Inspection on 06/08/09 for Astley Hall Nursing Home

This inspection was carried out on 6th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Astley Hall Nursing Home 17/06/10

Astley Hall Nursing Home 12/04/10

Astley Hall Nursing Home 18/11/09

Astley Hall Nursing Home 05/07/07

Astley Hall Nursing Home 20/07/06

Astley Hall Nursing Home 13/10/05

Astley Hall Nursing Home 28/04/05

Astley Hall Nursing Home 02/03/05

Astley Hall Nursing Home 18/01/05

Astley Hall Nursing Home 19/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Philippa Jarvis     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW 01299827020 F/P01299827020 Carisastley@aol.com None Mrs Kailash Jayantilal Patel,Mr Jayantilal James Bhikhabhai Patel care home 48 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 48. The registered person may provide the following category of service only: Care Home with Nursing (Code N) to service users of the following gender Either Whose primary care needs on admission to the home are withi the followng categories: Old age not falling within any other category (OP) 48 Physical Disability (PD) Age 50 years and over 48 Dementia (DE) Age 50 year and over 29 Date of last inspection Brief description of the care home Astley Hall Nursing Home, Church Lane, Astley, is a three storey, Grade II listed building, set in 20 acres of parkland and situated two miles outside Stourport-onSevern. Astley village is a short travelling distance away. Care Homes for Older People Page 4 of 33 29 0 48 Over 65 0 48 0 Brief description of the care home Astley Hall is registered to accommodate up to 48 residents who require nursing and/or personal care needs relating to old age and physical disabilities. A maximum of 29 residents of the 48 may have dementia illnesses and 2 people with a physical disability may be between 50 and 65 years of age. Accommodation is provided on all three floors of the home, and access to all floors is gained via stairs or a central passenger lift. Mr and Mrs Patel are the registered providers. The registered manager is Mrs Carol Wallington. At the time of the inspection the scale of charges was between £460 and £491 week. Additional charges are made for hairdressing, personal toiletries and newspapers where applicable. Information regarding the home was available from the reception area in the Statement of Purpose, the Service Users Guide and the most recent Inspection report. Copies of these documents are given to each new resident or their relatives. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent two days at the home, talking to the manager, the people who live there and the staff. We looked at some records that must be kept in the home to show it is being run properly. These included records that related to people who live in the home and the staff who work there. Before the inspection we asked the home to complete an Annual Quality Assurance Assessment, referred to in the report as the AQAA. This is a self assessment that allows the home to tell us what they are doing well, improvements they have made and plans they have for future improvements. It helped us to plan for the inspection and some of the comments made are detailed in this inspection report. We also received survey forms from people who live in Astley Hall, staff and some health and social care professionals. The information in these helped us to understand how well the home is meeting the needs of the people who live there. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Each person who lives in the home has a plan of care. The care plans are not good Care Homes for Older People Page 8 of 33 working documents and do not inform care staff about how to meet the needs of people living in the home. We found that the approach to meeting peoples personal care was not robust, for example some people did not have toiletries to help with personal cleanliness. We also found that there were some health conditions where there was no guidance about how to manage these. Risk assessments were not always carried out reliably, for example for the use of bed rails or management of diabetes. Some people experience problems in getting their clothes returned from the laundry. We found that some people do not have any information about how they like to spend their day or of any activities that they ahave been involved in. The unit that specialises in dementia care is on the first floor and people do not have access to the gardens. The secure area designated for people from this unit is weedy and does not have any seating area. We found that the food provided was not reliably appetising and there was some lack of clarity about the provision of meals for people who needed special diets. We were not confident that all complaints were logged and therefore dealt with appropriately. There was lack of understanding of safeguarding procedures within the management team. There are areas of the home that need redecoration. We also found furniture that was broken and unusable on the first day of our inspection. Some carpets were in need of replacement and some people did not have carpet on their bedroom floor. There were many stair gates in use on bedroom doors on the first floor. The home continues to rely on agency staff to meet the staffing levels needed in the home. There is a programme of training in the home. We found that there no evidence to show that some staff had completed the training that they need to carry out their role safely. A number of staff have taken training about dementia care but no one in the home has taken training beyond an initial stage even though the home contains a unit that provides a specialist service. The home has quality assurance policy but has not carried out a quality monitoring process for over two years. We found aspects of the service that should have been identified and work undertaken to address shortfalls in service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information to help them decide whether Astley Hall is the right place for them to come and live. They are also able to come and look round before making a decision. All prospective residents are assessed by the home so they can be sure that the necessary care can be provided. Evidence: There is a reception desk in the entrance hall where information about the home is available. The home has a brochure, a Service User Guide and a Statement of Purpose. Some infomation in these documents needs upgrading and we were told that they are in the process of being reviewed. The manager told us that she carries out an assessment of prospective residents before they are admitted and we saw copies of these on the files that we examined. They were written in sufficient detail for the home to be able to make a decision about whether they could meet the care needs of the people referred. She said that people Care Homes for Older People Page 11 of 33 Evidence: and their families are encouraged to look round before admission. In the AQAA the manager told us that there had not been any failed placements although we are aware of one since this document was written. The home also has a policy about how to manage admissions in the event of an emergency referrals. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Astley Hall have a plan of care. These are not fully developed to make sure that staff have all the information they need to provide full and appropriate care. There are times when peoples dignity is not upheld and they are not treated respectfully. The homes managment of medication is generally carried out in a way that is safe. Evidence: We looked in detail at the experience of three people who live in Astley Hall. We read their care plans and looked at aspects of their life in the home. We found little evidence that the residents, or their representatives, had been involved in the care planning process. One health care professional said, in their survey, that, Care plans are sometimes lacking in detail. The care plans did not detail how peoples personal care should be provided, for example what they could manage independently and areas where they needed assistance. The home has a bath rota that shows which day people have their weekly bath, or if they have one more frequently. Generally no record is kept to confirm that Care Homes for Older People Page 13 of 33 Evidence: people have received personal care. One resident does have a personal care chart at family request. There were limited entries made on this in July and none in August. We found that, whilst the people living in the home generally seemed to have clean clothes, there were a number of people that we saw with dirty nails or unshaven. When we enquired about why one particular resident, who we looked at in some detail, was unshaven the staff we spoke to did not know. We went into this residents room and looked for toiletries. There was no soap or toothbrush. There were denture tablets, a denture box, razor and shaving foam. A member of staff told us that they cleaned his dentures by rubbing them with their fingers. We then went into a number of other bedrooms and found that people did not have basic toiletries, such as toothbrushes and soap in place. The manager told us that the home holds stock of these items and did not know why people had not been provided with them. We found examples of action that had been taken that was not recorded in the care records. For example, we saw one resident had a dressing on her leg but when we read her record there was no information about this in there; either the reasons why it had been applied or further action to be taken. We also found examples of action that should have been taken but no guidance about this in the care plan or recording to show that the appropriate steps had been taken. In one situation we read on the long term assessment that indicated that the person haad problems with soreness that needed teatment but there was no care plan to indicate action to be taken. Another resident repeatedly wanted to leave the unit he was living on but there was no written guidance for staff about how to manage this behaviour thereby helping them to know how to handle the situation in an appropriate and consistent way. We also looked at the records of one person with diabetes. There was no care plan in relation to the management of their diabetes. Of particular concern was a record of their blood sugar monitoring levels taken over the course of one day. These showed that the levels had been erratic and outside those normally expected. The person was newly admitted to the home and they did not know what was usual for him. There was no information about any action taken with regard to this, either referral to GP or testing again the next day. We also read the file of one resident who had bed rails in situ on her bed. There was no bed rails risk assessment to determine whether this was the best course of action or whether they were properly fitted. We gave the home an immediate requirement to undertake this piece of work and they had completed this by the second day of or inspection. When we went into this residents room we found she had a specialist pressure relieving mattress. This was beeping to indicate a malfunction but no-one had taken any action to get this mended or to obtain a replacement mattress. Care Homes for Older People Page 14 of 33 Evidence: In the care records we found that there were risk assessments for nutrition and moving and handling. There was also information about involvement of doctors in the health care of people living in the home. We received surveys from five health care professionals and they reported a level of confidence in Astley Hall seeking and acting on advice about peoples health care needs. We asked the care staff whether they used the care plans for guidance about how to provide peoples manual handling but they told us that they receive this information verbally from a nurse. We found that they did not use the care plans much at all and one new member of staff said she had not read any, including guidance on moving and handling. In their AQAA the home told us that they access guidance about the management of people with compex needs. We did not see any written guidance for staff about how to manage peoples behaviours. We looked at some aspects of the management of medication and found that it was generally well managed. We found that there was secure storage for the medication. Deliveries are checked in by a nurse and many tablets are within a monitored dosage system (MDS). The records were well completed. There were some aspects that need attention such as ensuring that boxes and bottles outside the MDS were not dated when opened and some medications were treated as as required when they were prescribed to be taken all the time. We also found that when medication was prescribed as required there were no guidelines for the circumstances in which it should be administered. We counted some medications and found that the quantity in stock did not tally with the stock control record in all instances. One visitor told us that there were repeated difficulties with her relative having their own clothes returned following laundering and there were times when they had been wearing the clothes of other people. The home also told us that there were times when the return of clothes has been a problem. In shared rooms there was screening not only between the beds but also around the washbasin to help preserve peoples dignity. Whilst we saw many examples of kind and respectful interactions between staff and the people living in the home, the failure to reliably provide them with personal care does not promote their dignity. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for people to take part in although further consideration needs to be taken of their individual preferences. Visitors are welcomed to the home. There is a varied range of food provided but this is not to everyones liking and may not be as appetising or as nutritionally balanced as it should be. Evidence: The overall atmosphere in the home was friendly and relaxed. We spoke to visitors to the home who told us that they were able to visit at any time and were made welcome. A health care professional told us that they Make great efforts to communicate with the family. We observed staff entertaining residents with music and board games whilst we were in the home. On one afternoon a music and movement person provided a lively session in one lounge and some people were brought from the other floors to take part in this session. The home has a full time activities organiser who arranges a variety of acivities for the people living in the home. There is a file that details the involvement for each person. For the four people we looked at in detail, the two most recent admissions did not Care Homes for Older People Page 16 of 33 Evidence: have any information written and one person did not have any entries since 2007. Thus it was difficult to know whether they had participated in any activities in the home. There was no information about their interests or preferences for how they spent their time. Also there was no information about thier life history. The AQAA said that Our person centred plans allow for choice and preference on daily life and activity, whilst encouraging paticipation. We did not find that this was the case. In their survey one health care professional commented under what the home could do better that they needed, More stimulation for those with dementia. The home is set in spacious grounds. One person who is interested in gardening has a small patio area outside his room that he is able to tend. Some areas of the garden, close to the house, are accessible for people with mobility problems. We were shown an enclosed area that we were told was for people with dementia illnesses. This was weedy and unattractive. Furthermore, the specialist dementia unit is situated on the first floor and therefore people who are living in this unit are unable to access this space without staff specifically taking them there. The home is in the process of creating an indoor garden in one of the communal areas on the first floor. We found the meal provided at lunch time on the first day of our inspection unappetising. It was a fish cake, with mushy peas, baked beans and chips. People who needed a soft diet were given these items liquidised in their constituent parts with mashed potatoes instead of chips. We observed that several people in the ground floor dining area did not eat much of their meal. Dessert was apple crumble or angel delight. We were told that both were suitable for people with diabetes as they were made with sweetener not sugar. We looked at the menus and found that generally they reflected traditional home cooking. In the nine surveys that were returned 5 people told us that they always enjoyed the food provided, 1 person said they usually enjoyed them, 2 people said they sometimes enjoyed them and one person said they did not know. People told us that if they did not like the main meal being provided they could request an alternative. The chef said that he could always give them bacon or a burger form the freezer. We talked to the chef about the provision of fresh fruit and vegetables. From the menus we found that on many days there was no evidence that five portions of fruit and vegetables were offered to people living in the home. We were told that sometimes fruit was provided on the drinks trolley mid morning or mid afternoon and this was not reflected in the record of food provided. The chef is taking a National Vocational Qualification in catering but has not completed any training in the nutritional needs of older people. Care Homes for Older People Page 17 of 33 Evidence: In the unit that specialises in the care of people with dementia illnesses we saw a carer telling people about the meal and what there was to eat just before it was served which is good practice. We also saw staff helping residents with their meals where necessary in a sensitive manner. People could also choose where to eat; in the dining room, in their own room or in the lounge. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a complaints procedure. The home needs to ensure more robust recording procedures are in place when concerns are raised. The home needs to raise awareness of the procedures to protect people from abuse or neglect. Evidence: There is a complaints procedure and people are provided with information about this in the Service User Guide. However seven of the nine residents who responded to the survey said that they did not know how to make a complaint which indicates that the home needs to be more robust in telling people how to do this. The manager said that she has an open door policy and people are able to come and tell her about any concerns they may have before they become a complaint. The home has a complaints log. A complaint that we referred to them to investigate was not recorded in this file. We could not therefore be confident that the home has recorded all the complaints it received during the last year. They have however started to keep a log of concerns raised with them that they do not consider formal complaints. This is good practice as it helps the home to understand issues that concern people who live there. Recently we asked the home to refer a possible situation of abuse that they had not Care Homes for Older People Page 19 of 33 Evidence: identified within the home to the local multi-agency safeguarding team. They did not know how to do this. Since then they have put together a file with information for staff to access and that explains the course of action they should take. There has been safeguarding training for staff working in the home. We read three care staff files and found that two of them, excluding a newly recruited member of staff had taken training in this area of practice. We talked to staff about their safeguarding training and whilst they knew about reporting concerns, one person did not know whether the home had a whistleblowing policy. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Astley Hall provides the people who live there with clean and pleasant surroundings. Continued work is needed to keep the premises, furnishings and gardens safe, comfortable and fit for use. Evidence: Astley Hall is a large country residence. We looked round some areas of the house and gardens. In the AQAA the manager said that there had been Improvements to the main reception area, offering a welcoming and relaxing area for clients and visitors, with sensory-stimulating fish tank. However they also indicated that there was an ongoing need for flooring and decoration. We noted however that the home was generally odour free and was kept fresh smelling. There is a maintenace man who is resposible for minor repairs in addition to redecoration of the home. He has worked hard to redecorate the middle floor that accommodates people with dementia illnesses. The bathrooms on this floor have also been upgraded. However we found that there were aspects of the accommodation that did not meet appropriate standards. We found several items of furniture in residents rooms that were broken or did not have handles. Some of these were replaced before the second day of our inspection. We found that some residents did not have a lead to their call Care Homes for Older People Page 21 of 33 Evidence: bell and agian we were told that an order for replacement leads had been put in before we visited again. Some carpets were well worn. Several bedrooms had vinyl floor covering that had been put down because people had continence problems. However new residents coming into the room were not offered a replacement carpet as we expect to happen. On the first floor many rooms had a stair gate in the door frame. We were told that this was to prevent residents, other than the occupant of the room, entering that room. It would also prevent the person whose room it was going into there as well. This is not good practice as it inhibits the freedom of the person liviing in that room to use it freely. Whilst the setting of the home offers beautiful views over the surrounding countryside, and work has been done to help make areas of the grounds accessible to residents, some areas of the grounds were in need of attention. In particular the area designated for people with dementia was weedy and contained no plants or flowers for interest or stimulation. There is a large, new summer house in part of the garden available for resident use. We spoke with a domestic who confirmed that they had ample supplies of cleaning materials for the home. In their surveys most people told us that the home was usually kept clean and fresh. In one shared bedroom we saw a considerable amount of dust and bits under both beds. The home carries out a regular infection control audit using its own documentation. At communal wash basins, there was liquid soap and hand driers to help prevent spread of infection. THere was also liquid soap available in residents rooms for staff to use after providing personal care in that room. We saw staff using personal protective equipment appropriately. At one point we saw a door to a sluice room propped open. This room contained cleaning materials and a sharps box that were potentially unsafe should a resident have entered this area. We were told that there is a sluice on each floor. On the first floor the door to this room was wedged open and there were cleaning materials in there and a sharps bin that were accessible to residents. This practice posed a risk to them. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to meet the needs of the people living in the home. People who use the service can be confident that they are kind and caring. The home has appropriate recruitment procedures in place to help ensure that it emloys people who are suitable to work with vulnerable people. It needs to have more robust systems in place to make sure that staff receive the training they need to carry out their role in the home. Evidence: People living in the home told us that they liked the staff and that they found them kind, friendly and helpful. In the surveys we received comments like helpful carers, and Very helpful and cheerful staff, who not only get on well with the residents, but also with each other. One social care professional commented, Staff are helpful and welcoming. A health care professional told us, Staff appear to be very caring and have the residents best interests at heart. Staffing rotas showed that the home aims to provide adequate staffing levels to meet the needs of the people living in the home. On the first day of our inspection there were seven care staff expected to be on duty. One called in sick and robust efforts were made, successfully, to replace them with a member of agency staff. In addition there were two nurses plus the manager, two domestic staff, a cook and two kitchen assistants. Staff we spoke with during the inspection, told us that they find that they Care Homes for Older People Page 23 of 33 Evidence: have sufficient time to meet the needs of the people living in the home. All the staff who responded to our surveys told us that they usually have enough staff on duty. The manager is in the process of recruiting more care staff and one nurse for night duty. She hopes that this will enable to home to reduce the amount of shifts that are covered by agency staff. We read the files of four staff, three of whom had started since the last inspection. We found that generally the recruitment was carried to a satisfactory standard. Care had been taken to ensure that references had been obtained and criiminal record bureau checks and POVAfirst shecks were in place. However we did read one file where there was not a fully detailed employment history. Following recruitment, staff undertake a period of induction training using the Skills for Care induction standards, although this was not completed for one person because they had worked in another care home. The home needs to ensure that they work in a way that meets the standards within Astley Hall and should not therefore bypass all induction training. New carers also spend some shifts shadowing experienced carers. On the staff files there is information about the training they have completed. We were unable to find evidence that all required training had been completed in the files we reviewed. For example there was no information to show that one person had taken any training in moving and handling training, first aid, health and safety or infection control although the manager was confident that this training would have been completed. In addition to statutory training, the home tries to ensure that each member of staff completes training in dementia care. This is through a local organisation and is provided for a half or a full day. No one working in the home has completed more advanced specialist training in this area of practice and consideration should be given to staff representatives taking a more advanced course in this area of practice because of the large number of people living in the home who have a dementia illness. Following completion of induction staff are encouraged to take a National Vocational Qualification. In the AQAA the home reported that 18 staff have achieved this qualification. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service needs to be more robust to ensure that all residents receive the care they need and that their health and safety is promoted. Evidence: The registered provider and manager of the home remain unchanged since the last inspection. The manager has relevant experience and qualifications for her role. People who work in the home told us that they feel well supported by the management of the home. The manager commented that she is well supported by the service provider. They visit the home regularly and complete a report each month, under the requirements of Regulation 26, about how the home is functioning. This report lacks some depth of analysis of the situation as it is in the home, for example it should identify broken furniture and lack of personal care. The manager is supported by one member of administrative staff who also works as the receptionist for the home. Care Homes for Older People Page 25 of 33 Evidence: The home has a quality assurance system but the manager told us that she has not surveyed residents or interested others for over two years. The manager completed the AQAA. We found the information in this limited in content, for example some sections had no content at all. We found that there were a number of aspects of the running of the home that needed more careful attention such as the personal care of residents, the care plans and the quality monitoring practices. The AQAA indicated that policies and procedures were last reviewed in April 2008. Documents we looked at had not been reviewed since. We expect policies and procedures to be reviewed on an annual basis. Personal monies were held for residents in safekeeping. They were stored securely and records of transactions were maintained. Equipment in the home is regularly serviced and the home employs a maintenance man to carry out minor repairs. Fire safety systems were well maintained and monitored and staff had received in house training and taken part in a fire drill. The manager said that the home intended to provide staff with training in fire safety from an outside professional later in the year. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 8 13 Regulation 13(4). 13/08/2009 You must write a bed rail risk assessment for a named resident. This will help to ensure that they are used and fitted properly and that the resident is safe. This requirement had to be met within 24 hours of issue. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Regulation 12(1). You must make sure that people living in the home receive appropriate levels of personal care. This will ensure that their personal hygiene and dignity is promoted. 30/09/2009 2 7 15 Regulation 15(1) 30/09/2009 You must ensure that all aspects of each persons care that need attention are detailed in their plan of care. The resident or their representative must be involved in the preparation of the care plan. Page 28 of 33 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will provide all staff providing care with the information they need to ensure all the needs of people living in the home are met and that care is provided in a way that suits each persons needs and preferences. 3 9 13 Regulation 13(2) 21/08/2009 You must ensure that the date of opening a new box or bottle of medication is recorded on the container at the time of opening. This will help to ensure appropriate stock rotation and that medication does not become out of date. 4 9 13 Regulation 13(2). 30/09/2009 You must ensure that there is written guidance available to inform staff about how and in what circumstances as required medication can be used. This will ensure that people who live in the home receive this medication for the right reasons and in the right way. Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 12 16 Regulation 16(2)(n) You should include information about peoples interests in their plan of care. This will help you to provide opportunities and activities that are appropriate for them. 30/09/2009 6 13 16 Regulation 16(2)(i). You should ensure that people living in the home receive appetising meals of their choice, which meet the guidelines for the nutritional needs of older people. This will help to ensure that their health is promoted through having a good diet. 30/09/2009 7 19 12 Regulation 12 (1), (3) and (4). You should carry out a full risk assessment when stair gates are considered for use at the doors of residents rooms. This will help to ensure that this is the most appropriate course of action for you to take when taking into account peoples safety, supervision, their wishes and their privacy and dignity. 30/09/2009 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 19 23 Regulation 23(2). Furniture that is broken should be repaired or replaced promptly. This will ensure that people who are living in the home have somewhere to keep their belongings that is safe to use. 30/09/2009 9 33 24 Regulation 24(1) and (3). You should set up an effective quality assurance system that is based on seeking the views of the people who use the service and other stakeholders. This will help to ensure that the home is run in the best interests of the people who live there. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be used by the whole staff group, both trained nurse and care staff to inform them about peoples care needs and how these should be met. You should have a life history of each person living in the home who is unable to tell you this information themselves so that carers understand and can talk with them about their life experiences. You should ensure that some staff attend a training course in the management of safeguarding so that they have a 2 12 3 18 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations greater understanding of how the local system works. 4 19 You should make sure that the gardens are appropriately maintained so that they are suitable and pleasant for the residents to use. When you assess that a method of restraint is needed for access to peoples rooms, you should ensure that the most appropriate system is in place, taking into consideration their age and their health issues. You should ensure that you have a system in place to ensure that all staff receive training that is appropriate for the work they are to perform. You should ensure that they have robust systems inplace to record the training provided. 5 19 6 30 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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