Inspection on 02/09/08 for Aston House

This inspection was carried out on 2nd September 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aston House 04/03/09

Aston House 22/11/07

Aston House 30/10/06

Aston House 20/03/06

Aston House 11/08/05

Aston House 22/03/05

Aston House 16/08/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOME ADULTS 18-65 Aston House 45 Hampton Park Road Hereford Herefordshire HR1 1TJ Lead Inspector Debra Lewis Unannounced Inspection 2nd September 2008 09:40 Aston House DS0000024691.V370782.R01.S.doc Version 5.2 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 House DS0000024691.V370782.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 Adults 18-65. 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 House DS0000024691.V370782.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aston House Address 45 Hampton Park Road Hereford Herefordshire HR1 1TJ 01432 267996 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) Mr Mark Zylinski Manager post vacant Care Home 16 Mental disorder, excluding learning disability or Category(ies) of registration, with number dementia (16), Mental Disorder, excluding learning disability or dementia - over 65 years of of places age (2) Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd July 2008 Brief Description of the Service: Aston House is a large detached house set back from the road in a residential area of Hereford. The house has 10 single bedrooms, 3 double bedrooms, shared lounge, dining room, smoking room, meeting room and bathroom facilities. It has a good-sized garden. The home is registered to offer services for up to 16 adults who have experienced some mental health problems. For some service users it is their ongoing home, for others it may be less permanent, on the way to more independent living, but for all the aim is to provide a normal, homely and supportive environment. Mr Mark Zylinski, the registered provider, has owned the home since 1988. He is a qualified psychologist and visits the home on a regular basis. The home is currently without a registered manager. A new manager has recently been appointed. At the time of the inspection the Commission had not yet received her application to be registered. Information about the home, including fees, will be available in a service users’ guide, which is due to be updated. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The home’s last Key Inspection was in November 2007, when we found a number of problems in the home that had not been addressed. We then did some shorter inspections of the home, in June and July 2008, to check on what the home was doing to sort out these problems. Reports of these inspections are not on our website, but are available if requested from the Commission. By July 2008 we could see that progress was being made to rectify the worst problems. This was a Key Inspection. This means that we (the Commission for Social Care Inspection) checked all of the standards that have most impact on people using the service. This report includes findings from the visit to the home, as well as any relevant information that has been received about the home since the last Key Inspection. It includes some information from the shorter inspections. We were in the home over 2 days. As part of this key inspection one of our pharmacist inspectors again looked at some of the arrangements for the management of medicines, particularly to check if the improvements seen at the inspection in July 2008 had been sustained. The pharmacist looked at some stocks and storage arrangements for medicines, some medication records and procedures, spoke to two people in the home about their medication and visited three bedrooms. We talked with the provider, the new manager and care staff on duty. We also met and talked with several other people using the service about other aspects of the home, and looked around the shared areas of the home. We found that overall some progress was being made to improve the home, although there was still much to be done. The registered provider needs to ensure that rapid progress is made to raise the standards in the home, and that improvements are sustained in the future. Mistakes should not be repeated. What the service does well: People living in the home like the staff. Staff do not tell people living in the home what they cannot do, unless it is to protect them from harm. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 6 The food is good and people living in the home like it. The home has good relationships with relatives of people living there. Staff in the home genuinely care about the people who live there. A lot of the people at Aston House are happy with their care. What has improved since the last inspection? What they could do better: Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 7 The home should keep better details of what help and care people need, to make sure they always get the right care that they need. Staff should work to avoid doing things “for” people, such as managing their money and buying their toiletries, unless absolutely necessary. They should also avoid routines, such as people queuing up for money at a set time and day, as this would increase people’s independence. The home must be very careful to ensure that they care properly for people’s health. They need to know exactly what care is needed to make sure people always get looked after properly. The arrangements and risk assessment for one person who self-medicated needed review and improvement. Some necessary improvements in some medicine records and practices were also identified. Staff should always keep a record of what they did, if someone living in the home has a concern or complaint. This will show that staff listen and act on what people say. The home would be better for people living there if it was improved to include ensuite facilities and to remove shared bedrooms, and arranged into smaller group living. Broken equipment or furnishings should be repaired without long delays. Staff need regular training to make sure they know how to give good quality care at all times, and that they understand the needs of people with mental health problems. The home should do regular full checks on how they work and what people living there want from them. This would help to improve the service for people living in the home. More care is still needed with safety in the home, such as making sure the house is kept as safe as possible for people living there. 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 House DS0000024691.V370782.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was obtaining assessments of people’s needs before they moved in, so they were aware of people’s needs and whether they could meet them. Written information was available, but was out date; this was being addressed, so prospective service users would in future have the information they needed. EVIDENCE: The new manager said she was updating the home’s statement of purpose and service users’ guide, which were out of date, and that she would provide copies to the Commission when they were updated. Previous inspections had identified that the home had not always obtained assessments of people’s needs before they moved into the home. There had been no new people moving into the home recently. The new manager was aware of the need for a proper assessment of needs and a phased introduction to the home. She said she will update the home’s policy and procedure to ensure it specifies that assessments must be obtained. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of people living in the home are mostly recorded in care plans, and so are individual risks to people. But these records are not very clear and do not have enough detail to make sure staff always know what care is needed by people living in the home. EVIDENCE: We looked at some care plans and risk assessments. We also talked to people living in the home and to staff, about the care people need and about how staff provide the care. Care plans and risk assessments were in place, containing basic details, but were confusing to follow. They were on a range of formats, some up to date, others not. It would be difficult for staff to find an accurate account of the right care needed. This would make it unlikely for staff to use the plans on a daily basis. For example, for one person there were two different forms covering the Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 11 same aspects of physical health needs. Some plans were signed by the person they belonged to others were not. Some contained aims and activities, others did not. Plans had been reviewed but this was only recorded as a date, with sometimes a comment such as “no change”. This did not demonstrate any evaluation of the success or otherwise of the plans, and did not show what progress had been made. The new manager said she would be changing the format to a new, consistent format which would ensure that all details were in place, and would also ensure that any staff member (e.g. a relief staff member) could easily see what care was needed for each person. Reviews would be regularly held, with relevant professionals invited 6-monthly. The registered provider is an appointee for 8 people living in the home. He has provided the Commission with a statement from his accountant confirming that the records they saw for these people’s money were accurate. One person, whose money was managed by the registered provider, said they did not know what happened to their money. The home should ensure that, where the registered provider manages people’s money, all relevant records including bank account statements and account books are available in the home for the service user to see when they want. This should help to reassure them that their money is being properly managed. The number of people living in the home who do not manage their own money has been reduced in recent years and the home should continue to improve people’s independence in this area. People living in the home had some say about some aspects of everyday life, but sometimes what was easier for the home took precedence over finding out what people really want and need. For example, when choosing a room colour, a service user was encouraged to choose magnolia, as it was easier than a change of colour. We discussed with the new manager how she intended to promote independence for people living in the home. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people in the home lead varied and independent lives. There have not yet been enough staff available to help those people who need more support to access activities. Daily life in the home can be over reliant on routines for some people. Family and friends are welcome in the home, and people living in the home like the food. EVIDENCE: We talked to people living in the home, staff and the manager. We looked at care plans and records of activities. We saw food being served and looked at menus and records of food provided. Activities and occupation by people living in the home very much depended on their own interests and levels of independence and motivation. Some people were very active and lived fairly independent lives, attending college, part time Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 13 work, and leisure activities of their choice. Others who required more support or encouragement were not always getting this. In November 2007 we advised that the home should do more to find out about and encourage individuals’ hobbies and interests, to improve their quality of life. During this inspection we found that some care plans had no record of people’s chosen activities, or their aims and aspirations in life. This would make it difficult from them to get the support they need, if staff are unaware of their wishes and interests. In addition, staff and people living in the home (during this inspection and previous ones) have commented that staff levels are too low to enable staff to support individual people living in the home with their activities and interests. We have previously advised the home to improve this situation. The rota showed that there were normally only 2 care staff on duty, making it difficult for staff to support individuals outside the home. This would be particularly frustrating for some people on weekends and evenings. It also meant that during medication administration times, when 2 staff were needed, no staff were available to help people living in the home with anything else. On this occasion the registered provider said that he would be introducing some “floating shifts” from new relief staff, which would be aimed at providing more support to those most in need. Family and friends were welcomed at Aston House and there was evidence of regular visits to or by families, when this was possible. In 2007 we noted that “Daily routines in the home were, in some ways, not restrictive, for example people could come and go as they wished. There was an institutional culture whereby things were done at set times on set days, such as collecting weekly money from the office. Whilst it is recognised that some people in the home may have such habits, there is much that staff could be doing to encourage more individual decision making by people living in the home, which would increase their independence and self esteem.” We did not find evidence of significant change during this inspection, apart from with the provision of food. However the new manager said she intends to promote independence. The home now had a cook. Food had greatly improved since the last key inspection in November 2007. Food was nutritious, and appetising, of good quality and people living in the home said it was very good. Special diets were catered for, and these were usually recorded, although this could be more consistent. Vegetarian options were now much more varied and fresh. On previous inspections we advised the home to look at alternatives to dishing up food on a plate. Food was now being served in dishes on the tables, so Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 14 people could take the portions they wanted. Most people were happy with this, and said it was better, but one person was concerned about hygiene and about fair portions. This should be discussed in a house meeting. There was no menu choice available. People living in the home did not complain about this as they usually liked the food, but a choice would be another way to improve their independence and sense of control. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home usually get the help they need with their health and personal care. Sometimes the help they get is not properly recorded, which could mean they don’t always get the care they need. There are still adequate arrangements in place to make sure people in this home have their medication safely, and the improvement in the management of medication seen at the last inspection (in July 2008) has been sustained. The inspection did highlight a few weaknesses where these arrangements need some revision or more attention to detail in order to protect the health and wellbeing of people living here. EVIDENCE: We talked to staff and people living in the home, and looked at care plans and medication records. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 16 Personal care was being given in an appropriate way; for example, a specific issue was discussed and staff were managing it sensitively and as the person wished. Basic health care needs were recorded, but not always very well. For example, for a person with diabetes, there was no record of the frequency of blood tests required. Results were recorded sporadically. This could mean they miss out on the tests they need to stay healthy. Actions taken to implement care plans were not always recorded. For example, one person’s plan said staff were to encourage them to agree to a specific health procedure, which they were reluctant to undertake but which would be beneficial for them. The plan had been reviewed but there was no record of staff interventions to encourage the person. This could mean staff continue making the same interventions, which continue to be unsuccessful, rather than trying to find more effective ways to approach the concern. The Commission’s pharmacist inspector visited the home in November 2007 (when significant problems were found), again in the smaller inspections in June and July 2008, and again during this Key Inspection, when the following was found: Only certain staff were authorised to administer and handle medication for people living in this home. These staff have undertaken some training in the safe handling of medicines and three staff members were also attending more advanced training on the day following the inspection. One of the senior care workers said since the last inspection he had begun a modular course about the safe handling of medicines. We recommend an ongoing process be put in place to assess and record staff competence in this important area of care. A local pharmacy still provided many medicines each month in special blister packs called a monitored dose system (MDS). These help staff to see easily what medicines need administering on a particular day and time and what medicines have been administered. As part of this system the pharmacy printed a record each month of all the medicines the doctor had prescribed with a chart on which staff recorded when they had administered each medicine dose. Staff also kept records of the medicines that were received in the home and there was a separate book in which medicines disposed of via the pharmacy were recorded. We saw that the allergy sections of the medicine records were completed and there were photos with each record to help the staff to check they were giving the medicines to the right person. Complete and accurate records about medication are important so that there is a full account of the medicines the home is responsible for on behalf of the people living here and so that people are not at risk from mistakes, such as receiving their medicines incorrectly. During the inspection staff were unable to find previous medication charts but we found that the records that had been in use since 18th August 2008 were generally suitably kept. It is important that Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 17 previous medication records are available in the home for at least three years. The manager has since confirmed to us by phone that these records were available and kept in a locked filing cabinet. We noted that where medicines were supplied to people to take themselves when away from the home (at lunchtime for example) a code letter indicated this on the records but did not identify what member of staff had been responsible and if a medicine had been given or the dose was missed. Explanatory notes on the reverse of the chart would be one way to resolve this. We also noted that where variable doses of one or two capsules for example were prescribed the actual dose administered was sometimes but not always noted. It is important that records identify the actual medication administered. The records indicated that all the medication needed had been in stock during this period. On the day of the inspection we found that the morning and lunchtime medicines were administered at the correct times. We made some checks by counting the tablets or capsules remaining in the medicine cupboard and found that these generally agreed with the records of medicines administered although we identified some examples of discrepancies of one or two tablets. This was for medicines that were not packed in the monitored dose system. These packs generally, but not always, had a date of opening written on the container. This is a useful way to see that medicine stocks are properly rotated and provides a way of carrying out audit checks but for this to be properly effective there needs to be a way of indicating when the first dose from the pack was used (particularly important when there is more than one dose used in a day). We also strongly recommended to the manager designate that at the end of each four week medicine cycle the quantity of medicines carried forward to the next period (and therefore not supplied in the blister packs) be counted and recorded on the medicine chart as another check that people living in the home have received the right amount of their medicines. Staff must be careful to make sure medicines are replaced in the right packets after they have administered a dose. We found for one person using 5mg and 10mg tablets of the same drug that a strip of 10mg tablets was in the box of 5mg tablets. Following individual risk assessments, several people living in the home were looking after some or all of their medicines. We saw that suitable records for this were in place to keep an account of the medicines. Since the last inspection individual lockers have been provided in bedrooms so that people can keep their medicines safely. We spoke to two people who showed us their new lockers and told us that staff always provided them with new supplies of medicines. We were concerned that one person left the key to the locker in the door. This may not be safe particularly as this was a ground floor bedroom Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 18 with an adjacent open window. We found that in another bedroom of one person who looked after some tablets, these were left on the bedside table and no locked storage seemed to be provided (the bedroom door was locked). We were also concerned that from the tablets remaining in the blister packs it appeared this person was not taking their tablets correctly. There was a risk assessment in place but this will need reviewing to provide more monitoring as not taking these particular tablets correctly would affect the health and wellbeing of this person. The risk assessment included a medicated shampoo but this was not included on the medicine chart so it was not clear if this was still to be used. On an open shelf beside the basin there were also several containers of two different creams or ointments. Some were now out of date and had been dispensed in 2004 and 2005. Neither of these was included on the current medicine records or risk assessment. The self-medication arrangements for this person needed thorough review. We looked at a sample of care plans to check that clear guidance was given to staff about administering medicines prescribed to use ‘as required’. We found this was mostly in place but there were examples where the guidance needed updating to include all medicines prescribed in this way or to include more specific information. People’s consent to the way their medication was handled was in individual records. Some care plans did not seem to be up to date with information about medication-related issues. For example, for some people it stated that they needed blood tests every four weeks but the last recorded test was 03/06/08. The manager designate confirmed they had actually had these tests. Another person’s plan indicated regular checks (of between two to six monthly depending on which section of the care plan you look at) with the nurse at the GP surgery but the last recorded visit was 17/01/08. Records such as this need to be kept up to date to make sure that people receive the care they are supposed to. Medicines were stored safely at the correct temperature. Medicines that were swallowed were segregated in the medicine cupboards from those that were applied externally. We strongly recommend that the locked container used for medicines in the fridge be attached to the fridge shelf. Some medicines in this box had an expiry date of September 2008. A special cupboard had recently been delivered in which to store controlled medicines when they are used. This now needs to be fixed in accordance with The Misuse of Drugs (Safe Custody) Regulations 1973. There were no medicines in this category in use at the time of the inspection. In one of the medicine cupboards there was a record of weekly checks of the medicine cupboard and another record of monthly returned medicine checks. The deputy manager generally signed these. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 19 There was a medication policy and procedures available so that all staff should be aware of how the manager and provider expected medication to be handled in a safe way. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home can talk to staff about their concerns, but staff do not always record whether they have done anything about the concerns. There is guidance for staff about what to do if they think someone is being harmed. Staff have not been regularly trained in this, but training has been arranged for October 2008, so they should then be aware of how best to safeguard the people living in the home. EVIDENCE: We looked at records of concerns and complaints, and talked to staff and people living in the home about how the home manages concerns raised by people living there. Some people living in the home said they would raise concerns. 3 concerns had been recorded in 2008 so far. The response had not been recorded at all in one case (from March 2008) and not recorded fully (other than “reported to management”) in another case (from June 2008). This did not demonstrate that the home was taking people’s concerns seriously or acting on them. We looked at the home’s policy on managing possible abuse of people living in the home, and records of staff training about this. We talked to staff about their understanding of the issue. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 21 The home has suitable written guidance for staff to follow in case of suspected abuse. Staff training had been lacking, but this was now booked for 13th October, for all staff in the home including the cook and cleaner, which is good practice as all staff need to be aware of how to respond in the best way to reduce the risk of abusive behaviour towards people living in the home. One service user had wanted to include a staff member in their will and the staff member had, appropriately, gently explained this was not possible. (It would raise serious concerns about possible pressure or encouragement from the staff member if they inherited money from a vulnerable person in their care). The home should be more alert to the need to protect people from self-harm (see environment section). Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not always maintained in a safe condition for people who live there. Its facilities are not up to modern expectations, for example there are no ensuite rooms and some bedrooms are still shared. Parts of the home are comfortable and there is a range of shared spaces. EVIDENCE: We toured the building and saw some bedrooms and most shared areas of the home. The home’s facilities do not come up to standards expected of new services, for example there are 3 shared bedrooms, and less bathroom facilities than are now expected. No rooms have ensuite facilities. It would be good practice to upgrade the premises, to provide a modern level of service for the people living in the home. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 23 There are no plans for organising the home into groups of a maximum of 10 people, as recommended in National Minimum Standard 24. It would have been good practice to have achieved this by April 2007, to make the home more comfortable and give it less of an institutional feeling for people living there. The smoking room did not have an extractor, so the room was very smoky. This was commented on in the inspection of November 2007 and in the following report, but no action had been taken since to repair or replace it. There were 3 shared bedrooms. These had still not been phased out, as would be good practice. The home should ensure that anyone sharing a room does so as a positive choice. Bedrooms were mostly lockable except for one that was used as access to a fire exit. Some fire exits led through bedrooms, which reduced the privacy of the people living in those rooms. There were sufficient shared areas including a large TV lounge, a small smoking room outside and a quiet room used for meetings or visitors. The laundry room is situated in a strange position, where people living in the home pass through it to reach the garden or smoking room or quiet lounge; but dirty laundry does not go through the kitchen or food areas. Food hygiene had improved since the last key inspection. The home now had a dishwasher and people living in the home were no longer hand washing their plates and cutlery. 5 more staff had had food hygiene training during 2008. Some parts of the home were being maintained, but others were not being kept in a suitable condition. The dining room carpet was dirty. More importantly, we have drawn the home’s attention to potentially unsafe windows on previous occasions; on this occasion we found an upstairs bedroom window that was unrestricted and was wide open. This had been recorded in the maintenance book in June but had not been repaired despite obvious significant risk of accidental or deliberate harm to the person living in that room. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home like the staff and they mostly get on well. There are not always enough staff to give people the support they would like. Staff have not had enough training to be confident of giving good quality care to people living in the home. EVIDENCE: We talked to people living in the home, staff, the registered provider and the manager. We looked at the staff rota and at records of staff training and recruitment. We were told that all 4 senior staff had done NVQ (National Vocational Qualifications) in care. Three care staff were doing NVQ 3 at the moment. There were no available records of enrolment on NVQs for two other care staff or for two relief care staff. This meant the proportion of qualified staff in the home was still not as high as recommended good practice (50 qualified by 2005) but some progress was being made. Such qualifications help to ensure Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 25 that all care staff have a basic understanding of current good practice when working with residents. People living in the home said they liked the staff and were treated well. Staff numbers on duty were low, normally only 2 care staff for 16 people living in the home. This made it difficult for activities to be arranged, especially for individual needs, for people who needed staff support to access their preferred activities. It also meant staff were not easily available during busy times, such as medication times or when they were preparing Sunday dinner. There was a cook during the week, but care staff did meal preparation on Sundays. There was no relief or weekend cook to cover for the regular cook’s day off. This limited staff availability to people living in the home. Previous inspections showed significant gaps in staff recruitment procedures, which had left people living in the home in the care of people whose backgrounds had not been properly checked. We looked at records of the most recently recruited staff and found that required records were now in place, except for one person’s proof of identity, which the home would have seen as part of their CRB (Criminal Record Bureau) disclosure application. The new manager had not yet recruited anyone to this home. She was aware of the need to follow schedule 2 of the Care Homes Regulations when recruiting staff. We discussed the need for recruitment to be done properly in future and for improvements to be maintained, in order to reduce the risk of exposing people living in the home to unsuitable staff. Previous inspections have also highlighted staff training as being insufficient. Clear records of staff training, and a training plan, were still not available, making it difficult for the new manager to produce evidence to us of training done or organised before she came to the home. Induction training has been lacking in the past. The new manager had been told by the previous manager that now all staff are enrolled on NVQs (National Vocational Qualifications), which automatically include the required level of induction. However the new manager could not find evidence of two staff being enrolled and agreed to find and provide this evidence to us. The registered provider told us that he would soon be personally delivering mental health training based on an NVQ 2 (National Vocational Qualification) community mental health unit, which will take about 15 hours. This is an improvement on the 2-hour training provided before. It will not be externally verified, as there is no local assessor for this. We did not see the course content. The training has not yet started. The new manager had found a provider of training in managing actual or potential aggression, and was in the process of identifying which staff were in most need of this training. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 26 The new manager was beginning to address the training shortfalls. Much work is still needed to ensure people living in the home have staff who are competent, aware of current practice and can meet their needs. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not yet have a registered manager, although a new manager has recently been appointed to the home. The home does not yet have a culture of examining its practice and updating it. This means it has slipped into poor practices that are likely to reduce the quality of life for people living in the home, and may put them at risk of harm. The home has not yet shown it can be relied on to ensure the safety of people living there. EVIDENCE: We talked with the manager, the registered provider, staff and people living in the home. We looked at some of the home’s records, and at how they were managing safety in the home. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 28 The home had a new manager who had only been in post for 4 weeks. She had begun to address issues from the last inspection, but had been kept busy with routine daily events such as ensuring people living in the home got to medical appointments. Staff and people living in the home spoke well of her. She was about to apply to the Commission to be registered as the home manager. The home’s quality assurance system had still not been developed any further than the issuing of questionnaires. This has been outstanding for several years. The registered provider does not take an active part in the quality assurance of his service. The home has become somewhat stuck in its ways, without evident analysis of what they are doing and what needs to be improved for the people who live in the home. The new manager and the registered provider said they planned to discuss quality assurance of the service. Health and safety was reasonably well managed in some specific areas, for example fire equipment safety checks and fire drills were up to date. Significant risks had been identified during inspections in November 2007 and June 2008, such as fire doors wedged open and hazardous chemicals freely accessible to people living in the home. Some improvements had been put in place since then, e.g. fire doors and storage of hazardous substances. In other instances there was evidence of risks still not being well managed, e.g. we had drawn the home’s attention to concerns about unsafe opening gaps in upstairs windows on more than one occasion. On this inspection we found an upstairs bedroom window that was unrestricted and was wide open. This had been recorded in the maintenance book in June but had not been repaired despite obvious significant risk of accidental or deliberate harm to the person living in that room. It had previously been restricted with a single screw which had been moved, rather than with a properly designed restricting device. We issued an immediate requirement letter to get this put right. The registered provider wrote to us on 11 September to confirm that the windows had been restricted to a safe opening gap. We also saw a fire door that had been wedged open. The manager immediately removed the wedge. All other fire doors were appropriately closed, or fitted with automatic closures. Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 1 X X 1 X Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 30 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 YA13 Regulation 18(1) (a) Requirement There must be sufficient staff on duty in the home to enable people living there to get the support they need with their chosen lifestyle and outside interests. Actions taken (such as staff interventions or medical tests) to meet the health care needs of people living in the home must be accurately and reliably recorded. This will help to ensure people living in the home get the correct care when they need it. 3 YA20 13(2) Where people living in the home 31/10/08 manage their medication make sure that the risk assessments are up to date with suitable monitoring that people are taking their medicines correctly and can store their medicines safely in a lockable space. (This refers specifically to the person identified at the inspection where shortfalls in the self-medication arrangements were identified.) DS0000024691.V370782.R01.S.doc Version 5.2 Page 31 Timescale for action 31/12/08 2 YA19 17(1) schedule 3(m) and 17(3) 31/10/08 Aston House This is to help make sure the medication the doctor has prescribed is taken correctly and is stored in a way that is safe for everyone in the home. 4 YA35 18 (1) (c) Staff must receive induction training appropriate to their work. Specifically, this must include induction meeting Skills for Care standards. This will help ensure new staff are properly prepared for their role. (Repeated from November 2007.) 5 YA35 18 (1) (c) Staff must receive further training appropriate to their work. Specifically, this must include mental health and prevention of, and response to, aggression. This will help to ensure that staff are able to provide good quality care to people living in the home. (Repeated from November 2007.) 6 YA39 24 (1)(5) The registered provider must establish and maintain a system for reviewing and improving at appropriate intervals the quality of care provided. This system must include a means of consultation with service users and their representatives. (Recommended from November 2007.) 31/12/08 02/09/08 02/09/08 Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 32 7 YA42 13 (4) (a) and (c) You must ensure that all unnecessary risks to service users are identified and as far as possible eliminated. Specifically, upstairs windows that are accessible to people living in the home must be assessed for risk and restricted to a safe opening gap, in accordance with current Health and Safety Executive guidelines. A suitable restrictor must be used which cannot be easily removed. This is to reduce the risk of deliberate or accidental harm to any service user at the home. (An immediate requirement was issued on the day of the inspection) 12/09/08 Formatted: Bullets and Numbering 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 YA1 Good Practice Recommendations The statement of purpose, service users’ guide and contracts should be fully revised and updated to ensure they are accurate, and produced in formats which are easily accessible to people living in the home and people who may be considering moving in. This is so that people who live in the home, or are considering doing so, have accurate, up to date information on which to base their choice. (Repeated from November 2007. The new manager stated that this is in progress) Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 33 2 YA2 A system should be set up to ensure that no person is admitted to the home, until the home has obtained a full assessment of their needs by a person competent to do such an assessment. This will ensure staff know, and can meet, their needs. (Repeated from November 2007). 3 YA6 Service user plans should be revised to ensure they identify the exact current needs of each person relating to their care, and specify in detail how and by whom those needs will be met. This includes physical and mental health needs, and chosen activities. This is to ensure all staff know the care people need at all times. (Repeated from November 2007.) 4 YA7 The home should actively promote independence wherever possible, and should not do things for people living in the home unless absolutely necessary. Reasons for such interventions should be recorded. This will help improve people’s independence and self esteem. (Repeated from November 2007. Not fully checked on this inspection) 5 YA7 Where people living in the home do not manage their own money, all records and accounts relating to their money should be available in the home for them to see when they wish, in order to increase their level of awareness and control over their money. Risk assessments covering individuals should be revised to check they are sufficiently detailed to ensure that risks to people living in the home, and actions necessary to reduce these risks, are properly identified. (Repeated from November 2007. Work in progress.) 6 YA9 7 YA17 You should ensure that all people living in the home are aware that access to food is not limited to certain times. (Repeated from June 2008. Not checked on this Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 34 inspection) 8 YA20 Securely attach the locked box for medicines in the fridge to the shelf or body of the fridge. This is to make sure that medicines are stored here safely and cannot be removed by unauthorised persons. Arrange to fix the cupboard acquired for controlled drugs storage to comply with the Misuse of Drugs (Safe Custody) Regulations 1973. This is to make sure if you stock these medicines in the future they are stored securely and in accordance with the law. When stocks of medicines are carried forward to the next medication cycle record the stock balance carried forward. This is to enable audit checks that medicines are being used correctly. You should ensure that your record of complaints includes details of what action was taken in response to each complaint. This will help to ensure concerns are properly followed up and appropriate action taken. (Repeated from November 2007.) 12 YA28 The smoke extractor, which has been out of action since 2007, should be repaired or replaced without any further delay, to make the smoking room comfortable for people using it. The new manager should apply for registration without any delay. The registered provider and the new manager need to work together to ensure the management culture in the home is open, positive and working towards significant improvement in the home. (Repeated from November 2007. Not checked on this inspection) 15 YA41 You should check all records required to be kept in the home according to regulation 17, schedules 3 and 4; and make sure in future they are all in place, up to date and available for inspection in the home at any time. (Repeated from June 2008.) Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 35 9 YA20 10 YA20 11 YA22 13 14 YA37 YA38 16 YA42 You should ensure that in future all staff involved with food preparation and other care tasks have been trained in food hygiene and infection control. (Repeated from June 2008. Progress being made.) 17 YA42 All staff should be trained in health and safety to ensure they are aware of possible consequences of unsafe practices. The registered provider should ensure that visits to the home under Regulation 26 are used effectively to monitor conditions in the home, and to ensure the service is improving. 18 YA43 Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI Aston House DS0000024691.V370782.R01.S.doc Version 5.2 Page 37 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!