Inspection on 06/12/07 for Aspreys Nursing Home

This inspection was carried out on 6th December 2007.

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

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

Other inspections for this house

Aspreys Nursing Home 23/04/09

Aspreys Nursing Home 04/06/08

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

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

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 1 Kents Road Torquay Devon TQ1 2NL Lead Inspector Judy Cooper Unannounced Inspection 9:30 6 December 2007 th 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.V350805.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.V350805.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.V350805.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/dependency 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 25th April 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. The fee levels were stated at the time of the inspection in April2007 to range from £350- £540. (New information has not been received from the management to state that these levels have since changed). The fees are dependant on the care needs of the peoples and the room Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 5 occupied. Additional charges include chiropody, hairdressing and any personal purchases. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on Thursday 6th December 2007 between 9.30 a.m. and 4.30 p.m. and two inspectors were involved in this inspection. Opportunity was taken to observe the general overall care given to the people who live at the home. The care provided for four people was also inspected in specific detail. A tour the premises, discussions with the management of the home, as well as discussions with other staff, some people living at the home and a visiting occupational therapist, also formed part of this inspection. Staff were also observed, in the course of undertaking their daily duties. The owner was also present for the last few hours of the inspection. Other information about the home, including the receipt of three completed questionnaires from relatives, six from staff members and one from a health care professional has provided additional information as to how the home performs. All of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection as well as some others, which related to the inspection. The Commission has received a comprehensive response from the home owner following receipt of the draft inspection report, and it is recommended that readers contact the owner to obtain their views. What the service does well: The owner has commenced a programme to improve the home’s environment, which helps maintain a homely place for people to live. The people benefit from a “community spirit” within the home and are encouraged and enabled to socialise with each other as desired. The result of this is that people can benefit from companionship with each other as desired but can choose to “keep themselves to themselves” if they so wish. The staff work hard to try to provide for the care needs of the people who live at the home and feedback from the three relatives who completed questionnaires felt the care needs of the people they have contact with were being met. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. When the home admits a person in emergency or intermediate care situation the senior staff member, admitting the person to the home, must ensure that they fully record and detail the needs of the person. This information should then be used to compile a detailed care plan for use after admission. This is so that all involved in the care of the person are aware of their needs and are able to deliver the appropriate care from the moment of their admission. The management must also forward a confirmation letter to any prospective person (who will be coming to live at the home permanently) and/or their family/advocate, 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 is so that each prospective person who is coming to live at the home permanently and/or their family/advocate can be sure that the home knows and then agrees to meet their needs. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 8 The care plans for each person, detailing the care to be given, must contain up to date information about each person, including a nutritional assessment, fully completed risk assessments and in depth information in relation to their personal care needs. The care plans must be complied, as far as possible with the person themselves and or/their family/advocate and should be undertaken in a person centred manner to ensure, wherever possible, the people and their families/advocates are fully involved in choices made regarding the care that is to be provided. This is to ensure that any care provided has been agreed with the person and that the person is happy with the both care to be provided and with the manner it is to be delivered in. Completed care plans must be both easily understood and made available to 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. All care plans for long term residents should continue to be reviewed with the person and/or their advocate on a monthly basis for the same reasons. Risk assessments, contained within care plans, must be further enlarged to ensure that all details appertaining to any risk to a person is regularly reviewed and updated as the person’s needs change. This includes the use, or not, of a cot side, the person’s ability to have access to non temperature regulated hot water and also their vulnerability in respect of being able to be in contact with non protected hot surfaces. The security of the home’s medicines must be upheld. medicine trolley must be secured when not in use. In particular the 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 owner/management should undertake a review of the home’s menu planning, specifically in relation to the suppertime menu to ensure it fully meets the needs and wishes of people. To ensure people remain protected the management must ensure that all staff receive training in the protection of vulnerable adults. Also, the management should ensure anyone who wants to is made aware of how to make a complaint, including to this Commission. Cleaning products should be stored securely to prevent any risk to the people who live at the home or to the staff working at the home. 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. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 9 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. A review of how the home’s laundry systems operate should be undertaken to help minimise the risk of cross infection within the home and so help protect the people at the home. The home’s management must review staffing levels to ensure that there is sufficient staff on duty at all times to fully meet the peoples’ needs. During the inspection there were several comments made which indicated that the current staffing levels are at times considered to be too low to allow staff to be able to fully meet the needs of all of the people. Other necessary training must regularly be provided to all staff. This refers specifically to providing an in-depth induction training when staff commence working at the home and infection control training. Additionally 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 management must undertake the home’s recruitment programme in a robust manner to ensure suitable people only are employed to work at the home. This must include obtaining two written references (with one being from their last employer) for each new appointment. The management should continue to provide regular supervision to all staff and keep written records of the same. This is to ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member the opportunity to discuss any issues regarding their role and also for the management of the home to be able monitor the progress of each staff member over a period of time and offer support/training as required. 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 as a recommendation at the last inspection but has not yet been undertaken. Necessary health and safety precautions must be taken to ensure that the people who live at the home remain safe. The owner must ensure that risk Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 10 assessments are carried regarding hot water temperatures. This is to ensure vulnerable people if deemed at risk, will be protected against sustaining a scald. All radiators and hot surfaces within the home within the home must also be individually risk assessed in relation to the people who live at the home, who have access to these surfaces, and subsequently protected where they are deemed to be a risk to the people. This is to prevent a vulnerable person sustaining a burn should they inadvertently touch or fall against an unprotected hot surface. This was raised as a recommendation at the last inspection but has not yet been undertaken. The owner must ensure that the home’s five yearly electrical wiring check takes place to ensure the electrical wiring of the home remains of a satisfactory standard and therefore ensures the people who live at the home are safe. The homes’ policies and procedures must be updated to include current good practice and made available to all staff. This is so that all staff are aware of what criteria they need to work to and are aware of what standard and guidelines they need to work within to provide the required and agreed care to the people. This will ultimately ensure that they receive good quality care. 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. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 11 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.V350805.R01.S.doc Version 5.2 Page 12 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 and 6. Quality in this outcome area is poor People, admitted in an emergency situation, had not have a thorough assessment undertaken. Therefore staff would not be aware of these peoples needs and this would place them at risk. The management have not made specific provision to ensure that needs of people in receipt of intermediate/respite care are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although the home’s full registration is for up to thirty three people it is currently providing care for up seventeen permanent people whilst also providing several regular emergency intermediate care beds, which are heavily utilised (there have been approximately 50 intermediate/respite care placements within the past year) and these provide a valuable resource for the local community and intermediate care team. However the home does not have a dedicated intermediate care facility, which is specifically intended to provide for the needs of people requiring intermediate care. Rather, if there are vacant rooms these are used randomly Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 13 whilst staff are not specifically trained to deliver care for those people that require intermediate care only. As the provision of an intermediate care service is a specialised one, this could put these people at risk of not receiving the care they need on admission and during their stay. Although the acting matron stated, within the homes’ annual quality assurance assessment, that new protocols and checks had been introduced to ensure all relevant information is collected for emergency admissions this was not found to be the case, neither was the statement that a care plan is completed for all people who live at the home, within 24hrs of admission identifying any particular needs, found to be being followed through. Two such peoples’ admissions were looked at in detail. In both instances the information gathered at the point of admission was incomplete, for example, the admission checklist nor the nutritional assessment had been completed whilst the care plans, developed from what information was gathered, were also very basic, for example two entries in the care plans read: “ Encourage more fluid intake” but there was no reason given why fluid intake should be encouraged and how best this could be achieved. and: “record and report any changes” - again there was no information in relation to what changes might be expected and why or how they should be best dealt with. Therefore the two people whose intermediate care placements were inspected were deemed to be at risk as staff would have had little knowledge of their needs or how to best meet them. Because there has been a high number of people requiring intermediate / respite care admitted within the past year, not having full and easily accessible assessment details has meant that staff have not always known immediately what care the person may need and due to staff being very busy, it had taken them longer to get to know this information from the people themselves, or by being informed by word of mouth from other staff providing care. There was a complaint received in September in relation to inadequate care being provided to a person receiving respite care, and although the acting matron did put into place actions to resolve the shortfalls associated with the complaint there still appears to be a lack of sustained appropriate care provided for people who are receiving this service. Staff said that they did not always feel that they had enough information available to know what the person’s needs would be from the beginning of their stay, and several staff were unaware of where the care plans were and how to access them. This means that the people may not get the needed care from the beginning of their stay. The newly appointed acting matron has however concentrated on redressing shortfalls in the respect of the long stay residents care needs and has ensured that the care planning processes for these people are in order and two files Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 14 inspected were seen to be complete with relevant information as to their admission as well as how best to address and meet their needs. A staff member’s comment included the following: “Due to staffing levels and residents’ needs, new staff are not always able to learn about each person’s needs. So it is word of mouth regarding the little things that the person needs that make all the difference to their care and quality of life”. This clearly evidences what was noted at the inspection. There was no form of written communication to indicate that the management of the home had confirmed with any prospective permanent person/and/or their family/advocate that the prospective person’s health and welfare needs could be met prior to admission. Therefore the person and/or their family/advocate would not be sure that the home knew and had then agreed to meet their needs. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 15 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,and 10 Quality in this outcome area is poor. The lack of information contained within a person’s care plan, and the subsequent lack of information for staff about peoples care needs, could put people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been some updating by the newly appointed acting matron to reformulate and improve the previously existing care plans, in respect of the long staying people living at the home, by introducing such things as a falls risk assessment, a multi-disciplinary report for each person to record all visits /advice given by outside professionals etc and a personal profile for each person listing their hobbies, interests, past details such as occupation, spiritual needs, plus the re-introducing of regular reviews of the care plans with the person and/or their advocate. However the care plans for those people who were in receipt of intermediate care services were poor, containing incomplete and limited information, which meant that each person needs could not be fully known by care staff providing Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 16 the day to day care. Shortfalls noted included an incomplete pre-assessment checklist and an incomplete nutritional screening whilst the risk assessment regarding the use of cot sides in respect of the respite/intermediate person was also incomplete and lacked detail. There are several hospital beds for use within the home. These beds were noted as having cot sides in place, which are mostly in use. Although there was documentation to show that that the use of the cot side was discussed with the person on admission this information was very limited. For example an entry in relation to the use of cot sides read only: “refused to sign”. The assessment did not say why the person did not want to use the cot side. Neither was there was any subsequent information as to whether this posed a risk and whether this had been discussed with other professionals. This could place the person at risk. There were no records in place to inform carers why the sides were to be used or any recorded agreement with other professionals/relatives etc. that the use of the cot sides was considered to be in the best interests of the person. The decision to use cot sides must always be discussed with the person involved, if possible, and/or their family/advocate as well as relevant professionals involved, ensuring that this form of protection is considered to be in the best interests of the person concerned. Care plans, in respect of the intermediate care/respite person had limited care needs and the ways in which these needs were to be met recorded, for example two entries read: “ Encourage more fluid intake” but there was no reason given for this or how it as to be achieved; whilst another entry read: “Report and record any changes” but again there was no detail of what changes to look for and what these could mean. There was no evidence to show that the care plans, for those in receipt of intermediate/respite care, had been drawn up with the involvement of the person and/or their family/advocate, wherever possible. There were daily records available in respect of all the people, which were written by the trained staff only, after discussion with the carers who provide the care, however the carers themselves had no input into these records. Carers stated they are provided with a work sheet at the commencement of their shift detailing what care they have to provide to what person. Care staff stated that they: “just followed the worksheet”. The staff did not feel the people had a great deal of choice over such things as when they got up or when they went to bed, but rather the home’s routines and work load dictated how and when people received care. Staff did not feel that the people were given a lot of choice in certain areas. Staff reported that if a person’s given bath time slot was not wanted by the person at their allocated time then another slot was not always offered and so consequently a person may miss their bath. The home’s systems for the administration of medicines were examined. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 17 A recognised dosage system is in operation and records relating to this system were accurate and up to date with peoples’ photographs also in place on each record to add a further element of protection whilst only trained staff administer medication. There was a locked clinical room for the storage of clinical supplies such as dressings and spare medications as well as for the storage of controlled medications. Records seen in relation to the administration of these were also in order. However it was noted that the medicine trolley was not secured properly at the commencement of the inspection and that there were some medications (eye drops etc) left out on the medicine trolley. Also it was noted that in several bedrooms various creams were openly on display, which may pose a risk if used incorrectly by the person in the room or by anyone else inadvertently entering the room. Such items should be put way in a safe place within a person’s room to remove this risk. These shortfalls were seen as compromising the security of the medications held in the home. Observation of staffs’ interactions with the people evidenced that the staff treated people with kindness. When staff were asked about what they understood by providing “person centred care” i.e. care that is provided in conjunction with the person’s own wishes and needs rather than just in accordance with the home’s routines, the majority of staff spoken with were not familiar with this phrase, and were providing care within the home’s routines rather than making the person the focus of the care given. Two of the people whose care was inspected were spoken with, when asked about whether the home had met their needs one person stated: “ the staff are quite good and come when called”; whilst the second person felt they had been made welcome and hoped their stay would help them get back home. Three feedback comments from relatives and one from a placing professional who also stated that they felt their relatives care was being provided for adequately. However staff comments received in relation to the question: “Are you given enough up to date information about the needs of the people who live at the home you support or care for?” stated: “I always have to ask about new residents” Other staff comments included:“ We never have enough staff and I feel that the residents are not looked after like they should be.” I think Aspreys is understaffed. I believe staff are under pressure because of this. I dont think enough time is given to residents because there are too many residents and too few staff”. “When a resident rings a bell for assistance they have to wait because not enough staff.” “Staff doing regular long shifts are tired although I believe the majority of the staff do genuinely care for the service users.” Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 18 “More staff is needed, residents deserve more time with staff.” “Training is needed for all staff in all areas. There is also a need for a system to keep all staff up-to-date with regard to residents needs and conditions. “ There can be a high turnover of staff, this makes meeting of needs disjointed, however when numbers of staff are sufficient care is carried out as individuals. I was just thrown into the job. Anything I needed to know I asked one of the staff. This indicates that the people are at risk by the staff not receiving the correct training to both know and meet all the peoples’ needs appropriately and by the care planning documentation not covering all areas of need specifically in relation to the receipt of intermediate/respite care. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15. Quality in this outcome area is adequate. People who live at the home are reasonably well supported to pursue their chosen lifestyles. The home’s activity programme does not currently meet everyone’s needs. 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 noted as pursuing their own interests, (e.g. reading, watching television). 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. The visitors’ book indicated that there were many visitors to the home at differing times and visitors were noted coming and going freely. Staff were noted as trying to meet the peoples’ needs effectively and were sensitive to their individual needs. For example, at lunchtime two staff members were noted as providing sensitive support for those people who needed help with meals. However the activities programme was limited. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 20 Although there is a regular weekly external entertainer there are few other regular activities planned and provided. This is mostly because staff, who normally run the activities, are too busy providing for the required care needs of the people to provide additional social activities. Therefore people are left to amuse themselves and it was noted during this inspection that for some people this meant just sitting in the lounges and not undertaking any specific activity. A comment from a staff member stated: “ If there was more time to spend just talking and interacting with the service users it would be better for them and us”. People were satisfied with the meals provided by the home, and there is always a choice available at mealtimes. The cook working on the day the inspection confirmed that the components of any liquidized meals were liquidized and arranged separately. She was enthusiastic about her role and clearly understood the elderly person’s need for nutritious meals. The lunch on the day of inspection was roast chicken with roast potatoes and fresh vegetables, followed by chocolate pudding and custard. There has been a complaint made recently about the size and quality of meals served and it was interesting to note that there was some conflicting feedback, received prior to this inspection, in respect of meals provided. Comments received included the following: “ The service has very good meals which helps them keep healthy. Whilst another stated: The service could improve by: “More food and a better selection” Menus were inspected and appeared to provide a variety of nutritious and wellplanned meals at lunchtime. However the tea time menu was more repetitive with the pudding most days, during the four weekly menu plan, being either mousse, jelly or ice cream. The cook stated that the owner’s partner prepares the menus and that she had little input into what the people had on a daily basis as she and the other cook followed the menu plan provided. There are two cooks who work opposite each other and they cook and provide the main meal of the day each day of the week, which is lunch. Care staff prepare and provide supper. Meals are taken at individual tables within the lounge areas, as the home’s dining room is currently not being utilised. The acting matron stated that this was the people’s choice although this meant that the people spent a lot of their time in one place both recreationally and when eating. As they also eat individually there is very little social interaction during mealtimes. People can also have their meals in their own room if they wish to. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 21 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 and 18. The quality in this outcome area is poor. Arrangements for protecting the people and responding to their concerns are such that they should be protected. However staffs’ lack of awareness regarding their ability to both recognise and know what to do if they suspect any form of abuse is taking place is putting people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection key inspection carried out in April this year, the Commission has received three complaints in respect of Aspreys Nursing Home. These have centred on different care issues which people have had concerns about. The first was received in May via a visiting professional who had been involved in the placement of a person receiving respite care. The concern was in relation to the quality and size of meal portions served as well as the staffing of the home. This was passed to the acting matron to address who informed the Commission that adequate steps had been taken to rectify any problems. The second complaint was received in June from a relative who was concerned that the equipment needed to deliver appropriate care had not been provided and the person’s needs were not being adequately met. The suitable equipment was subsequently provided through the continuing care budget and the person’s care could then be delivered appropriately. The third complaint was received in September and centred on insufficient and inadequate care being provided to a person having a respite stay at the home. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 22 The complaint was referred to the acting matron who stated she would instigate changes to ensure that appropriate care was provided to respite clients. This evidences that the management do take complaints seriously and will use information received to try to better the service. Therefore the people at the home can be confident that any concerns or complaints they may have will be taken seriously. Some staff spoken with stated that they didnt know what the protection of vulnerable adults meant or how they would deal with any allegation of abuse. On further questioning the same staff members were unaware of what actually constituted abuse. They were also unaware that there were any policies or procedures in relation to this issue within the home. In answer to the question: do you know what to do if the service user/relative/advocate or friend has concerns about the home? a staff’s reply was: I have not been told what to do but I know to send them to whoever was in charge of the day”. A second staff member stated they did not know what to do if a service user/relative/advocate or friend had concerns about the home but also stated: I would send them to the manager or head nurse. This places the people who live at the home at risk by staff being both unaware of what constitutes abuse and how to deal with it appropriately should they have to. The manger and owner have since informed the Commission that staff felt unsure and intimidated by the inspection and did therefore not confirm that they had already received appropriate training. Although a complaints procedure is displayed within the home’s hallway it could easily be missed if people were not aware of its location and not all of the people who live at the home would be able to access this area independently. Many people had not received a copy of the home’s Statement of Purpose or Service User Guide where this information would also be made available, so consequently several people at the home would be unaware of how to make a complaint or contact the Commission if they should need to. It is acknowledged that these documents were in the process of being up-dated by the owner at the time of the inspection. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 23 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): 19,25 and 26. Quality in this outcome area is poor. People live in an adequately clean and comfortable home. However, insufficient attention has been paid to the assessment of risks for the people who live at the home, which means that the people are not fully protected from harm. 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. The home is, in general, well decorated and the people consulted during the inspection stated that they liked their rooms and the facilities provided. On inspection the home was clean, comfortably furnished and mostly well decorated. The home employs a maintenance person three days a week. Since the last inspection the owner has been authorising some routine upgrading of the home including re-decorating. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 24 It was noted that one bedroom had a patch of damp in it that the owner stated had been caused by the heavy rain and blocking of the gutters and that he was in the process of addressing this. 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. Although the acting matron stated, within the homes’ annual quality assurance assessment, that “we provide a well maintained environment “this was found not to be the case in all areas. Most of the radiators in the home were of the high temperature surface type and were not protected. The owner stated that the risk to people of sustaining a burn was managed by the use of a risk assessment approach however, at time of the inspection, no risk assessments were available. The hot water taps servicing the baths were understood to have been fitted with water temperature thermostats. The owner stated that the risk to people of sustaining a scald was managed by the use of a risk assessment approach however, again at time of the inspection, no risk assessments were available. Both of these shortfalls placed the people who live at the home at risk, as these areas were not being routinely monitored in order to minimise or remove any identified risk. It was further noted that there were some relatively small items of maintenance, which was outstanding in the building that also represented a hazard to the people, for example some tiles in one of the showers were broken and had sharp edges exposed whilst the bathroom hoist on the ground floor (next to room 1) had the white coating peeling from the foot of the pillar and this also had sharp edges. These shortfalls put people at risk and there was no written maintenance schedule available to state when this work was due to be undertaken. During the premises inspection it was noted that several cleaning products had been left out around the home. This was discussed and it was understood that a review was about to be undertaken to ensure that the staff team followed the appropriate procedures in future to ensure that a safe environment was maintained for the people who live at the home. The laundry area of the home was well equipped. However, at the time of the inspection the member of staff, dealing with the washing, was removing soiled items from red bags (which are used to indicate that the contents are heavily soiled) by hand to then put these items into the home’s washing machine. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 25 This action was undertaken with the clean clothing nearby, which therefore increased the risk of cross contamination. Infection control training had not been provided to several staff members and this is evidence that a staff member, through not being aware of how cross infection can take place, could be placing the people who live at the home at risk particularly as it was known that some people who live at the home do have an infection. Comments received from some staff members also indicated that there were some concerns regarding the lack of infection control within the home for example: As far as I know there is no infection control. Ive had no training on the dangers of MRSA or other infectious disease or on how to prevent spreading infections/germs. I do not get told when someone is ill with sickness/diarrhoea/colds therefore residents and staff pass it round. There is no procedure to limit the spread of germs etc. There should be some sort of system in place to at least try to limit the spread of infections. Another comment received in respect of the home’s laundry system stated: Washing is not always done on the night shift. That means one of the day staff have to do it is as well as caring. It was stated by the management that it had been noted that the staff awareness needed to be raised in this area and that infection control training was therefore being given priority and there was a note detailing a forthcoming date for such training whilst the newly appointed business operations manager had commenced an infection control audit throughout the home. The home currently stores several hoists on the landings of the building near to bedrooms. At the time of the inspection some of the legs were left open and would be a hazard for anyone walking by. No risk assessments were apparent and no procedure was followed to ensure this approach was safe and appropriate. The recordings of the fire precautions undertaken in the home were in general well maintained and a fire risk assessment was in place. However, the recording of the checks, undertaken to ensure the fire exits in the home remain clear and working, were not up to date which could place people who live at the home at risk in the event of a fire. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 26 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. The quality in this outcome area is poor. Staff at the home are not always employed in adequate numbers to meet people’s care needs. Staff training is not providing new staff with the required skills to be able to fully understand the requirements and expectations of their role or longer serving staff with updated knowledge to allow them to deliver good quality care. The home’s recruitment programme does not always fully protect the people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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. Seventeen were permanent placements whilst four were in receipt of repite/intermendatie care. The staffing levels at the home were noted as not being adequate for the needs, numbers and different types of admissions the home is providing for. For example, three days before this inspection took place, the home had received a person for emergency admission in the early hours of the morning. As there are only two staff members on duty (one trained staff and one carer) this was inappropriate as the trained staff member had to deal with the admission leaving the carer to provide care for the other people in the home as necessary. The staff spoken to confirmed that they felt pressurized and unable to provide the one-to-one care that they sometimes felt was necessary. Such comments Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 27 from staff included: “ When we have enough staff, we can do the job properly and we have more time for the service uses. “ We have a very high turnover of staff which doesnt help. I think Asprey’s is understaffed. I believe staff are under pressure because of this. I dont think enough time is given to residents because there are too many residents and too few staff. When a resident rings a bell for assistance they have to wait because there are not enough staff. Staff are doing regular long shifts and are tired, although I believe the majority of the staff do genuinely care for the service users. More staff is needed, residents deserve more time with staff”. “People go sick or just dont turn in for their shift. “There can be a turnover of staff, this makes meeting of needs disjointed, however when numbers of staff are sufficient care is carried out as individuals. One staff member reported that the one thing the service could do better would be to: Employ more staff”. In respect of recruitment the home has had a very high turn over of staff within the past twelve months. Recruitment records were checked for three new members of staff. In two cases there was only one reference and this was a verbal reference, the third had references but one from her last employer, which had been a care home had not been obtained. CRB checks had been applied for and where these were not in yet place an initial check had been received for these members of staff. Two staff comments received in relation to their recruitment process stated: I was working about one month before my CRB and references came through. I went for my interview and the following day I started work. I started before my CRB was returned. Although the acting matron had stated in the home’s returned annual quality assurance assessment that “ induction programmes were completed on all new staff” this was not found to be the case. There was very limited information regarding the induction training that any new member of staff had been through. This made it impossible to verify whether the new members of staff had received the necessary training to allow them to be able to carry out their care duties in an appropriate manner. The home does not have the required ratio of qualified staff working with only two staff currently being qualified in care out of a staff group of ten. The management of the home stated that is was due to the high turnover of staff with several leaving who had had this qualification and the subsequent recruitment of new staff without this qualification. It is the management’s intention to provide this required training with two more staff currently undertaking this qualification and another two staff identified to commence the training in the near future. Staff comments received in respect of these shortfalls included: I never had an induction. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 28 “I have never had induction. Did not receive any training. Written induction was partly completed. Some of the knowledge was learnt on the job”. I was just thrown into the job. Anything I needed to know I asked one of the staff. “Training is needed for all staff in all areas”. Comments received both from the people who live at home and their relatives 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 current induction-training programme would not familiarise staff sufficiently to ensure they have the required skills to deliver care appropriately. Newly appointed staff members stated they were unsure as to what the term “protection of vulnerable adults” meant and were also unsure of how they would deal with such a situation. All new staff must be made aware of what constitutes abuse and how to deal with any concerns they may have so that the people who live at the home can be assured they remain protected at all times. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 29 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): Standards 31, 33, 35, 36 and 38 (some aspects of standard 37 was inspected but it was not inspected fully): Quality in this outcome area is poor. The service has not yet had time to recover from a sustained period of inconsistent management cover and people’s quality of life is poorer for this. The home is not currently operating in the best interests of the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last full inspection undertaken in April this year the owner has reappointed an acting matron who was the previously registered manager at the home two years ago. Although she is now back managing the home she has yet to register formally with the Commission. During the intervening two Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 30 years the management of the home suffered and the results are obvious in the poor record keeping, lack of staff supervision, and the poor general overseeing of the running of the home. The recently re-appointed acting manager has started to address some of these shortfalls and has been successful to some extent however, due to pressure of time, the high turn over of both the people using the service as well as staff working at the home she has not yet had enough time to instigate all the required changes/upgrading required. The owner has recognized this and has recently appointed a business operations manager to help with the heavy workload. This person is also highly qualified and experienced in the management of care homes for the elderly and is now working with the manager to ensure the home complies with the necessary requirements to provide a quality service for all the people who use it. Although the acting matron stated, within the homes’ annual quality assurance assessment, that staff supervision sessions are completed regularly as per CSCI’s requirements, this was found not to be the case. However, this newly appointed person has now taken on the task of providing supervision to all staff, with some supervision sessions undertaken already, since her appointment only a few days ago, as several staff had not had any recent supervision and she had identified this a priority area to address. She has also begun to update staff training records and address staff training needs as well as commence an infection control audit of the home. The owner has not yet commenced any form of quality auditing of the service and has not compiled an annual development plan for the home taking into account any potentially good or negative feedback, to allow the service to further develop. Neither has an annual development plan been compiled to take into account either good or negative feedback as well as providing timescales for necessary action to be undertaken in, which would then allow the service to further develop. This evidences that the home is not always run in the best interests of the people who live at the home. Comments received from staff in respect of the management of the home stated: “Sometimes we need more organisation and I think they need to be little more informative when giving reports about service users. “There is a need for a system to keep all staff up-to-date with regard to residents needs and changes” “Hand over time can be too short and interrupted. The office is the central area for meetings and telephones however another place for handovers is being considered. “ I believe information gets passed around on an ad hoc basis. Sometimes we are told. There doesnt appear to be a system in place of informing all staff of up-to-date information. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 31 Staff also said that sometimes they experienced problems getting jobs done in a timely manner and gave the example of having asked recently for a new battery for one of the hoists. This had not been provided and consequently the home was one hoist down, which affected the people that needed hoisting. Positive feedback included: “The acting manager discusses all areas of care and her support is greatly appreciated. Although I dont have meetings with management I do feel I could go to them if needed. This evidences that the manager is making headway within the home and that staff do have confidence in her approach. At the time of the inspection the home did not have a current electrical installation certificate available and the owner could not recall the date it had lapsed. It is understood that arrangements were in progress to have the system tested and to obtain a new certificate. This is a serious matter and places the people who live at the home at risk. Other health and safety shortfalls include the lack of risk assessments in relation to hot surfaces and the hot water provision to peoples’ sinks as well as staff lack of awareness in respect of ensuring peoples health is maintained by good infection control methods. 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 three people’s monies were checked and noted it was noted that the records balanced with the amount actually held. Although no financial transaction undertaken by the home is recorded with a signature and no signature is obtained from a person when money is issued, people’s monies held by the home were considered to be protected. Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 32 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 1 x 1 x x 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 2 2 x 1 Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. OP1 Standard Regulation 4 (1) (a,b,c) and 2 5 (1) Requirement The registered owner must ensure that there is an up to date service user’s guide and a home’s statement of purpose easily available within the home at all times. This documentation must also be made available to any prospective new person and or their family/advocate who might be considering living at the home. This is so that all people who live at the home and any prospective person considering coming to live at the home will be aware of the services and facilities available at the home. Also the Commission will also be aware of the services the home intends to provide. Timescale for action 06/02/08 2. OP3 14(1)(a) The registered owner must and (2)(a) ensure that any new person’s needs are fully assessed by the management and staff providing the care and any changes appropriately provided for. This will ensure that the person and/or their family/advocate can DS0000028780.V350805.R01.S.doc 13/12/08 Aspreys Nursing Home Version 5.2 Page 34 be assured that the staff are able to fully meet these needs. 3. OP3 14 1 (d) The registered owner must 06/01/08 confirm in writing to the prospective person that the home will be able to meet their assessed health and welfare needs. The registered owner must 06/02/08 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 contain details of peoples’ physical needs and routine monitoring such as nutritional needs. The care plans must also be such that they are easy to understand and access by the staff providing the care for the people. This will ensure that the people receive mutually agreed continuing support that meets their needs. All care plans must be reviewed monthly with the person and/or their representative. This will ensure that the people receive mutually agreed continuing support that meets their needs. 5. OP8 13 (7) The use of restraint measures such as cot sides must be risk assessed by the management of the home and advise sought as to the extent and use of such restraint from other relevant professionals. The use of such measures must always be discussed with the person it affects and /or their family/advocate. DS0000028780.V350805.R01.S.doc 4. OP7 15(1) and (2)(b) 06/01/08 Aspreys Nursing Home Version 5.2 Page 35 The final decision and the reasons for it should be fully recorded. This will ensure that the peoples’ health care needs are being met. 6. OP9 13 (2) The manager must ensure that 13/12/07 the home’s medications are held securely in accordance with recognised procedures. This will ensure that the peoples’ medicines remain secure at all times and people who live at the home are protected by the suitable storage of medicines in their own rooms. The registered owner must 06/01/08 ensure that unnecessary risks to the health or safety of the people are identified and so far as possible eliminated. This refers specifically to completing risk assessments for: the hot water supply, so that the people who live at the home can live in a safe, risk free environment 06/01/08 The registered owner must ensure that unnecessary risks to the health or safety of the people are identified and so far as possible eliminated. This refers specifically to completing individual risk assessments in relation to: the unprotected hot surfaces throughout the home. This so that the people who live at the home can live in a safe, risk free environment 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 DS0000028780.V350805.R01.S.doc 7. OP25 13(4)(c) 8. OP25 13(4)(c) 9. OP25 13(4)(a) 06/04/08 Aspreys Nursing Home Version 5.2 Page 36 10. OP27 18 (1) (a) 11. OP18 13 (6) burn. The registered owner must review the staffing levels at the home to ensure that there are sufficient staff on duty at all times and increase these levels accordingly where necessary. This will ensure that the people who live at the home can be provided with the level of care they need. Approved adult protection training should be made available to all staff members. This is to ensure that staff are aware of abuse issues and how to deal with them. This will then ensure the people who live at the home are protected. Additionally the registered owner must ensure that the staff, working at the home, receive appropriate training for the work they do. This relates specifically to providing an in depth induction training programme for new staff, providing infection control training for all staff as well as ensuring that all other statutory training is made available as required. This will ensure that the people who live at the home are cared for by an aware and experienced staff group and therefore receive the correct care. The registered owner must ensure that there is a robust recruitment programme operating within the home, which includes the receipt of two written references. This will ensure that only suitable people are recruited to DS0000028780.V350805.R01.S.doc 06/01/08 06/01/08 12. OP28 18 (1)(c) (i) 06/02/08 13. OP29 19 (1) (b) (i) 06/01/08 Aspreys Nursing Home Version 5.2 Page 37 14. OP33 24 (1) (a) and 2 provide care to the people who live at the home and therefore protect the people who live at the home. The registered owner must 06/03/08 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 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. 06/01/08 15. OP38 13 4(a) Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 38 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 O6 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. The owner/management should undertake a review of the home’s menu planning, specifically in relation to the suppertime menu Also the management should ensure anyone who wants to is made aware of how to make a complaint, including to this Commission if they needed to. Cleaning products should be stored securely 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. A review of how the home’s laundry systems operate should be undertaken to help minimise the risk of cross infection within the home and so help protect the people at the home. The management of the home should continue making national training in care available to staff to allow the home to have the correct level of nationally qualified staff on duty i.e. 50 percent. The management should continue to provide regular supervision to all staff and keep written records of the same. 2. 3. 4. 5. 6. 7. OP12 OP15 OP17 OP19 OP19 OP26 8. OP28 9. OP35 Aspreys Nursing Home DS0000028780.V350805.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V350805.R01.S.doc Version 5.2 Page 40 - 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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