CARE HOMES FOR OLDER PEOPLE
Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY Lead Inspector
Mrs Janice Patrick Unannounced Inspection 6th June 2006 09:50 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.V299804.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.V299804.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.V299804.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. 28th November 2005 Date of last inspection 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 on the ground floor level with additional communal space on the garden floor level. 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. The home is situated within one of the main residential areas close to the town centre and is near to several bus links, banks and shops. The fee costs 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. Astley House Care Centre DS0000016373.V299804.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 inspection over two days between the hours of 09:50am and 6.00pm on the first day and 10:35am and 4pm on the second day. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The judgements contained in this report have been made from evidence gathered during the inspection and by talking with residents who were able to express an opinion, through talking with relatives and friends visiting at the time of the inspection, through reading care documentation and by observing the care and services being provided. Relative surveys were forwarded to the home prior to this inspection for comments of which, one has been received by the Commission for Social Care Inspection (CSCI). Residents generally express content with their care and said the staff were kind and friendly. All of the Core, National Minimum Standards (NMS) were inspected including 5 additional standards. Some of the key areas inspected are as follows: • Case tracking exercises were used to follow residents’ care from admission to the present time. • Care documentation relating to this was inspected. • The processes in place that enable residents’ to make choices and to have their preferences met were inspected. • Arrangements in the home for dealing with concerns and complaints were inspected. • How the home protects its vulnerable residents was discussed and relevant documentation and records inspected. • Residents were asked how they spend their time and what opportunities there were for going out and seeing visitors. • Staffing numbers, training and deployment were both inspected and observed. • The environment, its maintenance and cleaning systems were inspected and observed. • Health and safety practice along with risk management was inspected. • Previous requirements under the Care Home Regulations were followed up. Both staff and the Registered Manager were helpful and feedback on the Inspector’s findings was given at the end of the second day. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The home’s weakness is its staffing levels, which are at a minimum across the board. Although the basic cleaning and laundry service is being maintained this is being achieved partly through the good will of some staff and an increase in the already minimum care staff numbers. Care staff are achieving minimal activities with residents but these are not adequate for many residents and do not enhance the quality of their lives as stated within the home’s Statement of Purpose. The company have been required to ensure the home is staffed adequately as it was in the previous inspection report and asked to consider how they can raise standards for the residents and give support to the staff in the areas mentioned. Some of the care planning would benefit both resident and staff if it were more specific to the resident making it more ‘person centred’ and if there were more involvement with the resident in the planning stage. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 7 The Registered Manager needs to ensure that she is reporting all situations/incidents appropriately to her line Manager and to the correct agency. There is also a need for the Registered Manager to update her knowledge in the county Adult Protection protocols and ensure that senior staff in the home are also aware of these. Fire and manual handling updates must be carried out. The frequency of fire training for night staff is seriously inadequate and poses a risk to residents living in a four-storey house. Training relating to the Control Of Substances Hazardous to Health (COSHH) may need updating for some staff. The security of the home needs reviewing without interrupting the independence that people enjoy. 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 DS0000016373.V299804.R01.S.doc Version 5.2 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 Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 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): 1, 3, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information is available on enquiry to help prospective residents to make an initial, informed decision regarding their care at the home. Arrangements are in place prior to admission to ensure the individual’s needs can be met at this home. Opportunities are afforded to prospective residents and /or their representatives to view the home before making a decision to move in. This home does not provide designated rehabilitation care. EVIDENCE: The home’s aims and objectives are on the notice board within the entrance hall. There is a notice informing visitors that the home’s Statement of Purpose is available to anyone who wishes to read it, but the document was not present. The Commission for Social Care Inspection (CSCI) recently received an updated version of a combined Statement of Purpose and Service User
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 10 Guide. During this inspection this was made available on the homes main notice board. The home’s brochure is also available in the main reception area along with other helpful information for visitors. Astley House Care Centre also features on the ‘Blanchworth’ website, but information in respect of the home’s registration category and who the home is registered with is not up to date. Information regarding how and when residents/representatives receive a contract and Service User Guide was explored during this inspection. The Manager confirmed that a pack is sent out to any prospective resident or representative when they make an enquiry to the company’s head office. An example of a contract with the company’s terms and conditions is within the Statement of Purpose. Contracts are held centrally and were not seen at this inspection. The pre admission details and assessments for three residents were fully inspected. Several others were referred to during the inspection process. The Registered Manager confirmed that one had been completed over the telephone. During this inspection a member of the public, looking for a care home for their relative called in without an appointment. She felt she had been well received and given the information she had asked for. This visitor was also given the website for The Commission for Social Care (CSCI) www.csci.org.uk by the Inspector in order for her to read the inspection reports of the homes she was visiting. Additional pieces of information, which the home gathers prior to an admission, were seen in care files such as the Care Needs Assessment carried out by Community and Adult Care (Social Services), discharge summaries from hospitals and various assessments completed by external health care professionals. Two residents who had recently been admitted, both of whom had had their needs assessed prior to admission, could not confirm that they knew they were coming into a care home. Both may have forgotten what had been explained to them previously, maybe there had been a presumption that they understood but both were bewildered with how they felt and were trying to adjust. Staff in the home were very aware of this and were gently helping them through this. This home does not provide designated rehabilitation care. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 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 this service. Arrangements are in place to ensure residents’ needs are clearly identified, planned for and that clear instruction is available to care staff in how to meet these needs. However, a more person centred approach would benefit residents with needs such as dementia and ‘end of life’ issues. Residents can be reassured that their health care needs will be met. A safe system is in place to ensure medication is administered safely, but the home must ensure poor practice is appropriately reported. Residents are treated with dignity and their privacy is upheld. EVIDENCE: A case tracking exercise was used to follow the care of three residents. Several other areas of care documentation were read during this inspection. The case tracking exercise showed that documentation commenced on the day of
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 12 admission with various assessments being carried out in the first few days. It was well reviewed and generally updated well. The residents’ needs had been appropriately planned, although there was one example where the actual care plan noted one thing but on talking with the resident, this appeared not to be so. This was referred back to the Manager and by the second day of this inspection the resident’s problem had already been reviewed and action taken. It would be fair to say that this resident was fairly new to the home and the staff were in a period of getting to know the person’s needs. When this process has developed further this should reflect itself in the care planning which, at the time of inspection was basic. This resident had several needs/issues that would need exploration sensitively over a period of time. At this point the Manager’s and Deputy Manager’s thoughts on how they manage ‘end of life’ needs were discussed. Another resident’s initial pre admission assessment was inspected. On reading the care planning it was obvious that the resident’s needs had increased. Staff confirmed that a referral had been made for these needs to be reviewed, but in the meantime they have to manage some challenging behaviour. Thought had been given to this and the family were involved, but because the care planning was not ‘person centred’ enough it did not reflect this action. The Manager is giving consideration as to how the care plans are to be managed and reviewed now she has a Deputy Manager and a residential care co-ordinator. This should give opportunities for the resident to be far more involved in the planning of their care. Care staff were very aware of the residents needs and have an opportunity to record their own summary of care. External health care professionals regularly visit the home. The qualified staff liaise with 11 different GP’s, including the community nurse services for those residents that are not banded as ‘nursing’. On the day of this inspection the continence advisor nurse was visiting. The needs of one particular resident were discussed and an assessment carried out by her. She confirmed that the home staff were always helpful and that the Manager and qualified staff appear very aware of the residents’ needs. One resident was awaiting a visit by the community psychiatric nurse. This wait had so far been six weeks. The Manager confirmed that access to the Mental Health Team could be difficult and lengthy. The value of admissions with a Care Plan Approach (CPA) was discussed. The medication system was inspected and was found to be organised with medication records completed well, however, despite the overall judgement for this group being good, there was a significant failing at the end of last year that had still not been dealt with appropriately at the time of this inspection hence the final score for standard 9 on the scoring sheet at the back of this report. Throughout this inspection staff were observed caring for and conversing with residents well. The residents’ privacy and dignity was observed as upheld and Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 13 residents were able to confirm this to be so when they are on their own with care staff. One resident confirmed that retaining her privacy within a communal living setting was extremely important to her. This included anything to do with her finances, although during this inspection she had got herself in a muddle with these during an outing. Staff go to great lengths to uphold this, although at times she probably could use some simple help. Astley House Care Centre DS0000016373.V299804.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 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 this service. Arrangements are in place to enable residents to make choices and to maintain contact with friends and family. The present recreational and social activities within this home are not adequate and are not meeting the needs of all the residents. The menus in the home are varied and meals are generally enjoyed. EVIDENCE: Residents are encouraged and supported to make choices in many different ways. This can involve when they get up, when they go to bed, what they eat and whom they socialise with. Several residents confirmed that they are able to go to bed and get up when they choose or that the staff are aware of their preferred times and try and accommodate these. One member of staff confirmed that there are usually at least seven residents up at least by 06:30hrs. These are a few regulars who have always preferred to get up at this time and others who may have been wandering and appear to have had enough sleep. Many residents confirmed they were happy with where they were sitting either in the lounges or in their bedrooms and said the care staff often come and talk to them. One carer was
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 15 seen specifically visiting residents who had chosen not to leave their bedrooms. The purpose of this being to make contact with them, ensure things such as their drinks were nearby and that they were comfortable. The daily care chart for one very frail resident, who was being cared for in bed demonstrated that she was receiving care hourly. One resident was in bed the first day of this inspection and seen by the Inspector to have not touched his beaker of tea and piece of cake. The Manager explained that there are days when he refuses all food and most drinks. If encouraged to eat on these days he gets agitated, so it is left with him for a period of time and on other days he will eat well. His weight chart was inspected and recorded his weight as stable. Another resident was sitting in her room devoid of any personal belongings, radio or television. She had only been in the home for 4 days and was finding it very hard to settle. Staff, who were aware of her isolating herself at times, were visiting regularly for short periods of time. When the resident chose to visit the main hall area, there was no pressure put on her to stay if she did not wish to. This resident’s GP visited the home to review another of his patients, he had been concerned about this individual in her own home for some period of time and he asked for an update on how she was settling in. Another resident loves to sing and clearly cheers up fellow residents. There was healthy ‘banter’ between residents and staff and one visitor who visits every other day said that this was commonplace. This relative was extremely happy with the care her loved one was receiving. Another resident was clearly not happy in care. This resident had complex needs both physically and mentally. Some of this resident’s needs were discussed with the Manager, who confirmed that this person and another would benefit from more dedicated one to one, recreational input in order enhance their quality of life. There were several residents where this would apply but the home has not replaced the previous activities co-ordinator and it is up to the care staff to meet the residents’ recreational/social needs. There has not been an increase in the already minimum staffing to accommodate this and although staff managed a quiz as observed on the first day of this inspection and provided pictures to colour in, this clearly is not adequate. If care needs are high care staff are not then able to put time to this. This was of concern in the last report and a requirement still stands for this to improve within this report. One resident thought the quiz was taking place because the Inspector was in the home. A weekly activities programme was seen which covered three days of the week. ‘TV and Music’ were two of the activities. The television was on most of the time and quiet music was playing at other times. Although these maybe enjoyed at times by some residents they do not constitute quality interaction and were not appropriate for some residents. Nail care was also recorded, but this was confirmed as taking place usually at bath time. One afternoon had bingo and another had a quiz planned. The Manager confirmed that a small
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 16 group of residents who do not usually leave their rooms had a cream tea in the garden a few days before the inspection. Several visitors were seen coming into the home and three were spoken with. They explained that they were always greeted well and are able to visit when they like. The cook explained how she manages the kitchen. She holds the budget and has a good knowledge of the residents’ dietary needs and adheres to the printed menus. Any foods served as an alternative to the main menu are recorded. The kitchen is cleaned according to a planned cleaning schedule seen at this inspection and inspected by the Environmental Health Officer. The dining room was laid attractively for each meal. Staff fed some of the more frail residents quietly in the lounges or their bedrooms. Residents made mixed comments about the food. Some could remember being given a choice others could not remember being asked. One carer was observed feeding a resident who was not able to verbally express herself. The carer was able to read her non-verbal cues whilst feeding her and the resident slowly completed her meal. Another resident likes to go out food shopping and buy specific foods that she prefers. Astley House Care Centre DS0000016373.V299804.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 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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure visitors are aware of whom to complain to. Systems are in place to ensure that residents are protected from abuse. EVIDENCE: Complaints are dealt with centrally at the company’s head office; however, an audit of verbal concerns/complaints was seen as recorded within the home. The complaint procedure was prominently displayed within the main hallway, although this still had the former name of the CSCI (The National Care Standards Commission) displayed and was very high up the wall. Residents walking by would not be able to view this. The complaints procedure is one of several main items of information forwarded to prospective residents/representatives on initial enquiry. All staff except those either new to the home or new to care and on their induction had received training on the Protection of Vulnerable Adults (POVA). The homes policy on this was available on the notice board within the manager’s office. On talking with some staff they were aware of some of the issues involved. Residents all confirmed that they were treated well and felt safe. Records demonstrated that staff are recruited upon successful clearance against the POVA list and later the Criminal Records Bureau (CRB).
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 18 Consideration should be given to providing a more regular update for staff in Adult Protection, maybe within their supervision groups. Both the Manager and her Deputy require awareness of the county’s updated protocol on Adult Protection and were informed of future training being offered by the Adult Protection Team for Gloucestershire. Advocacy services are referred to on the main notice board. Astley House Care Centre DS0000016373.V299804.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home that is well maintained and spacious. Arrangements are in place for residents to be able to personalise their own bedrooms. The home is basically clean with staff being aware of infection control practices in order to help protect elderly residents. Laundry arrangements appear to meet the home’s needs. EVIDENCE: The environment is spacious and light and is across four floors, which are split into zones for fire protection reasons. There is a shaft lift which has frequently broken down in the past, but which is in working order at the present time. One resident commented on these breakdowns as being a source of real
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 20 difficulty for her during the period that her husband was dying on another floor to her in the home. There is a rolling programme of maintenance of which some records were inspected. A maintenance person visits the home each Monday and records show that minor jobs are carried out quickly. Some more involved jobs such as changing an ensuite floor covering or mending a sash window appear to take longer with examples of both of these as not being completed, but identified in early April of this year. Domestic assistants report any maintenance issues and senior managers also audit the home monthly with this in mind. A leaking toilet was dealt with during this inspection as an urgent requirement. The gardens and patio area are well tended and offer a pleasant area to sit. A security issue, which put vulnerable residents at risk, was identified during this inspection and reported immediately to the nurse on duty and discussed with the Manager. This however, related to the same concern that the previous inspector had and although staff were aware of what was causing the risk, it is clearly still occurring and needs to be dealt with. This would be further highlighted if the home had more residents with dementia. Communal rooms are large and hold various different pieces of furniture that help meet the needs of the elderly and frail resident. One main toilet near to the communal rooms has double doors and is extremely spacious. It is able to accommodate large pieces of moving and handling equipment as well as the resident and staff comfortably. Residents own bedrooms vary in size and to what degree they or their family have personalised it. Shared bedrooms have curtains for screening. Two residents who probably would not be able to voice a view on whether they wished to share occupy one shared room. Another was at present occupied by one resident. All bedrooms have ensuite facilities. The home is cleaned Monday to Friday by two domestics, there is no domestic cleaning over the weekend therefore Mondays can be extremely difficult for these two staff members. Both are extremely experienced cleaners and one arrives earlier than her paid hours each day in order to get the communal rooms cleaned before the residents get up. Both were able to explain good infection control practice and confirmed training in the Control of Substances Hazardous to Health (COSHH) regulations, although the Manager was observed moving one cleaners trolley containing many cleaning products, into a bathroom and therefore out of sight of residents, during a domestics coffee break. Basic cleaning is achieved with this level of domestic staffing and is reliant on the good will of the staff who want to take a pride in their jobs. The laundry is being covered at present by the care staff. It was tidy and clean. One relative commented that quite often her relative has a garment of clothing on that does not belong to him, but she regards this more as an Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 21 irritation rather than a major thing to get upset about and confirmed that the resident would be unaware. There were ample supplies of bacterial soap and gloves in each toilet and ensuite. Staff also wore colour coded plastic aprons when serving food. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff and residents benefit from a team of staff that predominantly remain as a cohesive team; although a minimum number makes it difficult for the extras to happen that really enhance a resident’s quality of life Arrangements are in place for staff to receive basic training relevant to their work. Arrangements are in place to ensure good recruitment practice in order to help protect residents. EVIDENCE: Staffing is at a minimum across the board and although the staff team accomplish the basic requirements extremely well, unfortunately more specific time required by some residents and a good choice of activities does not happen. The Manager has established systems in place and is experienced in her role. The company head office deal with many administration tasks for her to enable her to be involved in the care of the residents. This however, has a down side in as much as she has no control over staffing numbers, how long some staff remain at her home and recruitment. The home has over the 50 required of staff that hold the National Vocational Award (NVQ) in care. The Manager has just acquired her qualification as an assessor and is therefore able to move staff through their award.
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 23 One carer holds NVQ Level 4 in care and has just joined the home as Residential Care Co-ordinator. This person also was observed as being particularly good at involving some residents in an activity and explained that she believes this to be an essential factor in keeping residents happy and content. The majority of staff have received training in abuse/challenging behaviour, health and safety awareness and manual handling, where appropriate. Fire training is ongoing. The recruitment files of five staff were inspected. All had been employed following clearances against the POVA list (see standard 18) and later the CRB, although one member of staff had the wrong level of clearance. The files of three staff employed in 1994, 1998 and 2002 were not displaying any references. A police check carried out in one member of staffs original country of origin had not been translated into English. One new member of staff was living within the home itself waiting for accommodation elsewhere. She had evidence of a CRB clearance but was awaiting her induction training. A dedicated member of staff was therefore supervising her. The majority of staff received training in dementia care in early 2005, others have completed this more recently. Training in mandatory subjects is carried out within the induction training; there is evidence of ongoing updating in these subjects although moving and handling (practical) training is behind for all staff. Fire training for some night staff was last held on 22/05/06. This however, was the only record confirming training for this group of staff within the last 12 months. This is not sufficient training and below the recommended amount by the Fire Officer. This is viewed as a significant failing as it could have serious repercussions for residents hence the final score for this standard. Fire training for 6 of the day staff also took place on the same day; some of these staff are also behind in the frequency of this training. The Manager was requested to provide ample training as soon as possible and to ensure night staff in particular received adequate training. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 24 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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents and staff benefit from the home being managed, by a Manager who is experienced and aware of the residents’ needs. Arrangements are in place to seek the views of those who use and visit the service. Additional auditing helps the Manager identify where specific improvements can be made. Arrangements are in place for residents to manage their own finances and for some to be kept safe. Staff are well supervised and their practices monitored in order for residents to be cared for well. The home is well managed with the residents health and safety in mind, although fire training is not adequate.
Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Manager is registered with the CSCI and has managed Astley House since 2002 although her management experience spans over several years. She is a registered nurse with past experience in several fields of nursing including district nursing and hospital management. She also holds the NVQ Award in Care Management. She keeps herself updated in the practical skills required and has supernumerary time to manage the home. She was observed as being very involved in the care of the residents and knowledgeable regarding their needs. Residents, staff and relatives like her. The home identifies areas that require improvement by using a system of auditing which is predominantly carried out by the home’s immediate line Manager from the company. However, staff representing areas of the home apart from care were unable to confirm that the senior Manager ascertains their views or opinions. The Registered Manager is also aware of where changes and improvements can be made but some of these are not in her control to implement. Satisfaction questionnaires went out to residents and relatives last month, but the Manager is unaware of the results. These, when collated are placed on the notice board. Residents’ personal monies are kept safe for them or they can securely store these independently. Records were inspected for 5 residents and two amounts of money did not correspond with the amount being held. One showed an amount spent but there was no receipt for this. On the second day of this inspection these anomalies had been rectified. One resident spoken to prefers to keep her financial concerns extremely private. Staff are aware of her struggling at times to manage these, but are unable to help her. Their concerns are therefore passed onto her solicitor. Care staff receive supervision and records of this are kept. The Registered Manager said she aims to comply with the standard of a minimum of six sessions per year, per person. She also said this may increase if she feels a member of staff requires more support. Other staff in the home do not at present receive supervision, so a similar system was discussed for these staff. The Registered Manager confirmed that she receives regular supervision from her immediate line Manager. The home adheres to many policies/procedures that relate to good health and safety practices. It also complies with external agencies such as the EHO and Fire Officer, although as previously identified the frequency of fire training requires attention. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 26 The Fire Risk Assessment was not seen on this occasion. Records were seen for several health and safety checks including maintenance of major systems or pieces of equipment. Various risk assessments were seen which identify specific risks and show how these are reduced. Some residents have specific risk assessments within their care documentation. One resident wished to return to her bedroom on the lower floor and was observed climbing the stairs to the wrong floor. On this occasion the Registered Manager showed her where her room was. Later that day she was found by the domestic in another bed on the top floor and was returned to her room. The Inspector was informed that this resident does not wander at night and that she would not attempt to leave via the open back door. Risk assessments were in place for this resident but may require more specific detail as she is clearly disorientated. Another resident has exhibited challenging behaviour and care plans and risk assessments were seen completed relating to this. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 27 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 17 Schedule 3(3)(j) & 37 Requirement Timescale for action 13/06/06 2 OP12 16(2m) 3 OP16 22 (7)(a) 4 OP18 13(6) The registered Manager must in the future report appropriately to the CSCI/Police or any other agency any adverse incident that affects the well being of any resident or which puts the resident/residents at risk. 14/07/06 The registered person must consult with residents regarding a programme of social activities, and provide recreational/social opportunities, having regard to their differing needs and abilities therefore fulfilling the emphasis put on this within the homes Statement of Purpose. This requirement has been repeated from the last inspection. The registered person must alter 30/06/06 the name of the commission on the complaints procedure on the reception wall to read: The Commission for Social Care Inspection. The registered Manager must 14/07/06 update herself in the county Adult Protection Protocol and cascade these to senior staff
DS0000016373.V299804.R01.S.doc Version 5.2 Astley House Care Centre Page 29 5 OP19 13(4)(c) 6 OP26 13(4)(a) 7 OP27 18(1)(a) 8 9 OP30 OP30 18(1)(c) (i) 23(4)(d) (e) 18(2) 10 OP36 within the home. The registered person must ensure that the use of external doors by visitors does not pose a security risk to residents. The registered person must ensure that safety procedures relating to COSHH are being adhered to. The registered person must provide enough staff to meet the needs of the residents, the home and take into consideration the size of the building. The registered person must ensure that all staff are updated in moving and handling training. The registered person must ensure all staff receive appropriate and adequate fire training. The registered person must ensure that all staff employed at the home receive adequate supervision. 30/06/06 30/06/06 30/06/06 14/07/06 30/06/06 14/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The home should have a designated person who is not part of the care numbers on rota available to provide activities, which meet the residents’ needs and capabilities. The complaints procedure in the hall should be lowered in height and in typed in larger print. The home should increase its cleaning staff either at the weekend or on a Monday. A percentage of annual leave hours should be covered. The home should have designated laundry staff working on each day of the week. A percentage of annual leave
DS0000016373.V299804.R01.S.doc Version 5.2 Page 30 2 3 4 OP22 OP26 OP27 Astley House Care Centre hours should be covered. Astley House Care Centre DS0000016373.V299804.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 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
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