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Inspection on 23/07/07 for Aston House Care Home

Also see our care home review for Aston House Care Home for more information

This inspection was carried out on 23rd July 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Prospective residents are assessed prior to admission. Staff care for residents in a caring and professional manner, respecting their privacy and dignity. Information regarding advocacy services is available. The home has an open visiting policy and visiting is encouraged. The food provision is good with choices available to meet the preferences of the residents. Systems are in place for quality assurance and monthly audits of the home take place. Residents personal monies held on their behalf by the home are being well managed. There are good procedures in place for the management of health & safety in the home.

What has improved since the last inspection?

The Manager Designate has been in post for 3 months and is very aware of the work necessary to bring the home back to a good standard. He has already started implementing change to address this. Some improvement in medication management has been noted, however shortfalls identified could place residents at risk. The laundry service and care of personal clothing has improved. The Manager Designate is very aware of the importance of respecting residents` wishes with regard to retiring to bed and is working with staff to address this in full. New kitchen and cleaning equipment has been provided and better systems are in place to repair or replace any faulty equipment promptly. Complaints and POVA issues are being appropriately managed with correct procedures being followed. Flooring has been replaced in several areas of the home, with plans to replace more bedroom carpets. This has gone some way to improve the malodours in the home, however more work is required in this area. Staffing has been reviewed to ensure the needs of the residents can be met at all times. There has been an improvement in the function of the call bell system and any new parts required are ordered for replacement.

What the care home could do better:

Shortfalls in the formulation of the care plans and associated documentation were identified and staff must ensure all documentation is completed in full. Some shortfalls have been identified in the management of medications. Residents and representatives` wishes in respect of end of life care are still not being fully recorded. The activity provision in the home needs to improve and daily activities provided to meet the interests and abilities of the residents. Although there has been some improvement in the environment, several shortfalls were again identified and sufficient financial investment needs to be made by Southern Cross Healthcare in order to bring the home up to a good environmental standard and maintain this thereafter. Some shortfalls were identified in the staff employment records viewed. Issues were identified in respect of Southern Cross Healthcare Services Limited Management moving the Manager Designate out of the home on a regular basis in order to assist with various matters at other homes, for example, complaints investigations and management cover. The Manager Designate must work full time at Aston House in order to initiate, implement and oversee the improvements necessary to bring the home up to a good standard throughout.

CARE HOMES FOR OLDER PEOPLE Aston House Care Home Angel Lane Hayes Middlesex UB3 2QX Lead Inspector Clare Henderson-Roe Key Unannounced Inspection 11:15 23rd & 24th July 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aston House Care Home Address Angel Lane Hayes Middlesex UB3 2QX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8569 1499 020 8569 1488 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Acting Manager Care Home 48 Category(ies) of Dementia - over 65 years of age (0), Learning registration, with number disability over 65 years of age (0), Mental of places disorder, excluding learning disability or dementia (1) Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To Comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. As agreed on 26th July 2006, one named service user under the age of 65 years, with a mental disorder, can be accommodated. The CSCI must be informed if this service user no longer resides at the home. 29th January 2007 Date of last inspection Brief Description of the Service: Aston House is a purpose built establishment situated in a residential area of Hayes. It is registered for 48 service users who are accommodated on the ground and first floors of a three-storey building. Thirty-two of the bedrooms are single and 8 are double and most have en suite facilities. There are two communal rooms on both the ground and first floors, with an additional quiet room with snoozelen equipment on the first floor. An activities room has been created on the second floor. There is an enclosed garden to the rear of the home with garden furniture and room for those in wheelchairs to sit out. The home is easily accessible by public transport. The current fees paid range from £578 - £813 per week. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 22 hours was spent on the inspection process. The Inspectors carried out a tour of the home, and service user plans, medication records, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. 10 residents, 8 staff and 6 visitors were spoken with as part of the inspection process. The CSCI Annual Quality Assurance Assessment document completed by the home has been used to inform this report. CSCI comment cards were sent to the home and the Manager Designate has given some to relatives, however none have been received by CSCI and therefore comments cannot be reflected in this report. What the service does well: What has improved since the last inspection? The Manager Designate has been in post for 3 months and is very aware of the work necessary to bring the home back to a good standard. He has already started implementing change to address this. Some improvement in medication management has been noted, however shortfalls identified could place residents at risk. The laundry service and care of personal clothing has improved. The Manager Designate is very aware of the importance of respecting residents’ wishes with regard to retiring to bed and is working with staff to address this in full. New kitchen and cleaning equipment has been provided and better systems are in place to repair or replace any faulty equipment promptly. Complaints and POVA issues are being appropriately managed with correct procedures being followed. Flooring has been replaced in several areas of the home, with plans to replace more bedroom carpets. This has gone some way to improve the malodours in the home, however more work is required in this area. Staffing has been reviewed to ensure the needs of the residents can be met at all times. There has been an improvement in the function of the call bell system and any new parts required are ordered for replacement. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information regarding prospective residents is obtained prior to admission so that the home can ascertain if they are able to meet their needs. EVIDENCE: The Manager Designate completes a referral form for all referrals of prospective residents. This is comprehensive and provides background information for staff to then carry out a pre-admission assessment, for which the home has comprehensive document in place. Four service user plans were viewed and one pre-admission assessment viewed was incomplete. Other preadmission assessments viewed had been fully completed. The importance of ensuring the document is completed in full was discussed with the Manager Designate. Copies of Social Services needs led assessments had been obtained, and these gave the home a good picture of the needs of the prospective residents. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plan documentation is not always completed in full, thus the staff are not provided with a complete picture of each resident and their needs. Although medications are generally being managed, shortfalls in administration and recording place residents at risk. Staff care for residents in a gentle and professional manner, respecting peoples privacy and dignity. Shortfalls in identifying end of life care needs place residents at risk of not having there needs fully met. EVIDENCE: The Inspectors viewed 4 service user plans. Some of the admission information was incomplete and documents had not always been signed and dated. From discussions with representatives it was clear that they had not always been involved in the formulation or review of the service user plans, thus important personal information had not always been included, for example, when representatives wish to be contacted if there is a significant change in the residents’ condition. There was evidence of staff reviewing the service user plans monthly. Risk assessments for falls were in place. For one resident this Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 10 had not been updated following a fall. A full update had been done for another resident who had experienced a fall. None of the residents had pressure sores at the time of inspection. Risk assessments for pressure sore risk were in place and where someone was identified as being at risk a care plan for skin integrity was also in place. Pressure relieving equipment was seen in use in the home. Continence assessments had been carried out and care plans for continence care needs formulated. Nutritional assessments had been carried out, however for one resident who had experienced weight loss, it was not clear what action had been taken to address this finding, plus monthly weights had not always been recorded. Moving & handling assessments had been carried out and the specific equipment to be used had been identified. Some of the assessment documentation was incomplete. The need for all documentation to be completed and for any significant findings such as weight loss to be appropriately addressed was discussed with the Manager Designate. There was evidence of input from healthcare professionals. One Inspector viewed the medication management for the home. A list of registered nurse signatures and initials was available. Medications were being securely stored and room and fridge temperatures were within safe range. Liquid medications had been dated when opened. Correct lancets were being used to monitor blood glucose levels. On the ground floor some gaps in signing for the administration of medications were found. For 2 residents there was a discrepancy in the prescribing and administration of one medication and the Manager Designate said that this would be appropriately reported and investigated. No shortfalls were found with the medication management on the first floor. Staff were seen caring for residents in an gentle and professional manner. Residents’ personal clothing is labelled and the Manager Designate has increased the personnel in the laundry to provide a better service. The day rooms were being supervised by staff, who were seen chatting with residents. Where appropriate to do so, relatives are encouraged to bring in items to personalise the bedrooms. Staff refer to residents by their preferred term of address. The Manager Designate said that he has made it very clear to staff that residents should go to bed when they wish, and not for the convenience of the staff. One relative did raise this as an issue and the Manager Designate said he would follow this up again. Information regarding the wishes of residents and their representatives in respect of end of life care is still not being recorded in all instances in the service user plans. Whilst it is accepted this is a sensitive topic to discuss, it is important to gain as clear a picture as is possible regarding this, so that their wishes are identified and can be respected. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an activities co-ordinator, however more work is needed to ensure activities are provided on an ongoing basis to meet the needs and interests of the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring residents right to independent representation is respected. The food provision in the home is good, offering variety and choice, thus meeting the resident’s individual needs. EVIDENCE: The home has a full time activities co-ordinator. Since the last inspection some of the ‘life history’ books have been completed by the residents’ key workers and one viewed was very comprehensive and evidenced involvement from the residents’ relatives to gain the information. More work is to be done to complete these for all the residents. Care plans for social activities were quite general and need to be individualised. The activities co-ordinator is the trainer for the ‘yesterday, today and tomorrow’ dementia care training at the home and is the facilitator for activities. The home does have an activities programme, and on the second day of inspection staff some activities were taking place. The importance of ensuring activities do take place on a daily Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 12 basis was discussed with the Manager Designate. The activities co-ordinator said that plans are in place to provide individual ‘rummage’ boxes for each resident and to provide a sensory area in the garden. He also said that he is aiming to reassess all residents in relation to activity provision. Action needs to take place promptly so that the activities provision can be reviewed to provide activities to meet the needs and abilities of the residents. The home has an open visiting policy and visiting is encouraged. Overall the visitors spoken with said that they are made welcome at the home. Information for ‘Care Aware’ advocacy services, which mainly offers financial advice, was available in the home. Hillingdon has withdrawn funding for the advocacy service that used to visit the home regularly. Contacting appropriate organisations such as the Alzheimer’s Society to enquire about the provision of advocacy services was discussed with the Manager Designate, who said he would look into this. One Inspector viewed the kitchen, which was clean and tidy. Kitchen records were up to date. Where needed kitchen equipment had been replaced since the last inspection. A new catering system has been introduced with the emphasis on providing freshly prepared and cooked meals to meet the nutritional needs of the residents. The chef said that he is working well with introducing this system and providing the choices offered on the menu each day. One change is the provision of a second cooked meal in the evening and the chef said that he is working on providing both cooked options for the evening meal as well as the lunchtime meal. ‘Snack boxes’ are also available with various food items that residents can snack on between meals. This was discussed with the Manager Designate and the chef and initial issues with the actual foodstuffs being provided have been looked into, with action taken to ensure appropriate foods in moderate amounts are provided, and stocks are available in the cupboards or fridges to top up the boxes. Staff were seen assisting residents with their meals as required, and were doing so in an gentle and patient manner. During the inspection some discussion was had with relatives who would like to assist their loved ones in choosing their menu choices for the week and the Manager Designate said he would ensure this was facilitated. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place for the management of complaints and adult protection issues, and these are followed, thus safeguarding the residents. EVIDENCE: The home has a complaints procedure with timescales for completion. At the time of inspection 4 relatives spoke with the Inspectors in the presence of the Manager Designate. Two had particular areas of concern and the Manager Designate undertook to look into these and report back promptly. The importance of using the homes complaints procedure and also of being aware of the Hillingdon complaints procedures for residents funded by Hillingdon Social Services and/or Primary Care Trust was discussed with the relatives concerned. The home had received 3 complaints since the last inspection plus one from 2006 had been revisited and finalised. Clear documentation was available to evidence that each complaint had been fully investigated and responded to. The home has POVA procedures in place and also follows the Hillingdon Safeguarding Adults procedures. Staff had received POVA training and those spoken with were aware to report any concerns of this nature. There had been one POVA referral since the last inspection that has been investigated and is being managed by the Hillingdon Safeguarding Adults Officer. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is evidence of some work having been done on the environment, however shortfalls are still being identified and thus the home does not provide a good standard of accommodation for residents to live in. Some improvements have been made with the management of odours with more work to be done in this area to provide residents with a pleasant environment to live in. EVIDENCE: The Inspectors carried out a tour of the home and viewed the external areas also. The flowerbeds to the front of the home were overgrown with weeds and all areas of the garden needed attention. The paintwork on the external of the building was peeling off and overall the outside of the premises looks shabby and in need of redecoration. Some hanging baskets did provide a splash of colour, however this did not overcome the poor appearance overall. Work has been done to decorate the paint bedroom doors and provide door furniture in Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 15 line with current dementia research. The maintenance man maintains a list of all areas that have been redecorated with dates of completion. Flooring had been replaced in the dining and sitting rooms, plus one bedroom. The ground floor corridor had been re-carpeted. Further flooring replacement is planned for 3 bedrooms. The importance of using flooring throughout the building that is appropriate for the needs of the residents was discussed. Where necessary, alternatives to carpet should be considered to assist with odour control, and the Manager Designate had considered this fact. Divan beds were seen in several of the bedrooms, and these are old and in some instances damaged by the bed rails. New bedrails had been obtained in line with health & safety. The bed linen was, in some cases, of poor quality. The Manager Designate said that he had already identified this and had ordered a stock of new bed linen and towels. The provision of duvets for those that wish was also discussed, as the majority of rooms viewed had sheets and a blanket on the bed. The Manager Designate said that there was no problem in providing duvets for those who preferred them. Several of the armchairs look worn and it was also commented upon that chairs are odorous due to urine staining. In the shower room on the first floor the shower door was broken and there was standing water on the floor. There is still a lot of redecoration and refurbishment work to take place, and the Manager Designate has an action plan to address this, however funding has to be approved by Southern Cross Healthcare Services Limited. They must ensure that adequate funds are provided in the short term to bring the home back to a good environmental standard and then in the long term to maintain this standard. This issue has been raised in several past reports and also discussed with the Responsible Individual for the home, and delays in addressing the environmental shortfalls in full give cause for concern. The laundry was clean and tidy. Personal clothing items viewed were labelled. There are two washing machines and these have sluice programmes for infection control. There are also two tumble dryers and ironing equipment. Protective clothing to include gloves and aprons were available in the home. The inspectors noted malodours in places and the cleaning staff work hard to manage these, however replacement of some furnishings and floorings will aid with odour control in the home. The fridge in the kitchenette on the first floor was in need of cleaning and some items were not being appropriately stored. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are kept under ongoing review, thus ensuring appropriate numbers of staff are on duty to meet the needs of the residents. Training provision is good, thus providing staff with the skills and knowledge to care effectively for the residents. Systems are in place for the vetting and recruitment of staff, however shortfalls identified could place residents at risk. EVIDENCE: On the first day of inspection the home was understaffed due to short notice sickness. The Manager Designate said that he had reviewed the staffing and had recruited to vacant posts, is building up the numbers of ‘bank’ workers, plus he is very aware to maintain the staffing levels to meet the needs of residents at all times. Overall the comments received at the time of inspection were that the staffing levels had been better and this had meant that supervision in the communal areas had improved. A key worker system has been introduced and it was clear that key workers are beginning to fulfil their roles, for example, identifying any items such as clothing and toiletries that their residents require and making suitable arrangements for these to be purchased. The laundry is better staffed and as a result laundry care has improved. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 17 The Manager Designate reported that 10 care staff are qualified to NVQ in care level 2 or the equivalent and one is completing this qualification. 10 staff are doing NVQ 2 in customer care. The domestic staff had undertaken NVQ in housekeeping and infection control. Two staff are commencing NVQ 2 in Health & Safety. Three sets of staff employment records were viewed. For one member of staff a reference had not been obtained from their most recent employer and no explanation for this had been given. This reference was sent for on the second day of inspection. For another member of staff a POVA First check had been carried out but the Criminal Records Bureau (CRB) check was not available. This was investigated and a further application was submitted. The member of staff was clear that they must work with a chaperone until the CRB check is completed. Application forms, healthcare questionnaires, photographs, job descriptions and contracts with hours of work were available on the files. Southern Cross Healthcare Services Limited has an induction programme based on the Skills for Care core standards. There was evidence that training in topics relevant to the specific diagnoses and needs of the residents had taken place. This included The Alzheimer’s Society ‘Yesterday, Today and Tomorrow’ training and also ‘Person Centred Approach’ training. The Manager Designate said that the training has helped staff to understand the needs of the residents better, and that some progress is being made putting the learning into practice, with further work to be done in this area. Staff spoken with said that they had received training and felt this had given them a better understanding of the residents needs. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager Designate has the experience to manage the home, and is open and approachable, however problems with the availability of the Manager Designate at the home are to the detriment of the effective management of the home. Good systems for quality assurance are in place, thus providing an ongoing process of management and practice review. Monies held on behalf of residents are being well managed and securely stored, thus safeguarding them. Systems for the management of health and safety throughout the home are good, however shortfalls in health & safety training could place residents, staff and visitors at risk. EVIDENCE: The Manager Designate has a diploma in Management Studies and has completed the Registered Managers Award, NVQ level 4. The Manager Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 19 Designate had several years of management experience. There is a registered nurse who is the clinical lead for nursing in the home. Staff spoken with said that the Manager Designate is open and approachable. CSCI experienced problems contacting the Manager Designate prior to the inspection and it was identified that Southern Cross Healthcare Services Limited management had sent him to other homes to assist, for example with complaints investigations and management cover. Aston House has been without a permanent manager for some years and this has been to the detriment of the home. The need to ensure the Manager Designate is working full time at Aston House in order to instigate, implement and oversee the improvements necessary to bring the home up to a good standard has been discussed with the Regional Manager. Southern Cross Healthcare Services Limited has a quality assurance system in place for each home. There is a monthly Managers audit that covers all aspects of the home and the Regional Manager does a validation audit every 2 months from which an action plan is produced. The audits show the home has been making steady progress over the past few months. The Manager designate said that there are staff meetings for carers, senior carers, registered nurses, kitchen staff and housekeeping staff and minutes are taken of each meeting, samples of which were viewed. The administrator reported that she is no longer an appointee for any of the residents. The home does manage some personal monies on behalf of residents, and has a ‘residents account’ into which these monies are paid. The records for 3 residents were viewed and clear individual records of income and expenditure are maintained. For those with larger amounts of money interest payments calculated and allocated. All receipts are available for all expenditure. The maintenance and servicing records were sampled and those viewed were up to date and clearly recorded. There was evidence of monthly fire drills taking place for day and night staff and the importance of night drills being timed to cause least disturbance to residents was discussed. Some of the call bells had been identified as ‘faulty’ however the maintenance man explained that this did not mean the actual unit did not function but that an element was awaiting replacement, for example, part of the call bell lead. Risk assessments for safe working practices and laundry equipment were in place. Good practice notices were seen in the laundry. Some gaps were noted in the health & safety training and this is a repeat finding. The Manager Designate is aware of the need for all staff to undergo health & safety training to include updates at the required intervals. Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 17 Requirement Service user plan documentation must be completed in full to provide all necessary information in respect of the individual. Risk assessments for falls must be updated following each fall. Previous timescale of 01/03/07 not met. Unless it is impracticable to do so, input from service users and their representatives must be sought in the formulation and review of the service user plans. Previous timescale of 01/04/07 not met. All assessment documentation must be complete and up to date to give a clear picture of each residents’ condition. Weight loss must be reported and appropriate action taken to address this in order to maintain the residents nutritional status. Medications must be accurately recorded when administered. Previous timescale of 12/02/07 not met. Medications must be administered in accordance with DS0000010924.V337927.R01.S.doc Timescale for action 01/09/07 2. OP7 17 01/08/07 3. OP7 15(2)(c) 01/09/07 4. OP8 17 01/09/07 5. OP8 17 01/09/07 6. OP9 13(2) 24/07/07 7. OP9 13(2) 24/07/07 Aston House Care Home Version 5.2 Page 22 8. OP11 12 9. 10. OP12 OP12 16(2)(m) &(n) 16(2)(m) &(n) 11. OP19 23(2)(b) (d) 12. 13. 14. 15. OP26 OP29 OP31 OP38 13(3) 19 Schedule 2 10, 12 13(4)18 the prescribed dosage. Information regarding service users wishes in the event of deterioration in their health, plus their care in their final days must be ascertained and recorded. Previous timescale of 01/04/07 not met. Care plans for activities and interests must be personalised and completed for each resident. The activities programme must reflect the assessed interests and abilities of the residents and staffing must be appropriate for the activities programme to be carried out on a daily basis. There must be adequate financial investment in the home for all environmental shortfalls to be addressed. An action plan to evidence this must be forwarded to CSCI. Additional action must be taken for the effective management of malodours. Staff employment records must contain all required information to safeguard residents. The home must be being effectively managed at all times. There must be evidence that all staff have received training and updates in all aspects of health & safety at the required intervals. Previous timescale of 01/04/07 not met. 01/09/07 01/09/07 01/09/07 01/09/07 01/09/07 17/08/07 24/07/07 01/10/07 Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 23 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 OP3 Good Practice Recommendations That the homes pre-admission assessment be completed in full for all prospective residents assessed so it can be viewed in conjunction with the Social Services assessment when ascertaining if the home are able to meet their needs. All entries on service user documentation should be signed and dated. 2. OP7 Aston House Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Care Home DS0000010924.V337927.R01.S.doc Version 5.2 Page 25 - 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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