Inspection on 27/11/07 for Astoria Park

This inspection was carried out on 27th November 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.

Other inspections for this house

Astoria Park 25/08/09

Astoria Park 11/06/09

Astoria Park 03/03/09

Astoria Park 21/04/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Astoria Park 15 Park Crescent Peterborough PE1 4DX Lead Inspector Elaine Boismier Unannounced Inspection 27th November 2007 9:55 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 Astoria Park DS0000069673.V355627.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. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astoria Park Address 15 Park Crescent Peterborough PE1 4DX 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) 01733 555110 01733 898497 Southern Cross Healthcare (Focus) Limited Ms Belindah Pasipamire Care Home 59 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (59) of places Astoria Park DS0000069673.V355627.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 with nursing 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: 59 2. Dementia - Code DE, maximum number of places: 22 The maximum number of service users who can be accommodated is: 59 1st May 2007 Date of last inspection Brief Description of the Service: Astoria Park is registered as a care home with nursing, and mental health needs, for people over 65 years of age. The home has one person, under 65 years of age as a variation of registration. The home is in a converted building with accommodation arranged on three floors. There are fifty-three single bedrooms and three double bedrooms. Fiftyfive bedrooms have en suite facilities and one bedroom has the sole use of facilities situated a short distance away. Astoria Park is situated in a suburb of the city of Peterborough approximately 10 minutes walking distance from the city centre and overlooking a large public park. Current fees range from £379.44 to £585.75. Additional costs include those for hairdressing and chiropody. Further information about fees can be obtained from Astoria Park. We, the Commission for Social Care Inspection have approved an application to register the new owners, Southern Cross. A copy of the inspection report is available at the home or via the CSCI website. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 5 Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This summary includes information that we have received since the last key unannounced inspection we did on the 1st May 2007 and up to this key unannounced inspection of the 27th November 2007. Information We receive copies of regulation 26 reports of monthly visits that have been carried out by a representative of Southern Cross, the registered owner of Astoria Park. These reports have provided us with information about the running of the home. For example the reports have told us about the standard of cleanliness of the home; the views of residents and staff and there has been information about the standard of records. Complaints Since the last inspection in May 2007 we have received 5 complaints about the home that have included concerns about the state of the laundry; lack of activities provided; the number of staff on duty and the smell of the home. We have also received concerns about the heating control in individual rooms. We asked Southern Cross to respond to two of the complaints made to us, and we were satisfied how these complaints were responded to. We informed the complainants that we would assess their areas of concerns during the next inspection of Astoria Park and the complainants were satisfied with our response. Safeguarding Since the inspection in May 2007 we have not attended any safeguarding meetings (previously known as protection of vulnerable adults against abuse or POVA) although we have been made aware of two incidents that have come under this umbrella. We the Commission for Social Care Inspection, made contact with the safeguarding team, following receipt of information from the home regarding these incidents occurring that affected the well-being of two residents. We are concerned that these two incidents were reported by us, rather than by the home, in the first instance. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 7 Key unannounced inspection 27.11.07 This key unannounced was carried out by two Inspectors between 9:55 and 15:55 and took 6 hours to complete. Before the inspection we sent out 20 surveys for residents, 10 surveys for staff and 15 surveys for relatives/visitors. We received 8 surveys from residents, 3 surveys from staff and 8 surveys from relatives/visitors. On the day of the inspection there were 48 people living at the home. We spoke with a number of these people, staff, including the Manager, looked around the premises, watched staff as they worked and examined documentation. Astoria Park provides an adequate quality service. Findings indicated that although some areas have improved other areas of care, with particular regard to medication and following correct safeguarding procedures, have caused us some serious concern. We remain also concerned about staff morale and staffing numbers. Unless action is taken to improve these particular areas, people who live at Astoria Park will not receive a good quality of life. For the purpose of the inspection report people living at Astoria Park are referred to as “people”, “residents” or “service users”. What the service does well: What has improved since the last inspection? Following the inspection in May 2007 we made eleven requirements and 2 recommendations. Eight of these requirements have been met and one recommendation has been considered. A requirement was made for the standard of people’s personal care, including bathing and hair care, to improve. This requirement has been met. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 8 An immediate requirement was made for medication not to be left unattended and for medication be given as prescribed. This requirement has been met in part as medication was not left unattended. A requirement was made for all complaints to be recorded and responded to. This requirement has been met. A recommendation was made for people to be given information in how to make a complaint. This recommendation has been considered. An immediate requirement was made for carpets to be safe for people to walk on without the risk of trips or falls. This requirement has been met. A requirement was made for stained and faded carpets to be replaced. Information provided to us in the regulation 26 reports suggesting that this requirement might have been met. Evidence on the day of the inspection suggested that this requirement has been met. A requirement was made for the home to be clean and odour free. Since the inspection information we have received from a complainant suggesting that this requirement might not have been met although on the day of the inspection most parts of the home were clean and free of odour. This requirement has been met. A requirement that had been assessed as not met, during previous inspections in 2006, was carried forward. This requirement was for required information to be obtained about staff before they work in the home. This requirement has now been met. A requirement was made for staff to attend training in protecting vulnerable people from abuse. This requirement has been met. Since the last inspection the dining room has been provided with new chairs. Since the last inspection an enclosed garden area has been provided with new fences. What they could do better: Medication is not always recorded as being given as prescribed. This was a requirement from the previous inspection and has been carried forward with a new timescale for action. The accuracy of the records made when medication is given to residents must be improved and a requirement has been made about this. A requirement was made for appropriate activities to be provided. Since the inspection information we have received from a complainant suggesting that Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 9 this requirement might not have been met. Evidence on the day of the inspection indicated that this requirement has not been met. We expect that people’s choices are valued and expect that this to be managed by the home. We expect food is served at temperatures that residents’ like it to be and that this is managed by the home. A requirement was made for people’s personal belongings to be cared for in a way to prevent damage or loss. Information provided to us by a complainant indicated that this requirement might not have been met. Evidence at the time of the inspection indicated that this requirement has not been met. A recommendation was made for low staff morale to be improved. This recommendation remains. A requirement has been made for staff to be professional in respecting confidential information disclosed by residents. We expect the home to remind staff of the correct safeguarding procedures (previously know as Protection of Vulnerable Adults Against Abuse or POVA), even when the Manager is not available. The refurbishment and maintenance of the home must continue to be improved upon. We expect the home to manage this, rather than we make a requirement on this occasion. A requirement has been made for care practices to be carried out to ensure there is no risk to the spread of infection. A requirement was made for people to be cared for by sufficient numbers of staff. Since the inspection information we have received from a complainant suggesting that this requirement might not have been met and evidence on the day of the inspection indicated that this requirement remains. 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. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 10 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 Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 11 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): 1 & 3 Quality in this outcome area is good. Prospective residents have access to a good standard of information t assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the 30th April 2007 we approved an application to register Southern Cross as the provider for Astoria Park. The Statement of Purpose and Service User’s Guide have been updated to reflect this change of ownership. Two of the most recently admitted people’s care records were examined and findings indicated that the people had been assessed before moving in to the home. Five of the residents’ surveys told us that the person had received enough information about the home before moving in, to help them in their decision where to live. Astoria Park DS0000069673.V355627.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 The outcome area is adequate. People benefit from an improved standard of personal care and care records although medication practices pose a risk to people’s health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nine people’s care records were examined and findings indicated that the detail in these records has improved; risk assessments are actively reviewed each month and care plans are detailed. Daily progress notes could be better to accurately reflect how the person was that day. For example where a care plan was initiated for the risk of malnutrition we were unable to tell if the person ate sufficiently. A requirement was made for the standard of personal care to improve. Two of the residents’ surveys said that the person considered that they always received the care and support that they needed; two of the residents’ surveys said that the person considered that they usually received the care and Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 13 support that they needed and four of the residents’ surveys said that the person considered that they sometimes received the care and support that they needed. A person wrote, “The care could be better if there were more staff” (see Standard 27 of this report). On the whole we noted that people’s hair and nails were generally clean. This requirement has been met. Care records indicated that district nurses, GPs, chiropodists and community psychiatric nurses have seen people. Care records indicated that where a person had some unintentional weight loss their weight had increased thereafter. Six of the residents’ surveys told us that the person always received medical attention when they needed and the two of these remaining surveys said that the person usually received medical attention when it was needed. A specialist pharmacist inspector examined the practices and procedures for the safe handling of medicines. Residents are protected by satisfactory security of medicines and the storage facilities provided are temperature controlled. Due to the small space provided for the storage of controlled drugs, some of these are not stored within the special cupboard required by Regulations. This is also not in line with the home’s own policy. It is expected that the home can manage this issue without the need for a statutory requirement. Records of the receipt and disposal of medicines provide a good audit trail of medicines but the record made when medicines were given to residents showed some problems. For example, there were a number of gaps in the records giving no clear indication whether medicines had been given or not, if not the reason why was not recorded. Where medication is given in a variable dose e.g. one or two tablets, the actual number of tables given is not always recorded. This could put residents at risk of receiving too much or too little medication. In fact the record for one resident shows that they may have received and overdose of paracetamol. The home staff do regular checks of the accuracy of the medication records and some, although not all of these problems had been picked up. A requirement has been made for medication records to be accurate and complete and the requirement that medication is given as prescribed as been carried forward. People told us that the staff were respectful and “good”. We observed staff working and their interaction with the residents was respectful. Astoria Park DS0000069673.V355627.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is poor. People’s quality of life could be much better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made following the inspection in May 2007 for appropriate activities to be provided to people living at the home. In October 2007 we received a complaint that there was insufficient activities provided at the home. A copy of the regulation 26 monthly visit report indicated that staff were to assume responsibility of providing activities to people until the vacant post for an activities co-ordinator was filled. During our inspection the Manager informed us that activities were to become part of the role of the care staff although care staff informed us that they were unable to meet this commitment due to staffing numbers (See Standard 27 of this report). Surveys from relatives told us …”the home always seems to be short staffed. There is consequently a noticeable lack of structured stimulation for residents” and “Social activities seem to be at a all time low. Entertainment is limited & not as stated on list.” Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 15 Two of the residents’ surveys told us that the home always provided suitable activities: three of the residents’ surveys told us that the home usually provided suitable activities: one of the residents’ surveys told us that the home sometimes provided suitable activities: two of the residents’ surveys told us that the home never provided suitable activities. The record of activities was not available in all of the people’s care records that we saw. Those activities that had been recorded showed that the variety of activities was limited to 1:1 discussion and these sessions were at the most, four times in a month. During our inspection we saw people sitting in lounges and the majority of the people were asleep. There were no activities provided to stimulate them. Televisions were on although no person appeared to be watching these. A television in one of the lounges was showing a children’s programme that might not be appropriate for older people. This requirement has not been met and has been carried forward with a new timescale for action. Care records, the visitors’ record book and what people told us indicated that residents can receive their guests at any time and they can go out to visit their families and friends. Staff informed us, choices of how people want to live, including having individual personal care (e.g. having make up applied) are often not valued due to insufficient number of staff to meet people’s needs in a timely manner and according to the person’s wishes. Residents’ that we spoke to indicated that their choice of how to live, including getting up, was not always valued. We expect that people’s choices are valued and expect that this to be managed by the home. Three of the residents’ surveys said that the person always liked the meals; two of the residents’ surveys said that the person usually liked the meals and three of the residents’ surveys said that the person sometimes liked the meals. One person wrote that they would like to see “More variety of food, not the same every week.” At our inspection people told us that hot food was often served cold. One person said that the meat was “lovely” but they could not eat it, as it was served cold. Other people told us that the vegetables were often served cold. We observed the serving of the food at lunchtime. The current system appeared chaotic: food for all residents, whether in their rooms or in the dining room was served simultaneously. Vegetables were put on several plates at the same time before the main choice was served on to these plates. We expect the home takes action to ensure food is served at temperatures that people like their food to be. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 16 Menus were seen and these indicated that people are offered a variety of food and choices were available. The lunch provided was the same as indicated on the current menu. Since the last inspection the dining room has been provided with new chairs. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 17 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 & 17 Quality in this outcome area is adequate. People feel they are not always listened to and are at some risk due to inadequate safeguarding reporting procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made following the inspection in May 2007 for all complaints to be recorded and responded to. Since the inspection in May 2007 we have received five complaints about the home. We asked the Company to investigate two of the five complaints although one of the three remaining complaints made to us was about the same issue. This was with regards to the heating systems of the home. We were satisfied with Southern Cross’s responses to the complaints about the smells in the home and staffing numbers. The remaining complaints were about the insufficient number of staff; offensive smells in the home, the “terrible mess” in the laundry and the lack of activities provided. We received a copy of the regulation 26 report, for November 2007, and this acknowledged that there was a vacancy for an activities co-ordinator; until this post was filled staff were to assume responsibility for this aspect of social care. One of the relative’s surveys informed us that although the person had made a complaint it was their view that “Some items (of the complaint) need pointing out more than once before it is dealt with!!” Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 18 A recommendation was made for everyone to be given information of the home’s complaints procedure. All the residents’ surveys told us that the person knew how to make a complaint. When we spoke with the residents, information that they provided indicated that they knew how to make a complaint Four of the residents’ surveys said that the person always knew who to speak to if they were unhappy; two of the residents’ surveys said that the person usually knew who to speak to if they were unhappy; one of the residents’ surveys said that the person sometimes knew who to speak to if they were unhappy. The remaining survey informed us that the person did not know who to speak to if they were happy. All of the residents’ surveys said that staff always listened to the person and acted on what was said to them. Any person has the right to make a complaint to us, as part of the home’s complaints procedure. Information shared with us, at any time, we consider to be confidential unless the complainant gives their permission for us to disclose their identity. During this inspection we were told that confidential information provided to us from residents, about their views of the home, had been overheard by a member of staff. The member of staff to other staff members shared this confidential information. This is an unacceptable breach of confidentiality. A requirement has been made about this. A requirement was made following the last inspection with regards to the standard of care of people’s personal laundry. A copy of the regulation 26 monthly report informed us that the laundry was-“cluttered and disorganised”. Information provided to us by a complainant told us that people’s personal laundry was not always treated with care and respect,” clothes are often not washed, only ironed and given back.” We visited the laundry and spoke with staff. Clothes that had come out of the drier had not been folded when warm; some clothes that, according to staff, had been ironed remained creased. We were told that the industrial iron was broken and a requisition had been made for this to be replaced although staff considered that the response to this was overdue. We were informed that all laundry, including bed linen was ironed on the domestic ironing board with the use of a domestic iron. The ironing board had holes in both the cover and the main part of the board. A number of personal items of clothing were in piles, as staff did not know whom these belonged to. Staff were discontented with the working conditions of the laundry (See Standard 27 of this report). We looked in some people’s wardrobes and found clothing often had been placed in drawers in an untidy manner. A person told us that staff, “Just throw things in”. A resident confirmed that their 100 wool cardigan had been Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 19 washed in the home’s laundry. The wool of this garment was harsh, possibly due to poor washing techniques. We saw men’s shirts that were hanging in wardrobes and these shirts were creased. (See Standard 27 of this report) Minutes of staff and relatives’ meetings held in October and November 2007 respectively showed that the issues with the laundry and people’s personal belongings had been discussed. We were informed in copies of the regulation 26 reports that there are plans to increase the size of the laundry area although we have not been informed of when this action is to commence. This requirement has not been met and has been carried forward with a new timescale for action. Following information received from the home, of two separate incidents affecting the health and safety of two individuals we instigated the local safeguarding reporting procedures, although this responsibility lies in the first instance with the home. The Manager informed us that she was on leave at the time that these incidents occurred. Although we acknowledge that staff have attended training in safeguarding people against abuse (See Standard 30) the understanding of staff in what to do in the event of possible abuse, is a concern. We expect the home to remind staff of what to do in such events, even when the Manager is not available. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 20 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): 19,25 & 26 Quality in this outcome area is adequate. People live in a place that is becoming more homely although they are at some risk to their health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two requirements were made following the inspection in May 2007. An immediate requirement was made regarding the safety of carpets and a requirement was made for those carpets that were faded or stained, to be replaced. We have received copies of regulation 26 monthly reports and for the months of July and November 2007 for example we were told that new carpets were being laid and that bedrooms were being decorated. During the tour of the premises we saw that bedroom carpets and carpets in the corridors of the ground floor had been replaced. The Manager informed us Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 21 that there is an ongoing programme for refurbishment of the home. Both of these requirements have been met. We noted that the bathrooms and shower rooms were uninviting as these were often used for storage space; wall and ceiling tiles, notably of one of the first floor bathrooms, were missing and in a poor state of repair; one bath was dirty and had a dead wasp in it; the door to a bathroom on Willow Suite was difficult to open; the door to the toilet of bedroom 26 could not be closed; coving in bedroom 26 was cracked and the wallpaper in some areas of this bedroom had bubbled up. We expect the home to manage such issues, rather than we make a requirement on this occasion. Since the last inspection in May 2007 we have received two complaints about the heating of individual rooms. We informed the home manager of the first complaint and we were made to understand that action had been taken to make sure that individual bedrooms could be heated in a way that suited the person living in the room. The second complaint we received two weeks after the first complaint. The complainant considered that the action to improve the heating in people’s individual rooms was taking an unacceptable long time. We received these complaints in October 2007. During our inspection we examined correspondences between the home and Southern Cross about this issue. Action remains outstanding as Southern Cross is carrying out comparative costing for equipment to control the temperature of radiators in individual rooms. We have made no requirement about this as individual rooms were heated comfortably and we received no complaints from residents about the temperatures of the room. Nevertheless we expect for action to have been taken for this heat-regulating equipment to ensure that people are comfortable and that people who complain feel that they are truly listened to. A requirement was made for the home to be clean and free from offensive smells. Since the last inspection in May 2007 we have received two complaints about the smells in the home and that these smells were considered to be due to the smell of urine. We requested the home to investigate these complaints and the response was for carpets to be deep cleaned. Copies of the regulation 26 monthly reports have informed us that the home is found to be free from offensive smells. Three of the residents’ surveys said that the home was always clean and fresh; two of the residents’ surveys said that the home was usually clean and fresh and three of the residents’ surveys said that the home was sometimes clean and fresh. During our inspection we noted that on the whole, the home was clean and smelled fresh and consider this requirement has been met. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 22 During the tour of the premises we saw that in a bathroom soiled incontinence pads had been deposited in a receptacle and these pads smelled. We noted also the white coats, for staff to wear when entering the kitchen, were dirty. In addition a tub of aqueous cream was found in a bathroom. There was no label on this tub and we had some concern that the aqueous cream could be used for more than one person. A requirement has been made. Staff were wearing alcohol hand gel for cleaning their hands and informed us that they had attended training in infection control. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 23 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. People are safer as staff are well recruited and trained although residents’ quality of life is compromised due to staffing numbers. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys that we have received from relatives told us that there is a “dedicated work force” and that staff are “Generally very caring people”. People told us that they lacked confidence in staff competencies. We were told that some staff were very good and experienced whereas there were some staff who did not have this level of experience. We were told that sometimes people could not understand staff who do not have English as their first language. According to the duty roster and the Manager such staff are attending English classes to improve their communication skills. A requirement was made, following the inspection in May 2007, for people to be cared for by a sufficient number of staff. Since the inspection we have received a complaint alleging that there was an insufficient number of staff on duty. We asked for Southern Cross to investigate this allegation. The investigation concluded that on one occasion that there were 3 staff on night duty, as 2 members of staff had phoned in sick and that the home was unable to cover the night shift even with agency staff. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 24 One of the 3 staff surveys told us that there is “usually” enough staff on duty although the two remaining surveys informed us that there was “never” enough staff on duty. One member of staff wrote, “We are always rushing around. Unable to give the proper care we would like to give to the residents.” During our inspection people told us that they had to wait for staff to attend to them. One person said that they had to “I can shout and shout but no one ever comes”. Another person told us that they had rung their call bell for help to go to the toilet. The person told us that they were helped to the toilet after waiting for an hour. Staff informed us that they are unable to provide person centred care (see Standard 8 of this report) and unable to engage residents in activities as they would like to (see Standard 12 of this report). This requirement has not been met and has been carried forward with a new timescale for action. During our inspection of 1st May 2007 we found that people were at risk to the health and safety as the morale of the staff was low, and we made a recommendation for this to be improved. In the copy of the monthly regulation 26 report, for July 2007, we were told that staff morale was “low”. Although a subsequent regulation 26 report, for November 2007, told us that staff morale had improved, a staff survey said that, “Morale is often very low… A lot of the good staff seem to be leaving.” The Manager informed us that since the inspection in May 2007, seven members of staff have left. According to the Manager the reasons for these people leaving included staff moving away from the area, staff pursing a career progression or obtaining better-paid work. One member of staff was dismissed from their employment. Two of the three staff surveys told us that the person felt unsupported by both the management of the home and the company, Southern Cross. Comments included in these surveys said, “”Since the take over everything has gone bad. Atmospher (sic) Staf (Sic) relations Communication Care Activitie (sic) appaling(sic)”. The surveys told us that the staff felt that they received no support and that communication about residents was poor. One of the surveys said that Astoria Park could do better by, “Better Management, Better Company, support for all staff.” At our inspection we received a views from staff and information provided to us indicates that staff morale could be better (see also Standard 18 of this report.) Although this recommendation remains, it will not appear again in the recommendation table of this report. Information provided by the Manager told us that there is 54.1 of care staff with an NVQ level 2 qualification. A requirement was carried forward from previous inspections, in 2006 and 2007, as not all the required information about staff had been obtained. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 25 Examination of two staff recruitment files indicated that this requirement has been met. A requirement was made for all staff to be trained in the protection of vulnerable adults against abuse. Information provided by staff and examination of staff files and staff training records indicated that this requirement has been met (See also Standard 18 of this report). Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 26 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): 31,33,35,36 & 38 Quality in this outcome area is adequate. People benefit from a home that is adequately managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last 12 months the Registered Manager has attended training in infection control, health and safety and palliative care. She intends to complete the Registered Manager’s Award by the end of 2007. In June 2007 surveys have been carried out by Southern Cross asking both relatives’ and residents’ their views about the home. The Manager informed us that results of these surveys have yet to be sent to Astoria Park. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 27 The Manager has carried out audits on care plan documentation and informed us that she has carried out an audit on medication. Three residents’ personal monies were counted and these amounts reconciled with the balances. Staff told us that currently they do not feel that they get the support that they need from the management team of the home (See also Standard 27 of this report) although according to the Manager staff receive 1:1 supervision. Records of these supervision sessions were not inspected on this occasion. Staff stated that they had attended training in moving and handling, fire safety, health and safety and first aid training. Examination of staff training records and their files confirmed that staff had attended this training. Records for fire drills, emergency lighting, fire alarms, temperatures of hot water checks and service checks on hoists and baths were seen and these were satisfactory. Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 28 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 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 15 2 x x x x x 3 2 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 2 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x 3 x 3 2 x 3 Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Medication must be given to people who use the service as it has been prescribed to ensure appropriate treatment is provided. Records of the administration of medicines must be accurate and complete. This will show that people receive the medicines prescribed for them. This is a repeat requirement. Previous timescales of 31/12/06 and 03/05/07 not met in full. 2. OP12 16(2)(n) People must be provided with 02/02/08 appropriate activities to relieve people from boredom and risk of depression. This requirement has not been met by the timescale of 04/06/07 and has been carried forward with a new timescale. People must be confident that 12/12/07 any information that they divulge is treated in a professional and confidential manner. DS0000069673.V355627.R01.S.doc Version 5.2 Page 30 Timescale for action 12/12/07 3. OP16 12(5)(a) Astoria Park 4. OP18 13(6) 5. OP26 13(3) 6. OP27 18(1)(a)( b) Personal belongings of people who use the service must be cared for in a way to prevent damage or loss. This requirement has not been met by the timescale of 09.05.07 and has been carried forward with a new timescale. People must be protected from the risk of spread of infection by ensuring that used incontinence pads are disposed away from communal areas and disposed of in a way that does not emit offensive odours; that white coats worn for entering the kitchen are clean and that aqueous cream is used for one person only. People who use the service must be cared for by sufficient numbers of staff. This requirement has not been met by the timescale of 15/05/07 and has been carried forward with a new timescale. 03/01/08 12/12/07 03/01/08 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 Astoria Park DS0000069673.V355627.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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