Inspection on 13/11/06 for Astell

This inspection was carried out on 13th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Astell 20/03/06

Astell 31/10/05

Astell 15/03/05

Astell 27/10/04

Astell 09/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Astell Overton Park Road Cheltenham Glos GL50 3BT Lead Inspector Mrs Helen James Key Unannounced Inspection 13th November 2006 09:30 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 Astell DS0000016372.V309786.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. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astell Address Overton Park Road Cheltenham Glos GL50 3BT 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) 01242 529012 01242 584520 Cheltenham Old People’s Housing Society Limited (The Lilian Faithfull Homes) Mrs Barbara Wilson Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20th March 2006 Brief Description of the Service: Astell is a large attractive Victorian property, which has been adapted to provide comfortable accommodation for 36 elderly residents who require personal care. It is situated in a residential area, close to the centre of Cheltenham and to local amenities. The Home is owned and managed by a charitable organisation and is one of the Lillian Faithfull Homes. The fees range from £340 to £440 per week with a one off Capitation Charge of £5000 to secure tenancy. Residents are accommodated on three floors of the Home, accessed by a shaft lift. The majority of the bedrooms have en suite facilities. A variety of aids and adaptations have been provided throughout the property to assist the less able residents. Communal areas consist of a large comfortable lounge, which may be divided by screens to provide two separate rooms, when desired. There is also a pleasant dining room and small library, which may be booked for private use. The Home is maintained and decorated to a good standard. The Home has the benefit of enclosed well-maintained gardens. These are easily accessible and may be enjoyed by the residents in pleasant weather. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Unannounced inspection took place over nine and a half hours on one day in November 2006 and was completed by two inspectors. Thirty-two Care Standards for Older People including all the twenty-two Key standards were assessed on this occasion. Of these twenty-six met the standard, five almost met the standard and one was not applicable. The new Manager for the service Mrs Barbara Wilson was appointed on 5th June 2006 and she has made immense progress in providing leadership and direction for the home and its staff. Time during the inspection was spent speaking with the Manager, residents, staff and visitors, examining documentation, management records and the environment. Those residents/visitors who were able to converse with the inspector discussed the admission process, care, food, lifestyle, activities and relationships with the staff at the home. The information in relation to care and welfare gained from these discussions and observation was then cross referenced with residents individual care records and other appropriate documentation. The local CSCI pharmacist inspector examined the arrangements for the management of medicines in this home. Two senior carers were spoken to and feedback given to the manager. Staff were very positive and helpful throughout the inspection. Three service users were visited in their rooms and spoken with. Questionnaires were sent out prior to the inspection and analysed prior to the site visit. Ten responses from residents were received out of fifteen sent, all were very positive about the care, food, activities and staff. Several commented on the improvements made since the new manager had been in post. One commented that bathing opportunities were inadequate but on discussion with residents and staff at the home this was not evident. The thirteen responses received from relatives/visitors out of fifteen sent, all were again very positive about the management of the home, care, food and attitude of the staff. One relative felt more staff were needed, but the inspector could find no evidence to support that more staff were required. Two relatives commented on not knowing how to access the last report for the home and this was discussed with the manager at the inspection. The six responses from the staff out of ten sent, were all very positive about the home, support, training /personal development and management they receive whilst at work. Several did comment on the lack of supervision but the manager is addressing this. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 7 Staffing continues to remain stable with many staff having worked at the home for a long time. They appear to enjoy working at the home and enjoy good team morale. Several staff have taken on new responsibilities within the team as trainee senior carers and this will assist in the smooth running of the staff team with direction and leadership of the care. A comprehensive programme of training and development has now been implemented to ensure all staff receive mandatory and developmental training appropriate to their needs. Several staff are keen to undertake their NVQ level 2 and this is being encouraged and facilitated by the new Manager. The laundry has been upgraded and floor covering replaced to provide a safe working environment with surfaces that have an impermeable finish that is readily cleanable. Financial records are now in place to record and safeguard service users’ finances. What they could do better: Care plans need to be developed further to ensure they contain all the required information and evidence the care that is being given by staff, so that large amounts of information is not written in the daily record. There also needs to be a method of evidencing the involvement of residents/ their representatives in the development of the care plan / reviews and their agreement or disagreement with it. Systems for supervising and reviewing performance of staff in relation to care practice must continue to be implemented to ensure consistency of the standards of the care practice within the home. The arrangements for the safe administration and safekeeping of medicines received into the home in relation to keeping medicines in the fridge secure and reviewing the procedures and records where residents self administer their medicines must be addressed. There must be suitable arrangements to prevent infection and the spread of infection at the home in relation to the identified failings in the laundry system within the home as identified in the report. The Manager has a comprehensive array of documented auditing tools in place too examine quality and effectiveness of systems in the home. But the Health and Safety and accident audits need to be formalised and the home also needs to seek and evidence the views of its community stakeholders to give a holistic assessment of the quality of service provided to residents by the home. There also needs to be an annual report of the effectiveness of the Quality Assurance systems in place for the inspector to review. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 8 In conclusion Astell provides good standards of care in a comfortable environment for its residents. The home has a warm and welcoming atmosphere that felt homely and comfortable for the residents and visitors. The new Manager has made an excellent start by providing leadership to the staff team with her Deputy and she is keen to continue improvements to the service for the benefit of residents, documentation and systems. There was a positive approach to the inspection process and a willingness to implement appropriate changes / improvements that were bought to her attention. 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. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 9 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 Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are well informed about the home prior to admission. Arrangements are in place to ensure that each prospective resident is fully assessed prior to admission. This is reassessed on admission, to ensure that all their specific care needs can be met by the Home. Residents or their relatives have the opportunity to visit the home. Respite care is provided but Intermediate care is not provided. EVIDENCE: The home has a Statement of Purpose and a Service User’s Guide that is being updated at the moment. Whilst a copy was available it was clear that the aims and philosophy require reviewing and updating. A copy of the statement of purpose was seen in the foyer of the home. This review will ensure that residents and their families receive accurate information about the home and Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 11 services provided. Each resident /their representative receive the information and it is on display in the foyer of the home. Residents/relatives spoken with confirmed that there was an assessment by the Manager at the home prior to admission if possible and they were reassessed when they arrived at the home or as their needs changed. They confirmed they are involved in the process with their relatives/representatives with the member of staff talking to them about their care. Documentary evidence of the assessment process was available, but residents or their representative had signed no records to evidence involvement. There needs to be a way of capturing this process with the parties concerned. Residents confirmed that they or their relatives visited the home prior to their admission or their friends had lived here. They all found the home to be very suitable. Residents had contracts (samples were not seen as they are kept at Head office). In discussions with residents it appeared that in the main relatives/representative or Social Services dealt with this and only a few residents themselves were able or wanted to be involved with the contractual issues. The Manager reported that the contract had been reviewed recently and it contained all the required details and had been examined by solicitors to ensure it was compliant with the Office of Fair Trading Standards. The issue relating to the £5000 capitation charge on residency for private residents was discussed. It is quite explicit in the contract and residents and their relatives are fully aware of this payment when they make enquiries for residency. Further discussions relating to this charge have been had with Mr Bennett and he is to examine the legalities of this in light of the Office of Fair Trading guidance. Several new residents were spoken with where the inspector was able to; they confirmed that they were given choice in what they do and independence was encouraged and maintained. All the comments made by residents, relatives/representatives in conversation and via questionnaires were very positive about the home, staff, care and the food. Several especially commented on the improvements that have been made since the new manager had been in post. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 7,8,9,10 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. All of the service user’s health, personal and social care needs must be set out in an individual plan of care. Health care needs are fully met. Service users feel they are treated with respect and their right to privacy is respected. Medicines are given to service users safely and most medicines are stored safely although the medicine fridge was not lockable. Some of the arrangements and records for service users who self-administer their medicines could be improved. The report identifies some areas where more attention to detail is needed. EVIDENCE: Care plans are kept in resident’s rooms; they are developed for each resident following admission. On examination of care records it was evident that residents have a pre-admission assessment. On admission this should inform the detailed individual plan of care that should be developed in consultation Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 13 with resident/representatives where possible. Three out of six seen did not give detail of identified needs (care needs), what is to be achieved, assistance/care intervention by care staff and evaluation of this care (monthly reviews). This must be addressed. There was no documentary evidence that residents or their representatives have been involved and agree/disagree with the assessment or the monthly reviews, the home needs to evidence this involvement. The Manager is to explore ways of evidencing this. Records of newly admitted residents and longer-term residents were seen and all had assessments completed with all required information, daily routines and risk assessments. Specific Care plans need to be developed for each resident so that less needs to be written in the daily communication record (daily record). From the six records seen at inspection the following were identified: • Specific Care plans need to be developed so that they identify the need, give the outcome to be achieved and the action on how this care is to be achieved with evidence that this is evaluated. • Religion must be recorded. • Where residents are self-medicating there must be a comprehensive risk assessment completed and this must be reviewed regularly. • All care record assessments must reflect the current status of the individual. • All parts of the care record contained within the care file must be completed, dated and signed. • All parts of the care record in the care file must be appropriate as some parts of the care record may not be necessary for every individual. These all require addressing to ensure care record information meets the required standards. Pharmacist Report; Medication policy: The home has a medicine policy and procedures but some of these need updating to describe the current practices in the home and to include all issues about safe management of medicines. Record keeping: The supplying pharmacy provides printed medicine charts each month. The allergy section needs completing so that staff can see this important information when they give out the medicines. The label on one laxative indicated to give doses three times daily but staff were giving twice daily. The correct dose to give needs checking. Some medicines are prescribed as a variable dose (one or two tablets) but the records are not always clear as to what dose has been given. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 14 A few charts were seen where there were no signatures to indicate medicines had been given but the tablets were not in the blister packs. The use of prescribed external medicines was not always recorded on these charts. Some audits were carried out by counting medicines and comparing this with the quantities the records indicate should be in stock. Two checks showed differences of one or two tablets but another check showed a difference of seven tablets. Other checks were in agreement including controlled medicines. Regular sample checks such as this are useful as part of a quality assurance system to check that there is safe management of medicines. Two staff generally sign handwritten entries or additions on the medicine charts but there were examples where this had not been done. Some medicines are prescribed to give ‘as required’. In some records additional information to explain this was added to the medicine charts. A senior carer described in some detail how another two medicines would be used. This sort of information needs to be written down so that any staff giving medicines are always clear about the correct use of the medicine. Administration: The lunchtime medicines were taken around the home and given out by a trained member of staff who followed safe procedures. Service users were treated kindly, with dignity and their privacy respected. Three service users were spoken to and were satisfied with the arrangements for their medicines and very complimentary about the home. ‘Staff are very competent, kind and loving; we are well looked after’. Night staff give a number of medicines at 7am and this may be the choice of service users. There is a potential risk of errors where staff administer medicines at the end of a long shift. Day staff give the rest of the morning doses starting at 8am. Some improvements for self-medication are needed to make sure that it is safe for all those involved. A proper risk assessment needs recording – the forms used are just for consent and some of these were not signed. All ways of selfadministration must be covered, such as leaving individual doses with service users, leaving containers of creams or ointments in rooms. Where service users look after their medicines lockable storage is provided in some, but not all rooms. When staff are ordering and receiving the medicines to give to a service user to look after themselves records are needed so that there is an audit trail to account for the medicines. Consideration could be given to having a printed medicine chart and using this to record the relevant information. Controlled Drugs: Separate locked storage is provided for controlled medicines. This would be best moved within the walk-in cupboard to bolt both sections to a solid wall. There is a controlled medicine record book and a separate notebook for particular sleeping tablets. It would be clearer if all these records were in the one printed record book. The amount of medicines in stock agreed with the recorded quantities although in one case a receipt and disposal record for the Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 15 same quantity had been missed. As well as recording in the disposal book medicines returned to the pharmacy should also be written in the record book and the stock balances changed. Storage: There are suitable arrangements to keep medicines safely and stock appeared well managed. Keeping items such as keys, money and handbags in the medicine cupboards is not good practice as it can compromise the security of medicines. The medicine fridge needs fitting with a lock to keep these medicines safely. Many containers of medicines had a date of opening written on - this is good practice and allows stock rotation and audit checks. This is also needed for external medicines, replacing with new supplies after the recommended ‘in use’ periods. Other: There is a process that provides training, observation of practice and signing off for the particular staff who administer medicines. The manager wants to train more staff and is working with the training department to achieve this. A list of staff trained and authorised to give medicines with their sample signatures and initials is advised as this helps to identify on records who has given a medicine. Staff have access to Patient Information Leaflets (PILS) about the medicines used. An up to date reference book such as the British National Formulary is strongly recommended as indicated in the home’s medicine policy. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Residents experience a stimulating and varied life at the home with visitors and community links encouraged. There is a full activity programme available to suit all abilities within the home. Residents continue to have the option for a varied lifestyle. Residents continue to be able to exercise choice and control over their lives within the individual ability to do so and maintain contact with family and friends. The meals at the home are wholesome and nutritious with choice at each meal. EVIDENCE: Residents confirmed that they have the opportunity to exercise choice in relation to their daily routines. Individual daily routines are recorded on admission to the home and residents alternate their routine as they wish and care staff facilitate this where assistance is required. There is access to advocacy services if required. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 17 The home has no Activity Coordinator at the present time it is all staffs responsibility to initiate the activities programme, but from January there will be an activities coordinator who will work three days a week and produce the programme of activities. The progress of this appointment and its impact on the activity programme will be reviewed at the next inspection. At the present time a whole range of activities are arranged and they are publicised around the home. Residents past life, hobbies and interests are recorded but there is no record of what individuals participate in at the home at present. Residents spoken to appear to be very happy with the level of activities provided and particularly spoke about the summerhouse they have in the garden, which they really enjoy. They have requested a heater so that they can enjoy it in the colder months of the year and this is being facilitated. Activities have included; trips out, readings, carol singers visiting, music and movement, craft, board games and one to one sessions talking with carers etc. Many of the residents are able to go out with family and friends and some continue attending clubs/groups that they were involved with prior to admission. Church services are provided and whether the resident goes to church or prefers to attend communion at the home or individually is entirely the resident’s choice. Visitors were welcomed into the home at any reasonable time and residents spoken to were able to confirm this. Two visitors told the inspector, “that they were always welcomed by the staff and always offered refreshment”. Meals can also be provided if required by visitors. Residents are supported by the home if they do not wish to see their visitors. Individual likes and dislikes and special needs in relation to food are ascertained on admission, recorded on individual care records and shared with the catering staff. The inspector was told that the Catering Manager has regular meetings with the Manager and audits the catering provision monthly. All residents/representatives spoken to state they enjoyed the food and the quality and quantity was much improved since the new Manager has been in post and has taken up the concerns several residents had about food. One resident monitors the menu for the manager and discusses the concerns about the food on a regular basis with her. Staff are aware of the specialist dietary requirements of residents and ensure their needs are catered for at each meal. A choice of food is available at all meals and the menus provided evidenced this. Snacks and drinks were available as required and there was plenty of fresh fruit available throughout the home. Nutritional monitoring is undertaken and recorded and two residents are being monitored at the present time. Resident participation in Resident meetings is very good as there are some particularly articulate people residing at Astell. The minutes seen demonstrated good attendance (17/18) and participation from residents. Documented minutes are available to everyone. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: No formal complaints have been received by the home. All concerns/grumbles are dealt with as and when they occur. The home has a complaints procedure that all spoken with were aware of. Four residents spoken with stated that ‘they have no concerns about the care or the home and that they always feel confident to discuss ‘niggles’/ concerns with the care staff on the floor, the Manager and deputy’. One resident shared an example of an issue she had had at the home and she was very positive about the way the home dealt with it. This was also evidenced from the questionnaires received; no one stated they didn’t know the procedure. The home has its own policy on abuse and adults at risk file. The Manager has attended enhanced adults at risk training. All staff receive abuse awareness/adult protection training on induction and this is updated regularly. Staff spoken with confirmed they had received this and in discussion knew what they would do if they saw abusive practice or saw anything that bothered them. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 19, 24, 25 & 26 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. The standard of décor within this home is good and no maintenance issues were identified. Residents live in a safe well-maintained environment. The standard of cleanliness was very good, but there was one serious issue relating to infection control identified relating to laundry. EVIDENCE: A tour of the building was carried out and all areas visited were generally well maintained and decorated. The home benefits from the attention of the maintenance team. There is a maintenance book for the recording of all maintenance issues to be addressed these are signed as they are completed to ensure an audit trail. Gardens are accessible, attractive and well maintained and the residents take particular pride in their summerhouse where many of them like to spend time. The residents have made a recent request for a heater for the summerhouse so that they can enjoy it in the winter and spring. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 20 There is a domestic team that keeps the home clean, tidy and odour free. The laundry has been upgraded and now provides good hygienic facilities for the laundering of clothes, which complies with infection control standards. The one issue that still does not comply with the infection control standards is the way the laundry gets to the laundry. At present all laundry is tipped down a chute from all floors of the home. During the inspection the inspector witnessed used tea towels being put down the chute (in no bag or container) that then just fell onto the concrete floor at the bottom of the chute by the laundry. It was confirmed by the deputy Manager that laundry is collected in bins on each floor and then it is ‘tipped’ down the chute by the care staff, this is how all laundry comes down the chute unless it is in a red bag. This is a serious infection control issue that must be addressed; a system for sending all soiled laundry down the chute must be implemented and there must also be a container at the bottom of the chute to receive it so that soiled laundry does not sit on the floor before it is sent through the laundry system. Also all kitchen laundry, as it is used in food preparation areas must be laundered separately from the homes’ general laundry. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 & 30 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers to meet the residents needs and care observed was appropriate. There appears to be a good leadership of the care practice in the home. Thus ensuring consistency of care practice in the home. Morale remains high with a low staff turnover so there is consistency for the residents. The procedures for the recruitment of staff are good and protect the people living in the home. There is a full staff-training programme from the internal training department that covers all mandatory training and care practice issues for all staff. EVIDENCE: Staff spoken with felt that staffing was sufficient to meet the needs of residents and that they had time to do their job. There are support staff who deal with domestic chores and a contracted catering company to deal with catering therefore care staff are free to deal with care issues. The care staff receive good support from the Manager and her deputy but regular documented supervision is in the process of being reimplemented. The new Manager did appraisals in July/August 2006. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 22 General team meetings occur every three months and senior care meetings every month. A verbal handover is given at each shift change. Three staff have completed National Vocational Training (NVQ) and seven have begun their NVQ. But the home does not yet comply with 50 of staff having obtained the level 2 NVQ. Completion of NVQ is related to a pay reward structure to encourage completion and motivate staff. There is also a performance management system in place that rewards staff through pay and bonus incentives. The Manager is in the process of reviewing the care records to assess what documentation is required. Care staff write the daily records and feedback any changes in condition to the senior staff on duty. The daily records written are long at present this is due to the fact that individual care plan records need to be more specific for each individual. All staff have access to the records and know all about the residents and how to meet their needs, but this needs to be better documented in individual care plans. Staff felt that there was a good supportive team in the home, it was a happy place to work and that they got good support from the new Manager. They feel there is enough time to give care to the residents and that the residents are given choice. Residents spoken with confirmed that the staff were very caring and met their needs. Many residents at the home are able to voice their wishes and opinions. Recruitment files were not inspected but a sample seen at head office during a previous inspection contained evidence that all pre-employment checks had been appropriately undertaken, prior to employment to comply with regulation 19. This included a sample of new staff Criminal Record Bureau (CRB) disclosures for the group of Lilian Faithful Homes. The Manager is keeping some personnel information at the home and this included basic information, work history, training records and all 3, 6 and 12 week review records and induction training records. The organisation has implemented induction training that includes all the mandatory training for all new staff and all other staff receive regular updates. Training records for two new staff were seen and evidenced this. The Manager gave the inspector evidence of the training planned for the year. The training department will give the Manager the training programme in December for the forthcoming year. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The Management of the home is good and the Manager provides leadership, guidance and direction to staff on a ‘day to day’ basis. The systems for service user consultation and Quality assurance are developed within Lilian Faithful Homes and the Manager is in the process of ensuring that they are adequately implemented at Astell. There are processes in place to safeguard the financial interests of residents. The health, safety and welfare of the people using the service are protected and safeguarded. EVIDENCE: Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 24 The staff reported that the Manager is approachable and has an open door policy so is accessible at all times. They feel they have good support from her and have had an appraisal with her. The Manager is in the process of reimplementing regular supervision of staff. Evidence was available to demonstrate that staff are receiving their mandatory training and other training pertinent to their needs. This is implemented through the in-house training department and includes fire, health and safety, moving and handling, food hygiene and first aid training etc, the training records for some staff were seen. The Manager is undertaking the Fire risk assessment of the home and documenting this. She is also reviewing the Homes Environmental Risk Assessments that are in place. The Lilian Faithful Homes have a comprehensive Quality Assurance system is in place and the home has accreditation for Investors in People and ISO 9001. The Manager has a comprehensive array of documented auditing tools in place too examine quality of systems and effectiveness of care procedures/practice in the home and these were seen during the inspection. Whilst the home audits residents and relatives views it is essential that views are sought from GPs, chiropodists, hairdresser, Community Nurses and other community stakeholders to give a holistic assessment of the quality of service provided to residents by the home. All financial dealings are completed through the invoicing system except for the resident’s personal monies. There is an appropriate accounting system is in place, which was seen at the inspection. This is to be linked into the invoicing system in the future. There is a Residents Fund that has receipted accounts. The Manager is in the process of re-implementing the quarterly supervision and yearly appraisals for all staff and senior staff will assist her in this in the future. Staff complete a self-assessment questionnaire prior to their appraisal and then this is discussed during the session both parties sign this record. Staff pay incentives have been introduced and these are linked to statutory training completion, performance and attendance at work and this is reported to work well in motivating staff. All the required documentation is in place and is stored securely. organisation is registered under the Data Protection Act 1998. The All the required Health and Safety checks were in place in the home and documentary evidence was available pertaining to this. The handyman checks all hot water outlet temperatures monthly records of these checks are available. Legionella water sampling is being done yearly and the home is waiting for the testing kits to arrive to complete this for this year. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 25 Accidents/incidents are appropriately recorded in the accident book and notified to the Commission for Social Care Inspection (CSCI) via Regulation 37 notices. But these are only informally audited by the Manager at the present time it is required that a formal accident auditing system is implemented. Maintenance is addressed through the Maintenance Advisor who meets with the Manager on a regular basis at the home and then sets the Maintenance programme. He then negotiates the contract and monitors the job to completion. The Manager monitors catering provision in house and meets with the Manager of the catering contractor on a regular basis and she is provided with a copy of their audit. Regulation 26 reports are received monthly by the Commission from the Chief Executive the quality of information received is more detailed and meets the criteria in the regulations. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 27 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. Standard OP1 Regulation 4(1 & 2) Requirement A copy of the reviewed and updated Statement of Purpose and a Service User’s Guide to be sent to the Commission. The registered person shall ensure that all care plans are set out in detail, with identified need and action to be taken by care staff, to meet the identified health, personal and social care needs of residents. The registered person shall ensure that residents’ care plans reflect the following: • Specific Care plans for individuals to identify the need, give the outcome to be achieved and the action on how this care is to be achieved with evidence that this is evaluated. • Religion is recorded. • Where residents selfmedicate there must be a comprehensive risk assessment completed and this must be reviewed regularly. • Care record assessments DS0000016372.V309786.R01.S.doc Timescale for action 30/04/07 2. OP7 15(1) 30/04/07 3. OP7 15(2)(b) 30/04/07 Astell Version 5.2 Page 28 4. OP9 13(2) 5. OP7 14(1c) & 15(2c&d) must reflect the current health and physical status of the individual. • All parts of the care record contained within the care file must be completed, dated and signed. • All parts of the care record in the care file must be appropriate some parts of the care record may not be necessary for every individual. The registered person must make arrangements for the safe administration and safekeeping of medicines received into the home. (This relates to keeping medicines in the fridge secure and reviewing the procedures and records where service users self administer their medicines.) The Registered Person to explore ways of evidencing the involvement of residents/representatives in the development of the care plan / reviews and their agreement or disagreement. The registered person must make suitable arrangements to prevent infection and the spread of infection at the home by: • Implementing a safe system for sending all soiled laundry down the chute to the laundry. • Ensuring that there is a container at the bottom to receive it. • Ensure that all kitchen laundry is laundered separately from the homes’ general laundry. The Registered person must implement a formal documented DS0000016372.V309786.R01.S.doc 28/02/07 30/04/07 6. OP26 13(3) 28/02/07 7. OP33 24(1) 28/02/07 Astell Version 5.2 Page 29 8. OP33 24 (2) accident auditing system to evidence the informal auditing that takes place. The Registered person must produce an annual quality assurance report to evidence the review of the quality systems in the home. This must include stakeholders’ views and future developments in the home. 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP9 OP9 OP33 Good Practice Recommendations Review the arrangements for morning doses of medication so that night staff do not administer too many medicines at the end of a long shift. Fix both metal medicine cabinets with rag / rawl bolts to a solid wall. Provide an up to date medicine reference book such as the British National Formulary. A quality assurance policy and procedure should be devised to detail how the systems are used within the home and how this affects the development of the service. Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Astell DS0000016372.V309786.R01.S.doc Version 5.2 Page 31 - 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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