Inspection on 08/05/06 for Aston Grange

This inspection was carried out on 8th May 2006.

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

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

Other inspections for this house

Aston Grange 17/12/07

Aston Grange 01/06/07

Aston Grange 24/01/07

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 8th May 2006 10:15 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.V293744.R01.S.doc Version 5.1 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.V293744.R01.S.doc Version 5.1 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.V293744.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 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.V293744.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is the findings of an 8 hour unannounced inspection in early May 2006. The recently appointed manager and business manager were present during the inspection. As part of the inspection the inspector read care records pertaining to the care of the service users and other documents relating to the running of the home. The inspector observed the interaction between staff and service users and how staff carried out some of their work. The inspector toured the home and saw some service users bedrooms in addition to the main kitchen and communal living spaces. The inspector spoke with both service users, staff and a relative visiting the home. A major part of this inspection was to monitor the service’s compliance with requirements made at the previous inspection. Going into the inspection the service had 12 statutory requirements, five of which were outstanding from an inspection in April 2005. 9 of the 12 requirements remain outstanding and many of these have been required over several inspections. This represents serious non-compliance with the services statutory responsibilities. A further 21 requirements were made at this inspection. The inspector would like to thank service users, staff and relatives for their assistance in the inspection process. What the service does well: What has improved since the last inspection? The service has introduced a TOPSS induction and foundation training for staff. Work has been undertaken to improve care planning however this still needs considerable development. It was evident that supervision sessions had commenced for some staff however this too is an area that also needs further development. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 6 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. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 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.V293744.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 Aston Grange fails to take sufficient steps to ensure it’s ability to meet prospective service users needs. EVIDENCE: The inspector read the file of a recently admitted service user to test the effectiveness of the services admission processes. The senior staff at the home undertake an assessment visit prior to admission. The findings of the assessment visit are recorded on a pre-admission assessment form, which does not lend itself to detailed recording. It was noted with some concern that in pre-admission assessment of someone diagnosed with dementia the mental health assessment was incomplete. It did not identify the degree of memory loss or orientation. The assessment failed to provide details on the service users history of absconding or aggression, both of which were highlighted in the social workers assessment. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The service fails to take adequate measures to prevent accidents to service users and when accidents occur the service fails to ensure prompt medical attention. EVIDENCE: The inspector was advised that the service has been working hard to improve service users care plans and training to staff in this area had been provided. The inspector randomly selected three service users care plans and found all three to be inadequate. On the first care plan the only need identified was personal hygiene where the objective was to ensure the service user “is clean and tidy”. There was no detail of the level of assistance staff were required to provide or detail on areas of personal care the service users could undertake for himself. The inspector viewed a second care plan which did not remotely reflect the service users needs, it was of concern that the paperwork recorded the care plan had been reviewed a week before the inspection and staff were advised to “continue with the plan”. The care plan detailed that the service user could feed herself and that cutlery was to be placed conveniently for her own use. The inspector observed and it was confirmed by staff that the service users had for some time needed full assistance with feeding. The care plan also detailed that the service user was to be “encouraged to mobilise at all times” and described how staff were to support the service user walking. Again the Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 10 actual picture of the service users needs was that she was wheelchair dependent. The inspector was concerned about the adequacy of the system in place to prevent, record and monitor accident in the home. There was evidence that when staff identified risks such as service user frequently slipping off her bed no appropriate action was taken, and the concern was not addressed in a risk assessment. The inspector was unable to undertake an audit of accidents or incidents in the home as there was no clear system on monitoring these nor were accidents routinely recorded in an accident form. There was no evidence of management review of accidents in the home or action taken to prevent further occurrences. Risk assessments were not reviewed following accidents. The inspector attempted to track accidents for one service user who had a high number of accidents. The inspector was concerned about the adequacy of staff response to several accidents, which occurred in the home in March and April 2006. On one occasion the night staff found a service user on the toilet floor she had sustained a bruise and cut to her left eye despite this the action taken by staff was to lift the service user into bed to return to sleep; on another occasion staff witnessed the service user fall and as she fell it was noted she hit her head on the corner of the door frame causing the service users head to bleed, the service user did not receive appropriate medical attention rather staff applied a compress to stem the bleeding; a service user sustained a “gash to head” and staff rang the on call GP service the locum GP retuned the call some thirty minutes latter and advised staff to get the service user to hospital. At the inspection it was fed back to the home manager that these responses are inadequate and that staff have a responsibility to ensure service users receive prompt medical attention. The services risk assessment were found to be inadequate the only risk assessment seen were nutritional, tissue viability and moving and handling. Despite service users being identified by social workers as having histories of aggression or wandering these were not assessed nor strategies put in place. The inspector was pleased to note that where a nutritional risk was identified the required action of weekly monitoring had been taking place. Medication is held securely in an appropriate unit. On the day of the inspection the new monthly medications had just commenced. The inspector checked one service users antibiotic therapy. According to the medication administration record staff had signed that the service user had been given her antibiotic 19 times however on checking the number of capsules left it was evident that the service user only had received her antibiotics on 11 occasions. So medication had been signed as administered when evidently it had not. On checking the Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 11 previous month’s medication administration records the inspector noted that medication for another service user had not been recorded as given or refused. The inspector noted on a tour of the home that the assisted bathrooms on the middle and top floors the entire locking mechanisms had been removed from the doors. With no locking mechanisms on these doors the service is unable to demonstrate how service users privacy and dignity is upheld during the delivery of personal care. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The service fails to provide adequate activities for service users. EVIDENCE: The service has recently appointed an activity co-ordinator and it was explained she plans to create an activity program to offer to service users. The co-ordinator was on leave and the staff confirmed they had no activity schedule to follow in her absence and that they had not had a schedule for sometime. The staff on one unit stated they had undertaken some painting with service users that morning. Apart from the absence of an activity program care plans offered no guidance to staff in how to meet individual service users interest or recreational activities. The inspector was concerned that in service users lounges on two units there was several dolls cots and a pram. It was explained that that the service offers doll therapy to service users. The service was unable to provide any care plan where doll therapy was a considered approach to support the individual needs of named service users. Such therapies need to be person centred, and the impact of the therapy needs to be monitored and reviewed including documenting how and when it can benefit a particular service user. Similarly consideration must to be given to the negative impact on the dignity of service users for whom doll therapy is not used and strategies need to be put in place Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 13 for this. The inspector did not observe any service user making use of the dolls, although a member of staff confirmed that named one service user to previously used the doll a great deal. The inspector met a relative who was visiting the service he commented that the staff in the home always keep him informed of his wife’s progress and that he consistently receives a warm welcome in the home. Service users spoke favourable about staff and commented on how supportive they found them. However the inspector could find little evidence of when service users exercise control over their lives. The inspector observed staff to be locking and unlocking service users bedrooms it was confirmed that most bedroom doors are locked during the day as confused service users wander into other service users bedrooms and remove items. The signage that may assist a service user find the toilet or his/her bedroom was non-existent. The absence of anything on the bedroom doors to assist a service user identify their own bedroom combined with the lack of personal familiar possessions dramatically undermines a service user’s ability to identify their own personal accommodation. It is unfortunate that because of the absence of appropriate signage to support service users their rights are further infringed by them being locked out of their private accommodation. Access through, in and out of the service is via a coded keypad so service users movement is restricted. Neither care plans nor risk assessments provided details on these restrictions. Service users told the inspector that they were not consistently offered a choice at mealtimes. They described how previously menus were given to them to make a choice of food but this procedure had stopped some time back. The cook confirmed this information. She was able to demonstrate that there had previously been a means in place by which service users were assured a choice at mealtimes. The inspector saw the end of the lunch meal being served and it appeared well presented and nutritious, additionally the inspector saw home made cakes prepared on the day of the inspection. However the feedback from service users on the quality of food was very mixed comments varied from “edible” to “fine”. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The service responds promptly to complaints and concerns raised. EVIDENCE: The complaints notice on how to make a complaint has not been updated despite a previous requirement. Inspection of the complaint log revealed that there had been one complaint recorded since the last inspection and it was responded to promptly within timescales. The service has procedures in place for responding to suspicions or actual abuse of vulnerable adults. The inspector interviewed a trainee member of staff about actions she would take in the event she suspected abuse. The inspector was satisfied that the worker understood her responsibilities in relation to adult protection. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 There is insufficient signage to support service users access their environment. EVIDENCE: The home consists of three floors two of which are for service users with dementia. Both of these floors lacked the signage that would benefit service users navigate their way around the unit. The service will need to introduce such signage and aids that would make the service users living space more accessible to them. Generally the home appeared clean although there was an obvious urine odour throughout the home. The home’s laundry and main kitchen are adjacent to each other on the same corridor. The inspector observed the doors to the kitchen to be wedged open. In addition to the fire safety aspects of this practice the inspector was also concerned about the potential risk of contamination from soiled articles going to the laundry. This will need to be risk assessed and addressed in the services infection control procedures. Staff were unaware of any special measures in place to prevent cross contamination in this area. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 16 The carpet on the top floor was badly stained the inspector was advised that new carpet had already been ordered for this area. The service had a recent outbreak of vomiting and diarrhoea. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The service places service users at risk by employing staff without completing adequate pre-employment checks designed to protect service users from abuse. EVIDENCE: The home is made up of two units of 16 service users and one unit with 17 service users. During the day each of these units have two careworkers with a senior care worker moving between the units. The senior careworker has very specific tasks to undertake whilst on duty such as administering medication to service users on all three units. This task is justifiably time consuming and not something the senior carer can be drawn away from. The service also has additional support from the recently recruited part-time activity co-ordinator and 18 hours a week from a trainee carer who because of her age cannot deliver personal care. Senior management in the service consider the staffing levels to be satisfactory. As the care plans lack sufficient detail and failed to reflect service users needs then the full assessment on the adequacy of the staffing levels cannot be made. However the inspector observed some activities/practices that are indicative of insufficient staffing levels such as staff actively discouraging service users from mobilising and physically guiding them back to sit on a chair as so she could be supervised by a member of staff who was feeding another service user. Staff feeding one service user and interrupting that task by moving to another service user to offer her a drink; whilst member of staff was assisting one service user she had to leave her in the corridor and return to the lounge as another service user who was mobilising Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 18 unsafely. The service had previously been required to review staffing levels to ensure its adequacy. There was no documentary evidence of this work being undertaken. The service manager advised that staff in a recent meeting had been consulted about the adequacy of staffing levels and all were satisfied with them. However when the inspector canvassed staff views on the adequacy of the staffing levels two considered the staffing levels to be insufficient. The service was given four days to provide evidence of staff NVQ qualifications. Copies of certificates of only four staff holding NVQ 2 were produced, this falls far short of the required fifty percent. The training offered to staff in the past 8 months was found to be inadequate, with only half-day sessions on health and safety and food hygiene. Staff require training on first aid, risk assessing, and further training on dementia care. The inspector undertook check of four randomly selected staff files. It was noted with concern that on two of the staff files there was no evidence that the service had obtained CRB disclosures, two staff files held only one reference each and one file had not references at all. To protect service users the inspector issued an immediate requirement notice to ensure the staff without CRB disclosures did not to work in the service unless disclosures are obtained. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 There was insufficient evidence that the service actively seeks feedback from service users as a means of securing positive outcomes for service users. EVIDENCE: There has been a new manager in post for the past three months, he has not yet applied to the Commission to be registered but needs to do so without delay. The recently appointed manager has held one meeting with service users but apart form this the service was unable to evidence how it actively seeks feedback on the service it provides. The Commission does not regularly receive the reports on the required monthly reports on the conduct of the home. The last report received in February 2006 does not reflect the evidence obtained during the course of this inspection. This leads to concerns about the effectiveness of the monitoring undertaken by the provider. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 20 The service does not assist any service user in the management of their finances nor does it hold any personal cash for service users. For those service users who do not manage their own financial affairs relatives undertake this function. The service has recently implemented a system where by purchases for toiletries may be made through the homes petty cash system then relatives are invoiced to reimburse the petty cash. There was evidence that the some staff have recently had a supervision session, however the manager confirmed that not all staff have yet received supervision. Therefore there was insufficient evidence that a structured supervision program was in place and staff were regularly receiving this form of support. The service has been undertaking fire safety checks including weekly alarm testing, the inspector saw that the kitchen stored food at the appropriate temperatures. The service also undertakes monthly health and safety checks, the findings of which are recorded. The service does not hold a fire list or an up-to date list of service users in the building, nor does the homes register accurately reflect all the names of the service users living in the home. Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 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 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 x 2 Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 22 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 OP3 Regulation 14 Requirement Timescale for action 01/07/06 2. OP4 14 The manager must: - ensure, in consultation with the service user and their representative, that the needs of residents are fully assessed prior to admission, recorded and regularly reviewed. - confirm in writing to the service user that the home is suitable to meet their needs. The assessment should include all of the information listed in standard 3.3. (Outstanding from April 2005 report. Date for compliance of 1 May 2005 not met.) The manager must: 01/07/06 - ensure, in consultation with the service user and their representative, that the needs of residents are fully assessed prior to admission, recorded and regularly reviewed. - confirm in writing to the service user that the home is suitable to meet their needs. The assessment should include all of the information listed in standard 3.3. (Outstanding from April 2005 DS0000007241.V293744.R01.S.doc Version 5.1 Aston Grange Page 23 3. OP7 15 4. OP12 15 report. Date for compliance of 1 May 2005 not met.) A written care plan to be generated from a comprehensive assessment and drawn up with each service user to provide the basis of the care to be delivered. The plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to ensure that all aspects of the health, personal, cultural, financial and social care needs of the service user are met. The plan to be reviewed regularly, at least once a month, and updated to reflect changing needs and current objectives for health and personal care. The care plan to be agreed and signed by the service user, whenever capable, and/or their representative. (Outstanding from April 2005 report. Date for compliance of 1 June 2005 not met.) A written care plan to be generated from a comprehensive assessment and drawn up with each service user to provide the basis of the care to be delivered. The plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to ensure that all aspects of the health, personal, cultural, financial and social care needs of the service user are met. The plan to be reviewed regularly, at least once a month, and updated to reflect changing needs and current objectives for health and personal care. The care plan to be agreed and signed by the service user, whenever capable, and/or their representative. (Outstanding from April 2005 report. 01/07/06 01/07/06 Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 24 5. OP16 22 6. OP27 18 7. OP19 23 8. OP29 19 Date for compliance of 1 June 2005 not met.) The complaints policy and procedure to be amended to include timescales for dealing with more complex complaints and to update the CSCI contact details. All complaints to be recorded. (Outstanding from April 2005 report. Date for compliance of 1 July 2005 not met.) Staffing levels to continue to be reviewed to ensure that the assessed needs of residents can be met at all times. (unmet requirement from September 2005 report. Date for compliance was 1/12/05) The home to be organised to provide an environment suitable to meet the needs of people with dementia, as recommended in good practice guidance. (From April 2005 report. Date for compliance of 1 October 2005 partly met.) The Manager to operate a thorough recruitment procedure to ensure the protection of residents. Staff must not be employed in the home unless suitable references, CRB checks and POVA checks have been obtained and the information listed in schedule 2 (as amended 2004) is on file. The manager to ensure that the documentation kept evidences a robust recruitment procedure. Sufficient, appropriate, detailed information to be requested from referees. References and qualifications to be verified and any gaps in the employment record explored. Records to include sufficient information to demonstrate the person s DS0000007241.V293744.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 Aston Grange Version 5.1 Page 25 9. OP36 18 10 OP8 13 11 OP8 13 12 13 OP9 OP10 13 12 14 OP8 13 fitness to work in the care home. A schedule of planned and structured supervision sessions to be implemented for all staff to start as part of the induction process, through the probationary period and then establish a regular pattern of supervision at least six times a year. A supervision contract to form part of the supervision procedure, defining the length and frequency of sessions and the areas to be included. Staff to have a named supervisor, be able to add items to the agenda, the sessions to be minuted and a signed copy given to the supervisee and kept by the supervisor for the staff records. Sessions to cover: all aspects of practice; philosophy of care in the home; career development needs. (Outstanding from previous reports. Timescale for compliance of 1 November 2004 and 1 July 2005 not met) The registered person must ensure service users receive prompt medical attention in the event of an accident and staff receive training on the action to take in the event of an accident. The registered person must ensure all accidents are properly recorded and in sufficient detail and a record held for inspection. The registered manager must ensure service users receive their medication as prescribed. The registered manager must ensure service users privacy and dignity is maintained by fitting appropriate locking mechanisms on bathroom doors. The registered person must ensure that there is a system in place by which accidents are DS0000007241.V293744.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 Aston Grange Version 5.1 Page 26 15 OP7 14 & 15 16 OP12 12&15 17 OP7 14 18 OP14 12 19 OP15 12 20 OP14 23 21 OP27 18 22 23 OP38 OP38 23 23 &13 reviewed and strategies put in place to prevent reoccurrences. The registered person must ensure that care plans are underpinned by a comprehensive up-to-date risk assessment. The registered person must ensure service users are provided with both group activities and are supported to undertake individual activities to meet their personal interests. The registered person must ensure that each service user has a documented life history that care staff are familiar with. The registered manager must ensure service users have unrestricted access to their private accommodation. Any deviation form this must be supported by a comprehensive risk assessment that provides evidence that full consideration has been given the service users rights. The registered person must ensure the system of ensuring service users choice at mealtimes is re-introduced. The registered person must ensure appropriate signage is introduced to ensure service users living space is accessible to them. The registered person must provide the commission with the details of its staffing level review. The registered person must ensure that fire doors are not wedged open. The registered person must undertake a risk assessment in relation to the possibility of cross contamination from the laundry to the main kitchen. DS0000007241.V293744.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 Aston Grange Version 5.1 Page 27 24 OP29 19 25 OP29 19 26 OP33 26 27 OP33 8 28 OP29 18 29 OP28 18 30 OP33 24 The registered person must undertake an audit of staff files and ensure there are no staff working in the service unless they have the required documentation as detailed in schedule 2 of the Care Homes Regulations 2001. The registered person must ensure that staff identified at the inspection do not work in the service unless satisfactory documentation as detailed in Schedule 2 are received. 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. The registered person must make arrangements to register the manager of the service with the Commission. The registered person must ensure staff have a comprehensive training plan that includes, dementia care and first aid. The registered person must provide evidence of how the service aims to have 50 of its staff team with NVQ level 2 awards. The registered person must implement effective consultation and means of seeking feedback for people who use the service. 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 28 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.V293744.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aston Grange DS0000007241.V293744.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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