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Inspection on 29/01/07 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 29th January 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

Service users are assessed prior to admission to ensure the home is able to meet their needs. The home has an open visiting policy and visiting is encouraged. The home has a Manager Designate who has the experience and qualifications to manage the home and who is aware of the need to manage the home effectively. Auditing processes are in place for monitoring the home for quality assurance. There are robust systems in place for the management of service users monies.

What has improved since the last inspection?

The activity provision at the home has improved and the new activities coordinator is enthusiastic and planning to bring in documentation to identify service users social and leisure interests to inform the activities programme arrangements for the home. A programme of training for all staff specific to dementia care has been introduced. NVQ training has been commenced and the Registered Manager is aware that there needs to be a rolling programme to provide 50% of care staff with this qualification.

What the care home could do better:

Although the service user plans had been completed and kept up to date, some shortfalls were identified in the completion of risk assessments for falls and in the completion of some wound care documentation. Lack of input from service users and their representatives in the formulation and review of the service user plan, or in the discussing and recording of their end of life wishes was identified and these need to be addressed. Medications are being well managed overall, however shortfalls still continue to be identified. More attention todetail will help address these issues. Some shortfalls with the laundering of service users personal clothing were again identified. Concern was raised regarding service users being changed into their night attire early in the evening and seated in the day room, and this must be addressed to ensure service users privacy and dignity are respected at all times. No contact information for advocacy services was available. Although the food provision in the home is satisfactory, some shortfalls with the kitchen equipment were identified, including delays in repairs being carried out. The home has clear procedures in place for the management of complaints and POVA. However, concerns highlighted to staff are not always being reported on and therefore are not being addressed. Some incidents of unexplained bruising and injuries, plus incidents of aggression between service users had been identified but not always reported, and had not been investigated. There continue to be environmental shortfalls identified and although an action plan to address these has been drawn up, omissions in the document mean that not all rooms have been included in the plan. Malodours are present due to the poor condition of some carpets that have still not been replaced. The home needs financial investment to bring the environment up to a good standard for service users to live in. Cleaning equipment was not all in working order, and there had been a delay in authorisation to replace one vacuum cleaner. The domestic staff work hard to keep the home clean, however with the shortfalls in the maintaining of the environment their job is made difficult. There are occasions when the home is short of staff, and this has posed a risk to service users, with aggressive incidents occurring in unsupervised communal areas and delays in responding to call bells because staff are busy attending other service users. There must be a full review of staffing to ensure appropriate numbers of staff on duty at all times to meet the needs of the service users. The Manager Designate has improved the levels of health & safety training, however gaps are still present on the training matrix and no staff are trained in First Aid. Some new practices that impact on service users care had been introduced prior to being risk assessed, causing concern. The need to carry out a risk assessment for any proposed new practices prior to implementation was discussed with the Manager Designate. Feedback of the findings of the inspection were given to the Manager Designate and also the Operations Manager at the time of inspection.

CARE HOMES FOR OLDER PEOPLE Aston House Care Home Angel Lane Hayes Middlesex UB3 2QX Lead Inspector Clare Henderson-Roe Key Unannounced Inspection 10:55 29 January & 12th February 2007 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.V326059.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.V326059.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.V326059.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. 26th June 2006 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 fees range from £650 - £750 per week. Aston House Care Home DS0000010924.V326059.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 16 hours was spent on the inspection process. The Inspector carried out a tour of the home, and service user plans, medication records, staff records and maintenance & servicing records were viewed. 4 service users, 9 staff and 5 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. The pre-inspection questionnaire and visitors comment cards have also been used to inform this report. This is the second key unannounced inspection of this service during this inspection year. The home has had several changes in management in recent years. It is hoped that continuity of management will afford the opportunity for shortfalls to be addressed and the home to be brought back to a good standard throughout. What the service does well: What has improved since the last inspection? What they could do better: Although the service user plans had been completed and kept up to date, some shortfalls were identified in the completion of risk assessments for falls and in the completion of some wound care documentation. Lack of input from service users and their representatives in the formulation and review of the service user plan, or in the discussing and recording of their end of life wishes was identified and these need to be addressed. Medications are being well managed overall, however shortfalls still continue to be identified. More attention to Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 6 detail will help address these issues. Some shortfalls with the laundering of service users personal clothing were again identified. Concern was raised regarding service users being changed into their night attire early in the evening and seated in the day room, and this must be addressed to ensure service users privacy and dignity are respected at all times. No contact information for advocacy services was available. Although the food provision in the home is satisfactory, some shortfalls with the kitchen equipment were identified, including delays in repairs being carried out. The home has clear procedures in place for the management of complaints and POVA. However, concerns highlighted to staff are not always being reported on and therefore are not being addressed. Some incidents of unexplained bruising and injuries, plus incidents of aggression between service users had been identified but not always reported, and had not been investigated. There continue to be environmental shortfalls identified and although an action plan to address these has been drawn up, omissions in the document mean that not all rooms have been included in the plan. Malodours are present due to the poor condition of some carpets that have still not been replaced. The home needs financial investment to bring the environment up to a good standard for service users to live in. Cleaning equipment was not all in working order, and there had been a delay in authorisation to replace one vacuum cleaner. The domestic staff work hard to keep the home clean, however with the shortfalls in the maintaining of the environment their job is made difficult. There are occasions when the home is short of staff, and this has posed a risk to service users, with aggressive incidents occurring in unsupervised communal areas and delays in responding to call bells because staff are busy attending other service users. There must be a full review of staffing to ensure appropriate numbers of staff on duty at all times to meet the needs of the service users. The Manager Designate has improved the levels of health & safety training, however gaps are still present on the training matrix and no staff are trained in First Aid. Some new practices that impact on service users care had been introduced prior to being risk assessed, causing concern. The need to carry out a risk assessment for any proposed new practices prior to implementation was discussed with the Manager Designate. Feedback of the findings of the inspection were given to the Manager Designate and also the Operations Manager at the time of inspection. 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.V326059.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.V326059.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. Service users are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. EVIDENCE: Pre-admission assessments were seen in the service user plans viewed. These were comprehensive and gave a clear picture of the service users needs. Copies of Social Services needs led assessments are also obtained. Aston House Care Home DS0000010924.V326059.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. Although the service user plans are being well completed, service users and their representatives are not always being involved in the formulation and review of service user plans, thus their views are not being ascertained and included. Although medications are being reasonably managed in the home, shortfalls identified could place service users at risk. Staff care for service users in a gentle and professional manner, however some practices need reviewing to ensure service users dignity is maintained at all times. Processes are in place for the care of the dying, however lack of information regarding service users wishes could lead to wishes not being fully met. EVIDENCE: Service user plans were sampled on each floor. Overall these were comprehensive, providing staff with a good picture of each service users individual needs and how these are to be met, including mental health and dementia care needs. There was evidence of monthly reviews being carried out. Risk assessments for identified risks had been completed. Risk assessments for falls were viewed. These had been reviewed monthly, but not Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 10 always following each fall, and in one instance the information needed updating to reflect the number of falls experienced by the service user. There was evidence of some input from service users representatives, however it was clear from speaking with representatives that they had had limited or no input in the formulation and review of the service user plans, and this must be addressed. Assessments for moving & handling, continence, pressure sore risk and nutrition were in place, and where needs had been identified care plans had been formulated. Wound care documentation was viewed for one service user and this was comprehensive, up to date and the pressure relieving equipment in use had been identified. There was also evidence of input from the tissue viability nurse. Where a service user had been identified as at nutritional risk, a care plan for nutrition plus weekly weighing had been implemented to monitor the situation. Risk assessments for bedrails had been completed and written consents for their use had been obtained. Input from the GP and other health care professionals had been recorded in the service user plans. Medication management and records were sampled on both floors. The home uses a monitored dosage system (MDS) for the majority of medications. Air conditioning units are in place in both medication rooms. Fridge temperatures are recorded daily and where temperatures have been found outside 2-8° centigrade, action was being taken to address this. Specimen staff signature and initials lists were available. Liquid medications and boxed medications had been dated when opened. For one medication with specific administration requirements, these instructions had not been included on the medication administration record (MAR). Administration of one medication on the first floor had not been signed for several days, although the tablet had been administered from the MDS. The stock supplied for another medication was insufficient to cover the prescribed doses for the 28 day cycle, but action had not been taken to address this. On the ground floor one medication had been out of stock for several days and it was not clear if any action had been taken to obtain new stock. The need to ensure that clear medication administration instructions are provided for all medications, plus appropriate stocks of medication are ordered and supplied was discussed with the Manager Designate, and by the second day of inspection she had spoken with the GPs and the dispensing pharmacist, plus with all the registered nurses involved in medication ordering and administration. Correct systems are in place for the disposal of medications. Professional lancing devices for blood glucose monitoring are in use in the home. Staff were seen caring for service users in a gentle, courteous and professional manner, and visitors spoken with expressed their satisfaction with the care given by staff. Personal clothing viewed was labelled, however comment was received regarding problems with clothing being returned to the right service user and service users sometimes being dressed inappropriately for the weather conditions. Also, it was reported that some service users are in their Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 11 night attire from 5.30pm and are sometimes seated in communal areas. This must be addressed to ensure service users wishes, privacy and dignity is respected at all times. Policies and procedures are in place for care of the dying. The wishes of service users and their representatives had not always been discussed and ascertained as to their care during their final days, and this needs to be addressed so that these wishes are known and respected. Documentation for recording this information is available. Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 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. 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 activities provision within the home is good, with work being progressed to meet service users individual interests. The home has an open visiting policy, thus encouraging service users to maintain contact with family and friends. Information regarding advocacy services was not available, thus service users rights to independent representation were not being met. The food provision in the home is good, offering variety and choice, with service users choices being respected, however shortfalls in some of the equipment provision need to be addressed. EVIDENCE: The home has an activities co-ordinator in post and an activities programme is in place. The activities co-ordinator has formulated activities assessment and care plan documentation and is to complete this for each service user, plus individual life history information. He is also carrying out training with all staff relevant to the dementia care and individual needs of the service users. Southern Cross Healthcare has a dementia care consultant who is introducing new ideas based on current dementia care research. An example of this is ‘doll therapy’, where there are dolls and soft toys available for service users to hold Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 13 and care for. Various activities are advertised on notice boards in the home. In the sitting room on the first floor armchairs had been arranged to encourage social interaction between service users. An activities room has been created on the second floor so service users can attend group activities. The ‘snoozelen’ room is in use and service users have individual time slot allocations to use the room with supervision. The activities co-ordinator is very enthusiastic and knowledgeable and is beginning to plan and implement an activities programme to meet service users individual needs. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home. Service users can receive visitors in their own rooms or in one of the communal areas. At the time of inspection there was no information on display of contact details of local Advocacy Services. The Manager Designate said that she would address this and make sure information regarding advocacy services is freely available to service users and visitors. The Inspector viewed the kitchen. Overall this area was clean and tidy. Some of the condiments were in need of cleaning and the chef arranged this at the time of inspection. Kitchen fridge, freezer and food temperature records were viewed and were up to date. The chef explained the reason for a gap in recording, and action had been taken to address this. Supplies of fresh, frozen, tinned and dried foodstuffs were available and the chef has a system for stock rotation and control in place. Water was seen coming from one of the fridges and the chef said this had been reported for repair. The food processor had been out of order for 2 months, and as a result comment was received that the mashed potato contains lumps, plus no cakes could be made. The chef said that this had been reported for repair. Any faulty equipment must be repaired or replaced promptly. Comment was also received regarding previous problems with the dishwasher and the chef said that these had been rectified. The overhead fan was also out of order, however the chef said that the engineer had been to attend this and a part ordered, for fitting in the near future. Staff were seen assisting service users with their meals, and staff explained that if there was any delay in assisting a service user then their meal would be kept warm. From discussions it was clear that at times the shortage of staff does mean there is a delay in providing assistance to service users. (see Standard 27) Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. 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 POVA. In some instances complaints or incidents have not been reported and therefore procedure is not being followed and this could place service users at risk. EVIDENCE: The home has a clear complaints procedure with timescales for addressing any complaints. 3 complaints had been recorded and the documentation viewed evidenced that these had been appropriately managed. From various discussions it was clear that when concerns are raised with some staff these do not always appear to be brought to the attention of the Manager Designate, and a process for this needs to be followed by all staff so that complaints and concerns are robustly addressed. Documentation for the recording of any concerns raised should be available, so that all issues can be recorded, together with the response given and action taken. The home has policies and procedures for the protection of vulnerable adults in place, plus the process and contact details for reporting any concerns is on display in the reception area. At the time of inspection some unexplained bruising and injuries were discussed. Action had not been taken to investigate these events, and although a record had been made in some cases in the service user plan, the Manager Designate had not been made aware of all the incidents. There had also been some aggressive incidents between service Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 15 users. Again these had not all been reported, and the Hillingdon Adult Protection Team had not been informed. From discussion it was clear that some incidents had occurred when the lounge was unsupervised and visitors had witnessed the event and reported them to a member of staff. A robust system must be followed to ensure all incidents are fully reported and appropriate action taken. The Safeguarding Adults Officer for Hillingdon is due to carry out POVA training in the home in the April 2007. Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 16 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. The home is in need of refurbishment in several areas, and thus it presently does not provide a good standard of accommodation for service users to live in. The poor condition some carpets and furnishings contribute to malodours in the home, plus there are shortfalls in the management of service user laundry, thus service users are not provided with a pleasant environment to live in. EVIDENCE: The inspector carried out a tour of the home. Several shortfalls in the environment were noted, examples of these being stained and malodorous carpets, stained armchairs, bedroom furniture that is old, marked and does not all match, a rusty bath hoist and bathroom flooring damaged. By the second day of inspection an environmental audit had been carried out and a copy of the action plan to address the shortfalls was given to the Inspector. The document did not include all the rooms and several entries had been duplicated. A copy of the amended document has still not been received by Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 17 CSCI. Areas of the home are shabby in appearance and the lack of investment into the refurbishment of the home leaves service users in a poor environment. Action must be taken to provide a comprehensive redecoration and refurbishment programme to bring the home up to a good environmental standard. The laundry room was clean and tidy. During discussions concerns were raised about the drying procedures for clothing as on occasion it was reported that clothing was returned still damp. Concern was also raised regarding staff awareness at ensuring any soiled items are laundered without delay. Also, items of clothing had gone missing and on occasion items have been returned to the wrong service user. A review of the management of service users personal clothing needs to be carried out and action taken to address the shortfalls identified. The domestic staff work hard to keep the home clean, however due to the poor condition of the carpets in some communal and bedroom areas malodours are present. On the first day of inspection one of the cupboards containing COSHH products had been left unlocked. This was addressed at the time and the importance of storing COSHH products securely re-iterated to the staff. On the second day of inspection one of the vacuum cleaners had been out of order for a week and the Manager Designate had requested authorisation to get a new one and was still awaiting this. Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Issues were identified with the home being short staffed at times, thus service users are at risk of not having their needs fully met. Systems for vetting and recruitment practices are in place and protect service users. The training provision within the home has improved with staff undertaking NVQ in care training plus training relevant to the specific diagnoses and needs of the service users, thus providing staff with the knowledge to care for service users more effectively. EVIDENCE: During the inspection, concern was expressed about the home being short staffed on regular occasions. The Manager Designate had identified a particular issue with weekend staffing, and other people spoken with said that the lack of care staff to ensure supervision in the communal areas at all times was a concern. Due to their diagnoses, some of the service users can be aggressive and it was reported that incidents between service users had occurred at times when the lounge was unsupervised. Also, the impact of being short of staff at mealtimes was also discussed. A full review of staffing to ensure there are staff available in such numbers to meet the needs of the service users at all times must be carried out, and action taken to address shortfalls identified. The Administrator has been helping out at another home and as a result has not been available to fully support the Manager Designate. Ancillary staff are employed in numbers to meet the needs of the home and the service users. Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 19 Action has been taken to access NVQ in care training for staff. Two care staff have completed NVQ level 2 in care. Within the care staff, 4 full-time and 2 part-time staff had undertaken nursing or medical training in their own country. 8 more care staff are commencing NVQ level 2 in care training and 5 domestic staff have commenced NVQ in housekeeping and domestic care. The Registered Manager is clear that there must be a rolling programme for NVQ in care training to bring the home up to 50 of care staff with this qualification. The Inspector sampled staff employment records. Those viewed contained the information required under the Care Home Regulations 2001. On the first day of inspection two staff photographs were required and the Manager Designate confirmed this had been addressed promptly. Southern Cross Healthcare has an induction programme based on the Skills for Care core standards, and the Inspector viewed a completed document. The Manager Designate said that she would ensure all new care staff were in the process of completing the induction training. There was evidence of training in topics relevant to the specific diagnoses and needs of the service users taking place. This included The Alzheimer’s Society ‘Yesterday, Today and Tomorrow’ training and also ‘Person Centred Approach’ training. This training is being given to all staff in the home, to provide them with the knowledge to care for service users more effectively. Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The Manager Designate has the qualifications and experience to manage the home, and is working hard to put systems in place to manage the home effectively. Systems for quality assurance are in place, thus providing an ongoing process of system and practice review. Service users monies are being securely managed, thus protecting service users interests. Systems for the management of health and safety are in place, however shortfalls identified in some areas could pose a risk to service users, staff and visitors. EVIDENCE: The Manager Designate is a first level registered nurse, qualified in both general and mental health nursing. She has a Batchelor of Science in professional studies, and has completed the Registered Managers Award, and Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 21 has submitted her portfolio for assessment. The Manager Designate has experience as Deputy Manager and Manager in care settings. She has been in post since September 2006, and prior to this the home had not had a longterm manager in post for some time. Staff and visitors spoken with said that the Manager Designate is approachable and supportive, listening to and acting upon any issues brought to her attention. The home has a comprehensive auditing system for quality assurance in place, and there was evidence that the audits of areas such as medications, service user plans, catering and a home audit are carried out regularly. Meetings to include 1-2 weekly heads of department meetings, monthly staff meetings and 3 monthly relatives meetings take place, with minutes taken and copies available. The Inspector was unable to view the records for service users monies as the administrator was not present on either day of inspection. The Inspector spoke with the administrator on the telephone and she confirmed that the robust processes in place at the last inspection are still being followed. The administrator said that she is in the process of transferring appointeeship for one service user over to Social Services, and is not an appointee for any other service users. Also, any build up of individual funds in the homes ‘z’ account is also being addressed appropriately. The Inspector sampled the servicing and maintenance records. The gas certificate was dated December 2005. The Manager Designate has followed this up but to date no confirmation that the service for 2006 was carried out has been received. The call bell checks carried out show several call bell points as faulty, and the Manager Designate said that a service of the call bell system had been carried out and the company were due to carry out the repairs. Some concern was expressed about the length of time taken by staff to answer call bells at times, and this whole area must be addressed. All other servicing & maintenance records viewed were up to date. The Registered Manager has formulated a training matrix for mandatory training. There were still some gaps in training and no staff are trained in First Aid. The training programme did identify planned training in health & safety topics, but not First Aid. Risk assessments for safe working systems and equipment were in place, with updates due for the Southern Cross Healthcare generic health & safety risk assessments. There are comprehensive policies and procedures in place for the management of health & safety. On the second day of inspection some concerns regarding the implementing of new practices without previously having risk assessed them were identified. The need to risk assess any new practice to identify the possible impact on and risk to service users was discussed with the Manager Designate. Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 22 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 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 17 15(2)(c) Requirement Risk assessments for falls must be updated following each fall and must be accurate. 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. Medication stocks must be monitored to ensure a stock of each medication prescribed is maintained. Previous timescale of 27/06/06 not met. Where there are specific administration instructions for a medication, these must be included on the MAR and the medication container. Medicines must be accurately recorded when administered. Staff must be diligent and ensure that after laundering, clothing is returned to the correct service user. Previous timescale of 14/07/06 not met. Service users must be dressed appropriately with their privacy and dignity being respected at all DS0000010924.V326059.R01.S.doc Timescale for action 01/03/07 01/04/07 3. OP9 13(2) 01/03/07 4. OP9 13(2) 01/03/07 5. 6. OP9 OP10 13(2) 17(1) 12 12/02/07 01/03/07 7. OP10 12 12/02/07 Aston House Care Home Version 5.2 Page 24 8. OP11 12 9. 10. OP14 OP15 12 16(2)(g) 11. OP16 22 12. OP18 13(6) 13. OP19 23(2)(b) (d) 14. OP19 23(2)(b) (d) 15. OP26 16(2) times. Service users must not be changed into night attire until they are ready to go to bed, unless it is their individual wish to do so prior to retiring. 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. Contact information in respect of advocacy services must be freely available in the home. Kitchen equipment must be maintained in good working order. Any repairs to equipment must be actioned without delay. All complaints must be appropriately reported and addressed. A record of all complaints must be maintained. All incidents to include unexplained bruising or injuries and incidents between service users, leading to physical contact, must be reported in line with POVA procedures. There must be evidence that the programme of redecoration and refurbishment is being adhered to and progressed. Previous timescales of 01/04/06 01/08/06 not met. The home must be maintained in a good state of décor and refurbishment throughout. Previous timescale of 01/08/06 not met The redecoration and refurbishment programme must be accurate and up to date, and include all the redecoration and refurbishment needs for the home. Action must be taken to provide suitable flooring throughout the home to meet the needs of the service users and reduce the risk DS0000010924.V326059.R01.S.doc 01/04/07 01/04/07 16/03/07 16/03/07 12/02/07 01/04/07 01/03/07 01/04/07 Aston House Care Home Version 5.2 Page 25 16. OP26 13(3) 17. OP26 23(2)(d) 18. OP27 18 19. OP38 13(4) 18 20. OP38 13(4) 21. OP38 13(4) of malodour. Timescales for this must be included in the redecoration and refurbishment action plan. Previous timescale of 01/08/06 not met Any soiled items of clothing must be appropriately laundered without delay. Clothing must be dried properly. Cleaning equipment must be maintained in working order. Any repairs must be actioned without delay. The staffing must be reviewed and updated to provide the number of staff required to meet the service users needs 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 01/08/06 partially met. The call bell system must be maintained in full working order and all calls must be responded to promptly. Any new practices that could impact on service users must be risk assessed prior to implementation to identify the risk to service users and action to be taken to minimise this risk. 12/02/07 01/03/07 16/03/07 01/04/07 01/03/07 12/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aston House Care Home DS0000010924.V326059.R01.S.doc Version 5.2 Page 26 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.V326059.R01.S.doc Version 5.2 Page 27 - 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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