CARE HOMES FOR OLDER PEOPLE
Astral Lodge Residential Home 35 Ailsa Road Westcliff On Sea Essex SS0 8BJ Lead Inspector
Christine Bennett Unannounced Inspection 21st September 2005 10:30 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 Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Astral Lodge Residential Home Address 35 Ailsa Road Westcliff On Sea Essex SS0 8BJ 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) 01702 345409 01702 340262 Mr Navneet Singh Johar Mrs Aunjali Johar Charlotte Jane Goodfellow Care Home 14 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (14) of places Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Number of service users to whom personal care is to be provided shall not exceed 14 (fourteen). Accommodation and personal care may be provided to no more than 14 older people over the age of 65 years (OP). Accommodation and personal care may be provided to no more than 4 service users over 65 with Dementia (DE(E)). Total number of persons over 65 years to be accommodated must not exceed 14. To provide suitable changing and storage facilities for staff within 12 months of registration. 9th May 2005 Date of last inspection Brief Description of the Service: Astral Lodge is a small family run care home which is registered for fourteen male and female people aged sixty five years and over. The home is also registered to take four people with dementia within this number. The home is conveniently located in a pleasant residential area of Westcliff, and is within easy reach of shops, bus routes and a railway station. The seafront and Southend and Leigh shopping centres are nearby. Accommodation is provided on two floors with ten single bedrooms and two twin bedrooms. Residents can access the first floor via a passenger lift. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 21st September lasting seven hours. The inspection process included discussions with the registered provider, the registered manager, two members of staff, one visitor, a visiting social worker and ten residents. A tour of the premises was undertaken and a sample of records and policies were examined. Discussion of the inspection findings took place with the manager and guidance was given. What the service does well: What has improved since the last inspection?
The home has appointed a new manager, who is eager to maintain standards and make improvements where necessary. One staff member described her as being “firm but fair”. She has introduced meetings for the residents on a regular basis to make sure they are happy with their life in the home. As a result of this, new menus with a choice are being introduced. Care plans have been revised to make sure the information written is clear for staff and therefore make sure that residents get the right care for their needs. The home has a better relationship with the local GP, staff training in medication has been updated, and it has recently changed it’s pharmacist to make sure that residents’ health needs are met. One bedroom has been redecorated and three carpets have been replaced recently. Paper towel dispensers have been put in communal areas for hygienic purposes and locks have been put on cupboards that store hazardous substances to ensure the safety of the residents. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&6 The home’s Statement of Purpose and Service User Guide provides information about the home to enable prospective residents to make an informed choice. EVIDENCE: The home has a Statement of Purpose and Service User Guide on display in the hall of the home. These both describe all the information that a prospective resident would need in order to make a decision whether to be admitted to the home. Minor amendments are necessary to update these documents. The home does not provide intermediate care. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 9. Care plans have information recorded to enable staff to meet the care needs of the residents. Medication procedures have improved but require further amendments to safeguard the health of the residents. EVIDENCE: Since the last inspection the manager has reviewed the care planning system within the home in order to make them more comprehensive for staff to meet the needs of the residents. Clear risk assessments were in place with actions to be taken and nutritional charts have been developed for individual residents. Residents were very complimentary about the care that they receive in the home. One resident said, “we are so lucky, it’s a wonderful team”. The home has made improvements to the medication system since the last inspection, and training is currently being given to staff. The manager said that the home has a much better liaison with the local GP, which has improved communication and regular reviews are carried out of each resident’s medication. The home has also changed the pharmacist it uses to dispense the prescriptions and is confident that this too will bring about improvements. However the manager recognises that there are still some areas that need improving. These include the temperature at which the medicines are stored, the safe storage of controlled drugs, photo identification of all residents, liquid medication to be dated on opening and an up to date list of side effects relating to all medication used in the home.
Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 Residents are encouraged to maintain their independence and supported to lead a stimulating life within the home. EVIDENCE: The residents have the opportunity to participate in numerous events both within the home and in the community. A member of the care team is responsible for activities and has organised many events over the summer period, including a sponsored walk and a bar-b-cue. These events encourage the participation of friends and relatives enabling the residents to remain part of the community. The home offers an exercise session each morning and the afternoons are spend doing a variety of different things including quizzes, games and one to one sessions. Residents confirmed that they have plenty to do within the home. One resident said that the manager would often take her in the car to the bank to sort out her financial affairs. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Staff have a good knowledge and understanding of Adult Protection issues, which protect residents from abuse. The complaints procedure is satisfactory and residents and their relatives are confident that any concerns would be acted upon. EVIDENCE: Staff spoken with had a good knowledge of different forms of abuse and how to report any suspected abuse. Some staff are at present undergoing protection of vulnerable adult training. The home has a satisfactory complaints procedure. The home has not received any complaints since the last inspection. Residents said that they could talk to the staff and management regarding any concerns and felt confident that action would be taken to sort it out. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 & 26 The home presents a comfortable, homely environment with no offensive odours. Fire procedures must be improved to protect the safety of the residents. EVIDENCE: The home has a pleasant relaxed atmosphere and the registered provider has decorated a bedroom and provided new carpets in three bedrooms since the last inspection. There are no offensive odours in the home. A social worker that had visited the home three times recently said there was always a nice atmosphere in the home and tea and cold drinks were freely available. Paper towel dispensers have been fitted in all communal bathrooms to prevent cross infection and cupboards in the kitchen and laundry, which house hazardous products, have been provided with locks to ensure the safety of residents. Some products in the laundry were still in an unlocked cupboard, which could be harmful to residents. The fire alarms in the upstairs hallway and the balcony were recorded as not working on 16/9/05. Fire doors were being propped open with wedges, and there was no record of fire drills. Advice must be sought from a fire prevention officer to ensure the building meets it’s
Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 13 requirements. The temperature of water delivered in some residents’ bedrooms was over 43 degrees and put the residents at risk of scalding. The recording of water temperatures had not been done since July 2005. A risk assessment must be in place regarding a door on the first floor, which leads onto the balcony and is not locked. As the home is registered for four people with dementia, this must be reviewed with each new admission. An unused bathroom is not having records kept that the water is being run weekly to reduce the risk of Legionella. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The procedure for recruiting new members of staff was not robust and could put the residents at risk. Staff at the home are well trained and able to meet residents’ needs. EVIDENCE: The staff files for two members of staff who had been employed since the last inspection indicated that the home had not undertaken all the necessary recruitment checks to ensure the protection of residents. Only one reference had been received for each file and this had not been verified by telephone confirmation. The manager evidenced a thorough training programme. Four staff members are currently pursuing an NVQ qualification and forthcoming training programmes were seen to include Dementia, Protection of Vulnerable Adults, Infection Control, Incontinence Management, Pressure Area Care, Medication and Vital Signs. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 The manager provides leadership, guidance and direction to staff, ensuring the residents receive consistent quality care. Some practices within the home must be developed to safeguard the residents in the home. EVIDENCE: The manager has been in post since July 2005, but has worked at the home for many years and has completed her NVQ level 4 in care and management. The residents and staff were very complimentary about her and felt she was very approachable. One staff member described her as being “firm but fair”, and said that she sorts any problems out immediately and respects confidentiality. She is supported by the providers who are frequent visitors to the home. The manager has recently introduced regular meetings with the residents to ensure that they have an input into how the home is run. As a result of this, the menus have been changed and a choice of meal has been introduced. A visitors questionnaire is also being prepared and staff meetings have been held on a regular basis. The providers have started to prepare a report on a regular
Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 16 basis to self monitor the service they provide and the results of all the information gleaned from these areas must be collated to provide an annual report on how the service is meeting the aims and outcomes for residents. One resident explained how she controlled her own money and the manager had assisted her by driving her to her bank to sort out her financial affairs. Money held by the home for some residents was recorded correctly and stored securely. Areas identified in an earlier part of the report concerning fire regulations must be addressed to ensure the safety of residents and staff. Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 17 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 X X X N/A 1 X X X X X 2 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 18 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 The registered person must make arrangements for recording, safekeeping and safe administration of medication. This is a repeat requirement The registered person must after consultation with the fire authority take adequate precautions against the risk of fire. This refers to wedges used in doors, fire alarms not working and fire drills in the home. This is a repeat requirement The registered person must ensure that unnecessary risks to the safety of residents are eliminated. This refers to the temperature at which water is being delivered, and running of unused taps, and the recording of this information. This is a repeat requirement The registered person must obtain two references when employing staff and be satisfied as to their authenticity.
DS0000057745.V249678.R01.S.doc Timescale for action 31/12/05 2 OP19 23(4) 30/11/05 3 OP25 13(4) 30/11/05 4 OP29 19(1)(c) 30/11/05 Astral Lodge Residential Home Version 5.0 Page 19 5 OP33 24 The registered person must continue to develop a system to review the quality of care delivered and make it available to residents and CSCI 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The registered provider should update the information contained in the Statement of Purpose and Service User Guide. The registered manager shall carry out a risk assessment for each new admission to the home relating to the upstairs door leading onto the balcony to ensure their safety. Residents are offered lockable storage in their room and documented in care plan. The registered manager shall ensure all hazardous substances are locked away and leaflets relating to them are stored in an orderly manner. 2 OP19 3 4 OP24 OP38 Astral Lodge Residential Home DS0000057745.V249678.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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