Inspection on 17/12/07 for Aston Grange

This inspection was carried out on 17th December 2007.

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

Other inspections for this house

Aston Grange 01/06/07

Aston Grange 24/01/07

Aston Grange 08/05/06

Aston Grange 29/09/05

Aston Grange 15/04/05

Aston Grange 04/08/04

Aston Grange 21/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Aston Grange 484-512 Forest Road Walthamstow London E17 4PZ Lead Inspector Peter Illes Unannounced Inspection 10:00 17 & 18 December 2007 th th 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 Aston Grange DS0000007241.V356241.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. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aston Grange Address 484-512 Forest Road Walthamstow London E17 4PZ 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) 020 8509 1509 020 8509 1609 yetty.adepegba@carebase.org.uk Aston Grange Limited vacant post Care Home 45 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (16) of places Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 16) 2. Dementia - Code DE(E) (maximum number of places: 29) The maximum number of service users who can be accommodated is: 45 8th November 2007 Date of last inspection Brief Description of the Service: Aston Grange is registered to provide care to 45 older people, 29 of whom have a diagnosis of dementia. The home is operated by ‘Aston Grange Ltd’, linked to ‘Carebase Ltd’, who own other care homes. Short-term respite stays are offered where there are vacancies between long-stay placements. The home is purpose built with accommodation on three floors, with all fortyfive bedrooms having en-suite facilities. There are sixteen bedrooms on the ground floor, called Daisy unit, providing residential care for older people; seventeen bedrooms on the first floor, called Lavender unit, providing residential care for older people with a diagnosis of dementia and twelve bedrooms on the second floor, called Primrose unit, also providing residential care for older people with a diagnosis of dementia. There are additional adapted bath and shower facilities and communal spaces including a lounge/ dining room on each floor and a kitchenette on Lavender and Primrose units. The home’s main kitchen and laundry facilities are situated on the second floor. All floors are linked by a passenger lift and two flights of stairs. The home has a pleasant paved patio garden that the manager stated will be further upgraded during 2008 and there is off street parking at the front of the home. The home is situated near the centre of Walthamstow in the London Borough of Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 5 Waltham Forest and is within easy access of public transport, shops and other community amenities. The stated philosophy of the home is to look after our Resident in the best possible way, in a home from home environment, creating an atmosphere to meet all care, social, spiritual and psychological needs. The provider organisation is aware that it must make information about the service, including CSCI inspection reports, available to people living at the home and other stakeholders. The current weekly charge is from £600 per week depending on the person’s assessed need. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. At the last key inspection serious shortfalls were identified in the home’s risk management procedures. Following this the Commission issued a statutory enforcement notice to the registered provider under the Care Standards Act 2000 requiring compliance and informing them that they may be prosecuted without further notice if compliance was not achieved. A random inspection was undertaken at the home on 8th November 2007 to verify compliance with the statutory enforcement notice and the results of that inspection are reported in the Health and Personal Care section of this report. This key unannounced inspection took approximately ten hours over two days. Mr Peter Godden-Kent, an Expert by Experience, employed by Help the Aged, assisted me with the inspection on the first day and his findings are reflected within this report. A new manager, Ms Yetty Adepegba, had been appointed since the last key inspection and she was present or available throughout the inspection. There were thirty-one people accommodated at the time of the inspection and fourteen vacancies. The inspection activity included: meeting and speaking with the majority of people living in the home, a number of them independently; independent discussion with relatives and friends that visited on the day; independent discussion with a number of staff; discussion with the manager, deputy manager and the home’s administrator; discussion with a placing social worker from the L.B. of Tower Hamlets who visited the home during the inspection; independent discussion with a district nurse who also visited during the inspection; independent discussion by telephone with a social worker from L.B. of Newham who was in the process of placing a person at the home and independent discussion by telephone with a contracts manager from L.B. of Waltham Forest. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection, a tour of the premises and documentation kept at the home. What the service does well: The service is working hard to provide good quality care to older people, some of whom have complex needs and a stable group of care staff assists with this process. The home is purpose built and provides a pleasant environment for people to live in. The Expert by Experience indicated: The ambience of the Home, it seemed to me, was generally hospitable, friendly and caring. There were no matters that caused me any real disquiet, and I am assured that the new Manager is quickly getting to grips with those matters that have previously been of concern to CSCI. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Aston Grange DS0000007241.V356241.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 Aston Grange DS0000007241.V356241.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People referred to the home, current residents and stakeholders have improved information about the home including the services it can offer and the services it cannot offer. However, individual contractual information needs to be reviewed for people that have lived at the home for some time, so that this information is up to date. The home has improved its systems for assessing people’s needs and preferences when they are referred to the home and for keeping these under review once admitted, to assist staff address and meet these needs. EVIDENCE: At the last key inspection a requirement was restated that the service develops a statement of purpose that details how the service is to function and meets the criteria as detailed in Schedule 1 of the CHR 2001. This was primarily because the inspector that undertook that inspection was concerned about Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 10 aspects of the home’s admission procedures and information relating to this. The inspector judged that the statement of purpose seen at that time still did not give sufficient clarity about the home’s admission procedure, particularly for respite. At this inspection I was given a copy of the home’s statement of purpose that the new manager and the provider organisation had revised in October 2007. This is a clear document that includes detailed information about the home’s admission and assessment procedures for both short stay and long stay referrals and states that the home will not admit any residents without sufficient background information. Statements of terms and conditions/ contracts regarding living in the home were sampled for some people. Although there was evidence to indicate that all people living at the home had such a document agreed when they entered the home a minority of those seen were quite old and did not reflect current information including the up to date cost of living in the home. The manager acknowledged that this was work that needed to be addressed although we agreed that she did need to prioritise this along with other improvements that she wants to achieve within the home. A requirement is made that the registered person ensures that the statement of terms and conditions/ contracts are reviewed with each person living at the home, and other stakeholders as appropriate, to make sure that they are up to date. This requirement is made with a negotiated timescale to allow the work to be appropriately prioritised. At the last key inspection a requirement was restated that the service undertakes an adequate assessment of need prior to admitting a prospective resident. The requirement included that all identified risks must be adequately considered prior to admission. This requirement was restated, as the inspector was clearly concerned about identified admissions to the home at that time. At this inspection I inspected the files of six people living in the home, including the file of the one person that had been admitted to the home since the last key inspection. The file of the person admitted since the last inspection contained a satisfactory pre-admission assessment undertaken by the home. Since the new manager has been in post the provider organisation has reviewed and improved the home’s pre-admission assessment format, a copy of this document was also given to me. The new format requires detailed responses in a range of appropriate tick boxes and text boxes and I was pleased to see that people’s needs and preferences regarding diversity issues are included in the format. The manager stated that this new pre-admission assessment format was being piloted with new referrals to the home. Following the last key inspection a statutory enforcement notice was issued relating to how the home identified and assessed risks and how these risks were dealt with. This statutory notice is dealt with in more detail in the Health and Personal Care section of this report. However, evidence was seen that identified risks are currently being addressed for people referred to and living in the home. Identifying risks and risk management are key features in the new pre-admission assessment format. The files of the other five people Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 11 inspected showed evidence that the person’s needs had been reviewed since the last inspection including with input from the referring authorities where appropriate. Evidence was also seen that the new manager was in contact with a number of referring authorities to keep them up to date with people’s progress at the home. Evidence was seen that the manager was seeking written clarification from one authority, L.B. of Redbridge, that the authority remained satisfied with the care of a number of individuals placed. The new manager has also reviewed the home’s overall in-house review and evaluation format, including in relation to risk management. This is to make the format more focussed and robust regarding identifying any changing needs an individual may have. The new format is currently being introduced along with a revised key worker contact sheet and copies of these were seen on some files inspected. The home does not provide intermediate care. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 12 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are benefiting from improved systems regarding risk management and care planning that is contributing to both keeping them safe and in having their needs addressed in a more effective and individual manner. People are supported to have their health needs addressed including by accessing a range of healthcare professionals. Effective policies and procedures for the safe administration of medication contribute to safeguarding people living in the home. People are also treated with respect and dignity by staff, which they and their relatives appreciate. EVIDENCE: At the last key inspection serious shortcomings in the home’s risk management processes were identified. As a result of these shortcomings the Commission issued a statutory enforcement notice requiring the home to: Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 13 • • ensure that all identified risks to service users were appropriately assessed and measures put in place to prevent harm or abuse. ensure that all incidents of abuse or harm were appropriately responded to in line with local safeguarding policies. The notice also informed the registered person that if they failed to comply within the given timescale they could be prosecuted without any further notice or warning. The statutory enforcement notice and the written representations the registered person made on 8th October 2007 regarding this were reviewed by Colin Hough, Regional Director, Commission for Social Care Inspection (London), who upheld the statutory notice. Colin Hough wrote to the registered provider on 1st November 2007 informing him of this decision. I subsequently received a letter dated 1st November 2007, from one of the provider organisation’s Business Managers, informing me of a range of progress being made at Aston Grange, including actions that had been taken to minimise risk to residents at the home. This included that in September/ October 2007 all staff had attended a two week block of training that included moving and handling, health and safety, fire awareness, food hygiene, learning to care, death, dying and bereavement, POVA (local authority), first aid and the Mental Capacity Act. The letter also stated that a second block of training had been arranged for November 2007 and that the newly appointed manager will be attending this training. I undertook an unannounced random inspection of the home on 8th November 2007 to test compliance with the statutory enforcement notice. At this inspection I was informed that since the last key inspection on 1st June 2007 all residents’ needs had been reviewed and as a result of this two people had moved on to different accommodation. I was also informed that only one new person had been admitted to the home during this period. I inspected the file of the person who had recently moved into the home and the files of an additional three people that had lived at the home for a longer period. All four files showed current assessment information, including recent assessment information from the placing authorities for two of the four people. All of the four files contained detailed and up to date risk assessments with evidence that these were being regularly reviewed. The risk assessments and the reviews were dated and showed the name of the person undertaking the assessment or review. Evidence was also seen on one person’s risk assessment that a new risk had been identified and included, following a change in the person’s assessed needs. The risks identified on the risk assessments sampled corresponded to the assessed needs of the person and gave guidance to staff on how to minimise the identified risks. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 14 Each file also contained a separate falls risk assessment that I was informed had been introduced for each resident from October 2007. These were also clear and satisfactory. I was informed that no new incidents of harm or abuse had been identified or bought to the attention of the home at that time. I was also informed that the home was clear that any such incident needed to be dealt with through the local authority’s safeguarding adults procedure. At this inspection I inspected the files of six people, including reviewing the file of the only new person to have been admitted to the home since the last key inspection, which I had inspected at the random inspection. These all showed up to date care plans that were informed by a general risk assessment; a moving and handling risk assessment and a falls risk assessment. Evidence was seen that care plans were being reviewed and evaluated monthly and that the home was introducing a new review and evaluation form to assist with this. Evidence was also seen that the role of the key worker was being further developed including that the key worker was required to make and record contact with relatives and any other identified stakeholder on a monthly basis to assist with the care plan review process. Key workers and relatives spoken to confirmed that this type of contact was improving. At the last key inspection three requirements were made regarding people’s care plans. These were in relation to ensuring that care plans were underpinned by a comprehensive and up to date risk assessment, that care plans include moving and handling strategies and that all information identified in the assessment process was appropriately recorded on the person’s care plan. Evidence was seen from the care plans and assessment documentation seen that these requirements were being complied with and discussions with some people living in the home, relatives and staff supported this. At the last key inspection two requirements were made regarding dealing with accidents. These were that all accidents are properly recorded in sufficient detail and a record held for inspection and, that a management response must be evidenced when a resident is injured as a result of staff handling. The home’s accident book was inspected and had a record of sixteen accidents since the last key inspection. It was noted that none of these related directly to moving and handling tasks undertaken by staff, which was a concern identified at the last key inspection. The accidents that had occurred had been recorded in sufficient detail with evidence seen of action identified to minimise future risk in the identified area. The manager is now signing the record of every accident recorded. At the last key inspection a requirement was made that care plans incorporate directions from other professionals in the management of care of residents with pressure ulcers. At this inspection a visiting district nurse was spoken to independently and evidence was seen that this requirement was being met. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 15 The district nurse stated that she currently visits the home three times a week and that two people currently had pressure ulcers. She stated that the pressure ulcers on both of those people were responding well to treatment and that communication between staff and her was good. The district nurse stated that she had visited the home since November 2004 and felt that the quality of care had improved over the past seven or eight months. The district nurse kept her own files at the home for people she was treating and I saw these. The files for the two people with pressure ulcers were inspected and were up to date regarding their skin vulnerability. The care plans also included guidance for staff including the use of specialist equipment including pressure mattresses and cushions. A staff member spoken to was able to tell me how she dealt on a day-to day-basis with the needs of one of the people with pressure ulcers who lived on the floor that she was working on. Records were seen that people living in the home were registered with a GP and also had access to a range of external health professionals such as a dietician, chiropodist, optician and dentist. The manager stated that the home was currently negotiating with a new visiting dental service to attend the home to improve the service currently being offered. At the last key inspection a requirement was restated that people living in the home receive their medication as prescribed and evidence seen indicated that this was being complied with. At this inspection a medication policy that had been reviewed in August 2007 was seen and elements of this were sampled and were satisfactory. Evidence was seen that all staff that administer medication had received appropriate training to assist them do this safely. Medication and medication administration record (MAR) charts were inspected for four people, two on the ground floor and two on the first floor. The medication corresponded to that recorded on the MAR charts and the charts were up to date. Each person had a medication profile that included a photograph and list of known allergies to aid safe administration. Controlled medication was also inspected for another person living on the first floor and this was properly stored in a controlled drugs cupboard. The controlled drugs record of administration was up to date with two signatures seen to record administration of the medication. Records sampled of medication received into, and disposed of, by the home were up to date. People living in the home and relatives spoken to indicated that people living in the home had their dignity and privacy respected. People living in the home were appropriately dressed and presented during the inspection, and it was noted that the term of address that people living in the home prefer is noted in their care plans and staff were observed using these when introducing me to people. The files of people with a diagnosis of dementia that were inspected contained a range of life history work and detailed the person’s likes, dislikes and things that were important to them. An example of this was noted for one person that had a preference regarding how their toileting needs should be met and that this preference was being respected. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 16 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. . People living at the home benefit from an increasing range of activities that they enjoy and that meet their needs and preferences. Relatives and other visitors are made welcome at the home and staff are working hard to develop more regular contact with some people that live some way away, which they and people living at the home appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. The home also provides a range of healthy and nutritious meals that people enjoy. EVIDENCE: At the last key inspection a requirement was made that scheduled activities for people living in the home take place as planned and activities are adequately resourced. Evidence was seen that this requirement was being met. The home has employed an activities coordinator since the last key inspection. The home had a full activities programme for the Christmas period that included a visit from local Salvation Army musicians, a visit from a Pearly Queen, a theatre trip and entertainment from a “Drag Queen”. The Salvation Army musicians visited Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 17 on the first day of the inspection and people were seen to be very much enjoying the music and singing. People living at the home and relatives spoken to stated that activities provided in and from the home had improved over the past few months. Evidence was seen on the files inspected that information about the person’s life history is recorded along with their likes and dislikes overall to assist, including regarding activities, in meeting the needs of people with dementia. The activities coordinator was spoken to independently and confirmed that a full activities programme was being implemented outside of the Christmas period. Ongoing activities included arts and crafts, trips out, quizzes and films. Evidence of this was seen from an activities file and confirmed by people living at the home, relatives and staff. Evidence was seen in correspondence from the manager to a placing authority regarding one resident whose interest is painting. The correspondence stated that a painting easel had been supplied in the person’s room and one-to-one staff support arranged to assist the person in using this. I also saw documentary evidence that the manager has agreed with the activities coordinator that most small-scale activities are organised on each floor rather than on one floor with people from other floors being bought to that floor. I was informed that this was to better meet the needs of people with dementia. The Expert by Experience indicated: A varied programme of activities and entertainments was being developed within the Home, with possibilities of outings also. I was particularly pleased to see that the Home has two resident cats; one of the residents told me that he looks after the cats at night, and that their arrival was a result of residents’ suggestions about three years ago, with the aim of providing a more homely environment (especially for those with dementia). The willingness of the Home to have resident pets is, in my view, commendable. This does not appear in any of the formal criteria for quality of care, but is a point which I believe would be important to many older people who may have an animal companion, for example a dog or cat whose company means a great deal to them and parting from whom can be very traumatic. I explored with the manager and other staff that arrangements whether arrangements were in place for if a person was not fond of animals and I was told that they were. People spoken to indicated that they liked seeing the animals in the home. Residents at the home include people from a range of ethnic minority cultures and religions. The needs and preferences of people from these communities were seen recorded on files inspected. The first language of one person living in the home is Creole French and the home had staff who could speak that language. I observed a staff member speaking with this resident during the inspection and the conversation appeared relaxed with the resident smiling and obviously enjoying the exchange. Evidence was seen by both the Expert by Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 18 Experience and myself that one person living in the home has, for personal reasons, requested alternative toileting arrangements to using the en-suite facilities in their room and this was being respected. However, following an observation from the Expert by Experience a good practice recommendation is made in realtion to this in the Environment section of this report. The new preadmission assessment format now includes a section regarding people’s sexuality with a prompt for the assessor to discuss issues surrounding sexuality. Separate sections are also included in the assessment format to ascertain the person’s religious needs and cultural needs with appropriate prompts for guidance in filling in these sections as well. Both the manager and other staff spoken to stated that they were clear of the importance of ascertaining such information to be able to properly address people’s needs and preferences regarding their care. The Expert by Experience indicated: There are people from ethnic minorities among both residents and staff; I saw no sign whatsoever of any tensions arising from this, and it seemed to me that cultural differences are wholly respected. Evidence was seen that relatives and friends are made welcome to the home. Relatives spoken to indicated that they were generally happy with the care provided by the home. One relative stated that there had been lots of changes in managers although they liked the current manager. The relative went on to say that they were always made welcome to the home and that any issues raised were dealt with. Another relative spoken to lives in Spain and was visting their resident on a Christmas trip to the UK at the time of the inspction. The relative stated that their resident had lived in the home for three years although it had only been recently that (the new manager) had initiated contact by e-mail, which he greatly appreciated. Another friend spoken to, that visits the home on a two weekly basis, was also positive about the home and singled out the key worker of the person they visited saying that “ the staff member has been very good and that all the residents love her”. The Expert by Experience indcated: They (the residents) said, and I saw, that their visitors were freely welcomed. Residents and their visitors were generally very complimentary about the attitude of staff, and about the new manager, confirming that staff listened to them and heeded their wishes and preferences. At the last key inspection a requirement was made that people living in the home are supported to exercise choice and control over their daily lives and where ever possible are involved in the decision making. This was because the inspector at that time was concerned that the views of people living in the home may not have been properly represented at initial six weekly review meetings after people were first admitted to the home. Evidence was seen from files and other correspondence that indicates that residents’ views are being represented at reviews held since the last key inspection. The home does not hold money for anyone living in the home with the provider organisation paying for items such as toiletries and then invoicing the person or their Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 19 representative. Evidence was seen from a relatives’ meeting held in November 2007, and from other documentation seen, that this had been discussed with residents and relatives. Both residents and relatives spoken to were satisfied with the way that the home deals with residents’ finances. The Expert by Experience indicated: What I saw and heard indicated to me that residents’ personal freedom and wishes, which are among the most important aspects from a resident’s perspective, were respected by the manager and staff, and I commend the management and staff of the home for this. The ambience of the home, it seemed to me, was generally hospitable, friendly and caring. There were no matters that caused me any real disquiet, and I am assured that the new Manager is quickly getting to grips with those matters that have previously been of concern to CSCI. The home has a four-week menu that was seen to contain a range of healthy and nutritious meals with a choice for each main meal. The chef was spoken to and stated that she and her staff talk to residents informally on a regular basis to obtain feedback on the meals served. She went on to say that people’s food preferences are sought when they are admitted to the home and also discussed at residents meetings. The home was catering for people with diabetes, gluten intolerance and for people who needed a soft diet. The chef also stated that the home could provide Kosher and Halal meals if required although none of the residents required these at the time of this inspection. The chef was also clearly proud to have received a “four star- very good” judgement from an Environmental Health inspection of the kitchen on 10th December 2007 and showed me the certificate that the home had just received. The Expert by Experience indicated: I met many of the residents, talking alone with some for several minutes, and joining one table for lunch (where the fare was well presented, enjoyable, and with generous portions). Feedback from both residents and relatives spoken to was positive about the meals served at the home. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 20 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home, and their relatives, have any concerns they raise taken seriously and acted upon appropriately. The home has reinforced with staff the implementation of its policies and procedures for protecting people from abuse and staff are clear about these. EVIDENCE: The home has a satisfactory complaints procedure that was seen, including a copy of the procedure seen displayed in the home’s reception area. The home had received two concerns since the last key inspection and the records of these were inspected. The records showed that one concern had been substantiated and the other had not and that appropriate action had been taken to address the substantiated concern. A comments book and suggestion box were also seen displayed in the home’s reception area. People and relatives spoken to indicated that they were confident that any issues they raised with staff or the manager would be promptly dealt with. No other complaints had been received by the home or by the Commission since that time. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 21 At the last key inspection serious concerns were identified regarding how the home’s risk management procedures, including referring allegations or disclosures of abuse to the local authority under the safeguarding adults procedures. As a result of this a statutory enforcement notice was issued requiring the home to ensure that all incidents of abuse or harm were appropriately responded to in line with local safeguarding policies. The home took appropriate action regarding this notice; please refer to the Health and Personal Care section of this report where the home’s response is dealt with in more detail. At this inspection the home had the latest copy (November 2007) of the L.B. of Waltham Forest’s safeguarding adults policy called “Dignity in Care”, the deputy manager confirmed that she had attended the launch of this policy. Documentary evidence was also seen that staff had received refresher training regarding safeguarding adults and staff spoken to confirmed this and were able to state the actions they needed to take should an allegation or disclosure of abuse be made to them. There had been no disclosures or allegations of abuse made to the home or to the Commission since the last key inspection. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 22 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, 21, 24 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a purpose built home that is well equipped, well decorated, well furnished, well maintained and the fabric of which is being further improved to meets their needs. However two issues relating to further ensuring people are kept safe need attending to. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors although a modification to the flooring in one person’s bedroom may improve their feeling of well being further. EVIDENCE: The home is purpose built with accommodation on three floors, with all fortyfive bedrooms having en-suite facilities. There are sixteen bedrooms on the ground floor, called Daisy unit, providing residential care for older people; Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 23 seventeen bedrooms on the first floor, called Lavender unit, providing residential care for older people with a diagnosis of dementia and twelve bedrooms on the second floor, called Primrose unit, also providing residential care for older people with a diagnosis of dementia. There are additional adapted bath and shower facilities and communal spaces including a lounge/ dining room on each floor and a kitchenette on Lavender and Primrose units. The home’s main kitchen and laundry facilities are situated on the second floor. All floors are linked by a passenger lift and two flights of stairs. The home has a pleasant paved, patio garden that the manager stated will be further upgraded during 2008. The home was in the process of finishing a refurbishment programme at the time of this inspection and this will include a kitchenette on the ground floor, Daisy unit, when complete. At the time of the inspection thirty-one people were accommodated. A number of residents’ bedrooms, both occupied and unoccupied, were seen on each floor during a tour of the home and all were well decorated and furnished. The rooms that were occupied had been personalised by the people living in them and both people living at the home and relatives spoken to stated that people were satisfied with their rooms. The Expert by Experience indicated: All the rooms are personalised, to varying degrees, with residents’ own memorabilia. The home was appropriately decorated for Christmas and looked festive. It was noted that in the communal areas on the first and second floors there were “fiddle boards” on the walls that provided opportunities for people with dementia to interact with. It was also noted that there was appropriate signage and other information displayed throughout the home to assist people with dementia orientate themselves, including locating their bedrooms and communal areas. The manager stated that new plasma flat screen televisions have been ordered to replace the existing television sets in the communal areas. During the tour of the building it was noted that one person, who spent the majority of their time in their bedroom, had their bedroom door wedged open. The manager stated that this should not have happened and a doorguard, a device that holds the door open but releases it when the fire alarm is sounded, was seen to have been fitted to the identified door later during the inspection. However, a requirement is made that fire doors are not to be wedged open unless by a device that is linked to, and is automatically released by, the home’s fire alarm system and that the device is approved by the fire officer. As indicated in the Daily Life and Social Activities section of this report, one person living in the home has, for personal reasons, requested alternative toileting arrangements to using the en-suite facilities in their room and this was being respected. However, the Expert by Experience indicated that there was a slight malodour in that person’s room when he visited it. Following discussion with the manager about this a good practice recommendation is made that non-porous flooring should be considered for this person’s bedroom, Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 24 following discussion and agreement with the person and any appropriate stakeholder. Apart from the bedroom identified in the paragraph above, the home was free from offensive odours and was clean and tidy during the two days of the inspection. The home has appropriate laundry equipment and infection control policies and procedures, the latter seen to have been reviewed in August 2007. It was noted that the non-porous surface on the plinth on which the laundry equipment stands was starting to deteriorate and a requirement is made regarding this to maximise infection control in the laundry area. Despite the requirements and recommendation made in this section of the report it was clear that the provider organisation is investing significant resources in ensuring that the environment of the home meets the needs of the people living there. It was also clear that the manager and staff are also working hard to ensure that these resources are being used effectively. The quality rating for the environment is therefore judged to be good. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 25 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported by a staff team with sufficient numbers to address their needs and who have a range of competencies. However, the numbers of staff deployed must be kept under review to ensure that people’s needs continue to be properly addressed. Staff have access to a range of training opportunities to assist them meet the needs of people living in the home. People accommodated are now better protected by improvements made to home’s recruitment procedures although formal confirmation is needed for a small number of staff regarding their right to work in the U.K. EVIDENCE: Staff at the home are currently deployed as follows: two care staff on both the early and late shift on each of the three units with one senior care staff on duty in the home on both shifts; at night time there are three care staff and one senior care staff on duty within the home. The deputy manager works two days a week as a senior on the floor and three days undertaking management duties. The manager’s hours are in addition to this and the home also employs an administrator, kitchen staff, cleaners and laundry staff. A staff rota was seen and accurately reflected the staff on duty during the inspection. The home was accommodating thirty-one residents at the time of this inspection. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 26 From observation throughout the inspection and from feedback from people living at the home and relatives spoken to, the staffing levels appeared sufficient to meet the needs of the people living at the home at that time. Evidence was gathered prior to this inspection that the registered provider was keen to increase the number of people accommodated in the home. The manager stated that as the home accommodated more people the staffing levels would be kept under review. The manager stated that as part of this she was discussing with the provider organisation for a senior member of staff to be deployed on each floor as resident numbers increased. The Expert by Experience indicated: I observed that the staff all seemed to be kept quite busy, throughout my visit, in attending to the current number of residents. Noting, however, that there were 14 vacancies, I did wonder whether the present staff complement would be sufficient to cope with the needs of full occupancy. A requirement is made that the staffing levels at the home must be kept under review to ensure that people’s needs continue to be met. This is to include if and when the numbers of people accommodated increase and also if the needs of existing people accommodated increase. The provider organisation must be able to demonstrate how it has calculated that any changing needs of people accommodated can continue to be met by the numbers of staff deployed. The manager stated that twenty-two out of twenty-seven care staff have achieved the national vocational qualification (NVQ) level two in care or above. Records sampled including the home’s staff training matrix and staff spoken to were consistent with this. At the last key inspection an immediate requirement was made that no staff are employed unless satisfactory details as required in Schedule 2 of the Care Homes Regulations 2001 are satisfactorily met. I was informed that the home had not employed any new staff since the last key inspection although two staff had been transferred from another of the provider organisation’s registered care homes for older people. A second requirement regarding staff recruitment was also made at the last key inspection that an audit of all staff files was undertaken to ensure the documentation of those appointed are checked and verified and meet the criteria of Schedule 2 of the Care Homes Regulations 2001. Following the last key inspection a letter was submitted to the Commission by a senior manager in the provider organisation stating that following an audit of staff files that the manager is ensuring that the home is in receipt of a Criminal Records Bureau (CRB) clearance, Protection of Vulnerable Adults (POVA) check, that people’s previous work history has been explored and that references have been verified. At this inspection I sampled the files for four staff members at random and each contained: proof of identity, including a recent photograph; a clear employment history; two written references including a last employer reference and an enhanced Criminal Records Bureau (CRB) clearance and Protection of Vulnerable Adults (POVA) check. However, prior to this inspection the manager had notified me that six staff had informed her that their passport was currently with the Home Office Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 27 so that as a new manager she was unable to verify their current status to work in this country to her satisfaction. Evidence was seen of written correspondence by the manager with the Home Office seeking confirmation that these staff are still entitled to work in this country. A copy of the latest letter to the Home Office, dated 14th December 2007, was seen during the inspection. A new requirement is therefore made that, as a matter of priority, the provider organisation must continue to seek clarification from the Home Office that the identified staff members remain entitled to work in this country and takes any necessary management action to maximise protection to people living at the home following receipt of that clarification from the Home Office. Evidence was seen from the home’s staff training matrix that since the last key inspection the provider organisation has provided a two week block of training including; moving and handling, health and safety, fire awareness, food hygiene, learning to care, death and bereavement, care of people with dementia, safeguarding adults and the Mental Capacity Act. The majority of staff undertook this training and I was informed that a second two-week block is planned for early 2008. Staff spoken to stated that the training had been useful and had been refresher training for most of them. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 28 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, 36 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home and staff benefit from the home being effectively managed although the new manager needs to be registered as such with the Commission. People living in the home and other stakeholders are being consulted as part of the home’s quality assurance monitoring, which contributes to identifying how the service can continue to improve. Staff receive regular supervision to assist them meet the needs of people accommodated and to assist in their own development. The home has generally effective health and safety procedures in place to protect people living there and others that work or visit the home although some further work is needed to ensure this protection is maximised. EVIDENCE: The provider organisation appointed a new manager to the home in October 2007 and provided additional management support to the home while the new Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 29 manager settled in. A different provider organisation business manager has also been supporting the new manager and the home since the last key inspection. The new manager has significant experience in managing services for older people and has a wide knowledge including undertaking the Dementia Care mapping course run by Bradford University, holds the national vocational qualification (NVQ) level 3 in care and the NVQ level 4 in management. The manager has also been proactive in keeping the Commission aware of progress the home has been making in complying with the requirements made at the last key inspection. Feedback about the manager from people using the service, relatives, staff and other stakeholders has been very positive during this inspection. The manager stated that she is in receipt of the Commission’s application form to register as the manager of the home but was waiting to receive a new Criminal Record Bureau check, counter signed by the Commission, that must be submitted with the application. However, as the manager has yet to submit the application a requirement is made that the provider organisation must ensure that an application is received by the Commission to register a suitable manager for the home. This is to comply with legislation and to verify to the Commission that the appointed manager is qualified, competent and experienced to run the home. At the last key inspection a requirement was made that the registered provider must review the skills and experience gaps within the management team at Aston Grange and provide the Commission with details of the measures that will be put in place to address these. This requirement is being complied with and various correspondence has been received from the provider organisation, and latterly from the new manager, to inform the Commission of actions being taken to address the shortfalls identified at the last key inspection. Evidence was seen that the home had sent satisfaction surveys to people using the service and relatives in October 2007. The manager stated that she was planning to send formal satisfaction surveys to other stakeholders including health and social care professionals in the near future although evidence was seen that the home had contact with placing authorities since the last key inspection. The home has also introduced a suggestion box that was seen in the entrance hall to the home. As stated in the Health and Personal Care section of this report the home is developing its key worker role to make it more robust, including in developing more effective ways of working with and obtaining feedback from people with a diagnosis dementia. Evidence was seen of both residents and relatives meetings held since the new manager has been in post. Evidence was also seen of monthly visits by the provider organisation to the home to monitor quality and progress being made by the home. A social worker from L.B. of Tower Hamlets, who had placed the only new person to be admitted to the home since the last key inspection, was spoken to independently during the inspection. He stated that he was pleased with the progress his client was making in the home. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 30 A contracts manager from the L.B. of Waltham Forest was spoken to independently by telephone. He stated that L.B. of Waltham Forest had concerns about the home following the last key inspection report and that L.B. of Waltham Forest shared the concerns about the home’s ability to manage risk appropriately at that time. The contracts manager went on to say that as a result of this L.B. of Waltham Forest had decided to temporarily suspend making new placements at the home until the home could evidence significant progress in this area. He also stated that the Borough had reviewed people that were currently placed at the home and decided that those people’s needs continued to be met. He concluded that the Borough was continuing to evaluate the progress the home was making and would review the decision to suspend new placements following that. I was also contacted by a social worker from the L.B. of Newham who was considering placing a person at the home but wanted feedback on the outcome of the random inspection that I undertook in November 2007 to assess compliance with the statutory enforcement notice issued at the last key inspection (see the Health and Personal Care section of this report. Following this feedback I was informed by the social worker that L.B. of Newham had also reviewed the home’s current ability to meet her client’s needs and would be pursuing an application to the home. The home does not hold money for anyone living in the home with the provider organisation paying for items such as toiletries and then invoicing the person or their representative. Evidence was available, including from staff spoken to independently, that staff receive supervision at least every two months. Staff spoken to felt that this was useful. At the last key inspection a requirement was restated that all assistance calls (from the home’s call bell system) can only be cancelled or silenced at the point of origin. Documentary evidence was seen that this had been complied with. The Expert by Experience indicated: Residents with whom I spoke told me that they were happy with their accommodation and with the care they received, including prompt response to “call bell” requests for help in their rooms (for example, when needing help with toileting). A range of satisfactory health and safety documentation was seen. This included: a gas safety certificate, portable appliance certificate and a range of health and safety checks undertaken by the home including weekly water temperature checks. However, a current electrical installation certificate could not be located during the inspection and a requirement is made regarding this. There was also no evidence to indicate that the home’s water storage system had been checked to minimise the risk of legionella since December 2003 and a requirement is made regarding this. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 31 At the last key inspection a requirement was made that registered person must review staff’s understanding of fire procedures within the home and assure itself of staff competence. At this inspection evidence was seen that staff had undergone refresher training in fire awareness. The home’s fire log was also inspected. This showed: that the home’s fire plan and fire risk assessment had been reviewed in June 2007, that weekly fire drills took place, that the fire alarm system and emergency lights were tested weekly and that the home’s fire fighting equipment had been serviced. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 32 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(c) Requirement The registered person must ensure that the statement of terms and conditions/ contracts are reviewed with each person living at the home, and other stakeholders as appropriate, to make sure that they are up to date. The registered person must ensure that fire doors are not wedged open unless by a device that is linked to, and is automatically released by, the home’s fire alarm system when operated and that the device is approved by the fire officer. This requirement is made to maximise protection to people in the event of a fire. The registered person must ensure that the plinth that the home’s laundry equipment stands on is non-porous to maximise infection control in the laundry area. The registered person must ensure that the staffing levels at DS0000007241.V356241.R01.S.doc Timescale for action 29/02/08 2. OP19 23(4) 14/01/08 3. OP26 13(4) 31/01/08 4. OP27 18(1) 14/01/08 Aston Grange Version 5.2 Page 34 the home are kept under review to ensure that people’s needs continue to be met. This is to include if and when the numbers of people accommodated increase and also if the needs of existing people accommodated increase. In addition, the registered person must be able to demonstrate how it has calculated that any changing needs of people accommodated can continue to be met by the numbers of staff deployed. 5. OP29 19 The registered person must, as a 31/01/08 matter of priority, continue to seek clarification from the Home Office that identified staff members remain entitled to work in this country and take any necessary management action to maximise protection to people living at the home following receipt of that clarification from the Home Office. The registered person must 31/01/08 ensure that an application is received by the Commission to register a suitable manager for the home. This is to comply with legislation and to verify to the Commission that the appointed manager is qualified, competent and experienced to run the home. The registered person must 31/01/08 ensure that the home has a current electrical installation certificate, which is kept available for inspection, to maximise protection for all at the home in this area. The registered person must ensure that the home’s water storage system is checked, by a DS0000007241.V356241.R01.S.doc 6. OP31 8 7. OP38 13(4) 8. OP38 13(4) 31/01/08 Aston Grange Version 5.2 Page 35 person competent to do so, to minimise the danger of legionella. 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 OP24 Good Practice Recommendations Non-porous flooring should be considered for an identified person’s bedroom, following discussion and agreement with the person and any appropriate stakeholder. Aston Grange DS0000007241.V356241.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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