Inspection on 26/02/07 for Attwoods Residential Care Home

This inspection was carried out on 26th February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Attwoods Residential Care Home 25/11/09

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 12/09/06

Attwoods Residential Care Home 14/11/05

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

CARE HOMES FOR OLDER PEOPLE Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ Lead Inspector Pam Dimishky Key Unannounced Inspection 26th February 2007 09:30 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 Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Attwoods Residential Care Home DS0000064183.V328696.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 Mr Ateeq Rehman *** Post Vacant *** 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.V328696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: Attwoods is a care home providing personal care and accommodation. It is registered for older people and also for older people with dementia. The home is situated in Cottingham within easy reach of the village centre and local amenities; a bus stop is outside the door and the railway station is nearby. The home is a large detached house arranged on two floors. Three bedrooms are on the ground floor and all other bedrooms, located on the first floor, can be accessed by the stairs or stair lift. There are six double and seven single bedrooms, however, some of the double rooms are used as singles. There are two lounges and a dining room on the ground floor; one of the lounges is used by residents who smoke. The kitchen is located directly off the dining room. A paved courtyard and flower-beds are situated to the rear of the building which has full access for wheelchair users and all other residents. There is also limited car parking in this area. The current scale of charges for the home is £286.86 per week with additional charges for private chiropody (£10.00), hairdresser (£12.00 perm, £5.00 wash and set and £2.00 trim), magazines and newspapers at cost. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection visit took place over six hours including one of the lounges also being the subject of a two hour observation study, undertaken by a second inspector, to judge the experiences of people with dementia. The lead inspector looked around all areas of the home and a number of records were inspected. Eight residents, one relative, two members of staff and the deputy manager were spoken to; other residents and staff practice were observed both directly and indirectly. Four requirements from the last inspection remain outstanding and two are partially outstanding. What the service does well: What has improved since the last inspection? Hot water outlets in areas used by residents are now controlled to maintain a safe temperature. Some further progress is being made with redecoration and this remains ongoing. Improvements have been made in the checks being made for newly recruited staff before they commence work in the home. Progress has been made in meeting standards of kitchen hygiene, fire protection and health and safety requirements. The registered person’s unannounced visits to the home are now being evidenced by monthly reports and notifications to the Commission of incidents occurring in the home have improved. An application to the Commission is being made to register a manager. Staff have undertaken a sponsored walk, backwards, over the Humber Bridge and DVD’s and a DVD player have been purchased with the proceeds. There has been an overall improvement since the last inspection following the deputy manager’s day–to-day involvement in the running of the home. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 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 Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about moving into the home and be confident the home can meet their needs. EVIDENCE: Since the last inspection a revised statement of purpose has been devised. However, despite the omissions identified at that time, the document continues not to contain all that is legally required. The deputy manager made a note of what is still required and is to forward a further amended copy to the Commission. Contracts were seen to be in place for the last three residents admitted to the home and these were noted to be signed by both the provider and the resident or their representative. Residents are assessed before coming into the home and confirmation is given in writing that the resident’s needs can be met by the home. The home is not registered for intermediate care. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care ensuring care needs are fully met. However, further improvements need to be made in recording the administration of medications to ensure residents are not put at risk. EVIDENCE: The home uses very detailed and comprehensive care plans which include assessments covering mental health, physical health, moving and handling, behaviour, pressure areas, nutritional screening and risk of falls. Four care plans were examined and good daily notes indicate the care provided. Arrangements are in place to access health service support, usually through the general practitioner. A district nurse was attending one resident at the time of the inspection and a physiotherapist attends another resident; no residents have pressure sores. Chiropody, dental, optical services are all accessed either through the NHS or privately. Residents spoke highly of the staff and the care they receive and staff were observed to have a caring and unhurried approach when speaking to or assisting residents. At the present time no residents have been assessed as being able to selfmedicate, however, a policy is in place to support residents if they are able and Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 10 locked facilities are provided for the purpose. Medical administration records were examined and for one resident three medications had not been signed for. The problem of staff omitting to sign for medications given is long standing and was also highlighted at the previous inspection during September 2006. It is important that this failure is now rectified. Some medication administration records were difficult to follow as medications given did not correspond with the start date on the forms; however, having checked these the total number of days the drugs had been administered were correct and the deputy manager was advised regarding the recording system. One member of staff has been assigned to audit the drugs weekly to ensure their accuracy, and the home takes very seriously any shortcomings attributed to staff negligence in not following the home’s policy and procedures. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from maintaining contact with relatives and friends which the home encourages, being able to exercise choice and control over their lives, and receiving a varied and wholesome diet. However, activities provided by the home and the opportunity to participate in religious observance may not satisfy their social, religious and recreational interests and needs. EVIDENCE: The home does not have an activities programme and staff stated they provide activities according to residents’ wishes. Following the last inspection residents were consulted during the next residents’ meeting as to their preferred activities but what is being offered in the home is very basic and down to staff having time available. Only one out of the eight questionnaires completed by residents indicated suitable activities are arranged by the home; six said sometimes and one said never. The deputy manager stated residents prefer to stay indoors during the winter months and entertainers come into the home approximately every two months; the church visits three or four times a year. The home takes account of individual preferences for socialising and engaging in social activities; three residents choose to spend most of their day in their own room and only occasionally join in with other residents. Recognition is Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 12 made to the commitment of the staff who undertook a sponsored walk, backwards, over the Humber Bridge; a DVD player and DVD’s have been purchased with the proceeds. As part of this inspection a two hour period of observation was spent in one of the lounges to judge the experience of the home of people with dementia who may be unable to discuss this with the inspector. During this period it became evident that the lounge is a major thoroughfare for staff and visitors to the home with over 44 occasions when people passed through in the two hour period of observation. This could be a source of interest and stimulation for the residents using the lounge. Unfortunately, people passing through the lounge only rarely spoke to or attempted to engage with the occupants of the room. In their turn the residents appeared indifferent to their surroundings, ignoring the people passing through and the television which was on constantly, and retreating into sleep for a great deal of the time. The provider needs to assess the impact of these arrangements and any associated environmental influences on the residents who use this lounge and take any necessary action to minimise the disruption to their comfort and privacy. Staff training should also be used to address the ways to meet the specific needs of people with dementia. Residents were observed apparently enjoying lunch of braising steak, carrots, swede, cabbage and mashed potato which looked appetising and plentiful; resident questionnaires said they always or usually like the meals at the home and those residents spoken to all said “the food is good”. The menu was displayed in the entrance hall and the deputy manager said there are alternatives provided according to the likes and dislikes identified in the care plan and information given to the kitchen staff. No records are kept of menus and the deputy manager was advised of the need to keep records of the food provided by the home. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s policies and procedures for making complaints and for the protection of vulnerable adults. EVIDENCE: The home has policies and procedures for making complaints and for the protection of vulnerable adults. Staff questionnaires indicated a good knowledge of protecting vulnerable adults from abuse and, although staff awareness training has not been carried out by the home, those members of staff qualified to NVQ level II and above have covered the subject as a unit in obtaining the qualification. Since the last inspection, two complaints have been received by the home and thoroughly investigated. Details of the investigations were sent to the Commission for information. A copy of the complaints procedure has been given to all residents and forms part of the service user guide. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the environment and health and safety have been achieved, but until the redecoration and refurbishment programme is complete not all residents will live in a homely and comfortable environment. EVIDENCE: Progress in improving the environment and health and safety in the home is very evident at this inspection. The provider confirmed all hot water outlets in areas used by residents are now controlled to maintain a safe temperature to minimise the risk of scalding. Redecoration and refurbishment is ongoing and not yet complete. Since the last inspection two bedrooms have new carpet and others have been redecorated. Two bedrooms are in need of new carpet and the deputy manager stated this is already in hand along with redecoration of a bedroom which has the wallpaper torn and hanging off the wall. The laundry was inspected and the deputy manager stated a new dryer is being purchased Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 15 very soon. The door into the small lounge does not close tightly into the rebate and needs some adjustment to ensure fire protection. An unpleasant odour was detected in one bedroom despite efforts being made by the home to resolve the problem, and in the entrance to the home but the latter was not evident later in the day and may have been attributed to the close proximity of a toilet. Furnishings in the small lounge were grubby and in need of freshening and it was clear that only the centre of the carpet was hoovered regularly. The home does not employ a cleaner over the weekend and this may contribute to these shortfalls. To minimise confusion residents would benefit from knowing the correct time and staff should ensure batteries are replaced when needed; clocks in the small lounge and in one bedroom were noted not to be working. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient care staff are employed on each shift to ensure the needs of the residents are being met. However, whilst the majority of staff have an NVQ qualification in care, the home cannot be sure residents are in safe hands at all times until mandatory training is complete. EVIDENCE: Twelve residents are currently living in the home and two care staff are on duty on each shift; the acting manager, and/or the deputy manager are also employed during the day, Monday to Friday. The acting manager and provider were not present at this inspection and therefore staff records could not be examined. However, the deputy manager stated all new staff have a Criminal Records Bureau (CRB) application in place and have had a protection of a POVAFirst check before commencing work in the home and they only work under supervision until the result of the CRB check is known and two satisfactory references obtained. The pre-inspection questionnaire completed by the home indicates all staff have had a CRB check and the results known. No staff training has taken place since the last inspection during September, 2006, despite this being a concern then, but a session on dental health had been booked and took place during the course of this inspection and a trainer was due in the next week to train all staff in moving and handling and to give training on using the mobile hoist; this has not been in operation as staff are not trained in its use. Other mandatory training needs include health and safety, first aid (in-house video only), and food hygiene. Nine staff are Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 17 qualified to NVQ level II or above and six staff are currently taking the qualification which meets the standard for at least 50 of staff to be so trained. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 &38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements for this home have improved which is enhancing residents’ quality of life and staff morale. EVIDENCE: An acting manager and deputy are currently running the home and an application is being made to the Commission for registration of a manager. Overall, since the last inspection, there has been an improvement since the deputy manager has become more involved in the day to day running of the home. The provider is making regular unannounced visits to the home, as required by regulation, to ensure the home is being run in the best interests of the residents and is making a report. However, a report for the month of February 2007 was not available, although the deputy manager confirmed a visit had been made. Resident meetings take place monthly when consultation takes place about the services provided in the home. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 19 The home is not involved in residents’ financial affairs which are managed by their family or representative. Some small amounts of money are held in safe keeping on behalf of residents but these were not checked at this inspection due to the deputy manager not having a key. However, at the previous inspection it was evident records werere being kept of incoming and outgoing monies, with receipts, and all those monies checked, were seen to balance at that time. Fire safety training is taking place twice a year using a video and the deputy manager was advised it would be good practice for staff to complete a questionnaire to test their knowledge. Fire alarm and emergency lighting checks are recorded as taking place weekly. Incidents entered in the accident book were seen to be appropriately recorded. An electrical wiring certificate for the home remains outstanding and the stairlift, bath hoist and mobile hoist are due a further six monthly thorough examination. The pre-inspection questionnaire indicated maintenance records are being kept and were generally up to date. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 20 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 4,5,6 Requirement The registered provider must make available to residents and/or their representatives an up-to-date statement of purpose which includes all the requirements listed in Schedule l of the Care Homes Regulations to ensure people have access to adequate information about the home. (Outstanding requirement) The registered person must ensure that records of medications administered to residents are accurate and up to date. The registered person must consult residents about the programme of activities and interests and make arrangements to enable them to engage in local social and community activities and provide facilities for recreation. The programme of internal decoration must be completed. (Outstanding requirement with DS0000064183.V328696.R01.S.doc Timescale for action 31/03/07 2. OP9 13 31/03/07 3. OP12 16 30/04/07 4. OP19 23 30/06/07 Attwoods Residential Care Home Version 5.2 Page 22 extended timescale) 5 OP22 23 If the toilet on the ground floor is to be used for storage, then proper provision must be made and the toilet removed and drains adequately sealed (Outstanding requirement) All parts of the care home must be kept clean and free from offensive odours The registered person must ensure that persons employed in the care home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to the work. (Outstanding requirement) Provide the Commission with evidence the home has a current electrical wiring certificate (Outstanding requirement) 30/06/07 6 7 OP26 OP27 23 18 26/02/07 30/06/07 8 OP38 23 31/03/07 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 OP31 Good Practice Recommendations The registered manager should have a qualification at level IV NVQ in management and care or equivalent. (Outstanding recommendation) It would be good practice for the home to keep a daily record of the food provided It would be good practice to keep a book recording complaints, including the investigation and outcome, to monitor whether any patterns emerge DS0000064183.V328696.R01.S.doc Version 5.2 Page 23 2 3 OP15 OP16 Attwoods Residential Care Home 4 5. OP26 OP12 The hours allocated to cleaning should be reviewed to include weekends The provider should seek ways to reduce the use of the small lounge as a thoroughfare to minimise the negative impact of this on the comfort and privacy of the residents who occupy the room. Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Attwoods Residential Care Home DS0000064183.V328696.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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