Inspection on 03/03/09 for Astoria Park

This inspection was carried out on 3rd March 2009.

CSCI found this care home to be providing an Poor service.

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

Astoria Park 25/08/09

Astoria Park 11/06/09

Astoria Park 21/04/08

Astoria Park 27/11/07

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 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Astoria Park 15 Park Crescent Peterborough PE1 4DX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Boismier     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Astoria Park 15 Park Crescent Peterborough PE1 4DX 01733555110 01733898497 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Healthcare (Focus) Limited care home 59 Number of places (if applicable): Under 65 Over 65 0 59 dementia old age, not falling within any other category Additional conditions: 59 0 The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category/ies of service only: Care Home with Nursing - Code N 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 Dementia - Code DE Date of last inspection Brief description of the care home Astoria Park is a registered care home to provide care, mainly for people over 65 years of age, some with nursing and mental health needs. The home is in a converted building with accommodation arranged on three floors. There are fifty-three single bedrooms and three double bedrooms. Fifty-five 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 £387.03 to £750.00. Additional costs include those for hairdressing and chiropody. Further information about fees can be obtained from the home.A copy of Care Homes for Older People Page 4 of 34 Brief description of the care home the inspection report is available at the home or via the our website at www.cqc.org.uk Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This summary also includes information about the home, since our last inspection of the 21st April 2008. 3rd September 2008 On the 3rd of September 2008 a protection of vulnerable adults, (now known as safeguarding) alert was raised and we attended the first safeguarding meeting in October and the second in November 2008. It was concluded that the home had failed to provide proper and adequate care for a resident who was assessed to be at high risk of malnutrition. During the investigation it was noted that there had been poor record keeping and poor monitoring, as part of the homes quality assurance, by the Care Homes for Older People Page 6 of 34 management of the Astoria Park. 5th September 2008 On the 5th September 2008 a safeguarding alert was made as there were concerns about the quality of nursing and care provided to a resident who had diabetes (mellitus). The home had not taken appropriate action to monitor this persons medical condition and there was a delay in the staff responding to the persons decline in health. When the person was admitted to hospital they were found to be in a deep coma; they had a grade 4 pressure sore which had no dressing on and the person was found to be clinically dehydrated. 9th October 2008 We received information, from one of the safeguarding lead practitioners that Considerable progress has been made in minimising the risks to one of the residents who had been subject to abuse from another of the residents. December 2008 In December 2008 we received information alleging that a resident had not been provided adequate care to their skin and to their personal care. It was found that there were issues around the standard of care planning and the standard of skin care, resulting in the person being described, by the complainant, as being smelly and having sores in their groins. 6th January 2009 and 9th February 2009 Following a safeguarding alert, made by the home, on the 30th December 2008, we attended a safeguarding meeting on the 6th January 2009. An allegation, of abuse had been made, by a member of care staff. It was found that this member of the staff was working in an unsupervised capacity although the home had not received the results of the member of staffs criminal records bureau (CRB): this was received two days after the alleged incident had occurred. Furthermore it was found that there had been a delay, by other members of care staff, in reporting this alleged abuse. On the 9th February at the reconvened safeguarding meeting, there was a general consensus that abuse probably had taken place although there was insufficient evidence to prove that this had actually happened. This outcome of the meeting was recorded as such. 6th January 2009 We received information that a resident had wandered out of the home and had been found, by the police, 45 minutes after the person was found to be missing. 27th January 2009 On the 27th January 2009 a person was able to exit the home via a fire escape without being noticed, and was found on the floor on a landing at the top of open fire stairs outside a fire door. The person had a grazes, bruises and a skin tear and bruise to their left forearm. We received a notification, dated the 29th January 2009 and received on the 4th February 2009, about this untoward incident that told us an x-ray test had confirmed that the person sustained a fractured, as a result of this untoward incident. 10th February 2009 On the 10th February 2009 we carried out an annual service review of the home. We looked at the results of surveys we have received from seven relatives and a member of the staff. We looked at the Annual Quality Assurance Assessment (AQAA) that was completed by the Registered Manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service.We looked at the history of the service since our last key inspection that took place in April 2008. Due to the concerns we had we decided to bring the next key inspection forward before the due date of 20th April 2010. 17th February 2009 On the 17th February we received information from the safeguarding team. The home Manager had contacted the team, informing them that a person, with diabetes (mellitus) had been treated, by the home, for low blood sugars but although the person was not responsive they were continued to be monitored, rather than emergency services were called, until 30 minutes later when the person was admitted to hospital. January 2009 In January 2009 we received information, from the local authority that their monitoring review had found that the standard of record keeping was unsatisfactory; there were issues with information about the staff being available and staff training and staff competencies. 29th January 2009 On the 29th January 2009 we received information, from one of the safeguarding practitioners, with regards to the safety of the premises. Although the home had carried out risk assessments and taken action, until the fire alarms were working safely, the staff had not noticed a resident leave their room and exit Astoria via the fire door on the 1st or 2nd floor. Following this concern we contacted the Fire Safety Officer (FSO) for their expert advice. 3rd March 2009 We, the Commission for Social Care Inspection, carried out this unannounced key inspection, by three Inspectors, between 10:00 and 15:00 taking 5 hours to complete. We case tracked 3 of the people; this means that we spoke with them, observed how they were looking, including the way they were dressed and their mood; we spoke with the staff who were looking after them and looked at these peoples care records. We also spoke with and observed some of the other people who were not part of our case tracking. Care Homes for Older People Page 8 of 34 We looked around the premises, spoke with other staff and looked at documentation. We have used some of the information that we have received in both the AQAA and the surveys from relatives and a member of the staff. For the purpose of this inspection report people who live at Astoria Park are referred to as person, people, resident or residents. Care Homes for Older People Page 9 of 34 What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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 Care Homes for Older People Page 10 of 34 7535. Care Homes for Older People Page 11 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good system in place to ensure that the home can meet the needs of any person who moves in. Evidence: The AQAA told us that Pre-admission assessments are carried out for all prospective residents to determine if we can meet their needs prior to admission. The AQAA said that there has been no placement breakdowns within the last year. Since December 2008 the local authority has suspended new placements to the home, due to the concerns about the standards of care and standards of management. As part of our case tracking we looked at three peoples care files and we found that there were pre-admission assessments, carried out by care managers, and this information was submitted to the home, before the person moved in. Care Homes for Older People Page 13 of 34 Care Homes for Older People Page 14 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some peoples helath and safety is at risk. Evidence: As part of our case tracking methods we looked at three peoples care records and spoke with these people and some of the staff. We also spoke with other people, who were not past of the case tracking. Evidence indicates that the care records do not meet Standard 7.We noted that the care plans for the management of diabetes (mellitus) provided insufficient guidance for the staff. There were no parameters of what the persons range of blood sugars should be, rather this was described as to be within normal limits. For the management of low blood sugar we read that the staff were to administer a medication hypostop before calling for emergency aid. From our safeguarding information we are aware that two of the people, who were part of our case tracking, were admitted to hospital, in unresponsive (coma) states, due to their low blood sugars. Care Homes for Older People Page 15 of 34 Evidence: An examination of the care records, of one of the residents we case tracked, indicated that they had complex medical conditions, and that they needed a urinary catheter. According to the records their catheter bag was last changed on the 17th January 2009 although a member of the staff told us that the protocol is for the catheter bag to be changed one a week. We noted that risk assessments are carried out for areas such as moving and handling and risk of pressure sores and these had been reviewed each month for two of the three people we case tracked. For the 3rd person their risk assessments had not been updated since 15th January 2009. This person had been admitted to hospital, as an emergency, in February 2009; the subsequent daily records indicated that the persons health, and therefore change of needs and risks, had increased, although the risk assessments had not been reviewed, based on these changes. We saw the person had body maps for abrasions and skin tears and these were accurate. We saw also a body map that told us the person had a sore, unbroken area on their bottom, as a result of their stay in hospital; their risk assessment, for development of pressure sores, had not been reviewed following their discharge from hospital. We spoke with a member of the staff who said that the persons risk of pressure sore development remained low. We saw a risk assessment, for pressure sore development of this person, that was carried out by a district nurse, since the 15th January 2009; this reviewed risk assessment showed that the person was now at a high risk of pressure sore development. A member of the staff told us that no one should be at risk should they have the care provided. This indicates that some of the staff might not understand the significance of risk assessments. We found insufficient evidence to suggest that the care plans were drawn up in consultation with the person. One of the people, who we case tracked, stated that they considered it cruel to have a urinary catheter in them. This suggests that the person might not have been consulted (and given permission) to this care practise. There was no other evidence, on the files that we saw, that the people had been consulted about their care. Other care records, that we saw, were not of an expected standard. For a person with a grade 4 pressure sore, on their bottom, we looked at their care plan, examined their repositioning chart and spoke with a member of the staff. We saw entries of when the person was helped to change their position, when in bed, and these were recorded for 2nd March 2009 and none for the 3rd March 2009, the day of our inspection. We saw a member of the staff make an entry for 13:40 although this was entered as 1:40 (the 24 hour clock was not used in this instance). The care plan stated that the person was Care Homes for Older People Page 16 of 34 Evidence: to have their position changed 2-4 hourly. The repositioning chart from 4:00am and up to 13:40 was blank of any entries. We saw that, at approximately 10:45, the person was lying on their left side, although the last entry of the repositioning chart, for 4:00am, indicated that the person had been placed on their back (and possibly directly onto their pressure sore). The member of staff was unable to tell us if the person had had their position changed, since 4:00am, and in accordance with their care plan. The repositioning chart provides an area for staff to sign: we saw that one member of the staff sign their name and the name of the other member of the staff, using their first names only. For the fluid balance chart, of another person, we saw that on the 2nd March 2009, they had their catheter bag emptied, of urine, at 13:05 and there was no other entry thereafter. We spoke with a member of the staff who examined this fluid balance chart, with us, and they stated that they had entered the amount of 500 millilitres (mls) of urine at 10:30, on the 2nd March 2009, but this had been amended, by another (unknown) person to record that the amount of urine the person had passed was 1500mls (rather than the 500mls that had been initially recorded by the member of staff who had emptied the persons catheter bag). In one of the care files we saw no record of a podiatrist visiting a person who had diabetes (mellitus). We saw, when checking records for their personal allowances, that they had received such treatment on the 26th February 2009. The records provided no other evidence that this person had received such necessary care and treatment of their feet. We have made a requirement about care records. The AQAA told us that the service provided is value for money as Our residents are well cared for and we continue to explore ways to improve the standards of care. We are constantly reviewing individual care plans in order to ensure residents` needs are met. Nevertheless we have found, during the sharing of information, at the safeguarding meetings (see the summary part of this report) that this has not been the case for some of the residents who have lived there. In one of the relatives surveys we read that they were dissatisfied with how the staff were meeting the specialist sensory needs (they have impaired vision) I had to report that carers, cleaners and nurses went into (my relatives) room and not once said who they were or even that they were leaving the room. I think staff need a course where they are blindfolded & left to fend for themselves in a room. Another of these Care Homes for Older People Page 17 of 34 Evidence: relatives surveys said Some staff do not appreciate the culture in which (my relative) lived (their) life. A third relatives survey said It would be nice if the resources available could cater for more individual care. Five of the seven relatives surveys said that the home always or usually met the needs of the residents with the two remaining surveys that sometimes such needs were met. The majority (6) of these surveys said that the resident they were linked with were given the support or care that they expected. A number of the female residents, had bare legs, with no tights, socks or stockings on. One person said that they would have liked to wear tights but the staff did not help them with this. For two people we saw, who had pop socks on, we saw that the skin was restricted by tight and incorrectly worn pop socks, causing the peoples legs to swell above the pop socks. For another person we saw that they were wearing a jumper on their top half of their body against bare skin. Other people we saw had dirt under their finger nails and another person, who told us they needed support to clean their own teeth, stated that this support was not always made available. We noted that the persons teeth had more than one days food on them. A person, who was not part of our case tracking, was in bed when we visited them. They looked uncomfortable, with their head pushed forward by the pillows. They stated that they felt uncomfortable but they were unable to call for assistance, as their call bell was out of reach. The person gave us permission to call for help, on their behalf, and this we did. A member of the staff responded promptly to the call but did not ask how the person was. Before the member of staff left the room, on behalf of the resident, we explained that they were uncomfortable. The member of staff said that they would get help from another carer. We informed the resident, as the member of staff failed to do so, what action was being taken, to make them more comfortable. We have made a requirement about the health and welfare. Practices and procedures for the safe storage, handling and recording of medication were examined by a pharmacist inspector. The home has good clear written policy and procedures for the safe use of medicines to protect residents. Storage for medication is adequate and the temperature satisfactory. Daily records are made of the temperatures, which were consistently below 25C. The daily records for the fridge temperature show that they are within the acceptable range. Stock levels of medication in use were kept at minimum levels. Dedicated storage is provided for controlled drugs and this is acceptable. Entries made in the controlled drugs register were satisfactory. Care Homes for Older People Page 18 of 34 Evidence: Records made when medication is received into the home and when it is given to residents are reasonably good and demonstrate that generally people receive the medication as prescribed. There were very few discrepancies in the medication and medication records and evidence was seen that the records are checked regularly by staff. Despite this, however, some deficiencies were found: there were several gaps in the medication administration records for several people on the evening of 01/03/09. This gives no clear indication of whether medicines were administered or not, and if not the reason why was not recorded. One persons medication had been stopped by the home staff but this was not in line with the prescribers instructions as the medication should have been reduced in dosage and not stopped. This would normally result in an immediate requirement notice being served but it was resolved during the inspection. In one persons room we found medication which was not labelled for them. We have made a requirement about medication records. People we spoke with said that the staff were good and we saw the staff knock on the peoples doors before entering. Care Homes for Older People Page 19 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are provided with opportunities to live a good social life. Evidence: According to the AQAA We have introduced new activities and in the process of consultation with service users we are re-starting a committee and also made social links with the local community.The AQAA went on to say Social care profile for every resident to be completed by relatives where possible, activities programme on notice board and given to all residents. Service users who prefer not to join in group activities are offered one to one activities. Service users` family and friends have no restrictions in visiting the home or taking their relative out. Service users are taken to town for shopping as they wish or down the village for a walk around the shops. We have entertainers who come to the home to perform twice a month.We have made social links with Thomas Moore School where service users visit and scool (sic) children are contributing in the activities in the home by providing entertainment. The AQAA identified where the home could do better by Increase on outdoor activities. We are working on improving on one to one activities for residents who are confined to their rooms and those who may not be able to participate in group activities. We are planning to get a new Mini bus in the new year. Encourage all staff to be actively Care Homes for Older People Page 20 of 34 Evidence: involved in all activities planned in the home.The AQAA told us that within the last 12 months the home has improved as Activities have become a daily part of the day in the home. Having 2 activity organisers has brought some stability in the home in terms of activities. One of the relatives surveys said that the residents Need more mental stimulation-outside trips,visitors, local groups to talk to (my relative). We saw that the home has now acquired a mini bus and the staff told us that there are staff who are able to drive this, to take the people out on trips. We spoke with the staff and we saw photographs of activities, including a tea party held, in one of the lounges, the day before our inspection. The programme of activities included bingo, crosswords, a visit from the Raptor Centre, carpet bowls and trips out to the local park. Peoples rooms were personlaised with their ornaments, furniture and photographs. We saw people receiving their guests and some of the people we spoke with said that they had visitors. The majority (6) of the relatives surveys said that home helped in making sure the resident kept in touch with their families and friends. A relatives survey said that the Kitchen meals are brought to my (relatives) room, sometimes cold & sometimes not what he ordered. When this was pointed out (they were) told (theyd) have to have this item instead. The people we spoke with said that they were offered a choice of what to eat. We received a range of views about the food from the people we spoke with from Very good to Sometimes good, sometimes bloody awful. We saw the menu in the main dining room and for one day each week there is an option of a cooked breakfast. For lunch the menu indicated there is a choice of a hot option and at tea time there is soup, sandwiches and a hot option is also available. Although there is no specific supper time we asked the staff about this, based on information provided by one of the peoples care records. We were told that the night staff offer sandwiches or any other food, after 20:00, and this is recorded by the night staff, in peoples care records. We did not observe the lunch time experience on this occasion. Care Homes for Older People Page 21 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 generally listened to although they are at some risk of abuse. Evidence: Up to when we received the AQAA, in January 2009, the home had received 13 complaints of which 12 were upheld and all of the 13 complaints had been resolved within the 28 day required time period. We examined the record of complaints and we found that these had been responded to within the required 28 day time period. None of these recorded complaints had recurring themes. Five of the seven relatives surveys said that the person knew how to make a complaint; one of these surveys said the person did not know how to make a complaint with the one remaining survey not being completed in this section. Four of these surveys, where a complaint or concern had been made, the person was generally satisfied with the homes response although we read in one of the relatives surveys said that they had cause to complain about the condition of their relatives room and the room Was painted after complaining this year but it took awhile!. The staff survey said that the person knew what to do if any person or visitor had any concerns, about the home. All the people we spoke with did not know who to speak to if they were unhappy about something. Care Homes for Older People Page 22 of 34 Evidence: The AQAA said that We ensure that all staff are trained in abuse and SOVA procedures so that they are aware of the requirements to report any incidents immediately although we have found evidence that this was not the case, during the safeguarding meeting, held on the 6th January 2009 (see the summary section of this report for further details).(SOVA= safeguarding of vulnerable adults). We saw, in the two staff training files, that these members of staff had attended training in safeguarding vulnerable people. The staff we spoke with told us what they would do if they witnessed an incident of abuse against any of the residents. Although the staff said that they would report the abuse via Southern Cross management lines, they had insufficient knowledge of who and how to contact other agencies, such as the police or the local safeguarding team. We expect the home to improve this standard of staff information. Care Homes for Older People Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 live in a generally clean home although there have been some risks to the safety of some of the residents. Evidence: From the AQAA we learned that We have decorated the dining room and lounges with colours chosen by service users,bedrooms have also been decorated with warm colours. We have also decorated the corridors, we have named the ground floor corridor Memory Lane and have a service users wish list board and We have improved the cleanliness of the home. Carpets have been replaced in all areas, lounges, corridors and bedrooms. We have a decoration plan in progress,bed rooms have been personalised and decorated to provide a homely enviroment (sic).Door furniture works have done ie painting doors, putting some door knockers, letter boxes and door plates. Service users with high level of incontinence have had their carpets replaced with non slip floors to allow deep cleaning daily.Refurbishment plan is ongoing we have replaced curtains in the consevatory (sic) longe(sic) areas and the dininig (sic)room. Most of the corridors have been decorated. The main kitchen floor has been replaced. Gardens are being well maintained and are a lot brighter. A relatives survey said that the Maintenance man is excellent with nothing to (sic) much trouble for him, the best they have had in 4yrs. Care Homes for Older People Page 24 of 34 Evidence: Although the AQAA said the home is managed well by Promoting and maintaining secure environment for all we have found that this is not the case with two separate incidents:on the 6th January 2009 we received a notification that a resident was found in a neighboring street and returned by the police; the home sent us a notification, on the 29th January 2009, that on the 27th January 2009, another resident was able to exit the home via the fire door without being noticed. We noted that there is an ongoing refurbishment programme to include decorating and replacement of carpets. We also noted that some of the corridor walls have been provided with pictures of film stars and fiddle boards. The home was generally well-maintained with the exception of a bathroom on the 1st floor where we found three wall tiles had come off the wall and the grouting was of a poor standard of the opposite tiled wall. We expect this to be managed by the home rather than we make a requirement on this occasion. One of the relatives surveys said that the home could improve with the Cleaning staff dusting and polishing of areas. hoovering thoroughly, with constant checks by an (sic) housekeeper, they only clean where they can see some areas are thick with dust. Another of these relatives surveys said that At times Ive raised concerns about the maintenance and general housekeeping of the home. We read in another of the relatives surveys The only complaint I have ever issued has been a envirementally (sic) one in as much as the shabbiness of (my relatives) room i.e. stained furniture, broken radiator guards left on the floor, broken toilet. The white gowns, for staff and visitors to wear, before entering the kitchen, were less than clean. We expect action to be taken by the home to reduce this risk of infection. We found that generally the home was clean and free of offensive smells. We saw that there was at least two members of cleaning staff on duty, busy cleaning bedrooms, corridors and the main dining area. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 at some risk due to the way staff sometimes work and due to the level of some of the staff competencies. Evidence: The staff survey said that there was never enough staff on duty as Residents with high needs need more time with them. We timed the response of staff to peoples calls for assistance and we noted that the people were attended to in a timely manner. However one of the people, that we case tracked, told us that they have had to wait for a long time, up to an hour, before they received a response to their call for assistance. They told us that no offer of an explanation, for such a delay, was provided. Of the 25 current members of care staff, 15 of these have National Vocational Qualification (NVQ) level 2 or equivalent, in care i.e. 60 . According to the staff, a number of care staff are currently attending this training programme. The AQAA said Robust recruitment process complies with statutory requirements although we have found that this was not the case during a safeguarding meeting when a member of staff was providing personal care to a resident, in an unsupervised capacity, before the home had received the results of the criminal records bureau Care Homes for Older People Page 26 of 34 Evidence: check. We examined three staff files, including the newly appointed Acting Manager, and we found that all the required information was available. The Acting Manager stated, and this was confirmed by a member of the staff, that he does not visit any of the residents, in private, unless supervised, whilst waiting the results of his criminal bureau check. Four of the seven relatives surveys said that the care staff always or usually had the right skills and experience to look after people properly; two of these surveys that sometimes this was the case with the remaining survey not completed in this section. The staff survey said that the person received an induction training programme that partly covered everything they needed to know about their job. This survey said that although there was ongoing, up to date and relevant staff training the member of staff said that they were Not always shown properly. The staff training records and staff files indicate that staff have attended training in a number of areas to include the management of challenging behaviours, care of pressure sores, customer care and diabetes (mellitus). The staff we spoke with confirmed that they had attended such training. Although the staff have attended such training, the evidence in the other areas of this report, such as Standards 7, 8 and 18, indicates that this training might not have been embedded into care practices. We expect the home to take action to ensure that the staff are competent to carry out their duties, rather than we make a requirement on this occasion. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have been placed at unnecessary risk to their health and safety due to the poor management of the home. Evidence: The Registered Manager, a Registered Nurse, has been working at the home for approximately three years. A relatives survey said, I am sure if the Manager of Astoria was a person who could handle staff and organise them properly, instead of letting them go their own sweet way, the care and nursing teams would soon snap into shape. What it needs is a captain and leader. Although the AQAA was completed in a satisfactory manner we found evidence, and recorded this in our ASR and in this inspection report, that some of the information provided, in the AQAA, was not always accurate. Therefore we consider the AQAA not to be reliable to demonstrate that the home has a good quality assurance tool. Care Homes for Older People Page 28 of 34 Evidence: Currently the Registered Manager is on leave and an Acting Manager has been appointed for the day to day management of Astoria Park. According to the Acting Manager there was no hand-over period before the Registered Manager went on leave. Although the Acting Manager receives some support from the organisation, Southern Cross, we were informed, by him and a representative of Southern Cross, that there are ongoing changes, at an operational level. Such management changes pose some uncertainty and poses some risk to the continuity of the management of the home. The management of Astoria Park, since our last inspection in April 2008, has placed some of the residents health, welfare and safety at unnecessary risk, that has resulted in the local authority not placing new admissions to the home, since December 2008. Evidence of the poor management of the home can also be found in other areas of this inspection report. (This report is no reflection on the Acting Manager, who has been in post since the 23rd February 2009). The AQAA told us that there is an Ongoing quality assurance (sic) programme but we consider that if the quality assurance programme was robust, then those residents, who have been subject to the safeguarding enquiries, with such issues arising to include care records and standards of care, for those people with complex medical and nutritional needs, a more robust quality assurance system would have noted such issues and appropriate action being taken. The one survey from a member of staff said that there are staff meetings held but Nothing comes of anything though. Surveys have been sent, from the home, in October 2008, to both residents and their relatives and some of these were received in November 2008 when the results were collated. We were told, by the staff, that an action plan is drawn up, following such collation, although there was no action plan available. Copies of the last two reports of visits made by a representative of the company were seen and these took into account views of people and some of the records were inspected such as complaints. Since our last inspection, in April 2008, there has been a change in how the home safeguards peoples monies. The majority of the current residents have their monies kept by the home, although there are no longer individual amounts of money kept on the premises. Any monies spent, such as those for hairdressing and podiatry treatments, invoices are made and records of individual balances are kept on a data base. We cross-referenced two peoples (who we case tracked) invoices with the Care Homes for Older People Page 29 of 34 Evidence: record of the balances and we found that these correlated with each other. The AQAA stated that service checks are in date to include those for portable appliance equipment, hoists and lifts, fire detection and fire fighting equipment. The AQAA told us that 37 members of staff have attended training in infection control and 12 of the staff have attended training in malnutrition and assistance of a person with their food. We examined safety checks for temperatures of hot water, fire alarms and emergency lighting checks, fire drills (some of which had been carried out before the day staff came on duty), hoists and lifts, and we found that these were satisfactory. In January 2009 we requested the fire safety officer (FSO) to inspect the premises and we have been informed that, although there were no major concerns, there are some areas that need attention before the end of March 2009 when the FSO intends to visit thereafter. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care records must be up to 25/04/2009 date and provide clear guidance; drawn up in consultation with people and not to be falsified. To ensure that staff have up to date guidance in how to meet the current needs of the people; to ensure that people are consenting to their care; to ensure that people are protected by accurate, and uncorrupted, care records 2 8 13 People must receive proper health and personal care To protect people from the risk of harm to their health and to value and promote their dignity. 25/04/2009 3 9 13 Records made when medicines are given to residents must be accurate and complete and if medicines are omitted, the 31/03/2009 Care Homes for Older People Page 32 of 34 reason why must be recorded. This will demonstrate that people receive the medicines prescribed for them. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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