Inspection on 04/06/08 for Aspreys Nursing Home

This inspection was carried out on 4th June 2008.

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

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

Aspreys Nursing Home 23/04/09

Aspreys Nursing Home 06/12/07

Aspreys Nursing Home 25/04/07

Aspreys Nursing Home 13/09/06

Aspreys Nursing Home 08/12/05

Aspreys Nursing Home 06/04/05

Aspreys Nursing Home 12/10/04

Aspreys Nursing Home 29/06/04

Aspreys Nursing Home 04/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Aspreys Nursing Home 1 Kents Road Torquay Devon TQ1 2NL Lead Inspector Rachel Proctor Unannounced Inspection 4th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aspreys Nursing Home DS0000028780.V364395.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. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aspreys Nursing Home Address 1 Kents Road Torquay Devon TQ1 2NL 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) 01803 201500 01803 201700 matron@aspreys.co.uk Friendly Care Homes Ltd Vacancy Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (10), Physical disability over 65 years of age of places (25) Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two lower ground floor rooms must not be used for Service Users who require nursing The number of Service Users who require nursing is limited to 31 A minimum staffing level that follows the previously agreed Health Authority staffing notice must be available to meet the needs/dependancy of Service Users who require nursing One named Service User, named elsewhere, under 60 yrs of age (PD Category) Service Users from age 60 years and above may reside at the home. 4. 5. Date of last inspection 6th December 2007 Brief Description of the Service: Aspreys Nursing Home is located in Wellswood, approximately one mile from Torquay town centre. It has level access to the local shops, pubic house and restaurants all being within 100 yards from the home and the St Matthias Church is within 200 yards of the home. The home operates its services on all of the four floors with the dining room and rear garden area being on the lower ground level, the lounges, matrons office and some rooms on the ground floor and the remaining rooms being on each of the two upper floors. All floors can be reached by a shaft lift. The home offers both Nursing and personal care mainly to people over the age of retirement (60 years). It is registered for up to 31 people who require nursing and for 2 people who require personal care only. The staff group is made up of registered nurses and social care staff (Health Care Assistants). There is a good level of specialist equipment like a Parker bath, hoists and stand aides available to meet the needs of disabled people. The inspection report is available on request at the home. A service users guide is provided in each person’s room and the homes statement of purpose is provided in the reception area of the home. The fee levels were stated at the time of this inspection as a range from £350£570. The current fee levels can be obtained by contacting the home. The fees are dependant on the care needs of the peoples and the room Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 5 occupied. Those people who require nursing care have higher fees. Additional charges include chiropody, hairdressing and any personal purchases. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection took place on 4th June 2008. This was a key unannounced inspection. A visit to the home was undertaken as part of the inspection. During this visit a tour of the home was completed. Four people had their care followed; three of these had been admitted for respite short-term stay at the home. People living at the home and staff were spoken to and some records were inspected. The owner was present for the latter part of the inspection. Information received from the home since the last inspection was also reviewed. The inspector spoke to one health and social care professionals who visited the home during this inspection. Some of the comments made during in the inspection have been incorporated into this inspection report. What the service does well: What has improved since the last inspection? The homeowner and staff team have responded to the Requirements made at the last inspection and have been able to meet the majority of these. When the home admits a person in emergency or intermediate care a full record and detail the needs of the person is made. This information is used to compile a detailed care plan. A confirmation letter is provided following a pre assessment visit to the person, stating that the home will be able to provide the appropriate care for the person’s current health and welfare needs. This ensures each prospective person who is coming to live at the home know the home can meet their needs. Risk assessments, contained within care plans, have been enlarged to ensure that all details appertaining to any risks to a person are regularly reviewed and updated, as the person’s needs change. This included the person’s ability to have access to non-temperature regulated hot water and also their Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 7 vulnerability in respect of being able to be in contact with non protected hot surfaces. The security of the home’s medicines has improved and the registered nurses responsible make sure the medicine trolley is secured when not in use. The owner has confirmed that the suppertime menu has been changed as a result of discussion with people who use the service. The majority of staff had received training in the protection of vulnerable adults. And, the people living in the home have been provided with their own copy of the service users guide, which includes how to make a complaint, including to this Commission. A new head of care has been appointed since the last inspection to lead the team of health care assistance in the home. Additional member of staff (night sleeper) has been provided since the last inspection. This means an extra staff member is available should they be needed at night. The induction training for new staff at the home has improved with the introduction of the Skills for care induction process in addition to the homes own induction checklist. The new head of care is coordinating this training for new staff. The home’s robust recruitment programme had been followed for people employed to work at the home. This included obtaining two written references (one from their last employer) for each new appointment and a police check. The supervision for staff is recorded and staff report that they feel supported to do their work. Risk assessment have been completed for individuals and the room they occupy to ensure risk for the use of hot water in the wash basins or the hot surface of the radiator does not pose a risk to them. Care plans had been reviewed monthly and changes to care needed recorded. What they could do better: The owner/management should consider ways of managing the busy intermediate care facility that now operates within the home taking into account the guidelines contained within the National Minimum Standards. This includes providing dedicated accommodation, together with specialised facilities, equipment and staff to deliver the short-term intensive rehabilitation, which enables people to return home. Completed care plans for long term people living at the home must be easily understood for all staff involved in the person’s care. This is so that staff who are providing the care understand and know what is needed and appropriate. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 8 The home’s activity programme should be reviewed to ensure that all peoples’ needs are being met. Additional activities and the staff required to provide the activities should be made available so that the people benefit from a varied programme that creates variety and interest. The menu’s for meals should be made available for people who live at the home. This will ensure they get meals they enjoy and are able to eat. The owner must ensure that all the home’s fire precautions are maintained in accordance with local guidance to ensure that the people who live at the home are fully protected. Fire doors must only be held open with a devise that will close in the event of a fire. This will help to protect the people from fire should a fire occur at the home. There should be a maintenance plan for the home detailing dates and timescales for work to be completed within as well as regular routine checks of the home’s environment to ensure that it remains safe and free from hazards that might place a person at risk. The home should continue towards maintaining the correct level of nationally qualified staff on duty i.e. 50 percent. This was raised as a recommendation at the last inspection but has not yet been completed. The owner must undertake a formal quality audit of the service, which must include seeking the views of the people who live at the home, their relatives/advocates and any other interested parties that may have contact with the home. The owner must then act on the information received by producing annual development plan, including a maintenance plan, for the home taking into account this feedback. This is to ensure the home is always run in the best interests of the people who live there and the building is maintained to a high standard. This was raised at the last inspection but has not yet been completed. The owner must ensure that the home’s five yearly electrical wiring check is completed ensure the electrical wiring of the home remains of a satisfactory standard and therefore ensures the people who live at the home are safe. 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 Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 9 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 10 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 Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 11 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): 1,3,6 Quality in this outcome area is good, The homes Statement of Purpose and Service Users guide are easily available for people who live at the home and visitors. This ensures that people have sufficient information about the home and the service it provides to make an informed choice about whether the home can meet their needs. The information and assessment and care planning process for people admitted for intermediate respite care has improved. This should ensure that staff have sufficient information about the care needs for individuals to provide continuity of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people had their care followed as part of this inspection. Three of these were respite intermediate care admissions. The four plans of care contained assessments of the people’s care needs and included medical history and medication requirements. A checklist was being used to record the equipment needed for people receiving intermediate care. Information from the Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 12 intermediate care teams assessments were also provided with the persons plan of care. Both people spoken to say the staff had spoken to them about their care and their future plans. One person said the staff at the home and the visiting physiotherapist were helping them to improve their walking so they could return home. The persons care goals had been recorded in their plan of care. Three people admitted through the crisis team were spoken to during the inspection. They said that staff had spoken to them about their care needs and staff at the home had told them about the home and it’s services. Their care planning information and assessments also contained copies of their community assessments and care plan. These detailed the aims of the emergency placement. However separate facilities for people accessing intermediate care placement at the home are not currently provided at the home. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. The assessment processes for new people admitted to the home ensure that staff are aware of the needs of the person. The way the people’s health and personal care are managed by the caring staff team should ensure that their needs are met. People admitted in an emergency for a short stay are not given the opportunity to continue to manage their own medication where possible; this may mean people may lose some independence with medication. Medication practices in general are safe and should protect people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the four people whose care was followed had a plan of care in place, which had been developed from an assessment of need. Three of these people had been admitted to the home for an emergency placement by the intermediate care team. These people had copies of the community assessment and care plan, which included a record of the medication that person required. The nurse in charge advised that medication is checked with Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 14 the GP surgery on admission where possible. And the person or their representatives are also asked about medication. A record for checking all relevant information was available for the people admitted for emergency placement was being used. These had been completed for the three people receiving intermediate care whose care was followed. Two of the people receiving intermediate care spoken to confirmed that they had been asked about their care needs at the time of their admission to the home. They said staff had encouraged them to do the things they could do for them selves and helped them with those they needed help with. One person said they normally manage their own medication at home. They said that since they had been at Aspreys the nurses had managed this for them and they had not been asked if they wanted to continue to manage their medication. The nurse in charge confirmed that they had a system and assessment process to find out if people were able to continue managing their medication. However when people are admitted in an emergency this is not looked at until they have settled in the home and plans to return home are started. A district nurse who was part of the intermediate care team visited one of the people whose care was followed. She commented that the staff at Aspreys always worked well with the team and followed instructions they gave. They said they were satisfied with the support the person was receiving and they had started to improve. One person who had been at the home for more than two years had their care followed. This person had their initial assessment of need in their plan of care. Some of the elements of their care plan had been rewritten and up dated others had changes recorded in the monthly evaluation review of care plan. This made the record of the care they currently needed difficult to follow. The person was seen in their own room. They were being cared for in bed and had an airflow mattress being used to reduce the risk of pressure sore development. An up to date manual handling risk assessment was in the room. The person was wearing clean night cloths and appeared comfortable. They were unable to talk but appeared to understand what was being said to them. The nurse in charge advised that their health had deteriorated recently. She further commented that because staff knew them well they understood what they liked. However the things staff had learnt about this person and how their care should be provided were not very clear in the care plan. The carer’s on duty at the time of this inspection were spoken to. They all confirmed that they receive information about the people they care for at handovers. One commented that they were a key worker for five people and had the responsibility to record in their care plan. The records of the key worker were seen in one of the long term peoples care plan. The carers said they looked at care plans if they needed more information and spoke to the nurse in charge or the head of care who had recently joined the staff. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 15 The medication practices and storage were reviewed with the nurse in charge. The medication trolley was locked and tethered to a wall. This contained the medication people were currently receiving. Since the last inspection the way medication is supplied to the home has changed. The pharmacy supplies individual packs of medication for people, which contain their medication for 28 days. The medication is listed on the pack and medication is stored in a blister pack with in this. Medications such as liquids were being stored in the trolley. Each person had a record of medication given, which had been signed by the nurse giving the medication. Four people whose care was followed had the record of their medication examined and the medication stored checked with the nurse in charge. These were completed as required. The controlled drug record book was checked against the stock for two people as correct. The medication disposal system had a record of the medication disposed of which had been signed by the registered nurse. A specialist disposal system for controlled drugs was in place. The medication and dressing being stored in the treatment room were for people being cared for at the home. The nurse in charge advised that dressing for people who required these were ordered through the GP and pharmacy. This was confirmed by viewing a persons care plan that was receiving wound care. The four people whose care was followed had a record of the multi-disciplinary team visits. These included members of the intermediate care team such as physiotherapists, occupational therapists and district nurse as well as chiropody. An NHS chiropodist was visiting one of the people in the home during the inspection. They said they regular attended to the home to see people who had been referred to them. GP visits were also recorded separately in their care plans. This showed that people continue to have access to health care and specialist therapeutic services following their admission to the home. Staff observed providing care were being respectful to the people they were providing care for. People asked said they had been asked how they wanted to be addressed and staff used this when they spoke to them. This was recorded in their care plans. The shared rooms were being used as single rooms at the time of this inspection. Screening had been provided in these rooms. People were seeing visiting professionals in the privacy of their own rooms. The staff spoken to during the inspection that had recently joined the staff team said that their induction included how to treat service users with respect. The induction programme for one of these staff was looked at with the newly appointed head of care. She advised that staff work through the Skills for Care induction as well as the homes own induction programme which orientates them to the home and what is expected of them. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is 12,13,14,15 adequate. The staff at Aspreys try to ensure that people living at the home have access to the activities they prefer and enjoy. Although the limited activity programme provided may not be meeting every one needs. The menu for meals were not easily available for people and not all had remembered what was for lunch that day. A record of people likes and dislikes for food had not been up dated for the kitchen staff and cook. This means that people may get food they don’t like. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home, who were able to, were pursuing their own interests, (e.g. reading, watching television). One person who had chosen to stay in their own room said they liked to be able to listen to the radio during the day. This was easy for them to reach. Two bright communal lounge areas are available for those who wish to sit and socialise. Those who wish to remain private are able to do so. Visitors were coming and going freely during the inspection. The times recorded in the visitors’ book showed that the home has not restricted visiting. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 17 Staff were seen trying to meet the peoples’ needs effectively and were being sensitive to their individual needs. For example, two-members of staff who were attending to a person’s personal care were talking to them about what they were going to do and involving them in their conversation. However the activities programme was limited. Two external groups provide weekly activities for people. A record of what activities had taken place and which people took part was being kept. One person said they looked forward to these. People spoken to in one lounge said they enjoyed chatting to each other each day it helped pass the time. The owner advised that for the majority of people either their relatives or the person’s representative helped them with their money. The records of money held for one person were checked against records during the inspection. A computer record was being kept of expenditure and money received. Receipts for these were being kept in this persons file for expenditure made on their behalf. A secure safe is proved for keeping money and/or valuables for people who wish to use this. People were satisfied with the meals provided by the home, and there was a choice available at mealtimes. Although not all the people asked knew what was for lunch that day. One person had left the broccoli on there plate following the lunchtime meal. They said they did not like this and had told staff they did not like this. The nurse in charge confirmed that likes and dislikes for food are always recorded in the care plans. However this did not appear to have been passed on to the people preparing the meals. Another person had said they had asked for fish instead of the chicken, when they were asked what they would like for lunch. The cook advised that people are asked and given two choices for lunch. However menu’s were not available for people prior to the lunchtime meal during the inspection. Food had been liquidized and arranged separately for the people who needed this. This enabled them to experience the different tastes of the food they were having. The head of care advised that a dietician from the local Care Trust would be providing training for staff for a nutritional assessment tool by the end of July. Each of the four people whose care was followed had a nutritional assessment completed in their care plan and a record of any likes or dislikes for food. Meals are taken at individual tables within the lounge areas, and in the home’s dining room, which is on the lower ground floor. Two people who used the dinning room regularly said it was nice to be able to meet others and have a chat over lunch. People observed eating their lunch were eating at their own pace and the mealtime was unhurried. People who needed assistance were being given this in a sensitive supportive way by the staff that were assisting them. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 18 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, Quality in this outcome area is good. The staff team at Aspreys value the people who live there and take any concerns they raise seriously. Evidence shows that management use concerns raised to improve people’s experience of care, by reviewing practice and making changes. People were aware how to raise concerns and say they have confidence that their concerns would be listened to. This means people have confidence in the staff who care for them. The recruitment practices protect people from unsuitable staff. Staff are provided with training that enables them to understand how to protect people. This should ensure that people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure and policy was easily available for people who live in the home, relative and staff. The complaints policy was in the service users guides, which were provided in each person’s room. Three people said when asked that they knew the information regarding how to complain was in the information they had been given. The people spoken to during the inspection said that they knew who to complain to if they had any concerns and had confidence that any concerns they raised would be dealt with sensitively by the staff team. The owner confirmed that he regularly talks to the people who live in the home and their representatives. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 19 A record of complaints received and the actions taken by the homes staff team to address the concerns raised was being kept. This showed the changes that had been implemented as a result of concerns raised. Three staff files were viewed during the inspection. These contained the information required. The home has a recruitment policy, in place. A record of training received and copies of certificates were provided in the staff files. These included fire training and manual handling. A training pack was also available for the staff regarding adult protection. Policies and procedures are in place to guide staff regard prevention, recognition and handling of incidents of abuse. Since the last inspection the majority of staff at the home have received training from the local Care Trust for adult protection. A record of this training was seen in the staff files viewed. The newly appointed head of care advised that further training dates were being sought for the staff who had not yet had the training. Staff spoken to during the inspection were aware of what adult protection and safeguarding meant and were able to say what they would do if they had any concerns. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 20 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): 19,26, Quality in this outcome area is adequate. People live in an adequately clean and comfortable home. Adaptations and equipment provided that meet the needs of the less able people living in the home. Assessment of environmental risks for the people who live at the home are completed for each person and the room they occupy. This means that the staff team are mindful of the safety of the environment people live in This judgement has been made using available evidence including a visit to this service. EVIDENCE: Aspreys Nursing Home is a spacious building with a range of different size bedrooms available, some of which have en-suit facilities. The accommodation is arranged on four floors with passenger lift access. A tour of the home was completed. All areas entered during the inspection were clean and fresh. Individual people’s rooms were clean and had been Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 21 personalised with items of that person’s choice. Several of the people’s rooms entered had been re-decorated and new carpets fitted. The people spoken to during the inspection said their rooms were kept fresh and clean. The staff rota showed that domestic staff are employed in addition to the care staff. The divan style beds in use in people’s rooms had been adjusted to allow hoists access under the bed. The owner advised that people who required height adjustable beds would be provided with them. A further three height adjustable beds had been provided since the last inspection. These were seen in use for people who required complex care. The owner advised that more of these beds would be purchased, as they were needed. The people seen in their own rooms had call bells easily accessible to them. Four of these people who were asked about their call bell system said staff responded when they called although sometimes they took a little bit longer particularly at mealtimes. Communal toilets and bathrooms were equipped with adaptations and equipment as necessary however, some of the bathrooms were well worn but it was stated by the owner that he intends to refurbish these in the near future. Most of the radiators in the home were of the high temperature surface type and were not protected. Since the last inspection a checklist risk assessments for the room people occupy have been included with the care planning information. These had been changed as new people used the rooms. These were seen in the four plans of care viewed for the people whose care was followed. The nurse in charge advised that the risks of burns from radiators are assessed for each person in the home. The risk assessment was a checklist with a space to identify any risks found. The owner confirmed that radiators were continuing to be covered on a risk assessment basis and should be completed by the end of the year. Warning notices for the hot water in washbasins in individual peoples rooms were displayed in each room entered. The nurse in charge confirmed that all the rooms with a wash hand basin had these notices displayed. The risk assessment for the room the person was occupying also included the hot water in the washbasin. These had been completed for the people whose care was followed. Prior to this inspection the homeowner had informed us that the home was having work done on the electrical installations to bring them up to the current safety guidelines. The contractor completing the work was spoken to. He advised that the homes electrical systems up date should be completed by the end of July. He confirmed this included replacing some wiring, fuse boxes and light fittings. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 22 The laundry area of the home was well equipped and sited away from people’s bedrooms on the lower ground floor. Sluicing facilities for bodily waste from bedpans and commodes are provided on three floors. Infection control training had not yet been provided to several staff members. However staff spoken to appeared to understand the importance of using gloves and aprons when providing care for people to prevent cross infection. Gloves and aprons were seen to be easily available for staff use. The newly appointed head of care confirmed that she had contacted the Health Authorities Heath Protection nurses who would be providing infection control training at the home on the 9th of July. She also confirmed that induction for new staff also included basic infection control principles. An example of the Skills for Care induction being used was shown. The recordings of the fire precautions undertaken in the home were in general well maintained and a fire risk assessment was in place. The owner advised that the maintenance man took responsibility for making sure fire checks were completed. He also advised that the maintenance man had left and he was in the process of finding a replacement. Staff spoken to all confirmed they had received fire training recently. The newly appointed head of care confirmed that staff had received fire training and they were awaiting certificates of attendance form the person who gave the training. However, the fire door from the kitchen was wedged open with a devise that would not close automatically in the event of a fire. This could place people who live at the home at risk in the event of a fire. Aspreys Nursing Home DS0000028780.V364395.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 Quality in this outcome area is good. People at Aspreys nursing home are cared for by a friendly and supportive staff team that have their best interests at heart. The way staff are trained and their skills developed needs to continue the improvements made, to ensure people are cared for by a staff team who understand their care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A duty rota was provided, which showed the number of staff on duty during the day and night. This showed that a registered nurse is on duty over a 24hour period seven days a week to monitor and manage peoples health care. The staff spoken to during the inspection felt they usually had enough time to care for peoples needs. However the fluctuating additional short stay respite placements, which increased the number of people they cared for some times made it difficult to provide the one to one support they would like to give to people living at the home. Staff reported that they would like more staff, which would allow them to spend more time providing care for people. The owner advised that he had limited the number of respite people admitted to the home. The home’s registration allows for up to thirty-three people to be provided with care. On the day of the inspection there were twenty-one people at the home. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 24 Sixteen were permanent placements whilst five were in receipt of respite/intermediate care. Staff comments included we can usually manage with the staff we have. However the number and amount of respite people admitted at the same time some times makes it difficult to provide the one to one care they would like for people. They also commented that the introduction of a night sleeper to work along side the Registered nurse and carer makes it easier at night. The rota for the week of the inspection showed that three staff were on duty at night. However one staff member said sometimes the night sleeper isn’t provided when staff go off at short notice. Staff spoken to also comment that they were working extra hours to cover one carer who had left recently and they would really like more staff to join the team. The owner advised that he had continued to advertise for carer’s and a manager for the home. The advert in a nursing publication was seen for the manager during the inspection. He also commented that the number of people being cared for in the home would not increase until sufficient staff were appointed. The Registered nurse in charge during the inspection confirmed that the number of care staff had increased since the last inspection. The appointment of head of care to support the care staff had also taken place since the last inspection. Comments received from the people who live at home evidenced that people feel the staff are caring and kind and that they try their best to meet the peoples’ needs. Staff also presented well at the inspection wearing a smart uniform which quickly identified them as carers. The newly appointed head of care has introduced a Skill for Care inductiontraining programme since the last inspection. She advised that this is in addition to the homes induction, which familiarises staff to the home and what is expected of them. Three staff that had started work since the last inspection had their records viewed. These contained information about the training they had received prior to starting at the home and since they arrived. Two staff spoken to had joined the staff team since the last inspection. They said they had had an induction and had worked along side a senior member of staff for a month before working on their own. They said they received training up dates for manual handling, fire protection and adult protection. Four recruitment records showed that staff had completed an application form, two references had been provided one of which was from a previous employed and CRB(police checks) and POVA first checks had been applied for prior to the person starting work at the home. One registered nurse employed since the last inspection had a record that their PIN number for registration had been checked with the NMC (Nursing and Midwifery Council) prior to them starting work. The registered nurse confirmed that they had received an induction and that pre employment checks had been completed before they started work. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 25 These newly appointed staff members were able to state what the term “protection of vulnerable adults” meant and were also able to say how they would deal with such a situation. The training records showed that they had received training provided by Torbay care Trust for adult protection. The head of care confirmed that staff that had not accessed this training would be attending a training day in the near future. Induction records were viewed with the head of care for three staff ,these showed the training they had received. She commented that she worked with the new staff to ensure they understood what was expected of them. Two member of staff who had started work at the home since the last inspection had been enrolled on the NVQ care course. The head of care confirmed that staff are encouraged to start this qualification when they have completed their induction. Two staff spoken to were pleased that they had the opportunity to complete the NVQ training and improve their knowledge and skills. Other training planned included Infection control to be provided at the home on the 9th July by the Health protection nurse from the Health Authority and nutrition assessment tool training to be provided by a community dietician at the home on 29th July. The supervision records for three staff were reviewed with the head of care and the registered nurse on duty. These showed that staff are receiving regular supervision to support them to do their work. Staff spoken to said they felt supported. The head of care confirmed that she would be completing annual appraisals for all the care staff. The registered nurse in charge of the shift advised that she was completing the appraisals and supervision for the other registered nurses who work at the home. She also advised that the owner had given her some supernumerary time to complete the paperwork. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 26 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): 31,33,35,38. Quality in this outcome area is adequate. A suitably qualified manager to lead the staff and oversee the quality of care would ensure that the people who live at Aspreys nursing home continue to have their health, safety and welfare promoted. Although commitment to quality audit and obtaining views of the people who live at the home is stated in the service users guide, the results of these are not easily available for people who use the service – this means that people may be unaware of the work that has been done to improve the services offered by the homes management team as a result of such audits. The improvements made since the last inspection and the commitment of the staff and owner should enable the people who live at Aspreys to have confidence that the home is being run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 27 The acting manager has left since the last inspection. The owner to ensure the management of the home continues on a day to day to day-to-day has put interim arrangements in place. The Registered nurses are in charge of each shift and are responsible for people’s health care. The newly appointed head of care is responsible for the health care assistance training, support and supervision. The owner confirmed that he spends more time at the home since the manager has left and is completing some of the management tasks the manager had responsibility for. The advertisement for a manager in a recent health journal was seen during the inspection. The owner advised that he had had very little response to the advertisement. He also said he was hopeful that a manager could be appointed form the nurses who had applied for the post. The quality audit systems for the home were discussed with the owner. The returned questionnaires form visitors to the home were made available for inspection. However the owner advised that the response to this had been poor. Since the last inspection staff have completed a safety audit of the home and records are being kept of the assessment for individuals occupying rooms. The results of audits conducted had not been made available for people who use the service. The service users guide has the following paragraph, which refers to user surveys and views of the home. “We are committed to maintaining and improving the quality of our service. We have a comprehensive Quality Policies and Procedures Manual, which is reviewed and revised. All significant policies are contained here, including our complaints procedure. An important part of our approach to quality assurance is to obtain the views of all our stakeholders, particularly those of residents, relatives and their representatives. We do this by our regular reviews with individual residents and, on more general matters, through separate meetings with residents and relatives.” Currently the home assists several people with the administration of their personal allowances. This is recorded with the use of a computer system. Money is available to people on request. Receipts are retained by the home of any purchases made on behalf of a person and when money is received on behalf of a person the home keeps a record page on the computer as a receipt. These records were seen to be in order and one person’s monies was checked and it was noted that the records balanced with the amount actually held. The people’s monies held by the home were considered to be protected. At the time of the inspection the home still did not have a current electrical installation certificate. However a qualified electrician was in the process of up dating the homes electrical systems and he confirmed that work would be completed by the end of July 2008 and a certificate would be issued then. Other health and safety shortfalls at the last inspection include the lack of risk Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 28 assessments in relation to hot surfaces and the hot water provision to peoples’ wash basins as well as staff lack of awareness in respect of ensuring peoples health is maintained by good infection control methods. Since this inspection a checklist risk assessment has been completed for individuals for the room they are occupying. These were contained in individual’s plans of care as part of the risk assessment process. The nurse in charge confirmed that all the people living in the home had had a risk assessment of the environment they were using (bedroom). The record showed that radiator temperature and hot water in washbasins had been assessed to ensure individuals using the room were not being put at risk by the unprotected radiators (hot surface) or hot water. The owner confirmed that all radiators in areas people who live at the home have access to would be covered using the risk assessment to ensure those posing most risk were covered first. Warning signs had been placed over each washbasin where water was hot. Aspreys Nursing Home DS0000028780.V364395.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 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) and (2)(b) Requirement The registered owner must ensure that all people using the service have an up to date, detailed care plan, which wherever possible has been drawn up with the person and or/their family/advocate. The care plans must also be such that they are easy to understand by the staff providing the care for the people. This will ensure that the people receive mutually agreed continuing support that meets their needs. The time scale has been extended from 06/02/08 because the care plans for new people admitted to the home meet the required standard Timescale for action 06/08/08 2. OP25 13(4)(a) The owner must further ensure that, if necessary, hot surfaces are protected. This will ensure that the people who live at the home are safe from the risk of sustaining a burn. DS0000028780.V364395.R01.S.doc 06/12/08 Aspreys Nursing Home Version 5.2 Page 31 The time scale has been extended from 06/01/08 because risk assessments had been completed for individuals and the owner has confirmed these will be covered 3. OP33 24 (1) (a)and 2 The registered owner must 06/10/08 introduce a structured system to monitor the quality of the service provided. This should include the views of service users and other stakeholders. An annual development plan must be drawn up after obtaining these views and this report must be made available to the Commission. This will ensure that all involved in the receipt of care are able to have a say into how that care is delivered and that the home has a structured plan to address any shortfalls and build on the positive aspects of the home. The time scale has been extended from 06/03/08 because work had been done towards this and improvements to the home environment have been made. 4. OP38 13 4(a) The registered owner must ensure that there is compliance with the necessary health and safety regulations involved in running a residential establishment. This refers specifically to ensuring the Electricity at Work regulations 1989 are adhered to. In this particular instance this involves ensuring that there is a five yearly inspection of the home’s electrical systems. This will then ensure the people who live at the home are protected. DS0000028780.V364395.R01.S.doc 06/08/08 Aspreys Nursing Home Version 5.2 Page 32 The time scale has been extended from 06/01/08 because work had almost been completed to bring the homes electrical systems up to date. 5 OP38 23(4)(a) Fire doors in the home must only be held open with a devise that will close in the event of a fire. 06/08/08 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. Refer to Standard OP6 Good Practice Recommendations The owner/management should consider ways of managing the busy intermediate care facility that now operates within the home taking into account the guidelines contained within the National Minimum Standards. This includes providing dedicated accommodation, together with specialised facilities, equipment and staff to deliver the short-term intensive rehabilitation, which enables people to return home. The home’s activity programme should be reviewed to ensure that all peoples’ needs are being met. People living at the home should be given a copy of the days menu so they can decide if they like the meals being offered and have opportunity to ask for a different meal if they don’t like what’s on offer. The cook should be made aware of peoples likes and dislikes for food so they get meals they will enjoy. There should be a maintenance plan for the home detailing dates and timescales for work to be completed within. The management of the home should continue making DS0000028780.V364395.R01.S.doc Version 5.2 Page 33 2. 3 OP12 OP15 3. 4. OP19 OP28 Aspreys Nursing Home national training in care available to staff to allow the home to have the correct level of nationally qualified (NVQ) staff on duty i.e. 50 percent. Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Aspreys Nursing Home DS0000028780.V364395.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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