CARE HOMES FOR OLDER PEOPLE
Auburn Mere Woodlands Oxhey Lane Watford Hertfordshire WD19 5RE Lead Inspector
Jeffrey Orange Unannounced Inspection 6th June 2007 07:20 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 Auburn Mere DS0000019276.V342169.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. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Auburn Mere Address Woodlands Oxhey Lane Watford Hertfordshire WD19 5RE 01923 247310 01923 247311 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) Trafalgar Health Care Manager post vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: There are none Date of last inspection 20th June 2006 Brief Description of the Service: Auburn Mere is a residential care home providing accommodation and personal care for up to 34 older people. It is owned and operated by Trafalgar Healthcare Limited, which is a wholly owned subsidiary of J. Sai Country Homes Limited. Auburn Mere is located in Watford Heath, on the outskirts of Watford and within easy reach of the towns amenities. It is situated in extensive grounds with accessible seating areas that benefit from outstanding rural views. Accommodation is offered on three floors in single occupancy rooms, with three bedrooms large enough for sharing on a positive choice basis. The majority of rooms have en-suite facilities and there are bathrooms and toilets on each floor. The communal areas are well situated throughout the home and are of varying sizes. All floors are served by a passenger lift. Weekly charges range from £390 to £735, additional charges apply for newspapers, hairdressing and chiropody. (These details were correct at 06/6/07) The home has a service user’s guide and statement of purpose that are provided to prospective service users. Copies of the latest report on the home from the Commission for Social Care Inspection (CSCI) are available in the home. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report draws on information obtained during an unannounced site visit to the home lasting approximately seven hours, starting at 7.20 am in order to observe the handover process between night and day-time staff teams. It provided an opportunity to speak to people living in the home, to visitors and staff and to inspect some key records, including those for medication, staff recruitment and care planning. The proprietor was again present throughout this visit and this facilitated a series of open and helpful discussions about future plans for the service. This report also draws on any information received by the CSCI about Auburn Mere since the last inspection report in June 2006. This includes some specific concerns raised by relatives as well as any issues arising from the safeguarding procedures of Hertfordshire County Council Adult Care Services. Staff and service user surveys are part of the ongoing inspection of this service and any issues arising from these will be assessed and will then inform further regulatory activity by the CSCI in respect of Auburn Mere. What the service does well:
The standard of care provided to people who live in the home is good; “They are really very kind and helpful” was one typical comment received. Because the staff team is quite consistent, they have a good working relationship with one another and have a very good knowledge and understanding of the needs, preferences and interests of people living in the home, several of whom have also been resident for many years. The physical environment of the home is good and the dedicated and experienced housekeeping and maintenance staff team are a particular strength of the home. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Auburn Mere DS0000019276.V342169.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 Auburn Mere DS0000019276.V342169.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): Standards 1 3 5 (Standard 6 does not apply to Auburn Mere) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Auburn Mere’s Resident’s Handbook (Service User’s Guide) does not include all the necessary information about fees and charges necessary to enable prospective residents make a fully informed decision about living in the home. The other information provided is well presented and together with opportunities that exist to visit the home will assist those considering Auburn Mere as their home to make a decision as to whether it can meet their needs and is a home that they would feel comfortable in. The proprietor must take great care to ensure that only those whose current and immediately foreseeable needs can be met are admitted, otherwise inappropriate admissions might have to be rectified which would be disruptive for the individuals concerned and for the service. The Statement of Purpose states that the home has a “limited number of places” for those with the “early stages of dementia”. This may be taken to imply that the home has a registration for dementia care, which it does not. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Service User Guide and Resident’s Handbook have recently been revised, however the copy seen does not meet the requirements of the revised Care Homes Regulations in respect of details of fees. Auburn Mere is not currently registered to accept people who have an existing diagnosis of dementia and does not have the staff training or activities in place to do so satisfactorily. The details of the manager in the Statement of Purpose and Service Users’ Guide are now out of date. Visitors spoken to confirmed that they had had opportunity to visit Auburn Mere when considering different potential homes for their relative. “We liked Auburn Mere because Dad could still smoke his pipe” was one factor in helping them make the decision they did. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 10 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): Standards 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not consistently completed satisfactorily and this makes it difficult for an accurate record to be accessed setting out resident’s current care needs how they are being met and any changes to their care that may be required. The storage and administration of medication remains adequate with some areas needing attention in order to maintain systems that will provide for the wellbeing of those residents who rely on the home’s staff to assist them with their medicines. A good standard of care is experienced by people living in the home and is provided by staff in a way that demonstrates respect for resident’s dignity and rights. People living in the home are able to access community healthcare services in line with their requirements. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 11 EVIDENCE: Those care plans seen were not always consistent, fully completed or up to date. The overall standard was too variable to give confidence that care needs were being accurately reviewed and recorded. There were some gaps in the records seen for medication provided on an as required basis (PRN)(like pain relief which is only occasionally needed). There were discrepancies in some medication checked, again in respect of PRN medication, with the regularly administered medication records being accurate and fully recorded. Some medication was stored at the wrong temperature and there is currently no routine monitoring of the storage temperature for the non-refrigerated medication, although its position does not suggest an immediate risk from extreme temperatures. There was evidence in care plans and from talking to people living in the home, that there is ready and appropriate access to a range of community health services such as opticians, out patient hospital appointments and general practitioners. The standard of care observed was good and people living in the home spoke positively about the standard of care received. “They are very good to us” was a typical comment made. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 12 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): Standards 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. People living in the home are able to maintain contacts with families and friends as they wish and can make use of community facilities in line with their personal preferences and circumstances. People living in the home can exercise a reasonable degree of choice over what, when and where they eat. The range and frequency of activities currently available in the home is poor and does not provide regular, dependable stimulation for people living there. EVIDENCE: The published activities programme is repetitive, not very imaginative and subject in any event to frequent change and cancellation. The cheese and wine session had not been held in the week of this visit and the arts and craft session, by far the most popular activity, had been cancelled at short notice.
Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 13 Service user meetings records expressed concern about activities, as did relatives spoken to. The staff team and proprietor are aware of the problem and it is understood that improvements are planned. However a year after the last report noted similar problems, little if anything has improved. Service user meetings are held; the minutes for one on the 7th March were seen. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 14 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): Standards 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints policy and procedure that provides opportunity for complaints to be dealt with appropriately. Records do not always include the outcome of any complaints or the timescale for dealing with them. Advocacy services are well publicised in the home and this should enable people who live in the home to contact them if they choose to do so. The proprietor and staff have a good understanding of issues around the safeguarding of vulnerable adults and have demonstrated an ability to deal with any allegation made appropriately, this should provide confidence to people living in the home and to those who care for them. EVIDENCE: Complaints records did not always contain details of the outcome of complaints made or the timescale of any resolution. The CSCI have received two complaints from relatives about specific issues of concern. One was satisfactorily concluded; “The home have pulled out all the stops” was the verdict of the family. The other complainant has been partially satisfied with the action taken.
Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 15 A further allegation of potential abuse is being dealt with by Hertfordshire County Council Adult Care Services under their safeguarding vulnerable adults procedure. The proprietor has co-operated fully with this process and has taken robust and appropriate action to address any concerns or issues raised as a result. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 16 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): Standards 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a comfortable environment for those who live and work in it. There is a good choice of communal lounges and dining rooms, which, together with extensive attractive grounds, give people who live in the home a wide choice of different areas in which to sit and relax. EVIDENCE: On arrival at the home at 7.20 am, the domestic staff were already in action keeping communal areas of the home clean and tidy. The proprietor has appointed an experienced member of the housekeeping staff to have principal responsibility for the overall state of the premises. This has already delivered significant improvements in décor and cleanliness.
Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 17 The maintenance person is efficient and approachable and, together with the domestic staff achieves a very good standard of maintenance, cleanliness and hygiene in the home. “There are no smells whatsoever “ was the verdict of one resident. People who live in the home said how much they have enjoyed those days when the weather permits them to sit in the grounds and enjoy “a breath of fresh air”. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 18 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): Standards 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. The recruitment practice of the home has improved and should now ensure that only suitable candidates are accepted for employment in the home. Staff numbers appear adequate and basic training is provided to help them meet the needs of people living in the home, however training records do not always reflect training achieved or required. As it is agreed a number of people living in the home now have some degree of dementia, this should be reflected in enhanced specialist training for staff to enable them to meet their changing needs appropriately. EVIDENCE: Several of the staff files seen had incomplete or inadequate training records or training needs analysis. Some staff are experiencing difficulty finishing NVQ courses following the failure of the assessing company used by the home. Little if any appropriate dementia care training is in place for staff who routinely have to provide care for people with some degree or other of dementia. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 19 Those files seen for recently recruited staff included the required checks made, including two written references and appropriate permissions to work in this country and criminal record bureau checks at enhanced level. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 20 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): Standards 31 33 35 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is again without a registered manager and this has led to a further period of instability that has, in turn adversely affected record keeping and the day- to- day administrative routines of the home such as staff supervision and care planning. The staff team, under the overall guidance of the proprietor have ensured as far as they are able that people living in the home have not experienced a reduced standard of care as a result, however the home needs a period of consistent, strong management input to achieve its potential. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 21 EVIDENCE: Formal staff supervision has not taken place since December 2006. Care plans are not being maintained at a consistently acceptable standard. There is a very stable and experienced staff team in place and this has enabled the adverse effects of the series of management changes for people living in the home to be minimised. There were no immediate health and safety issues arising from this inspection. Those matters currently being dealt with under the Hertfordshire County Council Safeguarding vulnerable adults procedure which included one instance of potentially inappropriate restraint have been dealt with satisfactorily and action taken to ensure there is no repetition. Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 22 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 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 1 3 Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 23 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 5 Requirement Timescale for action 31/08/07 2 OP1 4 3 OP9 13(2) The proprietor must review and amend as necessary the home’s Service User Guide so that it fully complies with the provisions of the revised Care Homes Regulations 2001 (Specifically regulation 5) The proprietor must review the 31/08/07 home’s Statement of Purpose to ensure that it does not wrongly imply that the home is registered for the provision of dementia care. The system of administration for 06/06/07 PRN medication must be reviewed and where necessary improved in order to achieve a consistently accurate record. The temperature of the home’s medication storage must be monitored and recorded to ensure that it remains within the range specified for the medication stored in it. An audit of care plans must be carried out to ensure that all relevant parts are fully completed and maintained up to
DS0000019276.V342169.R01.S.doc 4 OP9 13(2) 06/06/07 5. OP7 15 & 17 31/07/07 Auburn Mere Version 5.2 Page 24 date, that they provide all the necessary information and are kept regularly reviewed. This requirement is brought forward from the previous inspection and must be fully met within the revised timescale. 6 OP12 16(2)(n) The proprietor must ensure that the range and frequency of activities within and outside of the home available to people living in the home is based upon their needs and preferences and takes account of their interests and individual capacities. The home’s activities programme should draw on current good practice and make use of advice and guidance from accredited experts in the provision of activities to older people, including those with some degree of dementia. The proprietor must provide staff with adequate, appropriate training in the provision of care to people with dementia in recognition that a number of people in the home have some degree of dementia. Each member of staff must have a training record which clearly sets out training received, training due and a training needs analysis to set out future training and development required, including appropriate NVQ qualifications. Staff must receive regular, structured one to one supervision in line with the National Minimum Standards. 31/08/07 7 OP30 18 31/10/07 8 OP30 18 31/08/07 9 OP36 18(2) 31/07/07 Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 25 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 2 3. Refer to Standard OP3 OP9 OP14 Good Practice Recommendations The assessment process should be reviewed to ensure that no one with an existing diagnosis of dementia is admitted. The home should obtain a device to enable them to count medication safely, accurately and hygienically. The manager and staff should, with the active involvement of service users, review all the routines and activities of the home, including dining and bathing, to see if they can be enhanced to better meet the preferences of service users. How service user choice is ascertained and recorded should be reviewed to ensure that service users can be shown to have control and choice over the way they live their lives. This recommendation is brought forward from the previous report to enable further time to embed real choice in the day-to-day activities and routines of the home. Monthly proprietors’ reports on the conduct of the home should be provided to the CSCI until further notice. This recommendation is brought forward from the previous report Complaints records should always include details of the outcome for any complaint made with a clear indication of the timescale for dealing with it. 4. OP37 5. OP16 Auburn Mere DS0000019276.V342169.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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