Inspection on 06/04/05 for Aspreys Nursing Home

This inspection was carried out on 6th April 2005.

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

Aspreys Nursing Home 23/04/09

Aspreys Nursing Home 04/06/08

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 12/10/04

Aspreys Nursing Home 29/06/04

Aspreys Nursing Home 04/03/04

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The Vicarage

Fairfields Country Rest Home

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5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Aspreys Nursing Home I Kents Road Torquay Devon TQ1 2NL Lead Inspector Rachel Proctor Announced 6 April 2005 th 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 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 D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Aspreys Nursing Home Address I Kents Road, Torquay, Devon, TQ1 2NL Telephone number Fax number Email 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 201 500 01803 201 700 Friendly Care Homes Ltd Jacqueline Evans (awaiting registration) Care Home with Nursing 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 D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 12th October 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. The St Matthias Church is within 200 yards of the home. The home operates it’s 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 but can admit younger people with medical needs. The staff group is made up of registered nurses and trained 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. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This was an announced inspection starting at 9.30 and finishing at 3.30. The inspector spoke to 8 service users, 3 relatives and friends, 4 staff members, the newly appointed Manager and the owner. A tour of the home was completed with the manager accompanying the inspector for part of this. Records kept in the home were also examined. What the service does well: What has improved since the last inspection? What they could do better: New staff must be fully checked before they start working at the home. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 6 Some detail in care plans is lacking, this means that there is a risk to service users that they may not always receive the care they need. Service users were sleeping in the lounges and staff must ensure that this is not because there is nothing to do. Some environmental and health and safety improvements are needed. Woodwork is damaged; this is off putting to visitors and people living in the home, it detracts from the otherwise pleasantly decorated environment. The Manager did not provide a completed plan for the management and prevention of legionella with in the home – service users must be protected from this infection. Radiators should be covered to prevent scalding. It is unclear how new staff are trained to care for service users, the induction records consists of a tick list, they must show how understanding of care has been achieved and how it links to best practice guidelines. Medication which service users no longer need must be returned or disposed of. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, The assessment process adopted by the manager ensures that the care needs of the service user are assessed prior to the delivery of care. EVIDENCE: An assessment process, which assesses the Service user’s needs prior to admission to the home, is in place. One service user stated that someone from the home had talked to them about their needs prior to coming into the home. They also said they felt the care staff understood their needs. Some service users had social services care management assessments, care plans had been written that reflected the actions to be taken to address the needs highlighted by the assessment. One service user advised how they had received an assessment from their General Practitioner instigated by the Registered nurse to review their pain control medication and as a result the level of pain had been reduced. The Statement of Purpose was readily available for service user’s use. One relative told the inspector they had chosen the home as a result of a preadmission visit and the information provided in the Statement of Purpose. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 In practice, service users were being well cared for, however, records about some aspects of care given/planned are incomplete, this means that agency or new staff may not know what care each service user requires. This is a potential risk. EVIDENCE: A comprehensive care planning system is in place which links to the service users assessment of need. This clearly sets out how staff should take action to meet individual care needs. Service user asked said staff were friendly and understood their care needs. Although one service user was having their pain control managed successfully, how this was being achieved had not been recorded within the plan of care. The documentation therefore did not support the good practice taking place. Two service users were having their fluid intake monitored by staff. These service users appeared well hydrated and staff were seen providing and assisting with fluid intake. However the records were not fully completed to demonstrate fluid intake was being maintained. Potentially these service users could be at risk of dehydration. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 10 Service users spoken to stated that the care staff understood their care needs. One service user’s plan of care did not have a review documented since November 04. However, the service user’s care needs were still being met. Two service users who were able reported that they had been asked about personal choices and had been involved in their care plan. One service user advised that she enjoyed her own company and had chosen to stay in her room. The staff team had facilitated this. The inspector saw hoists available throughout the home; staff were using these. Each service user had an assessment of their manual handling care needs. Staff were observed to follow good practice guidelines when using the hoist to transfer a service user from an easy chair to a wheelchair. Service users were seen to have had their oral hygiene attended to, dentures had been cleaned and toothbrushes and denture cleaner were provided in the service user own rooms. Oral hygiene was part of the care plan record. Pressure relief mattresses were in use for service users who had been assessed at risk of pressure sore development. Nutritional screening had been completed in the service users plans. However, two service users who were unable to drink unaided did not have a fully completed fluid balance chart. During the inspection staff were seen giving service users drinks and assisting those who required this. The medication stored within the medicine trolley had one bottle of simple linctus, which expired in January 05. This was removed immediately, the nurse in charge confirmed that this was no longer in use. Two prescribed drugs for two service users, which the inspector was told, were no longer required were still held in the medicine cupboard. These had been prescribed in 2003. Staff observed providing care were doing so in a respectful, friendly manner. Staff were observed to knock on service user’s doors before entering their rooms. Service users were receiving visitors in one of the communal lounges or their own rooms during the inspection. The service users preferred name had been recorded in their plan of care, staff were seen to use this when speaking to the service user. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 It was difficult to judge whether or not the service users were socially fulfilled as there was no ‘activities programme’ and none taking place. The meals and menu choices provided are nutritionally balance and attractively presented. EVIDENCE: The inspector was given the information about the weekly entertainment available for service users. However, this information had not been provided in written form for the service users. The manager stated that staff provide one to one support for service users where possible. Social care planning was not fully completed in all service users care plans seen. An open visiting policy is in place. Service users were seen receiving visitors throughout the inspection. The manager confirmed that visiting is encouraged if this is the service users wish. During the inspection the majority of the service users were sitting in one of the two communal lounges. These service users appeared to be content and those asked did not make any comments about the social activities and entertainment provided. Two-service user spoken to in their own rooms told the inspector that they preferred to stay in their own rooms. No Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 12 entertainments had been arranged for the day of inspection. However, staff were seen talking to service users about topics of their choice. The meals were attractively presented and nutritionally balanced. Service users who required pureed food had this presented in a way that enabled them to taste individual items. Very little wastage was seen from the lunchtime meal. Service users asked said they enjoyed the food. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The openness of the staff towards the service user enables them to express their concerns and wishes knowing they will be dealt with in a sensitive way. The lack of information regarding the local adult protection process and the failure to complete all pre employment checks for new staff puts service users at risk. EVIDENCE: The home has a complaints policy in place that is easily available. Service users and their relatives said they knew who to complain to if they had concerns. They also stated that they felt they were listened to. Four complaints received since the last inspection regarding the standard of care provided had been addressed and actions taken to prevent reoccurrence. The manager provided the home’s policies for prevention and protection from abuse. However, local guidance and contact numbers for social services adult protection were not readily available. One staff member employed since the last inspection did not have a Criminal Records Bureau check applied for prior to them starting work. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 25, 26 Overall the home provides a pleasant and homely environment, which is clean and free from odour. Some woodwork is damaged and this detracts from an otherwise pleasant environment. EVIDENCE: A new maintenance man had been appointed since the last inspection, routine tasks were listed in a book containing a record of repairs and renewals. A picnic table is provided in the patio area within the grounds. However, no flowers or shrubs had been planted and the garden looked neglected. Some building material was awaiting collection in the car park of the home. The manager advised that the maintenance man would be tidying up the gardens for the summer to make it a pleasant place for the service users to sit. Several areas in the home had been redecorated and re-carpeted since the last inspection. The skirting boards in some communal corridors and room entrances had been badly scuffed and paint had been chipped off. This detracted from an otherwise pleasantly decorated home. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 15 An occupational therapist assessment had been completed for the home since the last inspection. Suitable equipment, stand aids and hoists are provided throughout the home. Assisted bathrooms have bath hoists fitted. A call system is in place for service users use. This was in use during the inspection. Service users who were able to use them had call bells within their reach. Service users rooms enable care to be provided from both sides of the bed, this allows easy hoist access. Service users do not have locks to their rooms. A system for assessing service users ability to use locks to their rooms is in place. The manager confirmed that locks would be provided if the service users risk assessments showed they would benefit and they had requested a lock for their door. Height adjustable beds had been provided for service users who required them. Not all the radiators in the home had been guarded. Heating can be adjusted in individual rooms to suit the service users tastes or requirements. A tour of the home revealed that individual rooms varied in temperature. A risk assessment for the prevention of legionella had still to be provided. The home was clean and fresh smelling at the time of inspection. Visitors asked told the inspector that the home is usually fresh and clean. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The staff team in place were friendly and supportive towards the service users. However, the way staff are recruited and the training and development of staff needs to follow good practice guidelines to ensure service users continue to be cared for by a suitable staff team, that understands their care needs. EVIDENCE: Duty rotas were provided, this showed the qualification of the staff on duty. A Registered nurse is available for all shifts through out the day and night. The rota showed that more staff are on duty at peak times. The manger is using agency staff to fill shift shortfalls. The manager confirmed that all staff providing care are over 18. Six ancillary staff are employed, this includes cook, kitchen assistants, laundry person, domestic and maintenance man. Two service users commented that sometimes, especially at night, staff take a long time to answer their call bells. Sometimes staff appear busy and hurried. Staff training records provided showed that three Health Care Assistants were working towards National Vocational Qualification level 2. However, none of the current Health Care Assistants have a National Vocational Qualification. An induction process for new staff was in place. However, how this links to guidelines was unclear. The manager advised that the induction process in use for new staff was in the process of being reviewed. The four staff files viewed did not contain a record of the questions asked. Criminal Records Bureau checks had not been provided in two of the four staff Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 17 files viewed. One of the four staff files contained only one reference and proof of identity was not contained in three of the four files. One Registered nurse file did not have confirmation of their Nursing and Midwifery Council registration within the file. The recently appointed manager had not completed training and development plans for the staff. Induction training is in place for new staff. However, it is unclear how this links to the National Training Organisations specifications. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 38 The new manager has worked well to engage the support of the staff and the service users. However, she has not been in post long enough to make all the changes to the way care is delivered or service managed, in respect of recruitment, health and safety and infection control. EVIDENCE: Three service users told the inspector they thought the new manager was friendly and approachable. Three staff member said the new manager was supporting them to do their work and was open to suggestions to improve the way care is delivered. A quality audit, which had been completed in December 03, was available. Ongoing repairs and renewals were taking place and improvements to the environment had been made since the last inspection. A continuous self-monitoring method had not been fully implemented. The home has insurance cover against loss or damage and the registered persons liabilities to employees, service users and third party persons. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 19 The manager advised that three service users control their own money. Individual records of money held for individual service users were being kept. A secure facility is provided in the office for the safe keeping for money and valuables on behalf of the service users. Policies and procedures are in place to protect service users and staffs health and safety. Individual service users had manual handling assessments and nutritional risk assessments in place. A risk assessment of legionella in the water systems had still to be completed. Staff observed using manual handling equipment were using this safely. Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x 3 x 3 2 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 2 3 3 x x 2 Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 18 Regulation 19(1)(b)(i ) Requirement All New staff must have all pre employment checks as per the homes policy and a satisfactory police check prior to starting employment. The registerd person must not employ a person to work at the care home unless- he has obtained in respect of that person the information and documents specified in Schedule 2 As Above Timescale for action 06/06/05 2. 29 19(1)(b)(i ) 06/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 8 9 12 Good Practice Recommendations All plans should have a review of their care documented monthly All service users should have the care they require documented and monitored Medication no longer in use by service users should be disposed of with in the recommended guidlines How service users are stimulated through social interaction and entertainment suitable for their needs should be D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 22 Aspreys Nursing Home 5. 6. 7. 19 recorded. Planned activies should be notified in a way the service users can understand A routine programme of maintenance should be avilable for inspection The covering of all radiators in service users areas should continue using the risk assessment process in place A record of the completed checks for the prevention of legionnella should be provided The induction process for new staff should link to best practice. 50 of the care staff should be trained to N.V.Q level 2 or above Training and development plans should be available for all staff Continuous self monitoring internal audit should take palce at least annually A record of the completed checks for the prevention of legionnella should be provided. (as standard 25) The induction process for all new staff should follow good practice (as standard 28) 25 8. 9. 10. 11. 28 30 33 38 Aspreys Nursing Home D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 D54-D07 S28780 Aspreys V212082 060405 Stage 4.doc Version 1.20 Page 24 - 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. 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