Inspection on 12/06/07 for Astley House Care Centre

This inspection was carried out on 12th June 2007.

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

Other inspections for this house

Astley House Care Centre 08/05/09

Astley House Care Centre 27/10/08

Astley House Care Centre 22/05/08

Astley House Care Centre 03/12/07

Astley House Care Centre 06/06/06

Astley House Care Centre 28/06/05

Astley House Care Centre 18/01/05

Astley House Care Centre 24/08/04

Astley House Care Centre 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY Lead Inspector Mrs Janice Patrick Unannounced Inspection 11th June 2007 07:00 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 Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astley House Care Centre Address 1 Lypiatt Road Cheltenham Glos GL50 2SY 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) 08453 455742 01242 255971 Mrs Sally Roberts Mr Jeremy Walsh, Mr Roy Harris Mrs Nandani Cook Care Home 33 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (27) of places Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 7th proposed Dementia Care bed, currently occupied by one named service user without a diagnosis of Dementia, will become a 7th Dementia Care bed when that specified service user no longer requires the bed on their discharge or death. 6th June 2006 Date of last inspection Brief Description of the Service: This care home is registered with the Commission of Social Care Inspection (CSCI) to provide nursing and personal care, predominantly to the older person. It is situated in a residential area near to Cheltenham Town centre and is in close proximity to local shops, amenities and bus services. Accommodation is on four storeys, and consists of 28 single bedrooms and 3 shared bedrooms, all of which have en suite facilities. On each level there are communal rooms with dining areas. Access to all floors is by a passenger lift or stairs. Behind the home is a large paved area, which provides a private and accessible area for residents to sit. The side and front of the building have been designed to provide planted areas with ample car parking. There are steps to the front entrance however wheelchair access is provided at the rear. The fees depend on the type of care being provided and the room occupied. Fees at the time of this inspection range from £475.00 (personal care, single room with ensuite) to £654.00 (higher nursing care, single room with bath en suite). The home’s terms and conditions outline any additional charges. The home did not display their previous inspection report. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection on one day between 7am and 7pm. Prior to the Inspector’s visit questionnaires were sent to residents, their relatives and to care staff to seek their views of the services provided. These views and comments have contributed to this report. As part of the inspection process a selection of care records were read and compared with the care that was being delivered. This included an inspection of the home’s medication system and other health related practices. Residents’ ability to make choices, have their preferences met and have their privacy and dignity protected was also explored. Arrangements for the protection of vulnerable adults and the responding to complaints were inspected. A tour of the environment was made and systems and records relating to its maintenance and safety inspected. All aspects of staffing the home were inspected, including staff rosters, recruitment and training records. Arrangements for the general management and administration of the home were inspected. Any past requirements made by the Commission and by other visiting agencies were inspected for compliance. What the service does well: What has improved since the last inspection? What they could do better: Make sure each pre admission assessment is carried out robustly and in a comprehensive manner. Improve the standards of physical and psychological care being given to residents. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 6 Take appropriate and timely action when residents’ healthcare needs present a risk. Ensure that the routine of the home is designed to meet the needs and preferences of the residents. Identify and get rid of any practices that are ‘institutional’ in nature that would prevent residents from being treated with dignity and respect. Support any improvements already made to enhance residents’ opportunities to access activities and social interaction and deliver these consistently and when planned to avoid disappointment to the residents. Increase opportunities for residents to have a choice in what they eat at lunchtime and improve how this mealtime is organised. Review the fire risk assessment with the Fire Safety officer and ensure current fire regulations are being met, both within the risk assessment and in practice in order to safeguard residents and staff. Make any bedroom to be occupied by a new resident welcoming. Ensure that the belongings of any previous resident are treated appropriately and sensitively. Keep communal areas tidy and welcoming. Adhere to the correct waste regulations so as to reduce the risk of infection. Replace the heavily stained carpets and other soft furnishings that can give the impression that the home is not kept clean. Provide supervision for staff that have not yet attended basic induction training. Improve upon how the management team direct and supervise care practices in order to safeguard residents. Use the auditing and quality assurance system to monitor care practices and to improve these where needed. Use bedrails safely. 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. The summary of this inspection report can be made available in other formats on request. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are arrangements in place to assess people’s needs prior to admission however, a lack of robustness when completing this process could put residents at risk once admitted to the home. EVIDENCE: All three care files selected for inspection demonstrated that a pre admission assessment had been carried out in order to ascertain the resident’s needs. Two residents had been assessed whilst in hospital and a third was in another care home. The recorded needs of one resident during the pre assessment process were not accurately identified and did not truly reflect the resident’s mobility needs at that time. The person who had completed this admitted that all the information had been gathered from the resident and none from the care staff Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 9 or the from the individual’s care plan. This resident at the time was not fully aware of what they could still achieve independently. This is poor practice and puts the home at risk of not fully identifying a resident’s needs, which could then be unmet. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor care practices are exposing people to risks that could be avoided. People’s preferences and dignity are not always being respected. EVIDENCE: Three residents’ care files were selected for inspection and additional care records were referred to as the general care of residents was being observed. The format used for documenting assessments and care is comprehensive, however some of the residents’ needs were not being fully identified. The written care plan was also not always reflecting the actual care required. There were also examples of written care plans not being followed. All of the above was evidenced in the case of one resident’s continence needs, which were not being adequately met. On the day of this inspection this resident was not taken to the toilet between 7am and 4.45pm. A member of staff on duty, who had helped several other residents to the toilet, confirmed that she had not taken this particular resident. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 11 A written care plan had been devised but lacked a ‘person centred’ approach and therefore did not address the specific problems staff were encountering with this particular resident when trying to meet this need. The nurse in charge explained that this resident would often refuse an offer to use the toilet, get verbally and physically aggressive or would sometimes ask for the toilet independently. The result was that staff were not provided with any guidance on how to deal with these issues and the resident’s need was not met. The same resident had a risk assessment that identified her as being at risk of developing pressure sores. This had been confirmed in an assessment carried out by a visiting healthcare professional and following this the health authority upgraded the pressure relief equipment being supplied to the home. However, observations made by the Inspector showed this person remained in one position for a considerable length of time. An opportunity to encourage a change of position in order to relieve pressure was missed when lunch was automatically served on a small table in front of the armchair the resident was sitting in. This care was contrary to the written care plan in place, which stated that a regular change of position must be carried out. The health authority also provided the same resident with a specialised bed to help reduce the risk of injury when she attempted to get out of or fell out of bed. This was put in place following an assessment carried out by an external healthcare professional. Advice on equipment to reduce these incidents was first discussed with the staff in the home in February of this year, it was not until late April that a request was made by the home’s staff for an assessment to be carried out regarding appropriate equipment. Once done this took less than a couple of days to organise. Records show that due to a lack of appropriate action between February and April, the resident fell out of bed a further three times sustaining minor injuries, which could have been avoided. This lack of action resulted in a complaint being made by the resident’s next of kin. The written risk assessment demonstrating how the above risks are to be reduced has not been updated since December 2006. Another resident had identified problems relating to challenging behaviour. There was no evidence to demonstrate that these had been individually and fully addressed within the person’s care plans and whether they were being adequately dealt with in practice. On talking to this resident they described current situations in their life that may account for why a certain form of expression was being adopted and which had not been considered or addressed by the staff. There were several examples of poor care practice observed and which have been raised within relative’s comments such as: “ my mother’s finger nails are always dirty” which they were on this inspection. Another relative said: “ the quality of care is just about adequate”. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 12 Two further relatives in contrast said they felt their relatives’ needs were being well met. The Inspector is also concerned about the delay in appropriate action being taken when residents’ healthcare needs are putting them at risk. This was evidenced in the care of the resident falling out of bed and again in the lack of guidance for staff relating to the management of a specific resident’s blood sugars. Although the home staff had discussed their concerns with the General Practitioner and certain investigations were to be carried out, there was no detailed plan of care, protocol or equipment to enable staff to monitor these in the interim. A situation had already necessitated the use of another resident’s prescribed anti hypoglycaemic treatment. The care of another resident with dementia was cause for concern. Although this home is registered for six residents, whose primary needs are that of dementia, the Inspector does not believe in this case, that staff are caring for her in a manner that is in her ‘best interest’. This person’s care is effectively being limited to the lower ground floor because of her wandering and interfering behaviour, which makes her unpopular with other residents. The Inspector sought reassurances that this person could voluntarily leave her bedroom. The nurse in charge confirmed that she is sometimes found on the top floor of the building. This form of care is subjecting this person to a degree of social isolation that she may not want or that is beneficial to her. It also raises questions regarding the provision of adequate supervision. The home’s medication storage and records were inspected. Administration of some medicines was observed. This was carried out safely and with ‘good practice’ being demonstrated. Associated records had been completed well. The medication is supplied by a pharmacy that provides all records for incoming and outgoing stock and who meet current legislation relating to the disposal of returned stock. For a specific reason, explained to the Inspector, not all of the medication storage was secure. Due to the length of time this shortfall had been present, an Urgent Action Letter was forwarded to the Registered Provider in order to secure compliance with the Care Home Regulations (2001) and reduce the risks to residents. Residents’ privacy was observed to be upheld at all times but the Inspector has concerns that residents’ dignity is not always respected, due to evidence collected during this inspection. This was demonstrated in the way staff interacted with some residents by showing a lack of interest or by not reacting to them at all. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 13 One resident said: “there is no one to talk to properly; no one has anytime to stop and talk, if they do it is on a superficial level and they are always on their way to something else” “when you talk to them you get half a face and they are gone”. Some relatives commented on this in their surveys. One said: “ there is little in the way of chats and smiles from staff”. The same person commented: “maybe its because so many have dementia, the staff have given up bothering”. Another relative commented: “staff need to possess warmth, sympathy and understanding and some are better at doing this than others”. And another said: “ a lot of the staff do not even answer my relative’s questions let alone talk to her”. Two surveys did say: “the staff can make residents feel that they are special”. “ the staff do what they can and bend over backwards to help”. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are such that residents often have to fit in with the home’s routine as opposed to the home accommodating their choices and preferences. EVIDENCE: In the previous inspection in June 2006 a requirement under the Care Home Regulations (2001) was made to address a shortfall in the activities and social opportunities made available to the residents. The home had no activities co-ordinator at the time and the staff were unable to spare time away from their care commitments to provide this. The home now has an activities co-ordinator. She is recorded on the staff roster as being responsible for providing designated activities between 10am and 4pm. For two hours either side of this she is part of the care team designated to care duties. On the day of this inspection the morning activity session began late at 11.40am instead of the allocated time of 10.00am. The reason given for this was that there were still residents to get up who had not had their basic care Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 15 needs addressed and therefore the person responsible for being devoted to activities between 10.00am and 4pm had to remain in her caring role. Nine residents enjoyed a quiz for 40 minutes before lunch. Another activity session took place at 2pm for an hour, cups of tea were then handed out and residents were given help and enjoyed the conversations that pursued. A schedule of activities for each afternoon has been devised by the company’s head office along with company activity co-ordinators for the year. The activities co-ordinator said that she adheres to most of these but some she will vary according to what the residents like and are capable of. In the mornings the activity co-ordinator can co-ordinate activities chosen by the residents. Records relating to the activities held within the home showed that ‘in house’ activities or trips had been cancelled 32 times since January of this year. The coordinator said that the residents get very upset when this happens and she now rarely advertises a trip out until the actual day so as not to disappoint them. A couple of comments from the pre inspection surveys indicated that there was still a shortfall in activities and mental stimulation being afforded to residents. Some said: “ there is little option for conversation” “ there is little attention given to mental stimulation”. Activity records did show that several residents who remain in their bedrooms or who are not able to join in a group receive some input on a one to one basis. There is a lack of choice within this home. Comments from relatives who visit frequently spoke of residents being got up or taken to bed at a time that suits the care staff. On the Inspector’s arrival there were five residents up and dressed in the lounge, four were asleep and one was being settled with his breakfast. Staff were asked if these residents wished to get up this early. There were a variety of reasons given as to why each resident was up, one resident said they like to get up early, however it was also confirmed by staff that they each have to get at least two residents up before they go off duty (a total of 6). Most residents from the lounge areas had been taken to bed before the Inspector left the building at 7pm, although two residents said that they ‘were ready for their beds’. Comments within the surveys also indicated that there was no choice in the food provided. One survey said:“ occasionally it would be nice to have a choice of meals i.e. not a set menu” Another said:“ I think the meals could be a lot better”. One resident said: “the evening meal is not very good”. The home provides one main course at lunch, which follows a set menu that the home can access from the company’s computer. The cook did explain that if a resident would prefer an alternative they could have one. For example she Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 16 was going to prepare something different for one resident at teatime, as he did not like fish. The Inspector did observe that a variety of porridge and cereals were being provided in the morning. Several residents were seen waiting for a considerable length of time at the dining room tables following breakfast. One resident asked for help to go to the toilet, this was organised and involved staff needing to locate the moving hoist. One member of staff commented that this kind of request is often difficult to meet when so many residents were still not up or waiting for their breakfasts. A comment made in one of the relative’s surveys said: “ I have found my relative still sat at the dining room table in her wheelchair at 11am when I have visited”. The cook explained that she does try to help with the serving of breakfasts, but this can be difficult some days as she works without a kitchen assistant. The dining room at lunchtime was disorganised and a group of residents waited 15 minutes between their first course and their pudding. This caused confusion amongst them, as some could not remember if they had already had it and some thought they had been forgotten. Staff were observed to be very busy as there were several residents who needed help with feeding. This was carried out in an unhurried and dignified manner. Several trays also had to be delivered to bedrooms. Meals were provided in different consistencies as required by the resident. One resident explained to the Inspector that she had been unable to cut her meat and had ‘gone off the idea of eating the meal altogether’. When she repeated the problem to a member of staff who later came to clear her plate, this important piece of information was not met with an offer to cut the meat up or an alternative; instead she was served her pudding. The nurse in charge was informed of this observation as a concern that staff members may not be ensuring that residents are eating well. The home does provide information on external advocacy services if required by residents who feel they may require an advocate. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are arrangements within the home to enable residents and visitors to make a complaint and staff are trained in issues relating to adult abuse. However, the routines and approach taken by staff within the home encourage the delivery of institutional practice that impacts on the quality of life enjoyed by the residents. EVIDENCE: Despite this outcome being assessed as adequate there are several shortfalls within this report that need close scrutiny by the company to ensure that the residents are not being subjected to practice that is not in their best interest. The home has a complaints policy and procedure that is in a prominent position. A requirement from the last inspection report to ensure the Commission’s correct details were in place has been met. The home’s complaint file contained very brief notes on one complaint, which the Commission has already been aware of and which has been referred to earlier in this report under Health and Personal Care. The nurse in charge said there had been several complaints from the same source and explained that these were being held and dealt with at the company’s head office. The company’s head office has confirmed receipt of two complaints, of which the Commission were aware. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 18 The Community Adult Care Directorate (CACD), formally Social Services, have confirmed that they have not received any recent complaints about the home. One of the above complaints was reviewed by CACD, as the complainant remained dissatisfied with the Registered Provider’s outcomes. Computer based records show that staff have received training or update training in the Protection of Vulnerable Adults (POVA). A requirement in the last inspection report for the Registered Manager to update herself with the county’s adult protection procedures has been met according to the nurse in charge at this inspection, although there was no certificate/information to this effect on record. Recruitment processes ensure that staff are checked against police records and the POVA list, therefore offering added protection to residents. Despite these safeguards there is evidence within this report that is indicative and supportive of the view that the home is being run in an institutional manner, which is detrimental to the quality of life of the people living there. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from some health and safety checks being carried out, although others are not robust enough to offer full protection. The home could improve its presentation in places and be more sensitive when preparing accommodation for residents in order to help them feel settled and welcome. EVIDENCE: Although this outcome has been assessed as adequate there are significant shortfalls that need addressing. The Inspector was unable to evidence a comprehensive fire risk assessment. Several checks on the fire safety system are carried out and recorded both by the company itself and by external specialists. There is a ‘stay put policy’ in the event of a fire which must be replaced with a robust evacuation policy in order Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 20 to meet current fire regulations. Advice must be taken from the Fire Safety Officer on these matters. Records show that staff are receiving fire training and fire drills are being instigated in the home. One of the maintenance team visits the home once a week to carry out immediate and small maintenance jobs. He also carries out various health and safety checks, which are recorded. Larger refurbishment and redecoration tasks are organised by the company’s head office. One bedroom looked as if minor maintenance work should have been carried out before the new occupant moved in. Items such as picture hooks still in place but without a picture present and several holes or areas of damage on walls contributed to an unwelcoming presentation. The storage of a deceased resident’s clothing in black bags in a room that had been reoccupied makes for unacceptable practice and shows a lack of planning and sensitivity. Other bedrooms where the resident has brought in personal effects and or has a supportive family, looked personalised and comfortable. The Inspector expressed concerns with the present use of some bedrails. The current practice was not meeting the guidelines issued by the Medical Devices Agency and in three examples bedrails were putting residents directly at risk. The nurse in charge was shown these and requested to address the situation urgently. There have been some concerns expressed in the pre inspection surveys regarding the cleanliness of the home. This was also raised within a complaint earlier in the year. The staffing roster indicates that there are two cleaners on duty Monday to Friday with one working through to the afternoon and evening on some days. There is also a cleaner working in the mornings at the weekend. One cleaner had started work in the home three days before this inspection. He had a good grasp of his duties and had been given guidance on various health and safety issues. He was able to explain to the Inspector what he would do in certain situations but it was noted that he had not completed his induction training and was working unsupervised. Cleaning arrangements are in place but examination of some armchairs, dining room chairs and bathroom floors showed the home is not effective in its deep cleaning arrangements. The home also has arrangements in place for the removal of clinical waste. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the company’s recruitment procedure and policies, but insufficient staffing means that not all of the residents’ needs are being met. EVIDENCE: A proportionate view has been taken when assessing this outcome; there are significant shortfalls in the staffing numbers in comparison to the residents’ needs, which require a review. The home is not staffed adequately to consistently meet the needs of all the residents. This relates to the inconsistent provision of activities, the shortage of support to residents at mealtimes, the lack of care provision in some specific areas, the lack of quality time being spent with residents and the lack of sufficient care and supervision of those with dementia. The duty rosters were examined and it is understood that these are initially planned and devised at the home’s head office with the home’s management having the ability to make changes before the final roster is agreed upon. The Inspector is aware that resident numbers have dropped and that the company have acted accordingly and dropped the staffing numbers. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 22 There is also however a possibility that the needs of the residents within this home have changed and dependency levels have increased. It is therefore imperative that the people who are devising the rosters and determining the staffing levels are very clear about the ‘needs’ of the residents within the home and staff according to need not numbers. The rosters demonstrated that five staff currently employed at the home hold the National Vocational Qualification (NVQ) at Level 2 and above. This is below the 50 required within the national minimum standards. This has however been identified by the management team as one of the areas that requires improvement within the next 12 months. Electronic recruitment files for three members of staff were inspected. Records were accessed via the home’s computer system and indicated that they were all cleared against police checks and the list for the Protection of Vulnerable Adults (POVA). As paper copies of these clearances are not held within the home the Commission will make arrangements with the company in the future for these to be inspected at the company’s head office at least annually. References for two employees were seen, but for one who had worked for the company since 2003 there were no references seen within the electronic file. Again this will be followed up with the company’s head office. Records show that staff are provided with induction training which is delivered on a corporate basis and covers several basic mandatory subjects, with additional ‘in house’ training completing this process. This induction training is based on the Skills for Care ‘common induction standards’ and gives the foundation knowledge required for the National Vocational Qualification (NVQ) award. Completed induction training was recorded in the recruitment records of a member of staff employed earlier in the year. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there are several systems in place to maintain residents’ health and safety, a lack of effective management in some specific areas is placing people who live in the home at risk. EVIDENCE: The manager of the home was not present during this inspection but was due to return soon after a few weeks of absence. She is registered with the Commission as a Registered Manager and is a Registered Nurse. She has been managing Astley House since 2003. There is a Deputy Manager in post who was available on the day of this inspection. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 24 The evidence gathered in this report demonstrates that the home is not being adequately managed on a day-to-day basis. This is not just down to the current absence of the Registered manager but also a lack of hands on management and practical supervision of staffs. One relative said: “ I would like to see more evidence of the management supervising more closely the quality of care given to residents, the impression I have is that staff are carrying out tasks in a manner that suits them”. The company have an extensive quality assurance system, which includes seeking the views of residents and relatives on the services and care provided. Records show that this information was collated and presented in July 2006, showing strong and weak areas of performance. It shows that the home scored well in many areas of the feedback, but that its weakness was in the lack of activities provided. This has been addressed by employing an activities co-ordinator but as evidenced previously in this report, there are still shortfalls in this area. Another area that was addressed following the company’s auditing process was that of the laundry. This has improved and there is now a member of staff in the laundry each day. The Inspector has been told that several residents’ personal monies are held securely. An inspection of these monies within the homes safe was not possible as the nurse in charge was not sure where the safe key was. This shortfall has been reported to the company’s senior management. Due to the lack of knowledge as to the whereabouts of this key by a senior member of the staff at the time of this inspection and because presumably a resident would not have been able to access their money at this point, the Inspector views these arrangements as unsatisfactory. Records demonstrate that staff receive training in safe moving and handling and update training for all staff was being advertised in the home at the time of this inspection. Despite this, the Inspector witnessed a poor moving and handling technique when staff transferred a resident from a wheelchair to an armchair. There were also several recorded incidents where residents had sustained an injury due to poor or careless moving and handling practice. The nurse in charge was made aware of these findings at the time of this inspection. Health and safety records held in the home were made available for inspection. These demonstrated that visual checks were being made by the by the home’s maintenance person on all fire fighting equipment, as well as fire escapes. The main fire alarm system is tested weekly along with the emergency lighting system. The wheelchairs are also visually checked and tyres are pumped up as needed. Records showed that one wheelchair had been appropriately taken out of use, Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 25 as it was not safe. It was noted that the records for three of the wheelchairs consistently recorded the absence of footplates. The Inspector did observe detached footplates in several areas of the home at the time of the inspection. This again is indicative of poor moving and handling practices in operation. Records show that all electrical equipment was tested for safety in 2006. The company confirmed that records for 2007 checks are currently at the head office. Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 2 Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Residents must have written care plans that are relevant to their identified needs and, that give staff clear guidance on how those needs are to be met. This is with particular regard to pressure relief care and continence care. The home must promote and make proper provision for the health needs of residents to be met. This is with regard to shortfalls in timely referrals to external healthcare professionals when residents are at risk and the shortfalls in how a diabetic resident’s blood sugars are to be monitored. Suitable arrangements must be made to ensure that the home meets the needs of those with specific disabilities and demonstrate it is operating with their ‘best interest’ in mind. This is with particular regard to the care of residents with dementia. The home must be conducted in a manner, which respects residents’ dignity. This is with DS0000016373.V338039.R01.S.doc Timescale for action 01/08/07 2 OP8 12(1)(a) 01/08/07 3 OP8 12(1)(b) 01/08/07 4 OP10 12(4) 01/08/07 Astley House Care Centre Version 5.2 Page 28 5 OP12 12(3) 6 OP19 23(4) 7 OP19 23(2)(b) & (d) 8 OP19 16(2)(c) 9 OP22 13(4)(c) 10 OP27 18(1)(a) regard to shortfalls in how staff interact with and respect residents as individual people, the lack of sensitivity shown when preparing accommodation for new residents and the manner in how a deceased residents belongings are disposed of. In meeting residents’ personal care and health needs, so far as is practicable, their wishes and feelings must be ascertained and met. This is with particular regard to the general routine of the home, the time that residents get up and go to bed and what they eat. The Fire Safety Officer must be consulted to ensure that the home is meeting current fire regulations. This is with particular regard to the implementation of a fire risk assessment and policy/procedure on safe evacuation. The premises must be kept in a good state of repair and all parts of the home are to be reasonably decorated. This is with regard to the condition of the walls, wallpaper and paint work in some of the bedrooms that are prepared for new occupancy. Adequate furniture and floor coverings must be provided. This is with regard to the replacement of heavily stained carpets and armchairs particularly within the main communal areas. Unnecessary risks to the health and safety of residents must be identified and so far as possible eliminated when using bedrails. The home must be staffed with enough staff to meet the needs of all the residents, also taking into account the size of the DS0000016373.V338039.R01.S.doc 01/08/07 01/08/07 01/08/07 30/09/07 16/07/07 16/07/07 Astley House Care Centre Version 5.2 Page 29 11 OP31 13(4)(c) building.(This requirement has been repeated from the previous inspection). Staff and their care practices 01/08/07 must be effectively managed and supervised so that risks to residents are minimised. This is with regard to the unsafe practices reported on in this report and the number of unnecessary injuries being sustained by residents. 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 Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Astley House Care Centre DS0000016373.V338039.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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