CARE HOME ADULTS 18-65
Astor House 12 Oakwood Avenue Purley Surrey CR8 1AQ Lead Inspector
Barry Khabbazi Unannounced Inspection 8th December 2005 8:50 Astor House DS0000025750.V271290.R01.S.doc Version 5.0 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 Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Astor House Address 12 Oakwood Avenue Purley Surrey CR8 1AQ 020 8763 0267 020 8668 2471 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) Surrey Oaklands NHS Trust Ms Elisabeth J Murray Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th April 2005 Brief Description of the Service: Astor House is a large detached house situated in a residential road in Purley. The property is keeping with the other houses on the road. The town centre has bus and train services, a shopping centre and a Tesco superstore in addition to other services. The home has its own minibus. There are ramps to the front and back to facilitate wheelchair access to the home and rear garden. There is a lift serving the bedrooms on the first floor. Astor House has been designated by the Surrey Oaklands trust as a home for more elderly service users who have a learning disability and may also have a physical disability. As the service users are over 65 years old, the inspector has advised the registered manager to apply in writing for the registration to be amended to reflect this situation. The home is therefore applying for its registration to be changed from Younger Adults to Older People. The home is reminded that it must meet Older Person Standards now. These Standards were also considered in this report and will be looked at in full at the next inspection. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This home meets {and exceeds in some cases} most of the National Minimum Standards and has demonstrated many areas of good practice. All of the Commission’s service user and relative surveys have also confirmed this view, with only positive comments about the home being received to date. Where shortfalls have been identified these are of a minor nature and the manager has proven committed to fully meeting all areas and exceeding them where possible. This un-announced inspection focused on observing breakfast and the morning routine for the Service users and following up on previous requirements. The key Standards identified throughout this report were all inspected at the last inspection. Please see that announced inspection report for a full audit of all the key Standards. All the residents were met during this inspection. Although it was possible to follow up the implementation of a number of previous requirements, it is recognised that the manager was not present to evidence other requirements that may have also been met. What the service does well:
The move to person centred planning is seen as good practice as this ensures care needs are identified from the service users perspective. A few days before the last inspection, the service users asked staff for a barbeque instead of the planned meal for that day. The home’s willingness and ability to respond to this wish in a spontaneous manner, and to change plans at the last minute, is to be commended. Staff attend hospital with service users and stay with those admitted. This provides continuity and re-assurance for service users, and improves the overall level of hospital care by staff being able to communicate effectively with the service user. It was seen as good practice that medication training occurs annually and additional annual training occurs in ‘as and when medication’, and also in diazepam usage. The residents’ needs regarding terminal care and following death are met well and this Standard is exceeded for the following reasons: During these periods, relatives can visit at any time day or night if wanted by the resident; if and when no relatives are present, a staff member is available to provide a continual vigil if wanted; the home maintains contact with relatives following death of a resident; funerals have occurred at the home; the home has provided transport to assist relatives to attend funerals; and although residents have the right to die at their home, where there is a medical reason for a hospital admission at these times, the home sends staff to the hospital so that the resident does not have to be alone in their final moments. The previous report recorded that ‘the home gave the impression of a clean and hygienic home. The building was clean and tidy and rooms were generally free of offensive odours.’
Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 6 It was good to see that this was also the case at this unannounced inspection. The home is particularly hygienic and clean. As this has been seen to be the case on a number of unannounced inspections, this area can now be assessed as continuing good practice under Standard 30. What has improved since the last inspection? What they could do better:
The areas below relate to previous requirements. It is accepted that these may have since been implemented but as the manager was not on duty at the time of this inspection, it was not possible to access records to confirm if all the previous requirements had been met. Although the Service Users Guide has been much improved and is now also more accessible, it does not contain the views of the residents. This is important so that new residents are clear about how other residents feel about living in this home. Residents do not receive all the paid holidays they are entitled to.
Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 7 Each resident should be offered a seven-day holiday paid for by the home as a part of the contracted price. This would facilitate more funding and additional holidays for residents that they do not have to pay for. Although this home manages complaints well, all versions of the complaints procedure should clarify that the Commission can be contacted at any point of a complaint, this will allow residents to make their complaints known if there are difficulties raising them in the home. Residents’ rooms do not contain all the furniture required. This may be because a resident has chosen not to or because of risk. However, this must be recorded to ensure that residents have all the furniture they are entitled to. The completion of staff induction and foundation training within Sector Skills Council training specifications is not being met satisfactorily. This could also affect the home’s ability to meet all a resident’s needs. Although progress has been made with regards to the home to implementing a quality assurance system and an annual development plan, with both involving residents, more work in this area is required. Although not having this fully in place could limit the involvement of the residents and relatives, both residents and relatives have commented about being involved in decision making in practice. The manager must ensure that the glass doors to the lounge have safety glass or safety film fitted. 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. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Although the home provides most of the information needed for potential residents to make an informed decision about moving in to the home, the residents do not have all the information they need. EVIDENCE: The Statement Of Purpose contains all the elements required, including the size of the bedrooms and communal rooms, the number of bathrooms and toilets, the experience of staff, and the fire procedures. The last inspection report contained a requirement for the service users guide to contain the views of the service users. Since the last unannounced inspection, the service users guide has been made more accessible with the use of symbols and pictures. The home has sought the views of the service users through questionnaires, this information now only needs to be collated and included in the service users guide. The existing requirement will remain until fully met. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 9. Information regarding the home’s policies, activities and services, are now more accessible to the service users. Service users are appropriately supported to take risks as part of their independent lifestyle and risk assessments now contain all the information required to facilitate minimising restrictions of liberty for the residents. EVIDENCE: The move to person centred planning is seen as good practice under Standard 6. The last inspection report contained a requirement under Standard 8 for the home to provide service users with accessible information regarding its policies and services. Since the last unannounced inspection, the Service Users Guide has been made more accessible with the use of symbols and pictures, and a symbol complaints procedure and activity list have been produced. In addition a pictorial menu has been created. This requirement is now met.
Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 11 The last inspection report contained a requirement for risk assessments to contain all the information required under Standard 9.4, and in particular, details of how training and other options have been explored and the involvement of relatives or independent advocates. This was seen to have been implemented in files examined. This requirement is also now fully met. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Service users do engage in appropriate leisure activities and holidays, although the residents do not receive all the placing authority funded holidays they are entitled to. EVIDENCE: Activities within the home include: Barbeques, tea parties, skittles, dominoes, board games and music. Two members of staff from the Driscoll Centre come to the home and run in house activities suited to an older service user group such as reminiscence, hand massage and music therapy. The service users also attend the Driscoll Centre for individual activities. The staff team at the home also arrange day trips and outings for the service users. Residents are offered a holiday with £150 of extra staffing hours. The residents are currently required to pay for the cost of the holiday themselves. The following previous recommendation remains regarding this: Each service user should be offered a seven-day holiday paid for by the home as part of the contracted price. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 13 The following good practice has been previously identified under Standard 17: A few days before the last inspection, the service users asked staff for a barbeque instead of the planned meal for that day. The home’s willingness and ability to respond to this wish in a spontaneous manner, and to change plans at the last minute, is to be commended. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Residents’ medication is well managed to ensure maximised good health. The residents’ needs regarding terminal care and following death are met well and this standard is exceeded. EVIDENCE: The following good practice has been identified under Standard 19; Staff attend hospital with residents and stay with those admitted. This provides continuity and re-assurance for residents, and improves the overall level of hospital care by staff being able to communicate effectively with the resident. The following good practice has been identified under Standard 20: It is also seen as good practice that medication training occurs annually and additional annual training occurs in ‘as and when medication’, and also in diazepam usage. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 15 All staff who administer medication have had approved medication training. The home has a copy of the British Medical Association guide to medication in place. Medication profiles and clear medication administration record sheets are available. Medication and the M.A.R sheets are kept securely in a locked metal cabinet fixed to the wall. Individual blister packages are used for tablets instead of bottles for easy identification and monitoring. Homely remedies are only used in consultation with the G.P. Self-medication does not currently occur. The last inspection report contained the following requirement under Standard 20: The home must obtain and record the service users’ consent to medication. Where verbal consent is not possible, the home must obtain this for new service users through the use of independent advocates. For existing service users, a record of the advocated view will be accepted. Any advocated view of non-consent must also be recorded. This has occurred and this requirement is now met. The residents’ wishes regarding terminal care have now been sought and recorded. This Standard is exceeded for the following reasons: During these periods, relatives can visit at any time day or night if wanted by the resident; if and when no relatives are present, a staff member is available to provide a continual vigil if wanted. The home maintains contact with relatives following death of a resident, funerals have occurred at the home, the home has provided transport to assist relatives to attend funerals. Although residents have the right to die at their home, where there is a medical reason for a hospital admission at these times, the home sends staff to the hospital so that the resident does not have to be alone in their final moments. The above was re-confirmed during an interview with the shift leader whilst discussing the practice during a recent death at the home. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Complaints are generally managed well and there were no complaints since the last inspection. However, all versions of the complaints procedure should clarify that the Commission can be contacted at any point of a complaint, this will allow residents to make their complaints known if there are difficulties raising them in the home. EVIDENCE: The home has a complaints procedure in place, which met all of the elements of this Standard except the following: The complaints procedure within the Service Users Guide stated that the Commission should only be contacted after a complaint had gone through the internal system and then only if the complainant is still unsatisfied. This is not the case and the Commission can be contacted at any stage of a complaint, as recorded in the main Surrey Oakland’s Complaints procedure. An existing requirement remains in force to address this shortfall. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, and 30 The environment and furniture generally met the residents’ needs, and the environment promotes the residents well being. The home is particularly hygienic and clean, homely and comfortable, this environment therefore facilitates the residents’ health and emotional wellbeing. EVIDENCE: The home is a detached house situated in a residential area in Purley close to transport links. The home was decorated and furnished in a domestic style and free from offensive odours. There is a ramp providing access to the front of the home and is a garden to the rear that has level access. Maintenance for the home is provided on an as required basis by The Trust Works department. The overall condition and décor of the home was reasonable, with some areas needing attention. The last inspection report identified that the path in the back garden was uneven and requires levelling to promote safe access for the residents. A recommendation was set under Standard 24 regarding this. Since that time the path has been levelled and this recommendation is now met.
Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 18 The last inspection report recorded that, ‘although dignity is for residents is generally well maintained, dignity is not being maintained to the required level at meal times. The manager informed the inspector that this was because there are not enough chairs to allow staff to sit next to a resident while assisting with feeding.’ A recommendation regarding this was then set under Standard 24. By the time of this inspection more chairs had been acquired and the previous recommendation is now met. Residents’ rooms were individually decorated and rooms had been individualised by the residents. The bedrooms on the first floor are accessed via a passenger lift. Residents’ rooms do not contain all the furniture required. This may be because a resident has chosen not to or because of risk. However this must be recorded to ensure that residents have all the furniture they are entitled to. A requirement remains regarding this. The home has two accessible baths, one of which is a Parker side access bath and the other is an automatic chair lift bath. The home has three separate toilets. The last report also recorded that ‘the home does not have a shower. A shower would promote choice and independence and a recommendation regarding this has been set under standard 27.’ Since that time and accessible bath with a shower has been acquired, this meets the residents needs appropriately and therefore also meets the previous recommendation set. The previous report recorded that ‘the home gave the impression of a clean and hygienic home. The building was clean and tidy and rooms were generally free of offensive odours.’ It was good to see that this was also the case at this unannounced inspection. The home is particularly hygienic and clean. As this has been seen to be the case on a number of unannounced inspections, this area can now be assessed as continuing good practice under Standard 30. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Although there has been progress in implementing the induction training programme, the home has not completed staff foundation training within Sector Skills Council training specifications and timescales. This could also affect the home’s ability to meet all residents’ needs. EVIDENCE: All staff recruited since April 2002 undertake a comprehensive induction. This does not currently meet the topics and timescales required to be covered in the first six weeks induction and following six month foundation training as specified within Sector Skills Council workforce training targets. A requirement remains in force regarding this. However, it is accepted that this requirement may have been met as the manager was not available to provide staff records. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 Although progress has been made with regards to the home to implementing a quality assurance system and an annual development plan, with both involving residents, more work in this area is required. Although not having this fully in place could limit the involvement of the residents and relatives, both residents and relatives have commented about being involved in decision making in practice. The health and safety and welfare of the service users is promoted and protected. EVIDENCE: The last inspection report contained the following requirement under Standard 37: The home must pull together its quality assurance tools into a structured Quality Assurance system that makes the service users central to the process. The home must also introduce user/relatives satisfaction surveys and an annual development plan that is open to the service users, to allow measurement of achievement in improving quality. This could not be evidenced as completed as the manager was not present.
Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 21 This requirement will therefore remain in force until such time as the home can evidence it’s full implementation. The last inspection report contained the following requirement under Standard 42: An up to date 5 year wiring certificate must be sent into the Commission. This has now occurred and this requirement is now met. The last inspection report also contained the following requirement under Standard 42: The manager must insure that the glass doors to the lounge have safety glass or safety film fitted. This could not be evidenced as completed as the manager was not present. This requirement will therefore remain in force until such time as the home can evidence it’s full implementation. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23 Score 2 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x 3 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 3 x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 2 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Astor House Score x x 3 4 Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x DS0000025750.V271290.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? 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 YA1 YA22 Regulation 5 12[3] 22 Requirement The Service Users Guide must contain the views of the service users. All versions of the complaints procedure must clarify that the Commission can be contacted at any point of a complaint, and not following the internal stages being exhausted.{previous timescale of 1/12/2004 not met} Service users’ rooms must contain all of the items listed in Standard 26.2 unless the service user has made a positive choice not to and this is evidenced in their files or recorded risk assessments show otherwise.{previous timescale of 1/9/2004 not met} All staff recruited since April 2002 must undertake a six weeks induction {by the 11/2004} and six month foundation training to Sector Skills Council workforce training targets The home must pull together its Quality Assurance tools into
DS0000025750.V271290.R01.S.doc Timescale for action 01/09/05 01/12/04 3. YA26 16[2]c m 01/09/04 4. YA35 18[1]a c 01/11/04 5. YA37 24,1,2,3 01/12/04 Astor House Version 5.0 Page 24 6. YA42 12 a structured Quality Assurance system that makes the service users central to the process. The home must also introduce user/relatives satisfaction surveys and an annual development plan that is open to the service users, to allow measurement of achievement in improving quality. {previous timescale of 1/12/2004 not met} The manager must ensure that 01/07/05 the glass doors to the lounge have safety glass or safety film fitted. 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 YA14 Good Practice Recommendations Each service user should be offered a seven-day holiday paid for by the home as part of the contracted price. Astor House DS0000025750.V271290.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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