Inspection on 24/01/07 for Aston Grange

This inspection was carried out on 24th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Aston Grange 17/12/07

Aston Grange 01/06/07

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 Zita McCarry Unannounced Inspection 24th January 2007 09:45 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.V326178.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.V326178.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 manager@astongrange.fsnet.co.uk Aston Grange Limited ** Post Vacant *** 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.V326178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th May 2006 Brief Description of the Service: Aston Grange is registered to provide care to 45 elderly 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. Each of the three floors is designed as a separate unit, the upper two accommodating residents with dementia. All residents have a single bedroom, with an en-suite lavatory and washbasin. There is one bathroom with a bath suitable for assisting people with limited mobility, a shower room, and a sluicing facility in each unit. A large lift links all levels. One of the seating areas on the middle floor can be used by residents to meet visitors in private. Meals are prepared in the kitchen on the second floor and served in the dining area on each unit. The ground floor sitting/ dining room also has a kitchenette area where residents or staff can prepare drinks and snacks. The building is on a main road in Walthamstow, near shops and transport links. There is limited garden area, but it has seating areas and space to walk. Overall space standards for residents are adequate, but office and storage space is limited. A bonus for visitors is a good-sized parking forecourt as the neighbourhood has restricted parking. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is the result of an unannounced inspection undertaken by two inspectors over a twelve-hour period near the end of January 2007. The day following the inspection two further inspectors visited the home with the purpose of meeting a service user and supporting his communication needs. Evidence from their visit has been included in this report. The inspectors spoke with service users and staff. As part of the inspection the inspector toured the home, read service users records relating to the care provided in the home and documents pertaining to the management of the service. The recently appointed manager assisted the inspectors in the process. The service manager was present for most of the inspection. At the beginning of the inspection the service had 30 requirements outstanding from previous inspections. 20 of these were found to be met or partly met. 9 previous requirements have been repeated and a further 19 have been issued following this inspection. The inspector noted an improvement since the previous inspection it is evidenced that the home is beginning to make progress albeit slowly. However the Commission remains concerned about the performance of the service and this report identifies extensive areas where improvement is required and where the outcomes for service users are poor. The inspectors would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? The service has begun to put care plans in place, although more work in this area is required. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 6 The service is now recording accidents in the home and has put in place a system for management of these, although more work is required in this area. The service has introduced risk assessments although this area still requires considerable development. The service adheres to a robust recruitment policy. Bathroom and toilet locks have now been fitted ensuring service users privacy. Ensuring service users a choice at mealtimes has been reintroduced. Appropriate signage is now in place to guide service users. The service has invested in staff training and the home exceeds the required 50 NVQ target. 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.V326178.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 Quality in this outcome area is poor. The service fails to demonstrate it takes adequate steps to ensure it can safely meet the needs of prospective service users before admitting them to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the homes Statement of Purpose. It does not adequately provide the level of detail required by regulation. The document details what the service aims to do in respect of privacy, fulfilment choice etc but it lacks actual detail on the arrangements for how the service functions. For example the statement needs to detail how it will manage complaints, how it will organise care plans and reviews and the arrangements for fire and other emergency procedures. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 9 The service’s Statement of Purpose states that it will “ensure that every prospective resident has his or her needs expertly assessed before a decision on admission is taken”. To review the admission process the inspectors reviewed three service users files. The first assessment was for a service users admitted from hospital for “respite care”. The service user had been admitted to the home with an existing pressure sore, which was dressed by the district nurse. The service user had advanced dementia and needed a high level of support from staff in meeting everyday needs. It was of concern that despite a pressure sore the home had not undertaken a nutritional risk assessment or a general risk assessment. There was evidence in the second file checked that a social worker’s assessment of the service user noted a history that could possibly put other service users at risk. However despite these serious issues of concern being flagged in the assessment they were not given consideration in the care plan. On the day of the service user’s admission an additional report was faxed to the home. This detailed historical evidence that demonstrated a very real risk to other service users. Again the service was unable to demonstrate any action taken in response to these concerns. The failure to document such information in a care plan is regrettable, as it may have alerted staff for the need to ensure the protection of other service users. In admitting this service user without due regard to the identified concerns the service put the safety and wellbeing of all other service users at risk. The admission of a third service user to the home was reviewed. On review of his file the preadmission assessment lacked information on the service users background, life history and significant events. The service user was admitted to the home directly from hospital and there was information from the hospital that detailed that service users treatment and status on discharge. Despite this there was evidence that the service responded inappropriately to inaccurate information provided by hospital driver that brought the service user to the home. Senior staff gave inappropriate directions that seriously infringed the service users human rights. Staff were instructed that the service user was “not to leave his room”, they were instructed to remove all his clothing for laundering. The senior member of staff confirmed to the inspector that the service user was kept in his bedroom for several days and that if he left his room staff were under instruction to guide him back. The action of staff in response to inaccurate and unchecked information was based on ignorance and a lack of knowledge. There were no procedures in the home to guide staff in such situations and the management of infection control. The inspector was concerned about the impact such a poor admission has had on the service user and the apparent lack of understanding staff had about the consequences of their misguided actions. It is most regrettable that staff did Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 10 not clarify any disparities in information before effectively restraining the service user. The inspector met with the service user and was concerned about his apparent lack of wellbeing. He had been admitted almost a month earlier and remained distressed about his current situation. The outcome of the admission for this service user had been particularly poor. A second inspector met with the service user following the inspection and was concerned about the service users evident anxiety. It was noted again there was a lack of preadmission information and subsequently poor care plan. Relatively basic care needs were identified for the staff to address urgently such as a key to his bedroom, support to go out to the local shops, culturally appropriate food and access to an optician. The Commission has had concerns about the adequacy of the service preadmission assessments and made previous requirements to ensure service users needs were appropriately assessed so that admissions were safe. However the service has failed to comply. Therefore the Commission will take enforcement action to ensure compliance and ensure that prospective service users have their needs assessed prior to admission. Aston Grange DS0000007241.V326178.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. The service fails to manage service users medication safely. The service cannot demonstrate appropriate action is taken to prevent re-occurrence of accidents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an improvement in the services care planning arrangements. The recently appointed manager explained he was in the process of updating all service users care plans. This was evident; some care plans seen provided very clear concise directions as to how staff were to meet individual service users needs. However not all the service users care plans have been revised as yet and the timescale for this piece of work has expired. As noted earlier there was evidence on some care plans very important information was omitted. Neither the service users, relatives or advocates had signed any of the care plans seen. The service will have to demonstrate that Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 12 the arrangements made to meet service users identified needs have the consent of the service users themselves or those acting on their behalf. The service was unable to demonstrate where appropriate risk assessment underpinned the care plan arrangements for service users. There is a risk assessment format in place but these are not being completed appropriately, they do not underpin care planning and service users and relatives do not appear to be party to the process. The service uses an employee ‘Health and Safety at Work’ book to record service users accidents. The inspector reviewed the accidents recorded. Several of the accidents recorded were incomplete and gave no detail of any treatment given. For example a service user was found on the floor having sustained injuries to her ear, arm and elbow but there was no evidence of what treatment or action the staff took. A second service user tripped and complained of pain in her wrist again there was no record of action/treatment taken. The service has an accident monitoring system in place; this system must be viewed positively as it should identify trends in accidents and provide management information that ought to prevent re-occurrence of accidents. However on tracking the information recorded there it became evident that not all service users accidents are being recorded. The audit refers to a service user having two accidents in a set period of time but the there was only one accident form completed. Additionally, the management review recorded strategies for staff in an attempt to prevent further accidents for this service user. The inspector tracked the effectiveness of this management system and found that the strategies to prevent further occurrences were not reflected in the service user’s care plan that would guide staff how best to keep the service user from falling. From reading the daily records it was noted a service user fell sustaining a cut to the back of his head, from the record it was evident that staff responded appropriately and the service user was taken to hospital. However on tracking this accident it was not recorded in the accident records or service’s accident monitoring log. On a tour of the home it was noted that pressure-relieving equipment had been set at the wrong pressure for the service user. Staff were unable to advise what the correct setting should be and the manager stated that the district nurse set the pressure. This was later confirmed not to be the case. There was no detail in the service users care plan as to correct settings for the pressure relieving equipment. The visiting district nurse had undertaken a moving and handling assessment of the service user which directed that for the service user and staff’s safety all transfers must be undertaken by two staff operating hoisting equipment. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 13 However staff and the manager confirmed that this was not how staff actually assisted the service user to be transferred. The care plan made no reference to the use of hoisting equipment being used to move the service user. The Commission has evidence that the organisation released a press statement following an incident in the home. The statement provides sufficient information that identifies a service user to staff, relatives and external parties about a highly sensitive matter that was at the time still subject to adult protection investigations. It was noted that seven service users commenced antibiotics on the same day. The inspector randomly selected three of these service users records and could find no entries on their daily care records that would suggest ill health. Inspection of daily records and multidisciplinary contact sheets failed to evidence that the service users had been seen by their GP. In a handover book a request, a week earlier, was noted for the GP to “check” service users as they “sound too chesty”. The senior member of staff confirmed to the inspector that the antibiotics coming into the home were in response to this request. It is of concern that the service users did not receive treatment until seven days after the symptoms of ill-health reportedly presented. Consequently the service is unable to demonstrate that service users received prompt medical attention. Medication and medication records were checked for 6 service users the findings were as follows: Service user A- was prescribed 200mls of antibiotic suspension, according to the medication administration records the service user was administered 10mls on 25 occasions bring the total administered to 250mls despite only 200mls in the bottle. Service User B was dispensed 21 antibiotic capsules but according to the medication administration records staff record they administer 25 capsules. Service User C - was dispensed 21 antibiotic capsules but according to the medication administration records was staff record they administered 24 capsules. There were also blank spaces on the service users medication administration record so the service is unable to demonstrate the service user had her medication as prescribed. On checking the service users medication held it was evident that medication had been received into the home one tablet had been dispensed and but the medication was not present to be checked. There was no record of it leaving the home. Service User D- There was evidence that the service user was administered medication from another service users prescribed stock. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 14 Service User E - was dispensed 20 antibiotic capsules but according to the medication administration records staff record they administered 25 capsules. Service User F – inspection of the medication administration records highlighted blank spaces where it could not be demonstrated the service user received her prescribed anti depressants and blood pressure medication. It was positively noted that the service had undertaken work to ensure service users had free access to their rooms, and there was evidence that some service users were being offered a key to their private accommodation, this needs to be extended to all service users. Where keys are not provided this needs to be the result of a risk assessment. One service user showed the inspector the key to his room but confirmed he chooses not to use it. The service user spoke highly of staff saying he felt he was respected and confirmed staff will always knock and wait before entering his private accommodation. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. However service users who need additional support This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an improvement in the area of social and leisure activities offered service users. The service does provide in-house activities and there is an activity co-ordinator in post. There is a variety of group activity offered such as sing-a-longs and bingo. During a tour of the home the inspector saw various board games and puzzles. These activities are more successful on the ground floor were service users can join in with a lesser degree of support. However the service still needs to plan and deliver more interaction and social pursuits for service users with dementia. It was noted in the care plan of one service user who would need assistance to support an activity that staff were to provide painting and support with art work. However on tracking the inspector noted that there had been no record of this activity ever provided or offered to the service user. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 16 One service user told the inspector that he previously was supported to attend church regularly but this had stopped as he stated he was told “staff are too busy” to escort him. Management provided a different explanation but agreed to ensure that the support to enable a services attend their place of worship was provided. Another service user who was evidently distressed about the service’s locked door policy had little to engage him during the day. The service user had been in the home for over a month and the coded door locks restricting his movements caused him anxiety. Both the service user and manager confirmed that he had not been outside since his admission. It was agreed that the manager was to make arrangements for the service user to be enabled to get out of the home regularly and access the local community. One service user showed the inspector his room, it was comfortably furnished and full of personal possessions that were evidently very important to him. However the service has been unable to demonstrate that it promotes service user choice and autonomy, as there is no evidence that they or advocates are party to or have consulted about the arrangements for their care whilst in the service. The inspector observed lunch being served on one unit it appeared nutritious and well presented. Staff and service users described to staff how they were offer a choice of foods at mealtimes. One service user told the inspector the “grub is outstanding”. A second service user was less satisfied with the food provided; staff need to ensure that service users are offered food that meets their ethnic needs. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. The service was unable to present a complete record of complaints logged and for those that had been logged there was no evidence of when and what action had been taken or if the complaint had been responded to within timescales. The service failed to take sufficient steps to safeguard its service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the complaints log of the home. The new acting manager was unable to present a log that detailed complaints before 22/08/06. A log was seen at the last inspection. There had been four complaints recorded providing the detail of the complaints. However there was no evidence of action/investigation undertaken and whether or not the complaint was upheld. Without such documentation the service is unable to demonstrate that complaints are responded to within the timescale, or that a satisfactory investigation has been undertaken. The inspector found evidence of two other complaints that had been raised by a service user and a relative, however these were not recorded in the complaints log. The complaints procedure has not been updated since 2004 and the service has repeatedly failed to meet its requirement issued. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 18 There is currently an adult protection enquiry in progress. The Commission is satisfied that once the alleged abuse took place the service was prompt in notifying the placing authority and Waltham Forest Adult Protection team. However the Commission is concerned that the service failed to act on information provided by other agencies, which would have alerted staff for the need for either greater supervision or review of appropriateness of placement. In failing to give due attention to the information received the service failed to protect the existing service users. The service forwarded the inspector a revised policy on the protection of service users. As a policy to guide staff it was found to be lacking. The various types of abuse are listed but fails to define them or give examples as to how they could present in a care setting. The procedure gives no direction on Whistleblowing, which is an important safety valve in the protection of vulnerable people. In the section of the policy preventing abuse, there is no reference to the service’s responsibility to undertake robust preadmission assessments or the role of risk assessment. The action to be taken in the event of or suspicion of abuse needs to be clarified into a procedure to guide staff. The procedure needs to clarify any staff dismissed for gross misconduct that involved any abuse of a service user will be referred to have their name applied to the PoVA list. The policy makes no provision for required action when the manager is the alleged perpetrator of the actual or suspected abuse. The policy fails to make clear the fundamental role and function of Waltham Forest’s Adult Protection team. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. However the service will have to review its storage and ensure bathrooms are not used to store equipment. The service will also have to improve the continence management to reduce the malodours in some service users bedrooms. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The communal areas in the home appeared clean and hygienic however some service users bedrooms were malodorous. In particular one service users bedroom and bathroom seen by inspectors had an offensive odour of urine that required prompt attention and indicated the need for appropriate incontinence management. The inspector noted the condition of bedlinen in several bedrooms. Pillows had obviously deteriorated after washing and in many rooms were very lumpy and Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 20 misshaped. It was also noted the bottom sheets whilst clean were very worn and lay over waterproof plastic type mattress covers, this would not provide a comfortable bed. The service will need to ensure the adequacy of the bed furnishing and linen. It was positively noted that the service had improved signage in the home. The inspector accepts space is limited in the home however this is no rational for using service users bathrooms to store furniture. On a tour of the home an office chair, a portable hoist and cushions were found stored in one bathroom. It was noted that appropriate locking mechanisms have been put back on all toilet and bathroom doors. In general the home is kept in good decorative order and well maintained but again there were areas identified that require prompt attention such as the broken cistern in a service users private accommodation. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate however staffing levels are insufficient to meet the identified needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During day, early and late shifts there are two care workers on each unit. The ground floor unit provides care for 17 service users; the 1st floor unit provides care for 16 service users and on the 2nd floor 12 service users reside. There is a senior carer who supervises the shift and administers service users medications, makes arrangements with social workers communicates with health care professionals, arranges transport of hospital in addition to their delegated responsibilities. The inspector was particularly concerned about the staffing level on the two units where most of the service users have dementia of varying degrees. The service has been unable to demonstrate how two care workers can provide person centred care for 16 service users with varying degrees of dementia. At 4pm on the day of the inspection the inspector was escorted around some randomly selected rooms on two floors. It was noted that most of the beds were turned down with nightwear left out for the service user to change into. Curtains were drawn and the night-lights were switched on, despite it still being daylight outside. Both staff confirmed that this was a routine in the Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 22 home. When asked the purpose for such a routine the inspector was advised by both staff that to prepare the rooms and leave night clothes out at this time of the day saved time later. Such routines are institutional, disorientating and undermine attempts to provide a person centred approach. The service has exceeded the 50 ratio of NVQ trained staff. There was evidence that the service had invested in staff training; topics covered were care planning, first aid and dementia care. On the second day of the inspection two inspectors noted a female service user walking up and down the corridor outside the communal areas in a state of undress with her dignity severely compromised. There were no staff in the area to see the incident and consequently ensure the service users dignity was maintained. The inspector directed the manager who went to assist the service user. The inspector undertook an inspection of a random sample of four staff files to test the service’s recruitment of staff. It was evident that the pre-employment information required by regulation such as CRB disclosures and references were in place and satisfactory before commencement of employment. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. There is little evidence of effective monitoring of the service despite changes in management. Service user and staff safety is compromised by the absence of fire drill practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has been without a registered manager now for a prolonged period of time. Since the last inspection another manager is in post but he has not yet been registered with the Commission. The previous requirement therefore remains unmet. The new manager was appointed approximately six months ago and the Commission was concerned that there was little evidence of the managing organisation monitoring the conduct of the service during this period. The Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 24 Commission has received no reports on the conduct of the home required by regulation, in that period, and it has been confirmed none were undertaken. This is an unmet requirement from the previous inspection. There was evidence that the service does not consistently advise the Commissions of events in the home as detailed by regulation. During a tour of the home a large urn filled with boiling water was located on a work surface in the service users kitchenette. The urn was not secured and presented a serious hazard to service users and staff. The manager gave assurances that he would have the urn secured. The inspector saw the services insurance certificate; service records for lifting equipment and fire equipment. The service had undertaken portable appliance tests and undertakes weekly water temperature checks. There was no record of fire drills presented for inspection and the manager confirmed none had been undertaken. This needs to be rectified with some urgency so the service can be satisfied that staff will take appropriate action in the event of fire. On testing the call system on the ground floor it a service user cancelled/silenced the alarm call. This is of concern a call system must only be cancelled/silenced at the point of origin. There was evidence in the admission of a service user that staff were unaware of infection control procedures and there was no procedure to guide them. Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 25 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 1 x 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X 2 X X 2 X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X X X 1 Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4 Requirement The registered person must ensure 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. The registered person must ensure all staff receive training in infection control and the underlying principles of good care practice. The registered person must ensure all information identified in the assessment process is appropriately recorded in the service users care plan. The registered person must ensure that the use and setting for pressure relieving equipment is appropriate to the assessed needs of the individual and recorded on the service users care plan. The registered person must ensure that current moving and handling strategies are recorded in the service users care plan and staff follow to them. DS0000007241.V326178.R01.S.doc Timescale for action 30/04/07 2 OP4 18 30/04/07 3 OP7 14 & 15 30/03/07 4 OP8 13 30/03/07 5 OP8 13 10/04/07 Aston Grange Version 5.2 Page 27 6 OP9 13 7 8 OP10 OP12 12 12 9 OP14 12 & 15 10 OP15 12 11 OP16 22 12 OP16 22 13 OP18 13 The registered person must ensure that prescribed medication is not shared between service users, and that all medication is recorded as being received and returned. The registered provider must ensure that service user privacy and confidentiality is maintained. The registered person must ensure all service users have their social and leisure needs identified and planned for and sufficient support is given to service users who require additional assistance to take part. The registered person must ensure and provide evidence that service users are involved in the planning arrangements for their care. When relatives or advocates are involved this must also be documented. The registered person must ensure that the food provided meets the cultural/ethnic needs of service users. The registered person must ensure that the all complaints made are appropriately logged and provide evidence that an investigation has taken place. The complainant must be provided with an outcome to their complaint. The registered person must ensure the complaints procedure is amended so that it adequately guides staff in how to respond to a complaint and the action to take. Unmet from previous requirements. The registered person must ensure that the service amends its adult protection procedures to ensure it adequately guides staff DS0000007241.V326178.R01.S.doc 10/04/07 10/04/07 20/05/07 10/04/07 10/04/07 10/04/07 30/04/07 30/04/07 Aston Grange Version 5.2 Page 28 14 OP18 13 & 14 15 OP21 23 16 OP24 16 17 OP26 23 18 OP8 13 in the action to take in response to actual or suspected abuse, to include definitions of abuse and whistle blowing procedures and the role of the local authority adult protection team. The registered person must ensure that the service responds appropriately to information that would indicate the need for additional safeguarding measures. The registered person must ensure service users bathrooms are not used to store equipment or furniture. The registered person must ensure service users mattresses are provided with a topper or cotton protector to improve comfort and new pillows and bed linen is provided. The registered person must ensure that the service improves continence management and cleaning practices to reduce the mal odour in some service users bedrooms. The registered person must ensure service users receive prompt medical attention in the event of an accident or ill-health. Unmet for previous inspection. The registered person must ensure all accidents are properly recorded and in sufficient detail and a record held for inspection. Unmet for previous inspection. The registered manager must ensure service users receive their medication as prescribed. Unmet for previous inspection. The registered person must ensure that care plans are underpinned by a comprehensive DS0000007241.V326178.R01.S.doc 10/04/07 10/04/07 10/05/07 30/04/07 30/04/07 19 OP8 13 30/04/07 20 OP9 13 30/04/07 21 OP7 14 & 15 30/04/07 Aston Grange Version 5.2 Page 29 up-to-date risk assessment. 22 OP7 14 Unmet for previous inspection. The registered person must ensure that each service user has a documented life history that care staff are familiar with. Unmet for previous inspection. The registered person must provide the commission with the details of its staffing level review. unmet from previous inspection. The registered person must improve upon its staffing levels to ensure there are sufficient staff on duty to meet the assessed needs of service users and provide person centred care. The registered person must ensure all assistance calls can only be cancelled or silenced at the point of origin. The registered person must undertake a review of the monitoring visits undertaken and provide evidence that that the conduct of the home is being effectively monitored. Unmet for previous inspection. The registered person must make arrangements to register the manager of the service with the Commission. Unmet for previous inspection. The registered person must put in place a procedure for infection control in the home, which must include the management of MRSA, and C.Diff. 30/04/07 23 OP27 18 30/04/07 24 OP27 18 30/04/07 25 OP38 23 30/05/07 26 OP33 26 30/04/07 27 OP33 8 30/04/07 28 OP38 13 30/04/07 Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aston Grange DS0000007241.V326178.R01.S.doc Version 5.2 Page 31 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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