CARE HOMES FOR OLDER PEOPLE
Asra House 15 Asha Margh Holden Street Leicester LE4 5LE
Lead Inspector Helen Abel Announced 11th April 2005, 10:00am 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. Asra House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Asra House Address 15 Asha Margh Holden Street Leicester LE4 5LE 0116 266 2727 0116 2556246 None ASRA Midlands Housing Association 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) Mrs Husaina Hirani Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Sensory Impairment over 65 years of age of places (3) Asra House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 14th October 2004 Brief Description of the Service: Asra House is registered to accommodate up to thirty-eight older people and up to 3 people with sensory impairment. Asra House is part of the Asra Midlands Housing Association, which provides care for older persons with an Asian lifestyle. Asra House comprises of a series of self-contained flats on two floors with single and double rooms, joined by the communal areas, offices and a passenger lift to the upper floor. There is a large communal lounge on the ground floor, a ‘quiet / private’ lounge for special family gatherings and a dining room adjacent to the kitchen. Asra House provides culturally appropriate prepared meals for the residents. Asra House has access to a minibus that is used for day trips. Asra House is purpose built and wheelchair friendly.Asra House has a pleasant aspect and is set back amongst trees surrounded by a garden area with seating area around the shrubs and plants. There are many places to shop and community facilities on the main road nearby. Asra House is in the heart of a multicultural community and there are ample places of worship and appropriate community amenities and activities. There is ample public transport to the local facilities and the city centre, which is ten-minute bus-ride from the home. Asra House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. A Gujariti speaking Interpreter accompanied the Inspector for part of the inspection. Seven services users were interviewed to seek their views in the lounge and in their flats. Both floors of the home were inspected. Services users were seen taking lunch in the dining area. In the afternoon the Inspector spent time viewing documents and talking with staff and the management team. What the service does well: What has improved since the last inspection? Asra House Version 1.10 Page 6 There has been an improvement with the policies and procedures safeguarding service users from abuse. Procedures have been refined around staff recruitment and protecting service users. What they could do better: 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. Asra House Version 1.10 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 Asra House Version 1.10 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) 1 & 3 Written information is available to prospective service users to make an informed choice around living at Asra House. Assessments take place for all new service users before they enter the home. EVIDENCE: A Statement of Purpose/Service User Guide was available that still requires updating. The Inspecting Officer highlighted Regulation 4 guidance where more information may be obtained to include in this document. The Registered Manager undertakes written assessments of prospective service users before entering the home. New assessments were evident in care records and led onto the production of comprehensive care plans. Asra House Version 1.10 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, Care plans are detailed and effective. Improvements are required around the monitoring of service users weight gain or loss. This shortfall has the potential to place service users at risk. Medication management of the home is very good with supporting policies and procedures in place. EVIDENCE: The care plans are comprehensive with information around daily care needs and input from health professionals set out. Monthly reviews of service users care needs take place and are signed by service user and/or their relatives. The care plan is initially explained to service users and their relatives. Any significant changes to care needs are also explained. Service users have access to regular hearing and sight tests. Most service users are weighed regularly with records held. Some service users are unable to manage the weighing apparatus due to their health conditions and have not been weighed or monitored. More appropriate scales must be obtained. Asra House Version 1.10 Page 10 Staff who administer medication are looking to receive accredited medication training in May 2005. The medication area was exceptionally well organised with appropriate medication records held. Improvements around monitoring fridge temperatures for the cold storage of medicines were suggested. Service users may administer own medication if they are able to do so within a risk assessment framework. Supporting policies and procedures around medicines in the home were in place and were familiar to staff. Asra House Version 1.10 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 - 15 There is a strong emphasise on organising social and religious activities to match service users individual needs and choices. Every effort to maintain contact with family and friends and the local community is made. The service is exemplary around providing culturally appropriate varied meals. EVIDENCE: Services users confirmed activities and religious ceremonies are organised and maybe conducted in the common room or in their rooms. Family and friends of service users may visit at any time and were observed being warmly greeted and moving freely around the home. Service users are consulted about events particularly around religious ceremonies and activities. Service users meetings take place every two months. Recent feedback was received from service users around music, trips out, menus and furnishings in the home. The Registered Manager positively acted upon these points. For example changes were made to the menu, new CD’s were provided. Keyworkers are allocated at the point of admission and work with the service user to meet their individual needs. A service user reported asking staff to take him to the temple, which was arranged in the home’s minibus. Seven service users were interviewed and confirmed the food was very good. Meals offered are of mainly Asian origin vegetarian and non –vegetarian.
Asra House Version 1.10 Page 12 Diabetic diets are catered for. Meals being prepared and served looked very appealing and attractive. The cook was observed making Indian tea. A range of drinks are offered and encouraged throughout the day. Asra House Version 1.10 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) 16,17,18 Complaints procedures are evident in the home and meet this Standard. Service users rights to participate in forthcoming political processes are promoted. Policies and procedures around Abuse have improved and safeguard service users. EVIDENCE: Complaints policies and procedures are currently being updated. A short written complaint statement in the communal area should also be reviewed. This was not presented in a customer friendly way. The Registered Manager confirmed work is being undertaken to ensure service users are able to access postal voting for the forthcoming elections in May 2005. On discussion with the Registered Manager it is apparent she is familiar with the Protection of Vulnerable Adults (POVA) checks. Asra House Version 1.10 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) 19,20,25,26. The maintence of the home indoors and outdoors is generally very good. An identified aspect presents a safety hazard and is potentially putting people at risk. Indoor accommodation is clean spacious and comfortable. EVIDENCE: The home is maintained both indoors and outdoors to a generally very good standard. The garden area is equipped with benches and tables and has trees and borders plants around the home. Service users reported enjoying sitting in the garden in the warmer weather. Furnishings in the home are very good apart from the main lounge carpet, which was lifting off the floor and presents as a safety hazard to service users. This aspect was also identified by the Registered Manager for replacement. Flats are roomy and include a spacious living, dining and kitchenette area. Flats were observed safe and warm and cleaned to a high standard. The heating and lighting is sufficient to meet service needs. Asra House Version 1.10 Page 15 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, The staff group are able to meet the individual needs of service users. Staff are understanding of their roles and responsibilities to service users care. EVIDENCE: The staff group are reflective of the service users group and are able to speak to service users in their community language. Staff are undertaking National Vocational Qualification training in care. Keyworkers undertake care and domestic duties, taking responsibility for their designated service users and their accommodation. Two waking staff are on duty each night with a sleep in staff member on call in the home. Service users confirmed their satisfaction with staff at the home. Asra House Version 1.10 Page 16 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) 38 The home’s policies and procedures demonstrate good health and safety practice to safeguard service users and staff. EVIDENCE: Staff training is ongoing around health and safety. The Registered Manager ensures safe working practices through regular recorded checks of the fire, electrical systems, hot water, security of the premises, central heating and robust risk assessments for service users. Last check of pre set hot water valves was in May 2004. A suggestion was given around developing more regular hot water checks. Environmental Health visited the home in February 2005 with no concerns. The Fire Service visited in March 2005 some minor requirements are to be met. Highlighted new Managing Asbestos legislation to the Registered Manager. Asra House Version 1.10 Page 17 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 2 x x x x 4 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x x x x 3 Asra House Version 1.10 Page 18 No 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. 2. Standard 8 20 Regulation 14 23 Requirement Obtain suitable weighing scales. Keep under review the weight gain and loss of service users. Replace main lounge communial area carpet. Timescale for action 31st May 2005 30th June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 16 38 Good Practice Recommendations To ensure the minmium maximum and current temperatures are recorded for the identified medicine fridge. Ensure simple and clear complaints procedure are displayed. Maintain regular hot water temperature testing to reduce risks from scalding. Asra House Version 1.10 Page 19 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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