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Inspection on 28/04/05 for Astley Hall Nursing Home

Also see our care home review for Astley Hall Nursing Home for more information

This inspection was carried out on 28th April 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a comfortable homely environment for the residents. It stands in large well maintained grounds providing a pleasant outlook from the home. The manager visits potential residents to ensure the home can meet their care needs. Appropriate information is provided to assist them in making a choice. The home has a committed staff team many of whom have worked at the home for many years. Staff demonstrates good knowledge and understanding of the residents needs. Relatives and residents complimented the caring staff at the home. The home is well managed and maintains all the relevant records and registers that are required.

What has improved since the last inspection?

The home is in the process of changing the residents Care plans onto a new recording format. Health professionals made positive comments about the home, and the care residents receive from the staff. The home has purchased some new furniture for the first floor lounge and library that has enhanced the appearance of these rooms.

What the care home could do better:

Care plans should clearly reflect the care needs of the residents. The care plans should also include the resident`s activities and social assessments. Specific dementia training would be beneficial for all staff especially new staff. Some requirements were given to the home to assist in the safe management of medicines.

CARE HOMES FOR OLDER PEOPLE Astley Hall Nursing Home Astley Hall off Dunley Road Astley DY13 ORW Lead Inspector Christine Potter FINAL- Announced 28 April 2005 10:00 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. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Astley Hall Nursing Home Address Astley Hall off Dunley Road Astley Stourport-on-Severn DY13 ORW 01299 827020 01299 827020 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) Mr Jayantilal James Bhighabhal PATEL Mrs Carol Wallington CRH 48 Demential - over 65 Old age Physical disability - over 65 29 48 48 Category(ies) of DE(E) registration, with number OP of places PD(E) Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 2 March 2005 Brief Description of the Service: Astley Hall Nursing Home is a three storey; Grade II listed building, set in 20 acres of parkland and situated two miles outside Stourport-on-Severn. Astley village is a short, travelling distance away.Astley Hall is registered to accommodate up to 48 service users who require nursing and/or personal care - including service users who have short - term memory care needs. needs.Accommodation is provided on all three floors of the home, and access to all floors is gained through staircases or a central passenger lift.The home is owned by Mr and Mrs Patel who own additional homes in other areas. The manager for the home is Mrs C Wallington who is a registered nurse with many years experience in the both the private and health service. Mrs Wallington has been the manager for the home for the past ten years. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over ten hours on the day of the 28th of April 2005. The inspection was carried out, as part of the regular planned program of inspections and the pharmacy inspector was present. A tour of the premises took place. Care plans and staff records were examined. Health and safety records were checked. Four staff and several residents were spoken to during the visit. There have been no complaints made to the CSCI about the service since the last inspection. What the service does well: What has improved since the last inspection? The home is in the process of changing the residents Care plans onto a new recording format. Health professionals made positive comments about the home, and the care residents receive from the staff. The home has purchased some new furniture for the first floor lounge and library that has enhanced the appearance of these rooms. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 6 What they could do better: 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. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 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 Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 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) 1,2,3,4,5 Residents and relatives looking for a suitable care home are provided with appropriate information and advice to assist them in making a choice. The manager assesses all residents prior to admission to ensure the home can meet the assessed needs of the prospective resident. EVIDENCE: Prospective residents and relatives had been provided with a copy of the Service user’s guide and the Statement of Purpose is available at the home for reference. The manager completes a care needs assessments for prospective residents to ensure the home is able to meet those needs. The assessment then forms the basis of the residents care plan. Comments received from residents, relatives, General Practitioners and Social workers confirmed that the home is able to meet the care needs of the resident’s examples of comments received. “The staff are very caring”. “Staff work hard caring for high level of dependency”.” I feel this is a really good home offering a safe level of care matched to the needs of the service users”. “Astley Hall is a ‘Homely’ Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 9 Home the staff are cheerful and helpful.” “ My team regard Astley as an extremely valuable resource.” Observations made during the inspection also indicated that staff were aware of the care needs of the residents. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 The residents care plans required some changes to ensure they accurately reflect the care needs and risk assessments of the residents. Astley Hall has a good relationship with healthcare professionals who assist in meeting the care needs of the residents. The staff interviewed had a good knowledge of each service users medication requirements. At the time of the inspection the medication records and care plans did not reflect accurately what had been administered to the service users in all instances. EVIDENCE: Care plans are currently being reviewed by the home following the last visit by the CSCI. Copies of the new documentation was reviewed at the visit and appeared to address the previous problems with the current system. Given the number of residents the timescale discussed to change the documentation is reasonable. The need to include the social care needs of the service users into the care plan was recommended. Staff were helpful with supplying medication information requested and demonstrated they had an understanding of the service users medication requirements. The medication cupboard was very warm and was propped open during the inspection. The photocopies of prescriptions were last updated in Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 11 July 2004. Where there was a choice of ‘one or two tablets’ to be administered, staff were not recording the amount of medication actually administered. It was noted that some MAR Charts were hand-written, which did not detail full administration instructions. The receipt of medication was documented, however the date of opening of boxes was not recorded and an audit trail could not be fully completed. The documentation available was not always an accurate reflection of what had been administered. Medicines had been recorded as administered when they had not been or conversely medicines had been administered and not recorded. There were omissions on the administration records with no documentation. Warfarin dose changes were not confirmed in writing. The administration of ‘when required’ medication e.g. sedatives, antipsychotics were not documented into a service users care plan with a reason for the administration. There was excess stock of some medication stored in the cupboard. Staff were observed tending to the residents in a respectful manner. Staff who were spoken to gave clear information of the residents needs. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The home must review the resident’s care documentation to ensure details of the resident’s day and activities are included. Social activities are not well managed as there are no specific trained staff. Several care staff participate in the role. The meals provided offer choice and variety and specialist diets are catered for. EVIDENCE: Staff spoken to during the visit explained that activities are implemented by care staff within the resident’s level of competency. Staff assist the residents to choose how to spend their day. A small percentage of relatives commented on the pre-inspection feedback that more social stimulation could be implemented on the first floor. The residents care plan should include details of the social activities if appropriate for that resident. Staff interviewed felt that the residents who were not confused generally participated with the activities. Some staff spoken to stated they had received no specific training for dealing with residents with dementia. From the high percent of feedback received from relatives it is acknowledged that relatives and friends visit as they wish. The home operates an open visiting policy and relatives can visit in private or in communal areas depending on their preferred choice. The home also publishes newsletters for relatives to keep them informed of changes. Relatives commented they found this most helpful. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 13 The comments received about the food were good. Relatives, residents and staff made positive statements about the food. The menus showed a varied choice, and catering staff ensure they know the residents dietary likes and dislikes. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 14 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 are handled appropriately. The home provides training for all staff protecting vulnerable adults to ensure a safe environment for residents. EVIDENCE: The home maintains detailed complaints records. Only one complaint had been made to the home since the last inspection. This was in relation to care and a resident’s bedroom, the complaint was partly upheld in relation to the bedroom. The complaint records confirmed that the home receives very few complaints, and adheres to their complaint procedure. The complaints procedure is available in the Service User’s Guide and displayed in the entrance hall. The majority of feedback received from relatives confirmed they were aware of the complaints procedure. A small number stated they were unaware of the process, the manager was advised of this and would discuss with staff. The home has a procedure for responding to any potential allegations of abuse. All staff receive training during their induction period, and staff who were spoken to confirmed this. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 15 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) 19,20,21,22,23,24,25 & 26 The homes appearance would be further enhanced by a redecoration program in some areas. EVIDENCE: The home has continued their redecoration and refurbishment program since the last inspection. The home has provided new lounge and library furniture. A number of areas still remain in need of attention. • • • The lounge on the first floor creates a poor impression for the home. Some chairs in service users rooms are in need of repair and or replacement. Carpets in some areas were in need of replacement, and assessed they are not a trip hazard. The manager confirmed that the replacement carpets were in hand. Given the size of the home and dependency of the residents the home was generally observed to be clean and tidy. Odours of incontinent were confined Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 16 to two bedrooms and the manager was aware of this and ensures a cleaning program to reduce the odours is implimented. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staff would benefit from specialised training in Dementia care to assist them in meeting the needs of the residents on the first floor. Recruitment practices are professional and thorough which provides further protection for the residents. EVIDENCE: All staff are up to date with the mandatory training courses and the records are available and up to date at the home. The need to provide staff with specific training on dementia care was discussed. Staff also commented to the inspector they would find this training beneficial in assisting them to meet the needs of the residents. The home appoints a senior nurse to be responsible for key areas and direct and support the rest of the staff team. A random sample of three staff files was reviewed at the visit. All the required checks were in place and the staff members confirmed they had been given induction training prior to starting work. The need to ensure a full employment history is available in the staff application file. Staffing levels were in proportion to the number of residents. Staff spoken to confirmed that the staffing levels were satisfactory for the number and dependency of the residents. The home has a very stable staff team many having worked at the home for many years. Ninety two per cent of comments received from relatives and other professionals stated that the staffing levels were adequate. Eight per cent commented that staffing levels were down at weekends and they were unsure of who was in charge at weekends. With the exception of six care staff the rest have completed or are in the process of completing NVQ level two and three. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37 & 38 The manager is competent to ensure the needs of the residents are met. All staff are appropriately supervised and have an annual appraisal completed. Records and registers were available and up to date. EVIDENCE: The manager is a first level registered nurse with many years nursing experience in both the NHS and the private sector. The manager has worked at the home for twelve years and has successfully completed the NVQ level 4 award in care and management. Staff spoken to during the inspection confirmed that the manager is approachable and provides the staff with clear leadership. Out of the 34 comments received from relatives, other professionals and residents all but one stated that the manager was always available and performed the role satisfactory. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 19 The home has a formal quality assurance audit and the results are available at the home. Records inspected indicated that regular health and safety checks are carried out including fire safety tests. There are systems in place for risk assessments to ensure the safety of residents and staff at all times. Staff records evidenced that all staff have supervision every two months and a record is kept in their personal staff file. The home provides regular statutory reports as required for the CSCI. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x 3 x x 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 4 x 3 3 3 3 3 3 Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 9 9 Regulation 13 13 Requirement Medication must be stored below 25°C and a thermometer obtained to ensure this is met. Where the directions request more than one dose then the amount of medication administered must be documented The administration of medication must be signed for on the MAR (Medication Administration Record) Charts or a relevant code used. Written confirmation of Warfarin dose changes should be obtained and kept as a record. Administration of when requiredsedatives or antipsychotic medication should also be recorded and documented with reason into the service user care plan. The service users care plan should accurately reflect the care needs and assessed risks of the service user. Unless it is impracticable, service users or their representatives must be involved in drawing up their individual plans. Keep all parts of the home well E52 S4094 Astley Hall V215844 280405.doc Timescale for action 27/5/05 Immediate and ongoing Immediate and ongoing Immediate and ongoing. Immediate and ongoing 3. 9 13 4. 5. 9 9 13 13 6. 7 15 30/06/05 7. 7 15 30/06/05 8. 19 23 30/06/05 Page 22 Astley Hall Nursing Home Version 1.30 9. 30 12,18 10. 12 15 maintained and in good decorative order. The need to prioritise in need of urgency was recommended. A program showing timescales should be forwarded to the CSCI. All staff must receive training in the management of older people with short term memory impairment. The home needs to include details of the activities and include details in the residents care documentation. 30/06/05 30/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 9 29 Good Practice Recommendations Ensure that an up to date photocopy of the prescription is retained in the home. For any new staff the home should request a full employment history from the applicant. Astley Hall Nursing Home E52 S4094 Astley Hall V215844 280405.doc Version 1.30 Page 23 Commission for Social Care Inspection The Coach House John Comyn Drive Worcester WR3 7NW 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. 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