Inspection on 22/11/07 for Aston House

This inspection was carried out on 22nd November 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 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 02/09/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Aston House 45 Hampton Park Road Hereford Herefordshire HR1 1TJ Lead Inspector Debra Lewis Key Unannounced Inspection 22 and 28th November 2007 11:00 nd DS0000024691.V351636.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 DS0000024691.V351636.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. DS0000024691.V351636.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 None Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (2) DS0000024691.V351636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th October 2006 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. Information provided by the home shows that fees charged by the home range from £323 - £600 per week, with no additional charges. Information about the home is available in a service users’ guide. DS0000024691.V351636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection. This means that we, the commission, checked all of the standards that have most impact on people living in the home. This report includes findings from the visit to the home, as well as any relevant information we have received about the home since the last inspection. This includes details from a report on the home provided by the acting manager. Two inspectors and a specialist pharmacist inspector were in the home over two days, from mid morning until early evening. We met and talked with service users; with several staff on duty; and with the acting manager. Surveys were distributed to the people living in the home, to relatives and to professionals involved with the home. We received 9 responses from relatives, 8 from health and social care professionals, and 9 from people living in the home. Some responses needed to be followed up, which has led to delays in producing this report. In some ways the home does things well, but we had a lot of concerns about things that need to be improved. What the service does well: What has improved since the last inspection? Staff keep a record of any restrictions they do put on people, such as limiting their smoking, and make sure people agree these limitations are there to help them. A gardening group has been started for people living in the home. The home has begun to have regular fire drills, so that staff will know what to do if there was a fire in the home. DS0000024691.V351636.R01.S.doc Version 5.2 Page 6 The home has had their electrical wiring checked for safety, which helps make the home safer for people living there. What they could do better: The home needs to make sure they have full information about what people need before they move in, so everyone can be sure that staff can do what is needed for them. 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 needs to greatly improve its food. People living in the home should have choices at all times. Good quality food should be provided as alternatives or for special diets, e.g. for diabetics or vegetarians. Food should be of good quality and presented in an appetising way. This is so that the home ensures people get the health and pleasure benefits of good food. 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 home needs to be much more careful with how staff handle medication, to make sure they don’t harm people by giving them the wrong medication. Staff need to be trained in what to do if they think someone is being treated badly. The home would be better for people living there if it was improved to include ensuite facilities and to remove shared bedrooms. Staff need more 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 needs to make sure they do complete checks on staff before they work in the home, to make sure they do not employ people who aren’t suitable to work with the people living in the home. The home needs a suitable manager who is able to make the improvements needed to bring the home up to modern standards of care. DS0000024691.V351636.R01.S.doc Version 5.2 Page 7 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 needed with safety in the home, such as making sure staff know about First Aid and making sure the house is kept as safe as possible for people living there. In this inspection we found a number of concerns, some of which have been brought to the attention of the registered manager and registered provider in previous years. It was disappointing that they were still not sorted out. We need to see major improvements at this home’s next inspection. If we remain concerned about important issues in the home, we will need to consider legal action. 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. DS0000024691.V351636.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 DS0000024691.V351636.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, 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is written information about the home, but it is not up to date or fully detailed, so prospective service users don’t get an accurate picture of the home. The home does not always make sure they know exactly what care someone needs before they move into the home. This means they cannot be sure they can give the care that is needed by that person. EVIDENCE: We saw copies of the statement of purpose and service users’ guide. Both were out of date and did not give fully accurate information, e.g. the ex-registered manager was still said to be the manager despite giving up the post at the beginning of 2007; very out of date contact details were given for an obsolete National Care Standards Commission and an address not used by the Commission for Social Care Inspection since 2006. The acting manager said they had not been updated as no new manager had been registered. Details of how the home ‘s facilities compared to environmental National Minimum Standards were not included, as described in National Minimum Standard 1.1. The home has carried out some assessment of the needs of some people who came to live in the home. For one person who was admitted to the home DS0000024691.V351636.R01.S.doc Version 5.2 Page 10 earlier in the year, the home had not done an assessment, nor had they obtained an up to date assessment of needs from the social worker. This means staff could not be sure of what his needs were and if they could meet those needs. It is important that this is always done before anyone moves into the home, or vital care needs could be missed. The home issued contracts, copies of which were not all found on the day. Those seen were clear about fees and charges. The contracts could be improved by setting them out in a more accessible way to ensure people living in the home can easily make sense of them. DS0000024691.V351636.R01.S.doc Version 5.2 Page 11 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. Staff in the home keep a record of what support people need, but sometimes this information is not detailed enough to make sure people always get the care they need. People are usually free to come and go as they want, and staff usually help them to stay safe. Sometimes staff don’t encourage people to do more for themselves. EVIDENCE: There were written plans of care for people living in the home. These were not as detailed as necessary to ensure people’s needs were met, e.g. a care plan for someone with diabetes did not specify their dietary requirements or the frequency of tests needed on their blood sugar levels. Some plans were being reviewed to keep them up to date, but others were not. This was not being done consistently. This could leave the person living in the home at risk of receiving inadequate care for their medical condition. DS0000024691.V351636.R01.S.doc Version 5.2 Page 12 Plans did include a record of restrictions e.g. if some agreed that staff would look after their cigarettes, but did not record the reasons for these restrictions. People living in the home were able to make their own decisions in some areas, such as how they would spend the day, but staff were not actively encouraging decision making and there was a tendency for staff to do things “for” the residents, e.g. buying supplies of toiletries for people living in the home, and looking after money on behalf of more than half of the people living in the home. These practices do not encourage people to become independent or to make their own decisions. We found risk assessments in place, which were up to date. These were brief and in some instances may not be adequate e.g. one for a person’s mental ill health stated the necessary action was “To support”. DS0000024691.V351636.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence including a visit to this service. Some people living in the home lead independent lives, including education, employment and hobbies. Others, who need more help and encouragement to access activities, do not always get the help they need. Families and friends are welcome in the home. Daily routines are not usually restrictive, but do not promote independence. The home does not have a cook and the food is unappetising, unvaried and of doubtful nutritional value. EVIDENCE: 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 work, and leisure activities of their choice. Others who required more support DS0000024691.V351636.R01.S.doc Version 5.2 Page 14 or encouragement were not always getting this. Some effort had been made, for example a gardening group had apparently been set up (although there was no record of when this had taken place), as it was thought some people living in the home would enjoy this. Records of activities were limited for some people, for example one person had been for a walk twice in March 2007, been to a market twice in April 2007, had not wished to go bowling in May 2007; other than that there were no further recorded activities since May, except a weekly in-house art group. A list of daily activities showed things like “washing” as activities. The home should do more to find out about and encourage individuals’ hobbies and interests, to improve their quality of life. Family and friends were welcomed at Aston House and there was evidence of regular visits to or by families, when this was possible. Relatives spoke well of staff in the home. Daily routines in the home were, in some ways, not restrictive, for example people could come and go as they wished. On the other hand, access to food was limited (see below). 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. The home did not have a cook; this is a problem that has recurred for several years and must be addressed. Food records showed that breakfast was almost always just cereals. No choices were given for lunch, although staff said people could do their own options such as frying an egg. People living in the home said if they didn’t like a meal, they could have bread and butter or a sandwich. This is not an adequate choice of meals. The standard of food on the two days of the inspection was very poor. Care staff were preparing food. On one day the lunch was scrambled egg, baked beans and salad, served together, already on a plate, without toast. On another day lunch was lumpy tinned soups and tinned spaghetti, with raw onions, grated cheese and hot and cold white sliced bread, just defrosted in a microwave; on this occasion people living in the home were helping themselves from large hot saucepans. Neither of these lunches was in any way enjoyable or appetising and their nutritional value was questionable. Staff said special diets were catered for, but there was no complete record kept of these. Staff said vegetarian options were usually things like frozen burgers or pies, again not very appealing, varied or fresh. DS0000024691.V351636.R01.S.doc Version 5.2 Page 15 On a previous inspection we advised the home to look at alternatives to dishing up food on a plate, so people could take what they wanted. This was still going on and some people did not like the portion sizes. The alternative used by the home seemed to be people helping themselves from large hot pots in the kitchen, with possible health and safety risks. The home needs to try ways of ensuring people get what they want, while maintaining hygiene and safety. Access to food and drink was also limited. People living in the home said there was no breakfast after 9:00am and the kitchen was locked after 10:00pm. DS0000024691.V351636.R01.S.doc Version 5.2 Page 16 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, 21 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff help or encourage people with their personal care, if they need it. The home cares for people’s health needs, but is not always consistent enough with this, which puts people at risk of their physical health being neglected. Poor practices and record keeping for medicines put people at risk of receiving the wrong amount of medication. The home has cared well for someone who was dying. EVIDENCE: People in the home do not usually need help with personal care, but do need support and encouragement. Staff were seen supporting people in a sensitive way. Relatives felt staff supported people living in the home well with such needs. Comments from health and social care professionals were mostly positive, but included some concerns about staff lack of understanding of mental health DS0000024691.V351636.R01.S.doc Version 5.2 Page 17 issues and of medication. People’s healthcare needs were recorded, but sometimes not in enough detail to be confident that they would get the right care. For example, we looked at the plans to support someone with diabetes. There were no records of blood sugar test results, or of what food they had eaten; and there was no description of how to detect or manage low or high blood sugar levels. This could put the person’s health at increased risk. Someone who lived in the home had had a terminal illness. Staff in the home cared well for him, and put in significant extra effort to ensure he could be cared for in the home with the support of community nurses, as he wanted, rather than in hospital. A professional commented on the “High degree of sensitivity dealing with a service user’s terminal illness”. Another professional commented that “Staff …ensured that he could have his wish not to be taken to hospital or hospice. Someone was with him constantly through his last days.” A specialist pharmacist inspector checked the way medication was managed in the home and found the following: Medicines were mostly stored safely, but there were some improvements needed which we told the owner and manager about. There was a medication policy and staff were provided with training but despite this poor practices and records were found. There was poor record keeping for medication. For example, staff did not sign MAR charts (medication administration records) immediately after giving a dose of medication; and records indicated that, for a course of antibiotics, more doses had been given than had actually been received in the home. An error was reported to us on 12/11/07 and our investigation suggested this was likely to have been a result of the unsafe way medication has been managed in the home. There were no plans or protocols for when to give out p.r.n. (as required) medication. Unsafe practices such as these increase the risk of people receiving the wrong amount of medication. The full details of the pharmacist’s findings were as follows: Staff who administer medicines have undertaken a formal training process about the care of medicines. A medication policy is available so that the staff also have written direction as to how the home management expect them to handle medicines safely. Despite this we found poor recording and poor practices with medication. The lists for homely remedy medicines that may be used needs reviewing as these were authorised by the doctors in 2003 and 2004. For each person living in this home there are arrangements to make records of medicines received, administered and leaving the home or disposed of. Complete and accurate records about medication are important so that all DS0000024691.V351636.R01.S.doc Version 5.2 Page 18 medicines can be accounted for and residents are not at risk from mistakes and receiving their medicines incorrectly. We found that some of these records are not kept very well in this home and there were a number of issues that need attention: • On the day of the inspection, all the morning medicines had been administered to people living in the home but the medicine charts had not been signed to confirm this. This is poor practice and a risk to the people living here. • There were other examples of incomplete recording on some peoples’ records on several days so we do not know if they had their medicines correctly as prescribed or doses were missed. • Records for medicines received into the home were not always made. Some records for medicines returned were incomplete so we could not always tell exactly what had been returned. All these records are needed so that the home can be fully accountable for the medicines that they manage on behalf of people living here. • One person was prescribed a course of antibiotics three times a day. Records indicate this was given at 9am, 6pm and 9pm. The intervals between doses must be more evenly spaced over the day in order to obtain the best response from the treatment. For one course 23 doses were signed as given although only 21 capsules were signed as received. • There was no written information to help make sure medicines that the doctor has prescribed ‘as required’ are administered correctly and that staff have clear directions how these are used for each person. • Handwritten entries on medicine charts were not always signed and dated and there were no signed checks for accuracy by a second suitably trained member of staff. The allergy box on the medicine charts was blank. This information was not noted in care plans except for one person where an insect sting allergy is recorded. We were told that one person has a penicillin allergy. This information must be recorded in a way that is readily available to staff and health professionals. • The dates entered on a few charts were very muddled and it was not clear what dates some records of medicines administered recently referred to. This situation was not helped, as the pharmacy appeared to have made a mistake with the printed dates but the home need to adequately manage situations like this. We told the manager and provider about all of this at the end of the inspection. On 6th December 2007 we sent an urgent action letter for some of these issues to be put right by 19th December 2007. The provider wrote to us on 17th December 2007 to tell us what action he had taken. We saw forms of consent for medication but these need to include everything about medication. Care plans also need to reflect what choices people who live in the home are given and make about the way in which their medicines are administered and their consent to how staff handle and administer their medicines. Where consent is not possible because of lacking capacity records are needed of the agreement that the way in which medicines are administered DS0000024691.V351636.R01.S.doc Version 5.2 Page 19 is in the best interests of that particular person and in accordance with the provisions of the Mental Capacity Act 2005. There are records indicating the support needed and provided for the various health needs of each person. In some cases more detailed information is needed to help staff fully understand each person’s potential needs. Some people in the home are supported to look after and take their medicines themselves and there are risk assessments for this. Records must indicate the amount of medication each time any is given to the person to look after to help keep account of all the medicines in the home. For the rest of the residents two members of staff are involved as a check when medicines are administered. We discussed safe practices for the process of administering medicines and how important it is to arrange to take the medicines directly from the labelled pharmacy container adjacent to the person and make an immediate check with the medicine chart. The person actually seeing the medicine taken must sign the medicine chart immediately. The home needs to risk assess their medicine administration practice and introduce changes to make this safer as people are at risk of receiving the wrong medication. The manager recently sent a report to us because this happened. The report was disappointing as it attributed the cause as ‘human error’ and there was no follow up action included to reduce the risk of a similar occurrence. The poor records and administration practices we found at this inspection mean that the manager should have been more aware of the risks of error and already taken action to reduce this before another incident occurs. Safe storage is provided for medicines. In the medicine cupboards we found tablets and capsules loose in the plastic trays or in unlabelled medicine pots. This is poor practice. Generally we found that staff do not write opening dates on containers when medicines are first opened to use. This helps to make sure that medicines are used within the recommended shelf life and provides a system to make audit checks that the amounts of medicines in stock agree with the records. There was no opening date on a container of eye drops that was in use. This is needed, as eye drop containers must be changed every 28 days to reduce the risk of infection to the person using them. We also found a box of tablets that had an expiry date of August 2007. Records indicate that these are not used at present and staff confirmed this. There were no controlled medicines used at the time of the inspection but they had been used a few weeks ago. There have been some recent changes to the Misuse of Drugs Regulations which means that in future should any of this class of medication be used storage in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973 must be provided in order to comply with the law. DS0000024691.V351636.R01.S.doc Version 5.2 Page 20 DS0000024691.V351636.R01.S.doc Version 5.2 Page 21 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. There is guidance for staff about what to do if they think someone is being harmed. Staff have not been trained in this, so may not always do what is best to safeguard the people living in the home. EVIDENCE: The home had a complaints policy and people living in the home said they would talk to staff if they had a concern. All but one said they knew about the complaints procedure. 6 out of 9 relatives said they knew about the complaints procedure. We saw a record of complaints, which sometimes, but not always, included the action taken as a result of the complaint. This means there is not always evidence that concerns have been taken seriously and acted upon. 2 relatives responded to our survey and one said they knew how to complain, the other said they had no need to complain. The home has suitable written guidance for staff to follow in case of suspected abuse. No staff have had training in safeguarding adults since the last inspection, when it was a requirement. The manager said the local safeguarding coordinator had required a group of 15 staff to do training and they did not have this many staff. No alternative arrangements had been made for this training. The continued lack of training for staff increases the risk of people living in the home being mistreated. DS0000024691.V351636.R01.S.doc Version 5.2 Page 22 DS0000024691.V351636.R01.S.doc Version 5.2 Page 23 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, 25, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is reasonably well maintained and has a range of shared spaces. Its facilities are not up to modern expectations, for example there are no ensuite rooms and some are still shared. The home’s approach to controlling hygiene is not careful enough to protect the health of people living in the home. EVIDENCE: We toured the building and saw some bedrooms and all shared areas of the home. Generally the home was reasonably well maintained. Its 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. DS0000024691.V351636.R01.S.doc Version 5.2 Page 24 As yet 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 in there. The smoking room used to have an extractor but it had broken, so the room was very smoky. This needs to be repaired as soon as possible to make it bearable for people using this room. There were 3 shared bedrooms. These had 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 and infection control is a concern. 4 staff had not done food hygiene training and care staff were preparing food. No staff had done infection control training. There was no dishwasher and people living in the home were hand washing their plates and cutlery, then drying them with cloths. There are some obvious hygiene concerns associated with these practices. DS0000024691.V351636.R01.S.doc Version 5.2 Page 25 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 do not get enough training to be confident of giving good quality care to people living in the home. The home does not carry out thorough checks on staff before they start work in the home. This increases the risk of unsuitable people working with the residents. EVIDENCE: 2 of the 8 care staff held the required NVQ (National Vocational Qualification) in care. A further 3 staff were working towards it. Progress has been slow in reaching the national minimum target, which was for 50 staff to hold this NVQ; this should have been achieved by 2005. Such qualifications help to ensure that all care staff have a basic understanding of current good practice when working with residents. DS0000024691.V351636.R01.S.doc Version 5.2 Page 26 One relative commented on the good quality of emotional support given to people living in the home, particularly during illness or hospitalisation. People living in the home mainly said they liked the staff. There was some feeling that staff could be doing more with them. One person said they regarded the staff as their friends. Relatives commented that “They really care” and “I feel they do a wonderful job”. Staff levels in the home are low, with only 2 care staff on duty for most shifts. Extra shifts were sometimes arranged for special events or outings. However a general level of 2 care staff did not enable a flexible approach to the wishes of people living in the home; if they needed staff support with an activity outside the home, it would have to be planned in advance. A relative commented that staff did not seem to be available to accompany their relative out of the home. The home was still not taking enough care to carry out proper pre-employment checks on staff before they began work in the home. We found some staff who had begun work in 2007, where the home had no record of their employment history. References provided were inadequate; one had been provided via a mobile phone number, another was undated, unaddressed and headed “to whom it may concern”. Thorough recruitment checks are a legal requirement and help to protect people living in the home from unsuitable staff. We made a requirement for these checks to be done as long ago as March 2006, but practices in the home remain unsatisfactory. Staff training remains a concern. Training records seen were out of date and were not organised in a way that enabled the manager to see what training was lacking. It was presented as individual lists for each staff member, rather than as a training matrix. The acting manager, on request, provided a list of further training that had been done since the previous list was compiled. These records showed that induction training was not being done. The acting manager said they were not able to access a suitable course. The records showed that, of the 9 staff (care staff and acting manager), • 2 had done training relating to prevention of aggression / personal protection, one of these in 1999; • none had done infection control training; • 1 had recognised training in mental health; • 3 had done training in protection of vulnerable adults; • 5 had done food hygiene training within the past 3 years; • 3 had up to date First Aid training. These aspects were identified as necessary training to provide a reasonable service to people living at Aston House, and a requirement was made at the last inspection in October 2006 (following on from one made in March 2006) for this training to be done. It was disappointing that so little progress had been made. DS0000024691.V351636.R01.S.doc Version 5.2 Page 27 We were told that the registered provider normally does the staff mental health training, and that it takes “a couple of hours”. This is insufficient to give staff any basic understanding of mental health issues, and of how best to work with the people who live at Aston House. DS0000024691.V351636.R01.S.doc Version 5.2 Page 28 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, 38, 39, 41, 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 have a registered manager. The home does not 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. EVIDENCE: The home’s registered manager resigned in January 2007, and since then an acting manager has been in post. Staff and people living in the home liked the acting manager and he was seen relating positively and sensitively with people living in the home. DS0000024691.V351636.R01.S.doc Version 5.2 Page 29 We found at this inspection that the acting manager had “inherited” a large amount of improvement work needing to be done to bring the home up to minimum standards. It was disappointing that little had been done since the last inspection to address these improvements and there was little focus on what was needed from the manager or the provider in order to improve the service for the people who live there. Comments from professionals included concerns that the management culture at the home had over recent years not always valued the use of best practice, and discussions with the provider about the service had not always been easy. The home’s quality assurance system had 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. Health and safety was reasonably well managed in some areas and some improvements had been put in place, e.g. fire drills and electrical safety checks. In other instances there was evidence of risks not being well managed, e.g. for first aid, infection control, gas, window restrictors and Legionella there were no written risk assessments. Thorough risk assessments are a legal requirement and we required the home to have these in place by the end of 2006. There was evidence of some poor practice on the day, e.g. some fire doors were wedged open (which were not part of the fire risk assessment); an upstairs window in the staff sleep-in room was wide open and people living in the home had access to this. Practices such as these put the people living in the home at increased risk of harm, for example from fire, or from deliberate or accidental falls. Food hygiene was not well managed. The home’s risk assessment for food hygiene stated “All staff to attend a food hygiene course”. Care staff did the cooking and 3 had not done food hygiene training. No staff had done infection control training. People living in the home hand washed their own plates and cutlery and dried them with cloths. These practices cause a risk of infection to people living in the home. Only 3 staff had up to date First Aid training and there were often shifts where no staff had first aid training. This increases the risk to people living in the home should they have an accident or fall ill. First Aid training was also required at the previous inspection in 2006. DS0000024691.V351636.R01.S.doc Version 5.2 Page 30 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 1 3 X 4 X 5 2 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 2 25 2 26 X 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 4 1 1 1 X X 2 X DS0000024691.V351636.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Please note that requirements have been revised to focus on those most likely to lead to enforcement action. 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 YA2 Regulation 14(1) Requirement You must ensure that, for each person in the home where needs assessments were found to be lacking, you obtain a full assessment of his or her needs by a competent person. This is to ensure you know exactly what care is needed by each person. 2 YA13 16 (2) (m) and (n) You must consult service users about their social interests, and make arrangements to enable them to engage in local, social, recreational, training and community activities. This is to ensure people can follow their chosen lifestyle as far as possible. 3 YA17 17 Records of food provided must include any special diets prepared for individual service users. This is to help ensure that suitable healthy diets are DS0000024691.V351636.R01.S.doc Version 5.2 Page 32 Timescale for action 31/05/08 31/05/08 31/05/08 provided as needed. (Previous timescale of 31/12/06 not met) 4 YA17 16(2)(i) You must provide a choice of 31/05/08 nutritious and appetising food (which meets the recorded needs and preferences of each individual) in quantities that the people living in the home want, at times when they want it. This is to ensure that people living in the home benefit from a healthy diet and have the ordinary pleasure of enjoying their food. 5 YA20 13(2) You must always keep complete 19/12/07 and accurate records of all medicines received, administered and leaving the home or disposed of. This will help to make sure residents receive the correct medication. Included in a letter for urgent action dated 06/12/07. You must carry out a proper risk assessment for the administration of medicines and always follow safe practices when medication is administered to people living in the home and whilst people are away from the home. This will help to make sure residents receive the correct medication. Included in a letter for urgent action dated 06/12/07. You must make effective arrangements to make sure that all medicines are used only within the shelf life stipulated by the manufacturer or in accordance with good practice DS0000024691.V351636.R01.S.doc 6 YA20 13(2) 19/12/07 7 YA20 13(2) 19/12/07 Version 5.2 Page 33 guidelines. This is to reduce the risk to residents of using medicines that are contaminated or of the wrong potency. Included in a letter for urgent action dated 06/12/07. 8 YA23 13(6) You must make arrangements to prevent service users being harmed or suffering abuse, or being placed at risk of harm or abuse. Specifically, you need to ensure that all staff receive training in Safeguarding Adults. A system must be put in place to ensure that no staff are employed in the home until all the information required in schedule 2 of the Care Homes Regulations 2001 has been obtained. This is to help protect people living in the home from unsuitable staff. 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. 11 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. 30/06/08 30/06/08 9 YA34 19 31/05/08 10 YA35 18 (1) (c) 30/06/08 DS0000024691.V351636.R01.S.doc Version 5.2 Page 34 12 YA42 13 (4) (a) and (c) You must ensure that all unnecessary risks to people living in the home are identified and so far as possible eliminated. A risk assessment must be undertaken to identify the level of First Aid cover necessary to ensure that people living in the home can receive appropriate treatment in case of accident from a trained person. Sufficient staff must be trained to provide this level of cover. 31/05/08 13 YA42 13(4) 31/05/08 14 YA42 13(3) Necessary steps must be taken 30/06/08 to maintain good hygiene levels in the home. Staff preparing food and working on cleaning and personal care tasks need to be trained in food hygiene and infection control. This is to protect people living in the home from infections. 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. DS0000024691.V351636.R01.S.doc Version 5.2 Page 35 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. 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. 4 YA7 Accounts of service users’ finances, where the registered provider is their appointee, should be independently audited. (Repeated from March 2006 and October 2006) 5 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. 6 YA9 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. The home should consider alternatives to serving meals ready-plated, to allow for more service user choice. (Repeated from October 2006) 7 YA17 8 YA20 Make arrangements so there is clear written guidance to staff on how to reach decisions for all those medicines prescribed to be administered “when required”. A record must also be made of how staff have reached the decision to administer in accordance with the provisions of the Mental Capacity Act 2005. Care plans should reflect what choices people who live in DS0000024691.V351636.R01.S.doc Version 5.2 Page 36 9 YA20 the home are given about how their medicines are administered and their consent to the way in which staff handle their medicines. Where consent is not possible because of lacking capacity records must be made of the agreement that the way in which medicines are administered is in the best interests of that particular person in accordance with the provisions of the Mental Capacity Act 2005. 10 YA20 Keep a record when any medication is given to any resident to look after themselves so that there is a complete audit trail of medicines in the home. When there are handwritten entries on medicine charts make sure these are signed and dated by the member of staff writing this with a second member of staff checking and signing as correct. This is to help make sure records are copied accurately. Review and update the approved lists of homely remedy medicines so as to make sure that all these medicines are suitable for each person currently living in the home. Write the date on all containers of medicines when they are first opened to use to help with good stock rotation and allow audit checks that the right amount of medicines are in stock. Provide storage arrangements for controlled drugs that 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. 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. You should continue to increase the number of staff with a NVQ (National Vocational Qualification) in care. The registered provider should appoint a manager who has the necessary skills and experience to make the required improvements to the home, some of which have been outstanding for up to 2 years now. The new manager should apply for registration without any delay. DS0000024691.V351636.R01.S.doc Version 5.2 Page 37 11 YA20 12 YA20 13 YA20 14 YA20 15 YA22 16 17 YA32 YA37 18 YA38 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. The home should develop a more meaningful quality assurance process, to support an effective AQAA (Annual Quality Assurance Assessment) and development plan. This will help ensure that the registered persons evaluate the service provided to people living in the home and work to continually improve it. 19 YA39 DS0000024691.V351636.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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 DS0000024691.V351636.R01.S.doc Version 5.2 Page 39 - 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. 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