Inspection on 07/05/09 for Astor Lodge View

This inspection was carried out on 7th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Astor Lodge View 17/05/07

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Astor Lodge View Lamb Street East Cramlington Northumberland NE23 6SF Lead Inspector Anne Urwin Brown Key Unannounced Inspection 7th May 2009 08:30 DS0000069904.V375260.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astor Lodge View Address Lamb Street East Cramlington Northumberland NE23 6SF 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) 01670 735012 astorlodgeview@schealthcare.com Southern Cross OPCO Ltd Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 29 The maximum number of service users who can be accommodated is 29 17th May 2007 2. Date of last inspection Brief Description of the Service: Astor View Lodge is a purpose built home in a rural area of Northumberland on a site comprising of two homes: Astor View and Astor Court. Both homes have only recently been taken over by Southern Cross Opco Ltd. Astor Court was not part of this inspection, having its own separate registration. The village of East Cramlington is a short distance away, with a small range of local amenities including shops, public houses, a post office and Church. The area is served by public transport and the coastal areas of Northumberland and the town centres of Cramlington and Blyth are within easy reach by bus or car. Astor View is registered to provide care to 28 older people and 1 person under the age of 65 with a physical disability. All areas internally and externally are accessible to wheelchair users and all people living at the home are able to enjoy single bedrooms with en suite facilities. Externally, generous car parking is available. Fees range from £419.08 to £550.00 per week. There is a Statement of Purpose and Service User Guide in place to inform prospective residents and their relatives about the service provided at Astor Lodge. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Before the visit: We looked at: Information we have received since the last visit. How the service dealt with any complaints & concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 7th May, 2009 and a further visit was made on 13th May, 2009. The visits lasted a total of eight hours. During the visit we: Talked with people who use the service, staff, the manager, the line manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe & comfortable. Checked what improvements had been made since the last visit. We told the manager and line manager what we found. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 6 What the service does well: Good systems are in place to make sure that people have enough information about the service before they come to live in the home. Information about the support people get is generally well recorded in the daily log and in some peoples’ personal plans. People feel able to make their views about the service known and said that they could speak to staff working in the home if they had a problem. Astor Lodge provides en-suite bedrooms that suit the needs of the people living there. Good levels of staff who are well trained are available to meet the needs of the people staying at the home. Recruitment practices and procedures are clear and protect people using the service. Sufficient staff are available to meet the needs of the people living in the home. What has improved since the last inspection? What they could do better: Individual care plans must reflect the individual needs of each person and information from the individual assessments should be used to ensure that people receive the care they need and staff are clear about what their support needs are. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 7 Management systems must be used effectively to ensure that all care plans are regularly updated. This will ensure that people receive the care and support they need. Medication training for all staff must be completed and records kept showing when this has occurred. This will protect people living in the home. Staff dealing with complaints must be clear about the procedures to be followed and training should be provided. This will ensure that people living in the home are protected by good systems for dealing with complaints. Systems for recording staff training must be in place and kept regularly updated. This will meant that people living in the home are looked after by appropriately trained staff. Systems for reviewing the quality of care need to be used effectively so that people receive good services that suit their needs. Staff training in safe working practices must be provided at appropriate intervals to ensure that people living in the home and staff are protected. Peoples’ interests and emotional needs should be recorded within their individual plans so that staff are clear about the support that they require. People should be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities. The gaps at the top and bottom of the patio doors on the main corridor need attention so that there is not a constant draught. The garden maintenance needs to be given priority to ensure that people have attractive and safe areas to spend time outside the home. The capacity of the laundry to deal with items from both Astor Court and Astor Lodge should be reviewed to ensure that there are sufficient machines. This will ensure that people are not waiting a long time for laundry to be returned. Work should be undertaken to eliminate any unpleasant odours in bedrooms and systems should be in place for reporting and dealing with any problems with persistent odours. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 9 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 Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information about the service before they come to live at Astor Lodge. Good assessments are carried out so that people can be assured that their needs will be met. EVIDENCE: There is a Statement of Purpose in place that provides comprehensive information about the service provided to help people make a decision about coming to live at Astor Lodge. Information is clear and easy to understand and sets out the objectives and philosophy of the service together with a service user guide. The guide tells people what they can expect from the service and gives a clear account of the facilities, staffing arrangements, qualifications and Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 11 experience of people working at the home, how to make a complaint and information about recent Care Quality Commission (CQC) reports. Admissions are not made to the home until a full needs assessment has been completed and the management of Astor Lodge are satisfied that the person’s needs can effectively be met. Information from the assessment and from relatives and/or care management plans is also used to prepare an individual plan outlining each persons care needs. The home understands the importance of having good information about peoples needs before agreeing a placement. Intermediate care is not provided at Astor Lodge. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recording systems are not always used effectively to ensure that staff are clear about the support each person needs. Records of staff training are not kept properly to ensure that only qualified staff are giving out medicines. EVIDENCE: Each person has a personal plan in place; however it was evident from daily records that peoples’ changing needs are not always identified within their plans. Of the four plans seen at this inspection three plans were generally up to date and for the most part reflected peoples’ needs. Assessments in the other plan were not up to date and as a result the plan did not reflect the support needs of the person concerned. The moving and handling risk assessment had not been completed even thought the dependency assessment reflected high needs in this area. There was evidence of inconsistency in the use of recording systems that was not picked up at management reviews. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 13 There was evidence that health care needs are being met in daily logs, but recording systems are not being effectively used to evidence this. At a second visit during this inspection work had been undertaken to improve recording and assessments had been updated to show each person’s current needs. Evidence was available that peoples privacy and dignity is respected and that staff are sensitive to individual needs. There is in place an effective medicines policy that supports good procedures and practice. The manager said that staff training has been provided for all staff responsible for administering medicines; however staff files did not contain evidence of when this was provided and the training matrix was not fully completed. Medicines records are well completed and contain required entries. Arrangements for the storage of medicines are satisfactory. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to make choices about in most areas of their lives, however some routines and practices mean that people are not as independent as they might be. The activity programme has been affected by staffing issues and people living in the home have not always had sufficient opportunities for social stimulation. EVIDENCE: There was evidence from talking to people living in the home and from staff that people’s individual routines and choices are identified and met. It was not always clear from care plans what the routines and choices are for some people, however for others there was good information available. During the inspection it was observed that people are able to make choices about how and where they spend their time. Records are kept of activities planned, but sometimes this information was not available in individual records. Two people living in the home said that they were satisfied with their own routines, but sometimes felt that more activities were needed. The manager said that they Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 15 were currently reviewing the activity programme and a new activity organiser has been appointed, but is awaiting reference and Criminal Records Bureau checks to be completed. Three people said that they felt that there was not enough going on in the home. One person said “I spend most of my day sitting around or wandering from my room to the sitting room. It can be a bit boring, although I do chat to the staff now and then.” Another person said that she was happy spending time in her room where she had her own television and she could read. One visitor said that he was able to come and go as he pleased subject to his friend’s agreement. From the visitors’ record it was evident that friends and families visited regularly and three people living in the home said that they were happy with the arrangements for visitors. They said they really enjoyed seeing their family and friends and that staff welcomed them. Peoples’ rooms are personalised with items from their previous homes and show evidence of their own taste and interests. The home’s policies and procedures take account of equality and diversity principles and staff are aware of this in their everyday work. Menus are available and these show good account is taken of healthy eating principles. Alternatives are available at each meal time and people said during the inspection that they could ask for something else if they did not like what was available. Everyone spoken with said that the food was well cooked and that they liked what they had at mealtimes. Breakfast was being served at the beginning of the inspection and there was no butter, marmalade, individual tea pots, milk jugs available on the tables apart from for one person. Staff said that people usually have their toast buttered and tea poured out for them. This does not promote good choices for people and help them maintain their independence. Kitchen staff have completed Food Hygiene training. Food is cooked at Astor Court and brought over to Astor Lodge in hot trolleys. The kitchen in Astor Lodge has been well used and kitchen units are worn and in some cases the shelves are not very clean or are marked by use over the years. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The good systems for recording and dealing with complaints have not always been followed by staff. Systems for dealing with allegations are in place, but staff training in safeguarding has not been recorded in training records. This means that it is not clear that people living in the home have been as well protected as they might be. EVIDENCE: Since the last inspection two complaints have been made. One was investigated and recorded appropriately. One was not fully investigated and records kept of the investigation were not satisfactory. There are good policies and procedures in place for dealing with complaints, but on this occasion these were not followed. Southern Cross have taken steps to ensure that the issues raised are fully investigated and this was ongoing at the second visit of this inspection. They will report the outcome of this investigation to the Care Quality Commission. People living in the home said that they felt able to talk to staff if they had any concerns. One person said that she would speak to the Deputy Manager if she wanted to complaint about something; although she said she had never felt the need to do so. She said she was satisfied that her concerns would be taken seriously. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 17 Two safeguarding referrals have been made since the last inspection and good information was available to show appropriate action was taken. Staff records showed that not all staff had completed Safeguarding training and this was addressed by the organisation before the second visit to the home was made. At the first visit all staff spoken with were able to describe the procedure to be followed in the event of an allegation being made. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Astor Lodge provides spacious accommodation that is generally well maintained and suits the needs of the people living there. EVIDENCE: The home is purpose built and provides good quality accommodation that is suited to the needs of the people living in it. There are wide corridors, good sized rooms and a spacious sitting room and dining room. A smoking room and small lounge is available if people do not choose to use the main sitting room. Since the last inspection the main sitting room has been redecorated and laminate flooring laid in part of it. Some bedrooms have also been decorated and further work is planned. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 19 It was noted that there is a gap at the top and bottom of one of the external fire doors in the main corridor. This means that this area is cold and there is a possibility that vermin get into the home. Records show that maintenance issues are generally dealt with promptly. The garden is not well maintained with grass overgrown and weeds evident in the flower beds. This affects the appearance of the home and there is no safe seating area available for people living in the home. Parking is available to the front of the home. There are sufficient bathrooms and toilets, and appropriate aids and adaptations are available. Since the last inspection one shower room has been refurbished and the flooring replaced. All bedrooms have en-suite accommodation and are of a good size. People said that they were happy with their rooms; they liked having an en-suite and that they had been able to bring some furniture and other personal items when they moved in. Odours were evident in five rooms and these rooms were identified to the manager. All rooms have windows for ventilation. Central heating is fitted and the temperature can be adjusted. Radiator guards are fitted to protect people living at the home. Tests are carried out annually on all electrical equipment. Thermostatic controls are fitted to all hot water outlets. Emergency lighting is fitted. The laundry is now done in Astor Court and staff said that this is an improvement as the facilities in Astor Lodge were inadequate and space was very limited. The staff in the laundry at Astor Court said that no additional equipment has been provided and sometimes they do not have the capacity to cope with all the laundry. Infection control policies are in place, but it was not clear from staff training records or from talking to staff when the last training was completed. The units in the kitchen at Astor Lodge are damaged and in some cases marked and dirty. The freezer had not recently been defrosted. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are adequate to meet the needs of people living in the home. Good recruitment practices safeguard people at Astor Lodge. Training records do not show that staff have completed statutory training. EVIDENCE: The rota showed that staffing levels are adequate to meet peoples’ needs. People living in the home said they were satisfied that there was sufficient staff on duty at the home. One person said that “I like the staff and they come when I ring for them. They know what I need help with and l really like most of them.” Staff said that there are enough staff to cover the rota and that arrangements for covering holidays and sickness work well with people usually working extra hours when necessary. At night there are two waking night staff on duty and those living in the home said that they find this sufficient for their needs. Staff are committed to training and recognise the importance of gaining recognised qualifications. They said they feel training is usually well supported Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 21 by the management of the home. The manager said that he had new systems in place to start tracking training, but was not able to explain why records were not up to date to show completed training. It was not clear from records what percentage of staff have completed national qualifications in care. Staff recruitment policies and procedures are in place to protect people living at the home and records show that these are followed. Equality and diversity principles are incorporated into the policies to ensure that good practice is fostered. Appropriate reference and Criminal Records Bureau checks are carried out and evidence of these was in individual records. The training records were poor and it was not possible to identify how many staff have completed essential training. Records are not clearly maintained despite a good recording system being available. Staff files do not contain copies of certificates to evidence training that has been provided. The manager said that statutory training has been provided including moving and handling, food hygiene, first aid, fire, and health and safety, however it was not possible to confirm this from records or from talking to staff what training they had completed in the last year. Staff said that new staff receive appropriate induction training. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in place are not being used effectively to make sure that the home is managed effectively taking into account the needs and wishes of the residents. EVIDENCE: The manager is experienced in the care of older people and was appointed in December 2008. He has completed induction training and is aware of the need to undertake regular training to maintain and develop his own skills. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 23 There are good systems for auditing of the quality of the service provided, however these have not been used effectively in the past year. These do not show the current situation at the home where records are not being regularly updated and reviewed. Resident questionnaires are used and a relatives meeting is planned but there is insufficient evidence at this inspection to show that the quality assurance system is customer focussed. Formal supervision for care staff is not up to date and staff said that they do not always feel well supported by the management team. One staff member said that there are regular staff meetings, but there are often no minutes available afterwards. Systems are in place for safeguarding and managing money held on behalf of people living in the home including clear records. People using the service or their relatives have access to the records whenever they wish. Records show that training in health and safety matters is not always provided at appropriate intervals and individual training records reflect this. At the first visit of this inspection staff said that training in safe working practices was not up to date. At the second visit fire and safeguarding training had been completed for all staff. A plan had been drawn up identifying each person’s training needs by the second visit. Health and Safety checks are regularly undertaken and records were available to show good standards are maintained. Policies, procedures and risk assessments for safe working practices are in place to promote and protect residents and staff. Staff said that appropriate induction training is provided for new staff and records are in place to confirm this. Full details of accidents are kept, but it was not clear that these are always monitored for trends. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X X 2 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 2 Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 25 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. Standard OP7 Regulation 15 Timescale for action Individual care plans must reflect 15/07/09 the individual needs of each person and information from the individual assessments should be used to ensure that people receive the care they need and staff are clear about what their support needs are. Management systems must be used effectively to ensure that all care plans are regularly updated. This will ensure that people receive the care and support they need. 2. OP9 13 Medication training for all staff must be completed and records kept to show when this has occurred. This will protect people living in the home. Staff dealing with complaints must be clear about the procedures to be followed and training should be provided. This will ensure that people living in the home are protected by good systems for dealing with complaints. DS0000069904.V375260.R01.S.doc Requirement 30/06/09 3. OP16 22 30/06/09 Astor Lodge View Version 5.2 Page 26 4. OP18 13 5. OP33 24 6. OP38 13 Systems for recording staff training must be in place and kept regularly updated. This will meant that people living in the home are looked after by appropriately trained staff. Systems for reviewing the quality of care need to be used effectively so that people receive good services that suit their needs. Staff training in safe working practices must be provided at appropriate intervals to ensure that people living in the home and staff are protected. 30/06/09 30/06/09 31/07/09 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 OP12 Good Practice Recommendations Peoples’ interests and emotional needs should be recorded within their individual plans so that staff are clear about the support that they require. People should be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities. The gaps at the top and bottom of the patio doors on the main corridor need attention so that there is not a constant draught. The garden maintenance needs to be given priority to ensure that people have attractive and safe areas to spend time outside the home. The capacity of the laundry to deal with items from both Astor Court and Astor Lodge should be reviewed to ensure that there are sufficient machines. This will ensure that people are not waiting a long time for laundry to be returned. Work should be undertaken to eliminate any unpleasant DS0000069904.V375260.R01.S.doc Version 5.2 Page 27 2. 3. 4. OP19 OP19 OP26 5. OP26 Astor Lodge View odours in bedrooms and systems should be in place for reporting and dealing with any problems with persistent odours. Astor Lodge View DS0000069904.V375260.R01.S.doc Version 5.2 Page 28 Care Quality Commission North Eastern Region PO Box 1255 Newcastle upon Tyne NE99 5AS National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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