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Inspection on 26/06/06 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 26th June 2006.

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

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

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

The home is being well managed and there is good communication between the Manager Designate and the staff. Service users are comprehensively assessed prior to admission to ascertain if the home can meet their needs. The home has an open visiting policy and overall visitors spoken with said they are made welcome at the home. Service users appeared to enjoy the food provision and work is being carried out to review menus and record service users choices. The home has regular input from advocacy services. Complaints are being well managed. There have been no adult protection issues in the home. Staff employment records are in good order. Service users personal finances are managed and clear records kept.

What has improved since the last inspection?

Infection control procedures have improved. Systems for quality assurance are in place and there is ongoing monitoring carried out at the home. Staff supervision sessions are taking place and staff have received training in this area.

What the care home could do better:

Staff need to ensure that service user plans are in place promptly after admission, and thereafter updated regularly so that all areas are up to date and accurate. This area should be easy to address. Although there has been some improvement in the management of medications since the last inspection, more attention to detail is needed, particularly on the ground floor. There has been an ongoing issue with the lack of activities provision, and with the new activities co-ordinator in place, work must be done to ensure that the service users interests and needs in this area are identified and appropriately met. The environment on the ground floor and areas of the first floor needs work, and some areas are institutional in appearance. Suitable replacement flooring in areas is necessary as carpets are old, worn, and in some casesmalodorous. The night staffing provision needs to be reviewed to ensure there are enough staff on duty to meet the increasing needs of the service users and minimise the risk of accidents. Shortfalls in NVQ in care and other aspects of training for staff have been ongoing issues and action must be taken to address this in a robust manner to ensure that staff are provided with the training and skills to meet the needs of the service users at all times. Health and safety issues to include shortfalls in the fire risk assessment findings and requirements in the Environmental Health Inspection report need to be addressed as a matter of priority. It is clear that financial investment is required in several areas in order to bring the home up to a good standard.

CARE HOMES FOR OLDER PEOPLE Aston House Care Home Angel Lane Hayes Middlesex UB3 2QX Lead Inspector Clare Henderson-Roe Key Unannounced Inspection 10:30 26 & 27th June 2006 th 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.V294244.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 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 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) of places Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 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. One service user under the age of 65 may be accommodated at the home as agreed by the NCSC on 20.01.04. This applies to one specific user and is not transferable. One service user, date of birth 22nd December 1946, can be accommodated at the home, as agreed on the 14th July 2004. One service user, date of birth 1st November 1947, can be accommodated at the home, as agreed with the previous registering authority. 15th December 2005 3. 4. Date of last inspection Brief Description of the Service: Aston House is a modern 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, and an additional small lounge on the ground floor not currently in use. 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. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 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 17 hours was spent on the inspection process. The Inspector carried out a tour of the home, and service user plans, medication records, staff records, financial records, management records, administration records, maintenance and servicing records were viewed. 8 service users, 8 staff and 7 visitors were spoken with as part of the inspection process. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. What the service does well: What has improved since the last inspection? What they could do better: Staff need to ensure that service user plans are in place promptly after admission, and thereafter updated regularly so that all areas are up to date and accurate. This area should be easy to address. Although there has been some improvement in the management of medications since the last inspection, more attention to detail is needed, particularly on the ground floor. There has been an ongoing issue with the lack of activities provision, and with the new activities co-ordinator in place, work must be done to ensure that the service users interests and needs in this area are identified and appropriately met. The environment on the ground floor and areas of the first floor needs work, and some areas are institutional in appearance. Suitable replacement flooring in areas is necessary as carpets are old, worn, and in some cases Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 6 malodorous. The night staffing provision needs to be reviewed to ensure there are enough staff on duty to meet the increasing needs of the service users and minimise the risk of accidents. Shortfalls in NVQ in care and other aspects of training for staff have been ongoing issues and action must be taken to address this in a robust manner to ensure that staff are provided with the training and skills to meet the needs of the service users at all times. Health and safety issues to include shortfalls in the fire risk assessment findings and requirements in the Environmental Health Inspection report need to be addressed as a matter of priority. It is clear that financial investment is required in several areas in order to bring the home up to a good standard. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 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. Service users are assessed prior to admission, and the information gained is comprehensive, clearly ascertaining that the home is able to meet their assessed needs. EVIDENCE: Pre-admission assessments were viewed on each floor. These were comprehensive and gave a good picture of the service users needs. Copies of Social Services needs led assessments are also obtained to give the home an overall view of the prospective service user and their needs. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans overall were satisfactory thus providing staff with a picture of service users needs. Shortfalls should be easy to address. The medication management is generally satisfactory, however shortfalls have been identified that could potentially place service users at risk. Staff treat service users in a respectful and courteous manner, thus respecting their dignity. However, systems for the return of service users personal laundry are an issue and could potentially compromise this. EVIDENCE: Service user plans were sampled on both floors. The service user plans viewed on the first floor were personalised, comprehensive and up to date, with evidence of monthly updates and new care plans being formulated for any newly identified problems. The service user plans viewed on the ground floor were not always up to date, and some of the information was general and not personalised to the individual. In one instance the service user plan had not been reviewed for two months, although it had been reviewed monthly thereafter. For one service user a change in his condition recorded in the review section had not been updated in the main care plan section. Some of Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 10 the instructions for specialist care were not always being accurately followed. There was evidence of care plans being formulated to reflect new care needs. One of the service user plans viewed on this floor was very comprehensive, personalised and up to date and work needs to be done to ensure all the service user plans are being maintained to a good standard. Risk assessments for falls were in place and a fall had been clearly documented in the care plan, with a body map being completed to identify any injuries. Documentation for wound care to include pressure sore risk assessments, care plans and wound care records was viewed for one service user on the ground floor. There had been a delay in completing some of the documentation, although it had thereafter been kept up to date, and a separate care plan had been formulated for each wound. When a new skin integrity problem had been identified, the documentation had then been promptly completed. Pressure relieving equipment was seen in use in the home, and the Registered Manager completes a weekly dependency audit that clearly identifies the specific pressure relieving equipment in place for each service user. Assessments for moving & handling are in place, and the weekly audit includes the bed in use for each service user. The Registered Manager said that currently the bed provision meets each service users moving & handling needs, and she is working towards replacing beds as the need arises. Continence and nutritional assessments were in place. There is a clear list maintained to identify the GP each service user is registered with. There was evidence of input from healthcare professionals to include the Tissue Viability Nurse, GP, Community Psychiatric Nurse, Chiropodist and Optician. Other services can be accessed on behalf of the service users. The management of medications was viewed for both floors. The home has one clinic room and this was clean and tidy. The room temperature was being maintained below 25° centigrade. The maximum fridge temperature was on occasion exceeding 8° centigrade, although the actual temperature was within safe limits. The need to adjust the setting to address this was discussed. Liquid medications had been dated when opened. Copies of prescriptions were being retained each month. The blood glucose monitoring system in use was not suitable for multi-use, and this was addressed at the time of inspection. A copy of the medications policy is available in the policy manuals. For one service user on a variable dosage medication, the instructions had been clearly written, but the dosage actually given had not always been recorded. The stock control for some medications had not been adequate and some had run out of stock. On the first floor the clear codes had been used for any omitted medications. For one service user on the ground floor an ‘x’ had been used, and this is not one of the codes identified for use on the medication administration record (MAR). Also, there were some gaps in signing where the dose had been administered. There was evidence of regular medication inspections being carried out by the dispensing pharmacy, and some of the shortfalls noted by the Inspector had also been identified at their last visit. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 11 Generally medications are being well managed, and more attention to detail should make these shortfalls easy to address. Staff were seen caring for service users in a gentle and courteous manner. Service users looked well cared for and overall the visitors spoken with expressed their satisfaction with the home. One problem that was identified was an issue with laundered clothing not always being returned, even when labelled with the service users name. The Registered Manager said that she was aware of this problem and had spoken with staff to try and address this. It was noted that there were several items of unlabelled items of service users clothing in the laundry room, and staff need to work together to solve this problem. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities provision in the home is poor, thus service users do not have the opportunity to pursue hobbies and interests and lack motivation in this area. Visiting is encouraged, thus helping service users stay in touch with friends and loved ones. The home has input from Advocacy services, thus providing service users with an independent person to act on their behalf. The food provision is satisfactory and has been reviewed in order to ensure it meets the likes and needs of the service users. EVIDENCE: Since the last inspection an activities co-ordinator had been employed and then left. A new activities co-ordinator is due to start in the near future. The need to get an effective activities programme running so that the service users can participate in events and activities that meet their interests and abilities was discussed. The ‘snoozelen’ or quiet room was in use on the first floor and service users were seen sitting peacefully, supervised by a member of staff. The Registered Manager said that staff are carrying out simple activities with service users, but is aware of the need for the need for an ongoing programme. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 13 The home has an open visiting policy. Several visitors were spoken with and generally staff make them welcome, although refreshments are not always offered, and this was discussed with the Registered Manager. The home is secure and the key pad codes are changed whenever necessary to maintain the building securely. The home has input from the Re-Think advocacy service with an advocate who is very active in the home. The Registered Manager is also looking at another advocacy service specific to financial matters. The menu for the day reflected the meal served. Service users spoken with said that they enjoy the food. The Inspector was present for the lunchtime meal and food presentation to include the liquidised meals was good. Staff were available to assist service users with their meals where required. Sandwiches are prepared for service users to have overnight if they are hungry, plus drinks are also available and staff can access the kitchen. The chef showed the Inspector the proposed new menus with documentation to record the service users’ choices at each meal, and this is to be implemented in the near future. There were records of fridge and freezer temperatures and also preparation and serving temperatures for the hot food, although these needed to be clearly identified on the document in use. Temperature recordings for frozen/fridge deliveries were not available. The chef said that he does check the deliveries, and the temperatures need to be recorded. Cleaning records were not available, and the need for a cleaning schedule and records to be kept was discussed. The kitchen was clean at the time of the inspection, with washing up from the previous meal in progress. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place and these are followed to address any concerns received. Systems were in place for the protection of vulnerable adults, although staff training in this area is required to safeguard service users. EVIDENCE: The home has received one complaint since the last inspection. There is a clear complaints procedure that had been followed in dealing with the complaint. The home had also received several complimentary letters regarding the care of loved ones. The home has adult protection procedures in place and also follows the Hillingdon Safeguarding Adults procedure documentation. There had been no adult protection issues since the last inspection. Several staff had not received adult protection training, and this needs to be addressed. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Redecoration and refurbishment needs have not always been addressed, plus some of malodours were noted. Thus the home does not provide an attractive, homely environment throughout for service users. EVIDENCE: A redecoration and furnishings audit was carried out in March 2006. The home does have a redecoration programme with timescales for completion, but there are several areas that need attention and an update of the programme to include the findings of the homes audit and shortfalls identified at the time of inspection is required. Some of the bedroom doors have been damaged and filler used to repair them. These are fire doors and this needs to be discussed with the London Fire and Emergency Planning Authority in order to ascertain if the doors can be repaired or need replacing to maintain fire safety. The Inspector carried out a tour of the home. The ground floor corridor carpet is very worn and marked, and the corridor walls are in need of redecoration. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 16 This presents a somewhat institutional first impression on entering the home. The first floor does present a more homely environment, and the walls are painted in accordance with dementia research, plus the carpet is newer and in reasonable condition. Some of the armchairs both in communal areas and in service users bedrooms were noted to be worn and in need of replacement. Overall the bathroom, shower and toilet facilities were clean and apart from a few items removed at the time of inspection were not being used as storage areas. Some areas are in need of redecoration and this must be included in the update of the redecoration and refurbishment programme. There is a sluice room with an electronic disinfector on each floor. The Manager Designate carries out regular audits to include the bed provision for each service user in the home. She said that profiling beds are now ordered if a need is identified and that the replacement of the few divan beds still in use in the home is being progressed. The laundry room was clean and tidy. The risk assessments for safe working practices were out of date (see Standard 38). The COSHH safety data sheets for products in use were current, and the Manager Designate said that she would enquire about risk assessments for the laundry equipment, as these were not available in the Southern Cross risk assessments. Protective clothing to include gloves and aprons was available in the home. It was clear that the domestic staff work hard to keep the home clean, but some areas were malodorous due to continence problems, and where this is identified, suitable alternative flooring needs to be put place so that it can be easily kept clean, whilst still providing a homely environment. The carpets in the first lounge on both floors are due for replacement, and in both areas a stale odour was noted. It was clear that much work takes place to shampoo the carpets, however due to the deterioration of the carpets this is no longer effective. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are not always adequate to meet the needs of all service users, and thus service users are placed at risk. Staff have not all received adequate training which could impact on their knowledge and ability to meet the service users needs. Recruitment procedures are robust, thus safeguarding service users. EVIDENCE: At the time of inspection the two floors were being staffed to meet the needs of the service users. In addition to the homes rostered staff they also receive student nurses and supervised placement nurses from a local University. One area of concern raised is the fact that there are only 2 staff working on the ground floor unit at night. The service user group has changed over the years, and nearly all service users accommodated at the home have a diagnosis of dementia, and several require assistance with care from two staff. Some exhibit challenging behaviour at times and all need a level of supervision. The monthly accident audits identified accidents occurring on the ground floor, and a pattern of late at night and early in the morning accidents. The night time staffing needs to be reviewed as a matter of priority to ensure that the needs of the service users are being met at all times throughout the 24 hour period. The home has 4 staff qualified to NVQ level 2 in care or the equivalent. Several staff have been signed up in recent months to undertake the training, but Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 18 ongoing issues with funding have meant that their training has not commenced. This is an ongoing area of concern. Southern Cross must review their NVQ training arrangements in order to ensure that the home can meet the required 50 ratio of care staff with such a qualification in the near future. Three sets of staff employment records were viewed. POVA first checks had been received in all cases, and the Manager Designate was aware that where it is necessary to start staff working prior to a clear Criminal Records Bureau check being received, they must be chaperoned. All other required information was in place. The home has a comprehensive induction training programme based on the Skills for Care core standards, and there was evidence of these being completed with new staff. The Manager Designate said that some updates in dementia care had been arranged, but this needs to be in place for all staff so they have the knowledge and skills to meet the specialist needs of this service user group. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the qualifications and experience to manage the home. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Service users monies are well managed and securely stored. Staff receive supervision, thus promoting communication and review of practice. Shortfalls were identified with some areas of health & safety, thus placing service users, staff and visitors at risk. EVIDENCE: The Manager Designate is a first level registered nurse with a qualification in learning disabilities. She has also completed the work for the Registered Managers Award and has many years experience in caring for service users with learning disabilities, and also those with dementia care needs. It was clear from discussions with staff that they felt well supported by the Manager Designate and that she has good management and leadership skills. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 20 The home has auditing systems in place, to include monthly accident, pressure sores and medications audits. The three monthly facilities audit had not been carried out for nearly a year. The Manager Designate had carried out a home audit in April 2006. Staff meetings and relative meetings are held and minutes are kept. Copies of the Regulation 26 reports for the monthly unannounced visits to the home on behalf of the Responsible Individual are forwarded to the CSCI. Records of the service users monies were viewed. The Administrator has been working closely with the Local Authorities in arranging the transfer of appointee for 3 service users, for whom the home account holds substantial funds. Records of all income and expenditure of service users personal monies are maintained, and individual balances are kept. For the majority of service users only small amounts of money are kept. Receipts are given for all expenditure. Any cash held is kept securely. The Manager Designate said that work has been done with staff in respect of regular individual supervision sessions, and these are now taking place. The maintenance and servicing records were sampled. The maintenance man carries out and records regular health & safety checks for water temperatures, wheelchairs and bedrails, and environmental checks. In addition in house weekly checks of all aspects of the fire safety system in the home are carried out and recorded. The servicing records were up to date, with arrangements to be confirmed for the next external fire safety inspection and the next legionella testing and chlorination. Up to date risk assessments were in place for the environment, safe working practices and equipment, with the exception of laundry equipment, and the Manager Designate said that this would be investigated. The training records were viewed, and work is still needed to ensure all staff undergo health & safety training at the required intervals. A fire risk assessment dated April 2006 was received by the home on the second day of inspection. Several shortfalls had been identified and it was concerning that that it had taken 2 months for this document to be sent to the home. An Environmental Health Inspection had taken place on 22nd March 2006 and some of the findings had not yet been addressed. Action plans to address the findings on the fire risk assessment and the Environmental Health Inspection report must be drawn up and actioned as a matter of priority. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 3 X 3 3 X 2 STAFFING Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP8 Regulation 17 17 Requirement Service user plans must be up to date and clearly reflect the needs of the individual. There must be evidence that service users care needs to include specialist care needs are being accurately met. The codes described on the MAR must be used for any omissions in administration of medications. Action must be taken to ensure the clinic room temperature does not exceed 25° centigrade. Medication stocks must be monitored to ensure a stock of each medication prescribed is maintained. Where a variable dose of medication has been prescribed, the actual dose given must be recorded. Staff must be diligent and ensure that after laundering, clothing is returned to the correct service user. In conjunction with service users interests, an activities programme to reflect the interests of the service users DS0000010924.V294244.R01.S.doc Timescale for action 01/08/06 14/07/06 3. 4. 5. OP9 OP9 OP9 13(2) 13(2) 13(2) 27/06/06 21/07/06 27/06/06 6. OP9 13(2) 27/06/06 7. OP10 12 14/07/06 8. OP12 16(2)(m) (n) 01/08/06 Aston House Care Home Version 5.1 Page 23 9. OP15 13(3) 10. OP18 13(6) 11. OP19 23(2)(b) (d) 12. OP19 23(4) 13. OP26 16(2)© 14. OP27 18 15. OP28 18 16. 17. OP30 OP38 18 13(4) must be formulated and actioned. Previous timescale 01/04/06 not met. All kitchen records to include delivery temperature recordings and cleaning records must be in place and up to date. All staff must have up to date knowledge of safeguarding adults procedures to include Whistle Blowing. There must be evidence that the programme of redecoration and refurbishment is being adhered to and progressed. Previous timescale 01/04/06 not met. The home must be maintained in a good state of décor and refurbishment throughout. Advice must be sought from the London Fire and Emergency Planning Authority in respect of the damaged bedroom doors and the required action taken to ensure their effectiveness in the event of fire. Action must be taken to provide suitable flooring throughout the home to meet the needs of the service users and reduce the risk of malodour. Timescales for this must be included in the redecoration and refurbishment action plan. The night staffing must be reviewed and updated to provide the number of staff required to meet the service users needs. An action plan to show the planned programme for NVQ in care training to provide 50 of care staff with an NVQ in care at level 2 or equivalent must be submitted to the CSCI. Previous timescale 01/04/06 not met. Staff must receive training and updates in dementia care. Risk assessments for equipment DS0000010924.V294244.R01.S.doc 14/07/06 01/09/06 01/08/06 21/07/06 01/08/06 21/07/08 01/08/06 01/09/06 01/08/06 Page 24 Aston House Care Home Version 5.1 18. OP38 18 19. 20. OP38 OP38 23(4) 13(3)&(4) and all health & safety aspects of the home must up to date. This must include laundry equipment and safe working practices. Previous timescale 01/04/06 partially met. There must be evidence that all staff have received training and updates in all aspects of health & safety at the required intervals. The shortfalls identified in the fire risk assessment must be addressed. The requirements from the Environmental Health Inspection report must be addressed. 01/08/06 01/08/06 14/07/06 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. 2. Refer to Standard OP13 OP38 Good Practice Recommendations A system should be in place to ensure that staff are consistent in offering hospitality to visitors. It is strongly recommended that the recommendations from the Environmental Health Inspection report be addressed. Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection West London Area Office 11th Floor West Wing 26-28 Hammersmith Grove Hammersmith London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aston House Care Home DS0000010924.V294244.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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