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Inspection on 28/06/05 for Astley House Care Centre

Also see our care home review for Astley House Care Centre for more information

This inspection was carried out on 28th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The Astley Care Centre provides a pleasant environment for the residents living there, which is safe, generally well maintained and clean. There is a hard working staff team, of whom residents and visitors spoke well. Respect is shown towards the residents` privacy, dignity and choices, though some aspects associated with staffing can adversely impact on this, as reported below. There is a good standard of food provided for residents, which allows for a degree of choice, and for special diets. There is a good system for dealing with complaints and concerns when they arise, and residents and visitors confirm that the manager and staff are very approachable and helpful.

What has improved since the last inspection?

There have been a number of staff changes over recent months, and it appears that, despite some shortfalls, the team is working extremely hard for the benefit of the residents. An outside pond, which posed a possible risk to residents using the garden, has been filled in, and is no longer full of water. Very little else has changed since the last inspection, and review of progress towards compliance with the requirements for improvements issued will be undertaken at the next visit.

What the care home could do better:

Following this inspection the home must make some slight improvements to the completion and recording of assessments and care plans, so that residents` health and personal needs are more fully documented. The home is also required to pay closer attention to the manner in which residents` records are held, in order that confidentiality can be assured at all times. The home was extremely busy on this day, with the numbers of staff only just able to meet residents` needs, though not always in a very timely way. Calls upon their time meant that some residents were left unattended for prolonged periods, medications were late being administered, and the morning coffee round did not take place. Further to some residents` comments, including those given as part of a satisfaction survey, the appointment of an activities coordinator would be greatly appreciated. These circumstances require some close attention and review by the Blanchworth Company as soon as possible, and will be followed up by the Commission for Social Care Inspection.

CARE HOMES FOR OLDER PEOPLE Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY Lead Inspector Ruth Wilcox Unannounced 28 June 2005 09.50 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Astley House Care Centre Address 1 Lypiatt Road Cheltenham Glos GL50 2SY 01242 526218 01242 255971 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sally Roberts Mr Jeremy Walsh Mr Roy Harris Mrs Nandani Cook Care Home with Nursing 34 Category(ies) of Old Age not falling within any other category registration, with number (34) of places Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Temporary variation to client categories - 2 (two) named service users under the age of 65 years. The Home will revert to the original client categories when these service users leave the home. Date of last inspection 18 January 2005 Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 5 Brief Description of the Service: Astley House Care Centre is a registered care home providing nursing and personal care for 34 older persons, over the age of 65 years. Respite care can also be offered. The home is a Grade II listed period house, which is situated in the centre of Cheltenham in close proximity to local amenities, and is owned and managed as part of the Blanchworth Care Group. The accommodation is provided on four storeys, and consists of 28 single bedrooms and 3 shared bedrooms, all of which have en suite facilities. There are two communal lounges and two dining rooms. The home has been converted and extended for its current purpose, and provides a shaft lift access to all floors. The surrounding grounds consist of gardens and a patio area, with seating for the service users. The grounds and gardens have been well maintained and provide a pleasant and accessible area. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors undertook this unannounced inspection over three hours on one day in June. The Registered Manager was not on duty during the inspection, and the Nurse in charge at the time endeavoured to provide assistance where required. Care records and facilities to meet the health needs of the residents, and the standard of meals were inspected, as was the provision of staffing in the home. A tour of the premises took place, and staff were observed going about their duties whilst interacting with the residents. The care of four residents in particular was closely looked at. Seven residents and two visitors were spoken to directly to obtain their view of the care and services they receive in the home. There was direct contact with four staff, all of whom, though clearly extremely busy, were open to the inspection process, and were helpful. What the service does well: The Astley Care Centre provides a pleasant environment for the residents living there, which is safe, generally well maintained and clean. There is a hard working staff team, of whom residents and visitors spoke well. Respect is shown towards the residents’ privacy, dignity and choices, though some aspects associated with staffing can adversely impact on this, as reported below. There is a good standard of food provided for residents, which allows for a degree of choice, and for special diets. There is a good system for dealing with complaints and concerns when they arise, and residents and visitors confirm that the manager and staff are very approachable and helpful. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 7 What has improved since the last inspection? 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 Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 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 standard(s) 3, 4 & 6. The home’s admission procedure ensures that all residents are admitted to the home on the basis of an assessment of their needs, though the omission by the home to conduct its own assessment in all cases could potentially compromise their ability to provide the care that certain residents require. The provision and deployment of staff on this day meant that the home’s capacity to meet the needs of the residents on this day was compromised. EVIDENCE: Residents are admitted to the home on the basis of a fully documented assessment of their personal needs. The assessment tool used for this purpose is comprehensive, and goes on to form the basis for a care plan after the resident is admitted to the home. However, case tracking showed that the home has not always conducted its’ own pre-admission assessment, relying on the Social Services assessment and performing their own following admission; it is strongly recommended that the home conducts its’ own pre-admission assessment in all cases wherever practicable. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 10 In consideration of the home’s proposals to vary its’ registration to accommodate dementia sufferers in a designated proportion of the beds, it was noted that staff on duty on this day were struggling to meet all the residents’ needs in a timely manner, or at all in isolated cases. Staff were too busy to answer call bells, the door bell and telephone promptly, and were too busy to provide morning coffee for the residents, many of whom were unsupervised for long periods. Many residents could not have received their medications appropriately, as due to persistent and necessary calls on her time, the Nurse did not complete the 8am – 10am medication round until 11.35am. Given that this was the case for the current residents, it is of some concern that the higher dependency needs of dementia sufferers could be compromised if circumstances around the provision of staff do not change. Furthermore environmental adjustments that were required following a previous site visit have not been satisfactorily addressed in the proposed dementia care unit. The issues pertaining to the proposed changes are to be pursued separate to this inspection. The home does not provide intermediate care. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 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 standard(s) 7, 8 & 10. Although systems are in place to meet residents’ needs, some improvements to care plan recording would provide staff with better and more comprehensive information to follow, in order to ensure that health needs of residents are always satisfactorily met in all areas. Staff endeavour to provide care to residents in such a way as to promote their privacy and dignity, though staffing deployment on this day was compromising this to some degree. EVIDENCE: Each resident has a care plan, which is linked to their individual needs assessment, and which is regularly reviewed. Four were chosen as part of a case tracking exercise, and in some cases the Activities of Daily Living assessment detail was minimal, providing only sparse information on which to base a plan. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 12 Risk assessments were recorded, and in two cases where the person was at risk of developing pressure sores, or was nutritionally at risk, there was no associated care plan to demonstrate how these needs were to be met. However, it should be noted that case tracking confirmed that the health needs regarding the pressure sore vulnerability were being fully met, with the provision of appropriate support equipment. There were also instances where nutritionally at risk residents had not been weighed. Care records contained evidence of medical interventions where appropriate, with assessment and provision of appropriate equipment as needed. Residents spoken to confirm that staff are caring and attentive to their needs, with some saying that they are always respectful to them. Staff were clearly endeavouring to meet the needs of residents with due regard to their privacy and dignity, though the circumstances on this day meant that some residents were left unattended for long periods. Visitors confirmed their satisfaction with the care their relative was receiving, saying that staff were helpful and attentive. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 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 standard(s) 14 & 15. Staffing provision and deployment on this day was such that it was impacting on the abilities of some residents to pursue choices. Dietary needs of residents are well catered for, with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: Some residents were seen passing the time of day with each other, some reading papers or watching television. They confirmed that staff are mindful and respectful of their choices, though it was evident on this day that due to the absence of staff in the vicinity of the lounges whilst providing care in other parts of the home, that certain residents’ choices were somewhat limited due to their own limitations. Residents and one visitor said that since the departure of the activities coordinator some while ago they have less opportunities for choice day to day. Respect is shown towards those choosing to manage their own affairs, sometimes with the help of their family; the home provides a variety of information for residents and their families regarding outside support and advice agencies, which some may find useful. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 14 Residents confirmed that they enjoy a good variety of well cooked food, and that they are able to select alternative meals if they wish to have something different to the main menu. One person said that the food was ‘excellent’, another said that he gets ‘plenty to eat and drink, though staff do not always observe his preference for black coffee instead of white’. Cold drinks were available for residents, though morning coffee was not provided. The lunch time meal appeared very wholesome, plentiful and nutritious, and was served appropriately with staff assisting where necessary. Special diets were catered for, with soft and vegetarian options offered. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 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 standard(s) 16 The home has a satisfactory complaints system, with evidence that residents feel that their views are listened to and acted upon. EVIDENCE: A written complaints procedure is displayed in the home, and there is a record of complaints received, with copies of correspondence and actions taken in response included. Residents and visitors indicated that staff are responsive to their concerns when they have any. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25 & 26. The home is safe and clean, with only minor attention needed to some lighting to ensure residents’ comfort. EVIDENCE: Risks from hot surfaces, hot water and high level open windows have been greatly reduced throughout the residents’ environment with the provision of radiator guards, blended water to ensure safe temperatures and window restrictors. Lighting is domestic in character, and isolated areas are dim due to the need for some bulb replacement. Ceiling lighting in the shared room can only be fully utilised by one of the occupants, due to its position in relation to the privacy screening; the standard of lighting in all areas must be audited to identify where a remedy may be needed. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 17 There were two cleaners on duty on this day, and the overall standard of cleanliness in the home was good, with no odours detected and appropriate infection control measures observed throughout the home, including the laundry. Staff are provided with personal protective equipment, and clinical waste is safely managed. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. Despite the best efforts of the staff group, the current level of staff provision is having a detrimental impact on their ability to meet the needs of the residents. EVIDENCE: The staff group consisted of one nurse and three carers, all of whom were very busy, and evidently struggling to meet the needs of all the residents in a timely manner. There have also been occasions recently where odd shifts have been understaffed due to staff absence. Assistance to rise, dress and wash was only provided to some residents in time for lunch. Others were left unattended for prolonged spells, morning coffee was not provided, and the nurse was unable to finish the morning medication round until 11.35 am, due to constant calls on her time to provide hands on care to residents. Responses to resident call bells, telephone rings and door bells were not always very timely or appropriate. There was no activities coordinator, and staff were unable to provide any stimulation to the residents, due to their efforts to address basic needs. There was no laundry assistant on duty, and laundry was beginning to back up due to the constraints upon staff to deal with it. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 19 One cook was providing all the catering, and two cleaners were cleaning throughout the home. The staff team is evidently very hard working, with the best interests of the residents at heart. Resident and visitor comments indicate that the staff are well thought of. In order that residents’ needs are met more appropriately, it is vital that consideration be given to the current work load and the range of resident dependency levels, and the lay out of the extensive four floor building. The provision and deployment of staff is of some concern, particularly with consideration to the home’s proposals to vary its registration to accommodate dementia sufferers, who will require an increased level of supervision. This issue is to be discussed with Blanchworth senior management separate to this inspection. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 37. Systems for monitoring and reviewing quality of services allow residents to have some input into how their home is run. The omission of staff to consistently secure the storage of records could mean that the confidentiality of information relating to residents may not be assured. EVIDENCE: A Resident Satisfaction survey has been conducted earlier this year, during which their views of their home and the services they receive were sought. The results of this survey have been made available, with the results generally showing that the residents would appreciate improvements regarding social stimulus in the home. On the basis of this inspection this does not appear to have been successfully addressed at this stage. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 21 Accessibility of the manager and staff is welcomed by the residents and visitors, with people saying that they are approachable, and that their comments are listened to. A representative from the company visits regularly in order to conduct their own inspection of the home and services offered, and prepares a written report on that basis. It was said that these visits often take place in the absence of the manager, and that the manager would greatly appreciate the opportunity to meet with her line manager on some of these occasions, in order to discuss quality issues and associated concerns as they arise. Records required by regulation are maintained, though it was of some concern that the security and confidentiality of these records could not be guaranteed without the presence of staff in the vicinity, due to their unsecured location. On occasions when staff are absent from this area, the door to the designated storage room must remain locked to maintain safe storage of records. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 3 COMPLAINTS AND PROTECTION x x x x x x 2 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x 2 x Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement Staff must ensure that all assessment tools are completed in full, in order that residents needs are fully identified. Staff must ensure that care plans clearly identify how residents health and welfare needs are to be met. (On this occasion this is with particular reference to those assessed as being at risk of developing pressure sores, and nutritionally at risk). The home must monitor and record residents weights, particularly where a nutritional risk has been identified. The home must audit the standard of lighting to ensure that all is appropriately maintained, and is suitable to meet the needs of the residents. A review of staffing must be undertaken, and staff provided in such numbers as will meet the needs of the residents in a timely way, including their privacy, dignity and ability to exercise choices. Staff must ensure that all confidential information Timescale for action 31 July 2005 31 July 2005 2. 7 15(1) 3. 8 12(1.a) 31 August 2005 31 August 2005 4. 25 23(2.p) 5. 4, 10, 14 & 27 18(1.a) 30 September 2005 6. 37 17(1.b) 31 July 2005 Page 24 Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 pertaining to residents is kept securely in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations The home should conduct its own admission assessment on all new residents, prior to admission actually taking place. Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 25 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Astley House Care Centre D51_D03_S16373_Astley_V231428_280605_Stage 2.doc Version 1.30 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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