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Inspection on 08/11/05 for Auburn Mere

Also see our care home review for Auburn Mere for more information

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

What the care home does well

The standard of care observed was good and visiting health professionals, relatives and residents confirmed this. The environment of the home is attractive and clean, with a good range of communal areas. Staff feel well supported and the atmosphere in the home on the day of the inspection was very calm and positive.

What has improved since the last inspection?

Further work has been done to improve the range and availability of communal areas in different parts of the home. Staff supervision has improved in frequency. Lockable storage has now been provided in all resident`s rooms.

What the care home could do better:

Recruitment and medication practice and procedures still require some improvement. Further work is required to make the call bell system in the home satisfactory and the use of door wedges must cease. Whilst the improvements in care plan documentation noted before have been maintained, there are still inconsistencies with how fully all parts of the care plan are completed.

CARE HOMES FOR OLDER PEOPLE Auburn Mere Woodlands Oxhey Lane Watford Hertfordshire WD19 5RE Lead Inspector Jeffrey Orange Unannounced Inspection 8th November 2005 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 Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 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 Sandra Pauline Ewart Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th May 2005 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.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 which 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. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.75 hours and was the second inspection of the year. A number of residents and members of staff were spoken to individually and the inspection was also informed by the inspection questionnaire and self-assessment document completed by the home previously. Comment cards were handed out for relatives during the inspection and those received back are very positive and the views expressed have been incorporated in this report, together with feedback provided by health professionals. During the inspection observations were made of the home’s environment, including resident’s bedrooms and communal areas and discussions were held with catering and cleaning staff and staff principally responsible for the home’s medication practice. Where key standards were assessed during the inspection of the 5th May 2005 these have not all been assessed again on this occasion and reference should be made to the report of that inspection for details. Overall it was found that the progress reported following the previous inspection has continued and that care outcomes for residents are good. Resident and staff feedback received was generally very positive. Some areas of concern noted in the previous report still remain and are detailed below and in the main body of the report. The inspector was accompanied throughout this inspection by a CSCI training manager as part of the assessment process for the Registration of Care Services Award. The CSCI are grateful to the manager, staff and residents for agreeing to this and for their co-operation throughout this inspection. What the service does well: The standard of care observed was good and visiting health professionals, relatives and residents confirmed this. The environment of the home is attractive and clean, with a good range of communal areas. Staff feel well supported and the atmosphere in the home on the day of the inspection was very calm and positive. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 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. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This set of standards were fully assessed during the inspection of the 5th May 2005, please refer to the report of that inspection for details. EVIDENCE: Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Whilst the storage and administration of resident’s medication is generally well organised, care needs to be taken to monitor recording and administration practice to ensure that any errors made can be identified and rectified promptly. Care plans were generally adequate although they do need to be comprehensively completed to obtain the best out of the format used and this was not always the case. The standard of care observed was good and appeared to provide residents with the support they needed in an appropriate way. “Staff are very helpful” was a comment made by one resident. EVIDENCE: Care plans were examined, medication records were checked, with a few errors found. Residents, relatives and community health professionals were consulted during the inspection process and other records were tracked and crossreferenced to see if what happens in practice in the home is reflected accurately in the homes’ records. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 & 15 The improvement in the range and frequency of the activities available to residents, previously noted, has been maintained. However, further consideration should be given to the needs of the less able residents and the provision of activities throughout the whole of the day and week for all residents. Residents are consulted formally and informally, and their comments and suggestions are taken into account when the routines and care practices of the home are being determined. “The food is excellent” was one comment received. How residents can be further encouraged to express choice in the presentation of their food was discussed with the catering team. EVIDENCE: Discussions were held with both individual residents and the catering staff. Some comments by residents suggest that there is a perceived reduction in the quality of choice and service of the food provided at weekends. A recent firework party had been very well received and several favourable comments about being able to access the grounds of the home during the summer were made. An arts and crafts session was observed to be taking place upstairs.The activities available to some of the most dependent residents Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 11 in the main lounge appeared to be unstructured and inconsistent throughout the course of the inspection, both in the morning and afternoon. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents are enabled to exercise their legal rights directly and to participate in the civic process if they so choose. EVIDENCE: Care plan documentation includes evidence of the involvement of advocates with residents and details of advocacy services available are displayed in the home. It has previously been confirmed that residents are enabled to take part in elections, usually by means of postal voting. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 The overall internal décor of the home gives an attractive, homely feel. It is furnished in an essentially domestic style, which makes it more pleasant for residents and their visitors. The use of door wedges to keep doors open must be addressed, this was discussed with the manager and the proprietor. Although the positioning and availability of call bells has been reviewed, in some cases, the provision of lengthened cords has led to an unacceptable risk of tripping to staff and residents and this must be rectified. EVIDENCE: The home was seen to be clean and free from unpleasant odours during this inspection. The home has a maintenance man who was present during this inspection and it was also possible to talk to domestic staff, who confirmed that they had Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 14 received appropriate training. The physical condition of the home was monitored and recorded throughout the inspection process. Call bell cords were seen to present a trip hazard to staff and residents in some rooms. Door wedges were in use in some resident’s bedrooms. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The numbers of staff on duty appear adequate for the needs of the residents. Staff were seen to provide a good level of personal care and staff training provides them with the skills they require to safely meet the care needs of residents. Recruitment procedures are not always fully complied with. Concerns expressed by residents about some staff on duty at night have already been identified and addressed by the manager. EVIDENCE: Staff rotas were seen and discussions were held with the manager. Staffing levels are at least at levels previously agreed and are being kept under review and adjusted as the needs of the residents dictate. The files of recently recruited staff were seen – there are concerns about the number of references obtained in some cases and the recording and explanation of gaps in employment history. Staff were observed giving appropriate care to residents throughout this inspection. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 16 Staff were spoken to individually and demonstrated a good understanding of the care needs of the residents and gave details of training received. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36,37,38 Residents meetings are held regularly and minutes of these were seen. Staff confirmed that they are supervised regularly and senior staff have undertaken supervision training. Health and Safety policies and procedures are in place and staff confirmed that they receive regular training and updates. However concerns around the use of door wedges and the potential trip hazard posed by call bell cords have affected the assessment of standard 38. EVIDENCE: Residents meeting notes were seen. Supervision schedules were seen and staff were asked to confirm details of supervision frequency, which in most cases meets requirements. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 18 Door wedges were in place in several bedrooms and call bell cords were observed to pose a hazard in a number of resident’s bedrooms. Monthly provider’s reports on the conduct of the home have not been received by the CSCI for several months. Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 19 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 3 X X X X X 2 X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 2 2 Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Where medication is prescribed in variable dosages, the exact dosage administered must be clearly recorded on each occasion. This requirement is carried forward from the previous inspection as it has not been fully complied with. Medication records must be frequently and routinely audited to ensure that any errors can be identified and rectified appropriately and promptly. An audit of care plans must be carried out to ensure that all relevant parts are fully completed and maintained up to date. The positioning of call bell cords throughout the home must be reviewed to ensure that any avoidable risk to the health and safety of residents and staff through tripping over them is eliminated. The use of door wedges throughout the home should be reviewed, risk assessments carried out and recorded in each DS0000019276.V265131.R01.S.doc Timescale for action 08/11/05 2. OP9 17(3)(a) 08/11/05 3. OP9 17(1)(a) & 3 (c) 30/01/06 4. OP38 13(4) 15/11/05 5. OP19 13(4)(c) 23(4)(c) 08/11/05 Auburn Mere Version 5.0 Page 21 6. OP29 19 7 OP37 26(5) case and the advice of the fire officer sought and recorded. Any action recommended following this process should be taken. Two written references must be 08/11/05 obtained for each applicant, one of which should be wherever possible from their previous employer. Any gaps in employment history must be recorded and explained. This requirement is carried forward from the previous inspection as parts of it have not been fully complied with. Monthly proprietors’ reports on 01/12/05 the conduct of the home must be provided to the CSCI. 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 OP12 Good Practice Recommendations The range and frequency of activities for all residents, throughout all times of the day and week should be reviewed in line with current best practice, making use of the expertise and results of research, available to the care sector. The good work already in place with residents’ meetings and consultations should be reviewed in order to ensure that resident’s preferences, for example in respect of the size of food portions, can be ascertained and wherever possible acted upon. The manager should review the home’s catering processes and staffing to ensure that there is no deterioration in the provision of food at weekends. The manager should ensure that there are an adequate number of senior staff on duty at night in order to ensure that the good standard of care practice found in the home is maintained at all times. This should be monitored by the manager. DS0000019276.V265131.R01.S.doc Version 5.0 Page 22 2 OP14 3 4 OP15 OP27 Auburn Mere Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 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 Auburn Mere DS0000019276.V265131.R01.S.doc Version 5.0 Page 23 - 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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