Inspection on 25/11/09 for Attwoods Residential Care Home

This inspection was carried out on 25th November 2009.

CQC found this care home to be providing an Adequate service.

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

Attwoods Residential Care Home 09/02/09

Attwoods Residential Care Home 19/08/08

Attwoods Residential Care Home 18/04/08

Attwoods Residential Care Home 19/11/07

Attwoods Residential Care Home 26/02/07

Attwoods Residential Care Home 12/09/06

Attwoods Residential Care Home 14/11/05

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ Lead Inspector Diane Wilkinson Key Unannounced Inspection 25th November 2009 09:45 DS0000064183.V378585.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Attwoods Residential Care Home Address 46 Northgate Cottingham East Yorkshire HU16 4EZ 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) 01482 841133 01482 876110 Mr Ateeq Rehman Miss Rebecca Dawn Dixon Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2009 Brief Description of the Service: Attwood Residential Care Home is registered to provide care and accommodation for nineteen older people, including those with dementia related conditions. The home is situated in Cottingham, in the East Riding of Yorkshire, and is within easy reach of the village centre and local amenities, including public transport routes. The home is a large detached house and accommodation is provided over two floors. Three bedrooms are on the ground floor and all other bedrooms are located on the first floor - these can be accessed by using the stairs or the stair lift. There are six shared bedrooms (some of which are used as single rooms) and seven single bedrooms. There are two lounges and a dining room on the ground floor, and the kitchen is located directly off the dining room. A paved courtyard is situated to the rear of the building and this is easily accessible for all service users, including those in a wheelchair. Car parking is available to the front of the home on the main road. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 9th February 2009, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 9.45 am and ended at 4.30 pm. On the day of the site visit the inspector spoke on a one to one basis with the registered manager and staff members. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered manager told us that she had submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The original copy was not received by the CQC but the manager sent a further copy that was received. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. As part of the inspection process we sent survey forms to people living at the home, staff and a selection of health and social care professionals. Three were returned by people living at the home, four were returned by staff and five were returned by health and social care professionals. Responses in surveys and comments from discussions on the day of the site visit were mainly positive, for example, ‘I think the home does well’ and ‘good food, varied diet, fresh home cooked produce used’. Some comments from health and social care professionals raised areas of concern, primarily about advice given not been followed by the home. At the end of this site visit, feedback was given to the manager on our findings, including requirements and recommendations that would be made in the key inspection report. However, feedback was not comprehensive as some documents were missing and we agreed that they would be forwarded to the inspector following the day of the site visit. The manager told us that the current weekly fee for residential care is from £312.00 to 360.00 per week. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 6 when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People’s care needs are assessed prior to their admission to ensure that they can be met by the home. There are comprehensive care plans in place that inform staff of the up to date care needs of the person concerned. This includes their health care needs. Visitors are made welcome at the home and people are supported to live their chosen lifestyle; routines are flexible. People tell us that meal provision at the home is good and there is a choice available at every mealtime. The cooks have undertaken National Vocational Qualification Level 2 in Food Preparation. Most staff have undertaken the National Vocational Qualification at Level 2 in Care and some staff have achieved the Level 3 award. Recruitment practices at the home have improved but further improvements need to be made to ensure that only people safe to work with vulnerable people are employed. Monies held on behalf of people living at the home are held safely. What has improved since the last inspection? Staff have now had training on moving and handling, including a practical manual handling session, so they are better equipped to assist people safely. The amount of medication received from the pharmacist for each person living at the home is now recorded on medication administration records. This improves accuracy in record keeping. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 7 The complaints procedure is now displayed in the entrance hall to inform people living at the home and others about the action to take should they wish to make a complaint. The bathroom that is most used by the people living at the home has been provided with a bath hoist; this provides people with a choice of bathing facility and promotes their safety. The dining room has been refurbished and provides a more pleasant environment for people living at the home. The floor in the small lounge has been levelled and the trip hazard has been alleviated. What they could do better: The medication policy in use at the home has a number of omissions. Staff must have a detailed medication policy to follow to ensure that they adhere to the correct policies and procedures when administering medication to people living at the home. The lack of a detailed medication policy could leave people living at the home at risk of harm. It would be good practice to record concerns and suggestions to evidence that people are listened to and that their suggestions are considered. Staff would benefit from having more in-depth training on the topic of safeguarding adults from abuse to ensure that they are able to recognise poor practice and know what action to take should this occur. Information about advocacy services should be freely available at the home so that people can access it without having to ask, promoting their privacy and independence. There should be a record of all meals provided at the home, including special diets and alternatives, so that the home can evidence that nutritional needs are being met. Consideration should be given to the layout of the home to promote privacy and dignity for the people living there, and to reduce the risk of cross infection. There must be a record of the training achievements and needs of the full staff group to evidence that staff have the skills needed to provide support to the people living at the home. This would also help to identify refresher training. Only references that have been requested by the manager should be accepted as evidence that someone is suitable for the post they have applied for. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.2 Page 8 The quality assurance system should be fully operational so that people have the opportunity to affect the way in which the service is provided. Fire drills must take place consistently to ensure that people living and working at the home know what action to take should a fire occur, and to fully protect people from the risk of harm. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 was not assessed as there is no intermediate care provision at the home. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a care needs assessment prior to their admission to the home and are only admitted if it is considered that their assessed needs can be met. EVIDENCE: At the last key inspection the registered persons were advised to update the home’s smoking policy and Service User’s Guide to reflect changes in government guidance about smoking in public areas; this has been actioned. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 11 We checked the care records for someone that had been admitted to the home since the last key inspection. These included an assessment that was undertaken by the manager prior to the person’s admission to the home; this was brief but included the required information, and recorded, ‘application accepted’. In another person’s records we saw that an assessment that had been undertaken by the local authority had been obtained by the home. The assessment information had been used to develop an individual care plan for the person concerned. The care plan included assessments for mental health, physical health, pressure care, behaviour, nutritional screening and falls, as well as a general needs assessment and personal risk assessment. Pre-admission assessments were also seen in the care records we examined for another two people living at the home. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning documentation has improved and most records are being well maintained. Medication practices at the home have improved but need further improvement to fully protect people from the risk of harm, to include the development of a comprehensive medication policy. EVIDENCE: The care plans examined on the day of this site visit were recorded in preprinted booklets that have been purchased by the home. Relevant information was included in each care plan, including the person’s family history, social and leisure interests and current medication details. None of Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 13 the care plans we saw on the day of the site visit had been signed by the resident to acknowledge their agreement to the content. Each area of the care plan includes an assessment i.e. moving and handling, physical health, mental health, behaviour, pressure care, nutrition and falls. Where appropriate, risk assessments are included within the relevant section, such as the Malnutrition Universal Screening Tool (MUST) and a falls risk assessment. Risk levels are scored numerically and each section is updated on a monthly basis - we noted that care plans had been updated to reflect recent events, for example, falls and hospital admissions. Although care plans have improved, we recommend that they should contain more detailed information about the specific support that people require when being assisted with personal care. We did not see any information in the records we examined to evidence that people have an annual review of their individual care plan, either by care management or by the home. A record is made of all contacts with health care professionals, including the reason for the contact and the outcome. There is a weight record in place to assist with nutritional screening, although some of these do not contain regular entries. Daily diary entries record any assistance with baths or showers and how a person has spent their day, where meals have been taken etc. Following the completion of risk assessments, we noted that pressure care equipment had been obtained to assist people with tissue viability, such as pressure care mattresses and cushions. Some people had been provided with bed rails to prevent them from falling out of bed; the risk assessments provided by the Medicines and Health Care Regulatory Agency (MHRA) were in use at the home. We also noted that the manager checks any bed rails in use on a weekly basis and these checks are recorded. The lack of moving and handling training had been an area of concern when we did the last key inspection. Staff have now undertaken training on moving and handling and we noted that the training programme covered facts and figures and the law, anatomy of the spine, causes of back pain and a practical session on the use of hoists and other moving and handling equipment. The home does have a mobility hoist and the manager told us that a variety of slings could be fitted so that it can be used for more than one person. We did not observe any poor moving and handling techniques being used on the day of this site visit. We checked the arrangements for the storage of medication and medication administration records. Each medication administration record includes a photograph of the resident concerned plus information about allergies, medication prescribed and the person’s GP. In addition to this, there is a clear Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 14 record that indicates the colour codes for the times that medication should be administered. A PCT pharmacist technician visited the home in July 2009 and recommended that internal and external medications should be stored separately; this advice is not always being adhered to. The manager told us that staff that have responsibility for the administration of medication have completed appropriate training and there is a sample signature in medication records for all staff that have responsibility for this task to enable records to be checked. We noted that most staff completed medications training in January 2008 so this training is due to be undertaken again – this has not yet been arranged by the manager. We noted that one person who administers medication at the home has not undertaken medication training – the manager told us that she has observed this person whilst undertaking this task and has deemed her to be competent. However, there is no written evidence to support this - either medication training must be arranged for this member of staff without delay or they must cease to administer medication. We noted that there were no gaps in recording and that any handwritten entries made on medication administration records had been signed by two members of staff. The temperature of the drug cabinet is taken daily and recorded, and any medication that requires storage at a low temperature is stored in a separate container within the kitchen fridge. However, this container is not labelled clearly to ensure that all staff are aware that it is to be used for the storage of medication only. At a previous inspection we recommended that staff record the date on medication packaging to evidence when the pack has been opened for use. On occasions this practice is adhered to but this is not consistent. We also recommended that, when medication is delivered by the pharmacist, a member of staff checks the amount of medication delivered and records this on the medication administration record sheet; this has been actioned. None of the current service users have chosen to self medicate but there is an assessment form ready for use should they wish to do so. Any unused medication is recorded in a returns book and this is signed by the pharmacist when they collect the medication and return it to the pharmacy. Some people at the home have been prescribed controlled drugs. These are being stored appropriately and administration is recorded in a controlled drugs book; recording was seen to be satisfactory. We asked to see the medications policy in use at the home – the manager told us that she had this at home, as she was in the process of updating it; it was eventually sent to the Commission. We noted that there are several omissions in the policy, such as temperature recording in the fridge and drug storage Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 15 area, patient leave, self medication, controlled drugs, homely remedies and the use of MAR charts. We are aware that the manager has been given a lot of information to assist her with the development of a policy by the Care Quality Commission’s pharmacist inspector and by the NHS Pharmacist technicians. A medication policy that includes all of the required information must be developed by the home and used by staff. We noted that all bedroom doors had a sign stating ‘knock and wait’ and that curtains are provided in shared rooms; there is currently only one shared room in use. There is no private room where residents can meet with visitors or social/health care professionals but most people have their own bedroom where they could have private meetings. We noted that two bedrooms are located directly off the large lounge; this could result in the resident’s privacy being compromised, as people accommodated in these rooms have to go through the lounge to get to the toilet or bathroom. The location of these two rooms should be re-considered by the registered person. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are encouraged and supported to maintain their chosen lifestyle and to continue with their hobbies and interests, and visitors to the home are always made welcome. There is a choice of meal at each meal time. EVIDENCE: The care plans record a person’s family history, social and leisure interests and any hobbies. We noted that care plans record activities undertaken by residents in daily diary sheets and details of any visitors seen or contact with family and friends. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 17 There is no activities coordinator employed at the home but staff told us that, because there are only a small number of people currently living at the home, they are able to organise activities, usually on a daily basis. On the day of the site visit a sing-along session took place in the afternoon and one to one time is also spent with people who like to remain in their bedroom. Key workers also spend some one to one time with people and this is recorded in care plans. We saw that people are able to spend the day where they choose, to take their meals where they choose and to have visitors at any time of the day. A member of staff told us in a survey, ‘the home is not glamorous but the service uses are looked after, happy and able to make choices’. A visitor called into the home in the afternoon. This was the spouse of an exresident who continued to visit the staff and residents at the home; we observed that they were made very welcome by staff and that they were included in arrangements for the forthcoming Christmas party at the home. The manager told us that they have some information about Advocacy services but there is none displayed within the home. If this information were displayed in the home it would enable people to access these services without having to ask for assistance, promoting confidentiality and independence. There was a menu on display on the day of the site visit. This recorded the main meal on offer at lunchtime and an alternative, and a variety of choices at tea time. A member of staff that completed a survey told us when asked what the home does well, ‘good food, varied diet, fresh home cooked produce used’. All care plans now include a nutritional risk assessment and a weight chart to assist with nutritional screening, although some weight charts were not up to date. There are no set menus in place but the cook records the meals provided for residents each day; we noted that the main meal is recorded but not any alternatives provided, and that breakfast and tea is not always recorded. We recommend that a set menu be developed so that it is possible to monitor the nutritional value of meals provided at the home, and to check that residents are offered variety. The manager told us that special diets are catered for at the home, including low fat and diabetic diets, and we noted that some residents have been prescribed nutritional supplements. One person had been seen by a dietician and it was recommended that they have additional dairy produce added to their meals to help ‘build them up’. The cook told us that this person has extra cream in their mashed potato and porridge and that they had added cream to the macaroni cheese they prepared for them the previous day. We saw that one care plan included a ‘dysphasia report’ and that this recommended that pureed foods should be provided. The cook confirmed that this person is provided with pureed foods and that they puree foods separately when people Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 18 need a soft diet. However, none of this is recorded so that the information could be fed back to the dietician or to evidence that dietary needs are being met. On the day of the site visit six people had their lunch in the dining room and the rest of the people living at the home had their lunch in their bedroom. Staff assisted three people with their lunch and we noted that one person stood by the side of the person rather than sitting next to them to make them feel more comfortable. We were told that the people who eat their meals in their room need no assistance with eating and drinking. The manager told us that the three cooks working at the home have undertaken NVQ Level 2 in Food Preparation; this is good practice. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People tell us that they are aware of who to speak to if they have any concerns and how to make a formal complaint. People are protected from the risk of harm by the policies and procedures in place on safeguarding adults from abuse and by staff training. EVIDENCE: Three people living at the home returned a survey and two people told us that they know how to make a complaint. Four staff returned a survey and they all told us that they knew what action to take if someone expresses concern about the home. We saw the complaints log on the day of this site visit and noted that there were no entries. The manager told us that all residents have a copy of the Statement of Purpose in their bedroom and that this includes information about the complaints procedure; this was confirmed on the day of the site visit. There is now a copy of the complaints policy and procedure displayed in Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 20 the hall to inform people living at the home and other of the action to take should they wish to make a complaint. There is no comments book or suggestion box in use; this would encourage people to express concerns or make suggestions about improvements in the service provided and would be seen as good practice. We noted that the registered provider used to monitor entries in the complaints log but that these checks ceased in August 2008. It would be good practice for these to be resumed. The training and development plan seen on the day of the site visit recorded that all staff did training on safeguarding adults from abuse in April 2008 or October 2008. We recorded in the last key inspection report that the manager told us that all staff had training on safeguarding adults from abuse in January 2009, so the information in the training and development plan may be incorrect. At the last key inspection we saw the content of the training package and we felt that it was at a fairly basic level; we recommended that staff undertake further training on this topic to ensure that they understand the policies and procedures in place at the home and are able to identify poor practice. Staff have not had any training on this topic since the last key inspection. However, most staff have studied this topic when working towards their National Vocational Qualification (NVQ) award. The manager told us that new carers complete induction training that meets Skills for Care requirements and that this includes information about safeguarding adults from abuse. There was no evidence available on the day of the site visit to support this. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some redecoration and refurbishment has taken place but we detected unpleasant odours in three bedrooms. Fire safety arrangements at the home are satisfactory and this provides some protection from harm for the people living and working there. Consideration should be given to improving the layout of the home to meet the need for privacy and dignity. EVIDENCE: Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 22 There is a maintenance plan in place at the home – this consists of a ‘home improvement and work pending’ list and a ‘household management’ list. We noted that new dining tables and chairs had been purchased for the dining room, the dining room had been redecorated and a new carpet had been fitted. The floor in the small lounge had been levelled and a new carpet has been fitted; this had alleviated the trip hazard that was noted at the last inspection. We toured the premises on the day of the site visit. We noted that some bedrooms provide pleasant accommodation for residents but we found that three had an unpleasant odour. The manager was advised that the carpets and the mattresses in these rooms should be checked and replaced if necessary; it may be that the carpets can no longer be kept odour free by regular shampooing. There are three bathrooms/shower rooms available for residents and the manager told us that a new mobility hoist has been fitted in the bathroom that is most used by the people living at the home. There are now two baths available with mobility hoists and this increases choice and safety for people, as they no longer have to negotiate steps to reach a bathroom with a mobility hoist. After our last visit to the home we contacted the Fire Officer to ask them to visit the home to check fire safety arrangements, in particular the location of fire exits. The Fire Officer contacted us following their visit to the home and told us that the fire arrangements at the home were good and that staff appeared to have a good knowledge about the action to take should a fire emergency occur. The laundry room at the home is supplied with domestic appliances that do not have a sluice facility. Because of this, staff use the sink in the laundry room to sluice soiled linen. A separate sink should therefore be provided so that staff have somewhere to wash their hands; one sink cannot be used for both purposes. The training and development plan evidenced that only two staff had undertaken training on infection control. However, we observed on the day of the site visit that staff use protective clothing and follow good hygiene practices. We were concerned that the staff toilet was provided with a hand towel instead of paper towels; paper towels are a more hygienic option. Two bedrooms are located directly off the large lounge and this could result in staff having to carry soiled laundry through the lounge. The registered persons need to ensure that this task can be carried out safely, with no risk of cross infection. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty for the number of people accommodated at the home. There is a high level of achievement in National Vocational Qualification training but there needs to be a full record of the training needs and achievements of staff to evidence that they have the skills to meet the assessed needs of people living at the home. EVIDENCE: There is a satisfactory staff rota in place and the hours worked by ancillary staff are now recorded on the rota. The rota evidences that there are always two care staff and a cook on duty and that the manager is on duty in addition to these hours. Nine care staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and two staff have also achieved Level 3 in Care. In addition to this, Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 24 the three cooks employed at the home have achieved NVQ Level 2 in Food Preparation; this is good practice. We checked the recruitment records for two new members of staff. Both had completed an application form that included an employment history, the name of two referees and a criminal record declaration. Two written references had been obtained for both members of staff but, for one new employee, evidence suggests that the references could have been provided by the staff member rather than requested by the manager – both were addressed to ‘The Manager of Attwoods’. Only references that have been requested by and returned to the registered manager are acceptable, and one of the references should always be from the applicant’s most recent employer. Employment records did not record one staff member’s start date but the manager told us that Criminal Records Bureau (CRB) checks were in place for both employees prior to them commencing work. A start date must be recorded so that it is evident that all safety checks are in place before people start work. The manager told us that staff complete induction training that meets Skills for Care requirements before they work alone with vulnerable people. There is an induction checklist in place for one employee but this does not record the detail of topics covered during induction training. There is a staff training record in place for the other staff member but this records that no training has taken place. There must be evidence that staff have the skills needed to provide the service required by people living at the home prior to commencing work unsupervised. The manager told us that new staff ‘shadow’ experienced staff as part of the induction process but again, there is no evidence to support this. The employee who has worked at the home for 2 – 3 years has undertaken various training programmes, including infection control, fire safety, health and safety, equality and diversity, moving and handling, safeguarding adults, sensory deprivation and managing challenging and aggressive behaviour. The manager told us that staff are having training on first aid over three days next week; six staff will be attending. A member of staff told us in a survey, ‘the home employs friendly, caring, competent and hard working staff’. When asked in surveys if they receive relevant training to keep them up to date with new ways of working and give them enough knowledge about health care and medication, three staff said ‘yes’ and one said ‘no’. There is a training and development plan in place but it only records training recently undertaken by staff, so there is no full record in place of the training achievements and needs of the staff group, and no record of when refresher training is due on some topics. This would identify the training needs of the people who are telling us that they have not received appropriate training. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 25 There is no evidence that the manager checks staff competencies following their attendance on training courses. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is making progress towards achieving appropriate qualifications and keeping her practice up to date. There are systems in place designed to protect the health, welfare and safety of residents and others but more care should be taken with in-house fire drills. Quality assurance systems are not fully operational so residents and others are not able to affect the way in which the home is operated. EVIDENCE: Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 27 The manager told us that she has achieved NVQ Level 4 in Care and will be starting the NVQ Level 4 Leadership award next year. In the past she has had difficulty keeping her practice up to date, as there has been no IT provision at the home. However, she has now been provided with a computer so is able to access the Care Quality Commission website and other relevant websites. One member of staff told us, ‘the owner could support the manager more’ and another recorded, ‘the manager is friendly, tries hard and is approachable. However, she struggles with confidence’. Although some improvements have been made at the home, feedback from health and social care professionals is that the manager sometimes does not act on advice given and takes a long time to action requirements and recommendations. This may be due to lack of time, as she works care hours as well as management hours. An assistant manager has now been employed for 4 hours per week and it is her role to ensure that care plans are kept up to date. We checked quality assurance information at the home. The manager told us that surveys have been sent out recently to relatives, staff and health/social care professionals. Only two surveys have been returned so far; the manager intends to collate the information, take any necessary action and produce a report that will be displayed on the home’s notice board. This would evidence that people have the opportunity to affect the way in which the home is operated. We saw the minutes of the most recent staff meeting – topics discussed were hospital appointments, rooms, staff and bathing. The previous staff meeting was held in July 2009. Residents meetings were held monthly until July 2009, when they ceased. These should be reinstated so that people living at the home have the opportunity to express their opinions and affect the way in which the home is managed. We recommend that the information gathered via satisfaction surveys and resident/staff meetings should be used to formulate an annual development plan for the home. The registered provider used to undertake audits of the medication systems and care plans but these ceased in 2008; it would be considered good practice for these to be reinstated. We checked some monies held on behalf of residents and the associated financial records. These were found to be accurate and we observed that two members of staff check records and balances held on a monthly basis. At the previous inspection the manager told us that she writes a personal cheque for the chiropodist for services provided for residents and that she is reimbursed. This practice has now ceased – money is obtained from relatives in preparation for the visit from the chiropodist. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 28 We checked the records in place for fire safety. An annual test of the fire alarm system took place in September 2009 and in-house tests of the fire alarm system now take place each week. Records evidence that there should be a fire drill at the home twice yearly but the last one took place on 13/8/08; this is overdue and the manager was told that a fire drill must take place immediately. There is a gas safety certificate in place, the stair lift was serviced in June 2009 and a portable appliance test was undertaken in October 2008 - the manager told us that another one was booked for the following week. There are environmental risk assessments in place for each room of the home and to record the safety of work undertaken by the handyman/gardener. These should be expanded to include all health and safety activities within the home. We checked some accident records at the home and noted that these are monitored on a monthly basis by the manager. This monitoring led to one person having bed rails fitted to their bed to prevent them falling out. We also noted that the manager checks any bed rails in use on a weekly basis and these checks are recorded. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 29 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 30 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 OP7 Regulation 24 Requirement There must be evidence that individual care plans are reviewed and updated on a formal basis annually. This is needed to ensure that staff have up to date information to work to, to ensure that people receive the care and support they need. 2. OP9 18 The person who administers medication but has not had medication training must cease to undertake this task or have appropriate training without delay. This is needed to ensure that people receive their prescribed medication safely. 3. OP9 13 There must be a satisfactory medication policy in place at the home that can be used to inform staff. This is needed to ensure that staff working at the home know what is expected of them, and to Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 31 Timescale for action 31/01/10 31/01/10 31/01/10 ensure that people receive their prescribed medication safely. 4. OP26 13 The home must be free from unpleasant odours at all times. Previous timescale 0f 12/06/09 not met. 31/12/09 5. OP26 13 A separate sink must be 31/01/10 provided in the laundry room for staff to wash their hands, to reduce the risk of cross infection, or hand disinfecting facilities must be provided. The registered person must 31/01/10 make sure that they identify the training needs and achievements of staff. This should be recorded on an up to date training and development plan. Once this training has been delivered they must make sure that the staff understand and are competent in each area of training. Timescale of 12/06/09 not met. The manager must make sure that policies and procedures are kept up to date and made available to staff. There must be systems in place to ensure that policies, procedures and practices are adhered to by staff. 31/01/10 6. OP30 18,23 7. OP31 17 8. OP38 13 Fire drills must take place at the 31/12/09 intervals stated by the home to ensure that people living at the home and staff know what action to take in the event of a fire. Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 32 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 OP7 Good Practice Recommendations Care plans should include more information about the specific support needed by people when being assisted with personal care. Refresher training needs to be arranged for the staff who have responsibility for the administration of medication. The practice of recording on packaging the actual date when staff start to use the medication should be adhered to consistently. The layout of the home should be reconsidered; two bedrooms are located directly off the main lounge and this could result in people who want to access the bathroom and toilet having to go through the lounge in their nightclothes. This compromises their privacy and dignity. The registered person should make sure that there is information available to people about advocacy services that may support them in decision-making. A set menu would help to evidence that the meals provided at the home are nutritionally balanced. A record should also be kept of all meals provided at the home, including any alternatives to the main meal and any special diets catered for. Staff training on safeguarding adults from abuse needs to ensure that staff have a thorough knowledge of this topic so that they are able to identify poor practice and are able to take appropriate action should an incident occur. The layout of the home should be reconsidered; two bedrooms are located directly off the main lounge so laundry has to be carried through communal areas of the home. This could create a risk of cross infection. Only references that have been requested by and returned to the registered manager should be accepted. DS0000064183.V378585.R01.S.doc Version 5.3 Page 33 2. 3. OP9 OP9 4. OP10 5. OP14 6. OP15 7. OP18 8. OP26 9. OP29 Attwoods Residential Care Home 10. OP29 There should be a clear record of a person’s start date, the date they started and completed induction training, the date of any shadowing shifts and the date that they commence work unsupervised. This is needed to evidence that people have had the right safety checks prior to commencing work and that they have the skills to provide the support required by the people living at the home. The registered person should have records to evidence that staff undertake induction training that meets current Skills for Care requirements. This would help to show that staff have the knowledge they need prior to commencing work with people living at the home. The outcome of any quality surveys should be collated and published, and the collated information should be used to formulate an annual development plan. 11. OP30 12. OP33 Attwoods Residential Care Home DS0000064183.V378585.R01.S.doc Version 5.3 Page 34 Care Quality Commission Yorkshire & Humberside Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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