CARE HOMES FOR OLDER PEOPLE
Astley House 1/2 Hartley Gardens Seaton Delaval Whitley Bay Tyne & Wear NE25 0AB Lead Inspector
Karena M Reed Key Unannounced Inspection 1st June 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 Astley House DS0000000518.V289535.R01.S.doc Version 5.1 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. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Astley House Address 1/2 Hartley Gardens Seaton Delaval Whitley Bay Tyne & Wear NE25 0AB 0191-2377209 0191 2377209 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) Mrs M Powers Mr R Powers Miss L A Campbell Care Home 15 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (5) of places Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th December 2005 Brief Description of the Service: Astley House is a large, detached house that used to be the village police station. The home is situated in a residential area in the village of Seaton Delaval, it is close to local shops, doctors and public houses. It is also very close to the Northumbrian coast and the nearby countryside. It is registered to provide personal care to fifteen residents, the categories of registration are for five older people and ten older people with memory loss. Bedrooms are all for single occupancy, some are situated on the ground floor. There is a large lounge and a separate dining room which is also used as a quiet area when meals are not being served. Both living rooms overlook a well- maintained garden to the front of the building. There are two bathrooms both containing equipment that can be used to assist with getting in and out of the bath. A Statement of Purpose and service user guide are available for prospective residents and their relatives to give them information about the services provided by the home and the relevant charges. Fees payable for living at the home at the time of inspection in June 2006 vary between £356.30 and £383.52. Additional charges are payable for hairdressing, private chiropody, and personal newspapers. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over five hours. A partial tour of the premises took place and a sample of records were inspected which included: 4 care plans, the fire log, accident book, admission /discharge book, complaints record, 2 personal allowance records, staff communication book, staff meeting minutes and four staff files. The proprietor, manager, cook, two support workers and ten residents were interviewed at the time of inspection. What the service does well: What has improved since the last inspection?
Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 6 Several improvements in key areas have taken place since the previous inspection and further improvements will raise standards further. Improvements include: Systems have been introduced to strengthen recording systems to provide evidence of the care given to residents. Ancillary hours have been increased to cover weekends so carers may concentrate upon care duties with residents. Staffing levels have increased in order to provide more individual care to residents. Care planning is more focused on social aspects of care, so social activities offered may be more appropriate and of interest to residents. Dementia care training has taken place to give staff more insight into working with people with memory loss and how to provide care to them. Developmental training is available to give staff more insight into the specialist needs of some residents. Over 80 of the care staff have completed NVQ level2/3 giving them the knowledge and skills to improve the quality of care that they give to residents. Staff have completed training about challenging behaviour in order to understand the needs of some residents. A new complaints procedure has been introduced as part of the home’s quality assurance system. The diet of residents has become more wholesome after taking advice from a dietician. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 7 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 House DS0000000518.V289535.R01.S.doc Version 5.1 Page 8 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 Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 9 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): 345 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home now collects enough information about the needs of residents before they move in to help ensure staff are aware of the amount of care and support needs of the resident as they settle in. The home is welcoming and there are opportunities are available for prospective residents and their families to visit to decide if the home is suitable. EVIDENCE: Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 10 The records for a resident recently admitted to the home showed that an assessment of their care needs had been carried out before their admission. The resident and their family were involved in the initial assessment. This information and the care manager’s assessment of the resident’s care needs was used to ensure all the needs of the resident could be met by staff. The records contained a range of information. Four staffing files showed staff receive training so that they know how to meet the specialist needs of the residents. Staff have recently received training about dementia care and working with behaviour that may be challenging. Residents’ feedback cards all showed their needs were met and they were happy with the care offered to them. Comments included: Residents have the opportunity to visit the home as many times as they like to decide if they wish to live there. This may involve tea- time visits, day and overnight stays and can be adjusted to the pace of the individual. “ I visited the home prior to my mother coming. Felt that the home fitted all my mother’s needs.” Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 11 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 good. This judgement has been made using available evidence including a visit to the service. A system has been introduced to alert staff to the changing needs of residents. Information collected on a daily basis about their well- being is transferred to a monthly summary sheet. Any problem areas are identified and written into the care plan. This helps staff provide the necessary levels of support and also involve other agencies if required. Staff receive training before they are able to administer medication to residents. There are good arrangements in place to ensure residents health care needs are met. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 12 There are comprehensive assessments in the residents’ care plans. Personal support needs are well documented and give clear instructions to staff on how to support people in tasks such as washing, bathing, dressing, remaining mobile in order to help retain some independence. Care plans are amended and reviewed on a regular basis. Residents and their families or representatives are involved in the process. Moving and handling assessments are in place. Technical aids and equipment is available for residents. Residents care records showed that they have access to external health care services. GPs and Community Nurses were regularly consulted for advice and treatment. Records show district nurses visit the home as required and service users are assisted to access chiropody and optical services at least annually or as often as required. Training records showed senior staff members receive training about medication before they are able to administer it to residents. Risk assessments are in place. Care records, conversation with staff and observation showed the privacy and dignity of residents is respected. All of those residents spoken to, who could comment, said that they were treated well by the staff and well cared for. Attention was paid to service users’ dignity and staff were seen to act respectfully at all times. Comment cards included :”Medical support always available.” Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 13 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 adequate. This judgement has been made using available evidence including a visit to the home. Social care plans are in the process of being completed. Residents maintain contact with family and friends as they wish. More effort is now being made by staff to help more dependent residents to exercise choice and control over their lives. The diet of residents has become more wholesome. EVIDENCE: A programme of activities is in place for residents this includes: carpet bowls, videos, sing-a-long, memory lane bingo, manicurist, dominoes, hairdressing. Various parties are also arranged, which are well supported by relatives and families in order to raise money for the residents’ amenities fund. At the time of inspection a hundredth birthday celebration was being prepared with great attention to ensure all the residents enjoyed it. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 14 Some residents have the opportunity to visit the local community with relatives. One recently admitted resident said that staff had taken her to visit the local community when she moved to the home as she had lived in the area as a girl. An excellent system is in the process of being introduced to help staff ensure that the social and cultural needs of residents are given as much attention as the resident’s health and personal care needs. A new social assessment form has been developed. This can be completed with the resident and their family, to share information about their life before they moved into the home. A collage of each residents’ life is to be prepared with the help of family and the resident, respecting if the resident wishes to become involved. This will make reminiscence more personal and help staff engage and retain the involvement of residents with memory loss. Staff ask each resident about their wishes, interests and choices. Staff have recently followed a twelve week specialist course about memory loss. This training should help staff ensure residents are given choice in order to keep some control of their lives. The home’s menus are based on the known likes and dislikes of the residents. At least two hot meals are provided each day. Comment card: “ If doesn’t like the meal always offered an alternative.” On the day of inspection, the lunch served was bacon and sausage fry up or omelette and rice pudding. A dietician has been consulted about the nutritional value of full fat diets in order to build people up. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 15 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 good. This judgement has been made using available evidence including a visit to the service. Procedures are in place to protect residents from abuse or harm. Staff have received training about challenging behaviour. EVIDENCE: There is a complaints procedure, if complainants are not happy with the homes investigation and response. The home’s complaints procedure contains details of how to contact CSCI to make a complaint. The home keeps a record of complaints. Comment card: “I have no complaints and find the standards of care very high. “ Residents and their families are also asked at residents’ reviews if they have any complaints. Staff have recently received training about Protection of Vulnerable Adults and Prevention of Abuse. Staff have received training recently about working with behaviour that may be challenging.
Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 16 Staff have recently completed a twelve- week Dementia Care course which has given them more insight into the needs of people with memory loss. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 17 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 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There are constant efforts being made to improve the environment. Residents live in a homely, comfortable and safe environment. There is a good standard of hygiene around the home. EVIDENCE: There is a programme of redecoration and improvements around the home. Since the last inspection the kitchen has been refitted and a new cooker and ventilation system installed. The laundry room has been refurbished. The home was clean, well decorated and well maintained.
Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 18 The garden was well maintained and attractive. The home has sufficient sitting and dining space. Residents can see visitors in private in their own rooms. The home has increased the number of ancillary hours to ensure cleaning staff are available at the home over seven days of the week, rather than care staff carrying out cleaning duties at week ends when they could be caring for residents. Comment card: “ The home is always clean and fresh and has a lovely atmosphere.” Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 19 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 good. The judgement has been made using available evidence including a visit to the service. The number of ancillary hours have been increased so enough care hours are available for the needs of residents. Systems are in place to ensure residents are in safe hands at all times. Staff are trained to meet the care needs of residents EVIDENCE: Examination of staff rotas and discussion with the person in charge and members of the staff team showed that the numbers of staff are as follows: 8.00am- 1.00pm 3-4 care staff 1.00 pm –4.30pm 2-3 care staff 4.30 pm- 10.00pm 3-4 care staff 10.00pm-8. 00 am 2 care staff Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 20 These numbers include the manager who works some supernumary hours. There are 416 care hours provided to residents. There is a senior staff member on each shift. Other staff members are employed for duties such as food preparation, cleaning and gardening. The necessary checks are being carried out prior to the workers being appointed. Two written references were available on the staff files examined from the most recent employers. An application form had been completed for each staff member. CRB checks are carried out before a person is appointed. There is a stable committed staff team and there is a low turnover of staff. Staff stated that they enjoyed working in the home and were observed to be kind, caring and respectful to residents. Staff receive Skills for Care induction previously TOPSS. Eleven members of the care staff team have now achieved National Vocational Qualifications at level 2 and 3. 4 staff members are currently studying for level 2. Staff and their records showed that they also receive advice and /or training in other areas. Staff have received training in dementia care, challenging behaviour, health and safety, First Aid, Food Hygiene, Medication. Future training planned is to update Moving and Handling training for staff. Comment cards:” Staff always available to speak to.” “ All staff very caring and professional.” “Staff are very good and helpful.” Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 21 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 33 35 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Good efforts are being made to improve the service provided and there is capacity for continual improvement. All previous requirements have been addressed and systems put into place to benefit residents and involve within the running of the home and to increase choice and decision making within their lives. Lockable facilities are available for residents to keep their own money if they wish. If a resident does not wish to keep control of their own money, the home is able to provide the facility to hold a small amount of money on behalf
Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 22 of the resident for everyday living. Individual records show the home has a suitable system for accounting any monies held on behalf of a resident. Documents detailing fire safety, risk assessments in the environment, water temperatures, maintenance contracts for equipment for moving and handling were all up to date. Staff training relating to health and safety was up to date and training being planned to renew any that required updating such as Moving and Handling training. Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 23 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 x x 3 3 4 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 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 x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 24 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 2 Standard OP12 OP14 Regulation 16(n) 12(2) Requirement Suitable social activities must be provided for residents. Staff must consult with residents and involve them in decision making in their everyday living. Timescale for action 31/07/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Astley House DS0000000518.V289535.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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