rooms with the door open. As most of the service users were in their rooms staff were not always evident as they were assisting service users there. The inspector was concerned about the staffing levels at peak periods for example at lunchtime. As commented on earlier there were 11 service users to assist with feeding and 3 staff to undertake the task. The result was that in the kitchen service users meals were all plated up and left on a rack of trays, as staff finished feeding one service user in their room they return to the kitchen to reheat the plated meal in the microwave and then go and assist the next service user. Meanwhile the service users not in their bedrooms did not have care staff supervision at mealtimes. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 20 Two relatives the inspector spoke with commented on the staffing levels in the home. One described the circumstances of a service user having an accident in the lounge and there were no staff available in the area and staff had to be found to assist the service user off the floor. Another relative confirmed the inspectors observations of the inadequate staffing levels at peak times particularly meals as many service users appear to require assistance. Relatives commented positively on the activity co-ordinator in the home but were concerned that in his absence at the weekends there is little to occupy service users. On relative commented on staff communication skills with service users. The relative’s perception was that staff will interact with service users only when undertaking a task with the service user but stated that they do not sit and chat or read a newspaper with someone. It is unclear if is this is because of staffing levels and that staff are too busy to spend time sitting with service users or if it is a gap in skills. However the outcome for service users is unsatisfactory. One service user reported to the inspector that staff were not always responsive to her saying: “I call the nurse she never comes, I don’t know why we have nurses that never come. In the night I call out nobody comes”. The inspector would verify the service users experiences on the day of the inspection. There was evidence during the course of the inspection that a member of staff allocated to cover a unit was not familiar with the nurse call system. Later in the morning the inspector activated an alarm in a bath/shower room to test staff response. There were two staff on the unit at the time and both were assisting a service user in the privacy of their room. It was noted that a member of staff came out of the service users bedroom and silenced the alarm without checking the nature of the assistance call. It took staff 5 and a half minutes to respond to the call. The inspector cannot say with any certainty whether the poor response to a call for assistance was a result of incompetence or insufficient staffing levels. However the incident indicates that the service is failing to demonstrate a prompt response to service users calls for assistance. 47 of the staff team at Aspray House have an NVQ level 2 or equivalent. Whilst this is less than required there are another 24 of the staff team working toward the qualification. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 21 The recruitment processes within the home were inspected. On the day of the inspection three new staff were being inducted. The inspector checked two of these new member of staff’s files. The service has revised it application forms and the new format does not facilitate the applicants’ employment dates. Therefore the service has no means of identifying employment gaps to explore at interview. It was evident that the service had appointed both employees on the basis of a PoVA 1st check and not an enhanced CRB disclosure. Appointment on the basis of a PoVA 1st check is acceptable in exceptional circumstances where there is pressure on the service to recruit and failure to do so would put service users at risk. In such circumstances the service would need to be notifying the Commission of the staffing crisis in Aspray House. The Commission was not advised accordingly. Had the Commission been advised the manager would have been reminded of the special supervisory and induction arrangements that would have need to be put in place. The Commission would also have stressed the importance of very robust vetting on all pre-employment checks. At the inspection the service was unable to demonstrate it had undertaken such checks with sufficient diligence. Employee A Appointed on the basis of a PoVA 1st check. Photographic identification was present on file. Whilst employment dates were not available the applicant had recorded that she had worked in a care home. The references supporting the application bore no relevance to her suitability as a careworker, despite previously working in a care home no references from here were sought despite details given. The service were unable to demonstrate that it had verified the references . Employee B Appointed on the basis of a PoVA 1st check. Again there were no dates on the application form so gaps in employment or length of service could not be identified. Two references were given in which the applicant alleged were previous employers. The inspector undertook to verify the references during the course of the inspection and both were from apparently bogus organisations which did not exist as claimed by the applicant. The manager made arrangement to meet and clarify her application for employment. However the employee flee the building leaving her personal belongings behind. If the service had undertaken a sufficiently robust vetting and verification the applicant would never have been appointed and service users would not have been put at risk of harm. At the previous inspection the service was required to demonstrate a robust recruitment process, the evidence detailed above demonstrates a failure to comply with statutory requirements and as a result service users were put at Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 22 risk. In light of this the Commission will take enforcement action to ensure compliance and secure the safety of people who use the service. At the previous inspection the service had been required to provide further training in relation to gaps identified. The timescale had not expired at this inspection so these were not tested. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 23 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, 35, Quality in this outcome area is poor. The service users in the home are not adequately protected from harm because of a poorly managed recruitment process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the service is a qualified nurse and has extensive experience in working with the service user group. Whilst some of the requirements from the previous report have not been tested there is good evidence that the registered manager has worked hard toward complying with previous requirements. However the safe recruitment of staff is a key management responsibility and the management of the recruitment of staff into the service Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 24 evidences a departure from any safeguarding responsibilities. The presentation of references from a bogus organisation that did not appear to have been unverified is concerning as these should have been a tool to consider the safety and appropriateness of the recruitment decisions. The inspector checked the service arrangements in relation to service users personal finances. The home has a safe and an electronic printout listing the contents. The home will need to issue service users with receipt for all items held for safekeeping. Again on computer printouts the service keeps a running balance of personal monies held for service users. The inspector randomly selected 4 accounts to check. It was noted that the actual cash held tallied with the balance recorded on the cash record sheet. There was receipts for expenditures. However the organisation pools service users personal monies in one bank account called “Twinglobe Care Homes Ltd No 2 A/C”. In this account service users menies have accumulated and up to a week before the inspection there was over £34,000 in the account one service user personal monies accounted for over £20,000 of this. By managing the service users finances in this way it is evident that no service user has received interest payments on their savings. Whilst the inspector is not trained in financial auditing the computerised system of accounts appeared to be well organised and the inspector was able to track a selection of transactions. The regulations require that as far a practicable no person working in the home can act as an agent for the service user. However Twinglobe staff do have a role in the management of this account. For example if an expense is incurred such as a chiropody bill, the bill is forwarded to Twinglobe head office for payment, when the bill is paid the administrator within the home creates another bill in which she charges all the service users who received a chiropody service she then either makes a payment from collecting cash form monies held on behalf of service users or by writing a cheque to Twinglobe raised against the service users pooled monies held in the Twinglobe Care Homes Ltd. There was evidence that the service director undertakes a monthly audit and ensures that the cash held and bank account is reconciled every month. So this appears sufficiently robust. However the service will have to cease pooling service users monies in a bank account that is not in their name. Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 2 X X X 4 STAFFING Standard No Score 27 2 28 3 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 2 X X X Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 18 Requirement The registered manager must ensure that the staff undertaking the preadmission assessment of service users needs are appropriately trained to do so. The registered manager must ensure that service users are supported to use appropriate chairs that are fit for purpose. The registered manager must ensure that service users receive prompt and appropriate attention when required. With a view to reducing the likelihood of reoccurrence the registered manager must employ the organisations procedures to ascertain why staff failed to respond to the service users distress and discomfort on the day of the inspection. The registered manager must ensure that all service users are offered a key to their private accommodation unless a risk assessment indicates otherwise. The registered manager will have to review the menu planning to ensure appropriate alternatives DS0000044296.V343574.R01.S.doc Timescale for action 01/10/07 2 OP8 12 01/10/07 3 OP27 12 01/10/07 4 OP8 18 01/10/07 5 OP10 12 01/10/07 6 OP15 16 & 24 01/10/07 Aspray House Version 5.2 Page 27 7 OP15 18 8 OP15 12 9 OP22 23 10 OP27 18 & 24 11 OP35 20 12 OP35 20 13 OP31 24 & 18 14 OP7 15 15 OP8 13 &15 and variety are provided. In the event a service user is unhappy with the food provided there must be an alternative available to offer. The registered manager will have to ensure care staff are available to supervise and support all service users at mealtimes. The registered manager will have to ensure that the provision of food is appropriate to the individual cultural and religious persuasion of the service users. The registered manager must ensure that service users bathrooms are not used to store equipment. The registered manager must undertake a staffing level review for each of the 4 group living units and ensure there are sufficient number of skilled staff on duty to meet the service users needs. The registered manager must ensure that service users monies is only paid into bank accounts in their name and desist the pooling of service users funds. The registered Provider must ensure that service users are protected by detailing the role of staff in managing service users personal finances and the safeguarding measures in place. The registered provider must review the management processes within the home and to ensure service users are adequately protected. The registered manager must ensure that care plans provide sufficient detail to guide staff in the delivery of care. Not tested at this inspection. The registered manager must ensure that the moving and DS0000044296.V343574.R01.S.doc 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 20/07/07 01/10/07 Page 28 Aspray House Version 5.2 16 OP12 12 &15 17 OP14 18 18 OP27 18 handling assessments for service users are complete with the outcome recorded on the service users care plan. Repeated requirement over 2 inspections. The registered manager must ensure that the individual social and leisure needs of service users are planned for. Not tested at this inspection. The registered manager must ensure that staff receive training in how they can enable service users exercise more choice and control over their lives. Not tested at this inspection. The registered manager must evidence of further training in response to the skill gaps identified at this inspection. Not tested at this inspection. 20/07/07 30/07/07 20/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Aspray House DS0000044296.V343574.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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