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Inspection on 09/02/09 for Attwoods Residential Care Home

Also see our care home review for Attwoods Residential Care Home for more information

This inspection was carried out on 9th February 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

CARE HOMES FOR OLDER PEOPLE Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ Lead Inspector Diane Wilkinson Key Unannounced Inspection 10:30 9 & 11th February 2009 th 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.V374175.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.V374175.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.V374175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th August 2008 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. The registered manager told us that the current residential fees range from £272.70 to £346.50 per week with additional charges for private chiropody, hairdressing, magazines and newspapers. Attwoods Residential Care Home DS0000064183.V374175.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 that people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last Key Inspection of the home on the 19th August 2008, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over two days. The first day began at 10.30 am and ended at 3.30 pm, and the second day started at 2.15 pm and ended at 4.15 pm. On the day of these site visits the inspector spoke on a one to one basis with three members of staff and the registered manager, as well as chatting to residents and visitors. Inspection of the premises and close examination of a range of documentation, including two care plans, were also undertaken. As part of the inspection process we sent survey forms to all members of staff and nine residents; four were returned by staff and none were returned by residents. Responses in surveys were mainly positive, such as, ‘the food is excellent, especially the lunch and puddings’ and ‘as it is a small home we are able to cater for individuals needs/preferences’. Since the last key inspection we have undertaken three random inspections at the home. Two random inspections took place in October and both were to check progress on the completion of risk assessments for all windows that did not have a window opening restrictor in place, and the control measures taken to remove or reduce the risk. At the first inspection, these risk assessments could not be found. At the second inspection the inspector was accompanied by an Environmental Health Officer; they were shown these risk assessments but the Environmental Health Officer noted that some of the windows still had no window opening restrictor fitted and that this placed residents at risk of harm from falling out of a window. The Environmental Health Officer confirmed with us that all windows have since been fitted with window opening restrictors and on the day of this site visit we were shown the window opening restrictors that had been fitted to all first floor windows. The third random inspection was undertaken as a result of information received from staff by Social Services about poor recording on medication administration records. Some recommendations about the administration of medication were made as a result of that visit and these have now been actioned by the home. At the end of the site visit, feedback was given to the registered manager on our findings, including requirements and recommendations that would be made in the key inspection report. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 7 The home must be free from unpleasant odours at all times and this is currently not achieved. Weekly fire tests must take place on a weekly basis to protect residents and staff from the risk of harm. Staff at the home must have training on moving and handling techniques and how to use mobility equipment as a matter of urgency. This is needed to ensure that only safe manual handling techniques are used by staff. The training and development plan evidences that a lot of training undertaken by staff is out of date and must be updated. Relatives and other visitors to the home should have access to the complaints procedure. More in-depth training should take place on safeguarding adults from abuse in due course to ensure that staff understand policies and procedures and are able to identify poor practice. Some consideration should be given to the layout of the home, in particular, the location of the bathroom with a mobility seat and the two bedrooms that are located directly off the main lounge. Quality assurance systems should be expanded; information received in surveys is not currently collated and published. This information should then be used to formulate an annual development plan. This would ensure that residents and others have the opportunity to affect the way in which the home is operated. There is currently no separate sink in the laundry room to enable staff to wash their hands; this would promote good hygiene practice. To ensure that people safe to work with vulnerable adults are employed at the home, 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. Staff do undertaken induction training but this needs to be more in-depth so that it meets current Skills for Care requirements. 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.V374175.R01.S.doc Version 5.2 Page 8 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.V374175.R01.S.doc Version 5.2 Page 9 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 and 3. Standard 6 was not assessed, as there is no intermediate care provision at the home. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to their admission to the home and 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 had not been acted upon. We checked the care records for a resident 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, and a Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 10 copy of a care plan undertaken by the local authority that commissioned the placement. This 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. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 11 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care planning documentation has improved and records are being well maintained. Health care needs are met in a way that respects a person’s privacy and dignity although some concerns remain about the skills of staff in moving and handling techniques. Medication practices at the home have improved and now protect residents from the risk of harm. 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. One care plan had been signed by the resident to acknowledge their agreement, and the other had been signed by the resident’s key worker and the manager. A Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 12 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, and any assistance with baths or showers is recorded. The manager reviews each area of the care plan on a monthly basis to ensure that information is kept up to date. Daily diary notes record how a person has spent their day, where meals have been taken etc. A member of staff told us in a survey, ‘the manager is always checking care plans are up to date and contain the correct/current/relevant information’, but another recorded, ‘We need more time allowed to fill in care plans’. When we toured the premises 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; we were shown risk assessments in respect of these and noted that a weekly check is made to ensure they continue to be fitted safely. At the last key inspection the manager was advised that all residents should be offered a ‘flu’ injection; these had been offered to residents and all had taken up the offer. It was also recommended that residents should be supported to have appointments with a local dentist and optician. The manager gave us details of the arrangements that have been made for residents; all are registered with a dentist who is willing to visit the home and optical appointments are going to be made available once a year via Health Call. We met an occupational therapist on the day of the site visit who had been asked to visit a resident about moving and handling concerns. The occupational therapist said that they had received six referrals since the last key inspection of the home and one outcome of these visits was that staff had not had appropriate training on moving and handling techniques or on using mobility equipment. A ‘turntable’ has been loaned to the home by the occupational therapists but one needs to be purchased by them. We saw this in use on the day of the site visit and it was apparent that staff require further training in moving and handling and in using associated equipment. The registered persons agreed that this training would be organised within two months of our site visit for all care staff. 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. They do not have a lifting belt and we recommend that one should be purchased. 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. At the last key inspection staff were asked to ensure that the curtains dividing shared rooms were working properly; the manager told us that she actioned this herself and intends to make regular checks to ensure that the curtains remain effective. On the day of the site visit a district nurse visited one of the residents and we noted that it was normal practice for residents to be taken to their bedroom for any medical intervention. There is no private Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 13 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 residents accommodated in these rooms having to go through the lounge in their nightclothes when they want to use the bathroom and/or toilet. The location of these rooms should be reconsidered by the registered person. We checked the arrangements for the storage of medication and medication administration records. The manager told us that they have changed to a different pharmacist and they are happy with the service provided. As part of this package, they were provided with a secure medication trolley. 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 record that indicates the colour codes for the times that medication should be administered. 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. 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. The home should purchase a medications fridge; when in place, the temperature of the fridge should be taken daily and recorded. 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 recommend 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. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents 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: There are newly written care plans in place and these 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. On the day of the site visit a sing-along session took place in the afternoon, and one person went out to the local public house; staff said that this was a regular event and we saw that the resident told staff what time they were going and what time they would return to the home. A member of staff told us in a survey, ‘as it is a small home we are able to cater for individuals needs/preferences’. Information about Advocacy services is not made available to residents or visitors to the home. If this information were displayed in the home it would Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 15 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 (an omelette or a sandwich) and a variety of choices at tea time. A member of staff that completed a survey told us, ‘the food is excellent, especially the lunch and puddings’, and another said, ‘the home provides a wholesome, varied menu based on fresh produce’. The manager said that most vegetables served at the home are fresh; a delivery is received once weekly. All care plans now include a nutritional risk assessment and a weight chart to assist with nutritional screening. 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. 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. On the day of the site visit seven residents had their lunch in the dining room and six had their lunch in their bedroom; staff told us that these people needed minimal assistance with eating their meals. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are informed about how to use the complaints procedure but relatives and others need access to this information. Residents are protected from the risk of harm by the policies and procedures in place on safeguarding adults from abuse and by staff training. EVIDENCE: 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 no information displayed in communal areas of the home to advise relatives or others about how to make a complaint, and no complaints/comments book or suggestion box is in use. The manager told us that they no longer have residents meetings as so few people attend. Instead of this, she meets with the residents on a one to one basis. The manager was advised to record these meetings, as they could go some way towards evidencing that residents have the opportunity to express concerns or offer compliments about the service they receive. The manager Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 17 said that staff are told about the complaints procedure at the time of their induction training. All of the staff that returned a survey told us that they knew what to do if a resident or relative had concerns about the home. The training and development plan was not up to date but the manager provided information to evidence that all staff had training on safeguarding adults from abuse in January 2009. This was in-house training using information that had been purchased from a training company. We saw the content of the training course and found it to be at a fairly basic level. We suggested to the registered provider that this initial training could be followed up with something more in-depth. Five staff have achieved NVQ Level 2 in Care and they will have studied information on safeguarding as part of this training. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 18 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 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some areas of the home have been redecorated and some new carpets have been fitted but some areas of the home still require refurbishment, such as the dining room and the small lounge. We detected unpleasant odours in bedroom accommodation and action must be taken to improve this situation. There are numerous concerns about fire safety and any recommendations from the Fire Officer must be addressed following their visit. Consideration should be given to improving the layout of the home to enhance safety as well as meeting the need for privacy and dignity for residents. EVIDENCE: A brief maintenance programme was sent to the Commission for Social Care Inspection (CSCI) along with the required improvement plan. This recorded that some areas of the home have recently been redecorated, including the Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 19 outside of the home, and that new carpets have been fitted in some bedrooms. These improvements were seen on the day of the site visit. The carpet in the small lounge is fitted on top of uneven floorboards and this creates a trip hazard. The carpet is also soiled and has cigarette burns, and should be replaced. We toured the premises on the day of the site visit. The large lounge is well decorated and furnished but one of the residents told us that the chairs are sometimes dirty. One of the staff told us in a survey that, ‘the dining room chairs should be changed – they are rusty, old and aesthetically very ugly. Also, the dining room carpet is very dirty and stained’. Some bedrooms provide pleasant accommodation for residents but we found that some had an unpleasant odour and in one bedroom this necessitated the mattress being replaced. One of the care workers on duty agreed to action this on the day of the site visit. There are three bathrooms/shower rooms available for residents but we were concerned that the only bathroom that contained a mobility chair to assist people in and out of the bath was on the first floor and residents have to go down three steps to access this bathroom. It would seem more sensible to have the mobility chair in the bathroom that is most easily accessible. We were concerned that one of the fire exits was in a toilet on the ground floor and another was in a resident’s bedroom. In addition to this, there are some stairs at one end of the building that lead from the first floor corridor to the kitchen/laundry area of the home. The manager said that these stairs are only used by staff, but we were concerned that they could be accessed by a resident; if a resident had an accident in this area of the home it could be some time before they were found. It may not be possible to put a lock on this door as it could be a fire exit. The Fire Officer has been consulted about these concerns and will be visiting the home to assess the situation. The outstanding requirement for window opening restrictors to be fitted to all windows has now been actioned; the Environmental Health Officer who visited the home confirmed this, and we were shown those on the first floor on the day of our site visit. 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. Most staff have not yet undertaken training on infection control but we saw training information that has been purchased by the home and the manager said that this training is due to commence shortly. We observed on the day of the site visit that staff use protective clothing and follow good hygiene practices. However, we noted that two bedrooms are located directly off the large lounge and this could result in staff having to carry soiled laundry through the lounge. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 20 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 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices need slight improvements to protect service users by ensuring that only people that are considered as suitable to work with vulnerable people are employed. Some care staff have undertaken relevant training courses but many of these are out of date and staff should have refresher training on all core training topics, especially moving and handling. EVIDENCE: There is a satisfactory staff rota in place although the hours worked by domestic staff are not included on the rota. The rota evidences that there are always two care staff on duty and from Monday to Friday the manager is on duty in addition to this. There is a cook on duty every day. The domestic assistant only works for four hours on four days per week; comments received in surveys and on the day of the site visit indicate that there are insufficient domestic hours available to ensure that the home is maintained in a clean and hygienic condition. Five care staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and two staff have also achieved Level 3 in Care. More staff have enrolled on this award but records did not clearly show whether this was 2, 3 Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 21 or 4 staff. In addition to this, the three cooks employed at the home have enrolled on a catering NVQ qualification; this is good practice. We checked the recruitment and training records for two members of staff, and the training records for a further member of staff. One application form was filed with staff records but the other was missing; the manager said that this was at her own home and she brought it into the home for the second day of the inspection. Similarly, one reference was missing and this was also brought into the home for the second day. One other reference seen was written on a scrap of paper and there was no evidence that this reference had been requested by the manager. 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. Staff records should always be held at the home securely and should be available for inspection at all times. Records evidenced that staff do not commence work at the home until a Criminal Records Bureau (CRB) check or Protection of Vulnerable Adults (POVA) first check (in exceptional circumstances) has been received. When asked in surveys if they receive relevant training, three staff said ‘yes’ and one said ‘no’. The training and development plan seen on the first day of the site visit was out of date. On the second day the manager produced an updated version but this still evidenced that a lot of training is out of date and that staff require refresher training on most topics. For example, four staff did training on health and safety in 2002 and seven staff have not done this training, and nine staff did training on first aid in 2004; two people had refresher training in 2008 but five staff had received no training on this topic. As previously recorded, staff urgently need to have training on moving and handling to ensure that resident’s are assisted with mobilising by staff that have the skills and knowledge to do this safely. Some individual staff records included more up to date information on training achievements but this information had not been transferred to the training and development plan. Some training information on Infection Control, Medication, Safeguarding and Moving and Handling has been purchased from a specialist company. The home intends to offer this as in-house training and this process has commenced. The training information was seen by the inspector and it was felt to be adequate, but that more in-depth training on these topics should follow for all staff. Staff records evidence that people have induction training when they are new in post; there is a checklist in use but no record of what this training consists of or that it meets current Skills for Care requirements. There should be evidence that staff receive the information they need to provide the service required by the residents prior to commencing work unsupervised at the home. 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. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 22 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 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is making progress towards achieving appropriate qualifications and is 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 tests and staff training on health and safety must be up to date. Quality assurance systems should be fully operational so that residents and others are able to affect the way in which the home is operated. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager told us that she has almost completed NVQ Level 4 in Care; when this is achieved she intends to continue with NVQ Level 4 Management training. She has recently attended external training courses on First Aid and Continence to keep her own practice up to date. Staff told us in surveys that there have been problems with management practices at the home in recent months, but that these have recently improved. One person said, ‘There had been a lack of communication from management to staff approximately 6 to 12 months ago. However, this has improved dramatically’. Other staff told us, ‘The proprietor communicates different things to different staff, leading to confusion’ and, ‘the owner could support the manager more’. We checked quality assurance information at the home. The manager told us that surveys are due to be sent out to residents, relatives, staff and health care professionals; these were seen on the day of the site visit. We saw the returned surveys from last year. The manager told us that she reads all returned surveys and takes any action needed. However, the information is not collated or published, and is not used to formulate an annual development plan. This would evidence that residents and others have the opportunity to affect the way in which the home is operated. The manager told us that they have a staff meeting every month, but one person commented in a survey that they would like more staff meetings and records seen on the day of the site visit recorded the last staff meeting as November 2007. As previously recorded, the manager meets with residents on a one to one basis every month (in place of holding resident’s meetings, which were poorly attended) but these meetings are not recorded. The manager was advised to record these meetings and also to try to reinstate resident’s meetings. 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 now check records and balances held on a monthly basis. 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 should cease, both to protect the manager from allegations of mishandling residents’ monies and to protect the manager in the event of the cheque being lost. We checked the records in place for fire safety. We noted that the fire risk assessment does not record the frequency of fire tests or drills. An annual test of the fire alarm system took place in August 2008 but records for in-house fire tests evidenced that no weekly fire test had taken place since 17/8/08. The manager told us that she had the recent records at home. An immediate Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 24 requirement notice was left at the home and by the time we returned on 11/2/09 a fire test had taken place and records had been updated. The stair lift was serviced in May 2008, a portable appliance test was undertaken in October 2008 and there is a current gas safety certificate in place. We observed that environmental risk assessments have been undertaken in respect of health and safety topics. As previously recorded, training on many health and safety topics is overdue, especially moving and handling training. We also noted that fire safety training is needed for staff. Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 25 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 2 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 26 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. 2. Standard OP26 OP30 Regulation 16 13 Requirement Timescale for action 31/03/09 3. OP30 18,23 4. OP38 13 The home must be free from unpleasant odours at all times. Previous timescales not met. Staff must have training on 09/04/09 moving and handling techniques and on how to use mobility equipment. This is needed to ensure that staff use safe techniques when assisting residents with mobilising. The registered person must 12/06/09 make sure that they identify the training needs and achievements of staff. This should be recorded on a 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. Previous timescales not met. Weekly fire tests must take place 11/02/09 consistently to protect the health and safety of residents, staff and others. (This had been actioned by the required date). Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 27 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 home’s service user guide and smoking policy should be updated to reflect current government guidance regarding smoking. Staff should check tablets and other medication supplied by the Pharmacist and record the amount received on the medication administration record. These entries should be signed and dated by staff. The practice of recording on packaging the actual date when staff start to use the medication should be adhered to consistently. It is considered good practice for a separate medications fridge to be used to hold medication that must be stored at a low temperature. 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. The registered person should make sure that there is information available to people about advocacy services that may support them in decision-making. The registered person should make sure that there is adequate planning in the provision of meals to ensure that people receive a healthy balanced diet. A set menu would help to evidence this. There should be evidence that relatives and other visitors to the home have information about how to make a complaint. More in-depth training should take place on safeguarding DS0000064183.V374175.R01.S.doc Version 5.2 Page 28 2 OP9 3. OP9 4. OP9 5. OP10 OP19 6. OP14 7. OP15 8. OP16 9. OP18 Attwoods Residential Care Home adults from abuse in due course. 10. OP19 The layout of the home should be reconsidered; the bathroom that is most used has three steps down to it and is difficult for most residents to access. Fire exits are situated in a resident’s bedroom and a ground floor toilet. The safety of the ‘rear’ stairs should also be risk assessed. A Fire Officer will be visiting the home to assess these issues. The uneven floorboards in the dining room create a trip hazard; these should be repaired. The carpets in the dining room and small lounge should be replaced, and the dining chairs are damaged and should be replaced. To promote good hygiene practice there should be a separate sink in the laundry room to enable staff to wash their hands. Only references that have been requested by and returned to the registered manager should be accepted, and one of the references should always be from the applicant’s most recent employer. These records should be available at the home for inspection at all times. The registered person should make sure that staff undertake induction training that meets current Skills for Care requirements. This would help to evidence that staff have the knowledge they need prior to commencing work with the residents. The outcome of any quality surveys should be collated and published, and the collated information should be used to formulate an annual development plan. Residents meetings should be reinstated and staff meetings should be held more frequently. This would assist in evidencing that residents and others are able to affect the way in which the home is operated. Alternative means should be sought for paying the chiropodist on behalf of residents. 11. OP19 12. 13. OP19 OP19 14. OP26 15. OP29 16. OP30 17. OP33 18. OP35 Attwoods Residential Care Home DS0000064183.V374175.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V374175.R01.S.doc Version 5.2 Page 30 - 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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