CARE HOMES FOR OLDER PEOPLE
Auckland Residential Care 2 Ken Road Southbourne Bournemouth Dorset BH6 3ET Lead Inspector
Marjorie Richards Key Unannounced Inspection 11th October 2007 10:00 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 DS0000003916.V342608.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. DS0000003916.V342608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Auckland Residential Care Address 2 Ken Road Southbourne Bournemouth Dorset BH6 3ET 01202 427166 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) Mr David John Hart Mr Job Hart Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places DS0000003916.V342608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Two persons between the ages of fifty-five and sixty-five may be accommodated at any one time for short-term care. 25th July 2006 Date of last inspection Brief Description of the Service: Auckland Residential Care is a detached property, adapted to provide residential care. It is situated on a corner plot in a quiet residential area of Southbourne, with local shops, a pub and bowling green a short walk away. The cliff-top, with a variety of coastal walks, is approximately a quarter of a mile from the home. Buses are available to and from Southbourne, with a full range of shops, churches, library etc, as well as other parts of Bournemouth, Christchurch and beyond. Parking for visitors is available on roads adjacent to the home. Auckland Residential Care is registered to accommodate up to ten older people and five were in the home at the time of inspection. Service users accommodation is located on the ground and first floors of the home with access between floors via the staircase or a stair lift. The home is centrally heated throughout. A lounge and separate dining room are situated on the ground floor. Small garden areas are available at the sides of the property with seating for service users. There are sufficient communal bathrooms and WCs and seven of the eight bedrooms have en-suite facilities. The two double bedrooms are used as singles, unless two people request to share. All eight bedrooms are currently contracted to Bournemouth Borough Council Social Services in a “Re-enablement” scheme. This scheme provides service users with support, usually upon discharge from hospital, during a time-limited period of assessment and potential rehabilitation, before their longer term care needs are decided. Auckland provides 24-hour personal care, all meals, laundry and domestic services. However, service users are encouraged to do as much for themselves as possible as part of the rehabilitation process. Many activities are based on daily living tasks such as laying tables, making a cup of tea or preparing a snack. However, there are also a number of board games, cards, library books, jigsaw puzzles etc available for relaxation when required. The home assists service users, if they wish to make arrangements in accordance with their religious beliefs. The fees for the home, as confirmed during the inspection, are £600 per week.
DS0000003916.V342608.R01.S.doc Version 5.2 Page 5 Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people choosing a care home. aspx A copy of the home’s inspection report is made available to anyone wishing to read it, upon request. DS0000003916.V342608.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.5 hours on the 11th October 2007. The main purpose of this unannounced inspection was to review all of the key National Minimum Standards, check that the service users in the home were safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. On the day of inspection, five service users were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for all five service users. Time was spent observing the daily routine during the inspection, as well as talking with service users and the staff on duty. Neither of the registered persons Mr J Hart or Mr D Hart was available during the inspection. Discussion took place with the senior care assistant, who is currently making application to us to become the registered manager. Mrs Hart, wife of Mr D Hart, also made herself available for part of the inspection. The Annual Quality Assurance Assessment (AQAA) form had been completed by Mrs Hart and the senior care assistant and provided to the Commission for Social Care Inspection in advance of the inspection. Recent legislation has made it a legal requirement for all registered services for adults to complete an AQAA every year. The completed assessment is one of the ways in which the Commission for Social Care Inspection will assess how well the service is delivering good outcomes for the people using it. Additional information used to inform the inspection process includes the five completed comment cards from service users, one from a General Practitioner, one from a District Nurse and three from relatives of service users. All expressed general satisfaction with the care provided and some comments are included anonymously in this report. The Inspector was made to feel welcome in the home throughout the inspection. What the service does well:
Auckland Residential Care provides a clean and well-maintained home where service users are provided with support, usually upon discharge from hospital, during a time-limited period of assessment and rehabilitation, before their longer-term needs are decided. Service users are encouraged to maximise their potential, hopefully to return to their own home or, if this is not possible, to long or short-term care or
DS0000003916.V342608.R01.S.doc Version 5.2 Page 7 sheltered accommodation. They have access to healthcare services and staff administer their medication safely, if necessary The service users describe the home as a very relaxed and friendly place to live where the staff are helpful, cheerful and supportive. The staff treat service users with respect and provide encouragement for them to pursue their own lifestyles, wherever possible, and to make choices about their daily lives. Most activities tend to be seen as part of their rehabilitation. This might include staff accompanying a service user on a walk, assisting them in making a cup of tea or a sandwich or teaching them to dress themselves and manage the toilet unaided. However, service users also have access to leisure activities, such as a range of board games, cards, dominoes, indoor ball games, television and a selection of music and videos. Service users are supported to maintain contact with family and friends, enabling people living in the home to continue to enjoy relationships that are meaningful to them. Service users say that their visitors are free to visit at any time and are always made welcome. Service users may choose where in the home they eat their meals but are encouraged to come to the dining room as part of their assessment. Staff assistance is always available whenever needed. Mealtimes were seen to be relaxed, unhurried and flexible to fit in with daily living arrangements. Service users commented, The food is home-made and you cant beat homemade. The food is excellent, very tasty. The food is excellent here, it couldnt be better. They also expressed satisfaction with the laundry arrangements. The systems in place provide service users with the confidence that their complaints will be listened to and acted upon and they are protected from possible abuse. Service users said, I have no complaints about this place, quite the opposite. If I did have concerns, I would talk to the lady in charge.” If I had any worries, I would tell Nicky (senior care assistant) and she would soon sort things out. I find her very helpful with everything.” Service users speak highly of the staff at Auckland Residential Care. A number of very positive comments were received including, The staff here are very capable. They can cope with anything. You can talk to them, they are good listeners and they really seem to care about me and my problems. The staff were so encouraging and always pleasant and helpful, ready to help when needed whilst encouraging me to be as independent as possible. Of the six care staff employed at Aucklands, four have National Vocational Qualifications level 2 in care, so the target of 50 NVQ level 2 trained staff has been exceeded, helping to ensure that service users are in safe hands. What has improved since the last inspection?
DS0000003916.V342608.R01.S.doc Version 5.2 Page 8 Of the five requirements made at the last inspection, only two have been met in full. One of the two recommendations has also been implemented. A number of improvements to the environment have taken place since the last inspection. The lounge has been completely redecorated, including the provision of new armchairs and a large screen, wall mounted television with freeview channels. New carpets have been provided in the lounge, dining room, hallway and three bedrooms. New nonslip flooring has been provided in two ensuite bathrooms. One bedroom has already been refurbished and new furniture has now been ordered for a second bedroom. Replacement doors have been fitted to kitchen units and brighter lighting provided in the kitchen. Teak chairs and tables with sun umbrellas have been provided for use outdoors. The brick boundary wall has been rebuilt. The senior care assistant has recently completed NVQ level 4 training in care. What they could do better:
Discussion with service users during the inspection revealed that not all felt they had received sufficient information about Auckland Residential Care prior to their arrival at the home. “I knew nothing about this place before I came here, but I am glad I came.” The senior care assistant confirmed that she visits all prospective service users prior to admission, (unless it is an emergency admission) to ensure that the home can meet the service user’s needs. However, of the five current service users, only one had a full pre-admission assessment on file, one had a partial assessment and three files contained no evidence that a pre-admission assessment had taken place. The senior care assistant says she is currently working to improve the information supplied to prospective service users and also the documentation used for pre-admission assessments, so that the forms will provide more detailed information. The care plan for a service user admitted to Auckland Residential Care over a week previously had not been completed. The hospital discharge documentation highlighted certain risks, but there were no assessments in place showing how this was to be managed in the care home. The care plan for another service user demonstrated that a risk assessment had been carried out on admission, but did not include all aspects of the risk identified in the Local Authority assessment. It is important that care plans are developed as soon as possible after admission, considering all care needs and detailing how staff are to meet these needs. There are still some shortfalls in recruitment practice. These must be addressed so that newly appointed staff are thoroughly checked before commencing employment, to ensure the safety of service users. DS0000003916.V342608.R01.S.doc Version 5.2 Page 9 The registered persons have very little involvement in the day-to-day management of the home. Mr D Hart is on the premises from 8.00pm until 8.00am but is generally not present during the day. Most of the day-to-day management is left to the senior care assistant, supported by Mrs Hart when she is not working elsewhere. It is important to ensure that the registered persons provide regular management support to staff and service users each day. It is not sufficient for Mr D Hart to only be contactable by telephone during the day if needed. Mrs Hart confirmed that an application is now being made to the Commission for Social Care Inspection to register the senior care assistant as the manager of Auckland Residential Care. 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. DS0000003916.V342608.R01.S.doc Version 5.2 Page 10 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 DS0000003916.V342608.R01.S.doc Version 5.2 Page 11 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, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Auckland Residential Care. The information provided about Auckland Residential Care and the admissions procedure need some improvement to allow prospective service users to make informed decisions about admission to the home and ensure that only those whose needs can be met are offered places there. EVIDENCE: The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities. The Service User Guide is easily readable and gives a good indication of what a service user can expect from the home. A copy of this document is available in every bedroom. However, in answer to the comment card question ‘Did you receive enough information about this home before you moved in,’ three of the five responses said ‘No’ and only one said ‘Yes.’ One service user did not answer this question.
DS0000003916.V342608.R01.S.doc Version 5.2 Page 12 Discussion with service users during the inspection confirmed that not all felt they had received sufficient information about Auckland Residential Care prior to their arrival at the home. Service users commented, “I knew nothing about this place before I came here, but I am glad I came.” “It was arranged for me to come here. I did not know what this place was for, until they told me when I arrived.” The senior care assistant says she is working to improve the quality of information supplied to prospective service users before admission to the home. Individual care records are kept for each resident and all five of these were examined. All showed that, prior to moving to the home, care needs had been assessed by care managers from Bournemouth Borough Council who then provided care plans to the home. The senior care assistant confirms that she also visits all prospective service users prior to admission, (unless it is an emergency admission) to ensure that the home can meet the service user’s needs. However, of the five current service users, only one had a full pre-admission assessment on file, one had a partial assessment and three files contained no evidence that a pre-admission assessment had been carried out by the home. The senior care assistant says the documentation used for pre-admission assessments is being reviewed, as the current forms do not provide sufficiently detailed information. Mrs Hart says she has recently been involved in discussions with Bournemouth Borough Council Social Services Directorate regarding the service to be provided by the home in future. If the home were to provide Intermediate Care, this would require dedicated accommodation together with specialised facilities, equipment and staff, to deliver short-term intensive rehabilitation to enable service users to return to their own homes. However, it has now been proposed that all eight bedrooms would be used to provide a new “Re-enablement” scheme. This scheme provides service users with support, usually upon discharge from hospital, during a time-limited period of assessment and rehabilitation, before their longer term needs are decided. Currently therefore, Auckland Residential Care is not providing Intermediate Care and this Standard will therefore be reviewed at the next inspection. DS0000003916.V342608.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Auckland Residential Care. Service users have access to healthcare services and medication is administered safely. However, shortfalls in the completion of risk assessment documentation and care planning have the potential to place them at risk. EVIDENCE: After admission, the home draws up a care plan identifying the needs of each service user and how staff are to meet these needs. Although care plans are generally well written, one care plan for a service user admitted to Auckland Residential Care over a week previously had not been completed. The hospital discharge documentation highlighted a history of falls and episodes of incontinence, but there were no assessments in place showing how this was to be managed in the care home. The care plan for another service user demonstrated that a risk assessment had been carried out on admission, but did not include all aspects of the risk identified in the Local Authority assessment.
DS0000003916.V342608.R01.S.doc Version 5.2 Page 14 It is important that care plans are developed as soon as possible after admission, considering all care needs and detailing how staff are to meet these needs. The home aims to maximise the potential of each service user, hopefully to return to their own home or, if this is not possible, to long or short-term care or sheltered accommodation. Relatives are encouraged to be involved in the provision of care if they wish. A review of care takes place with care managers two weeks after admission. The review forms include the signature of the service user or their representative wherever possible. The care plan is reviewed regularly. Good information on daily care is maintained in individual service user’s records. These demonstrate that service users have access to health care services and attend appointments as necessary. There was evidence of visiting health professionals e.g., GPs, district nurses, chiropodists, etc. This was later confirmed in discussion with service users and staff. At the last inspection, it was recommended that where charts are being used to record nutrition and hydration, these should evidence all food and fluids being offered each day and record the amounts taken or whether refused. Such charts are not required for any of the current service users. However, the care plan for a previous service user was examined. This showed that very detailed charts had been maintained and demonstrated that the home provided sufficient nutrition and fluids when the service user was unwell. Each service user has a lockable medicine cabinet in their bedroom where their medicines are kept. Some service users are able to look after their own medicines whilst others need the support and guidance of staff. A few service users are not able to handle medicines and in this case, staff take responsibility and detail everything in the individual Medicine Administration Records. The medicines and records for one service user were checked and found to be satisfactory. Staff were observed to be interacting with service users in a relaxed and caring manner. It was clear from the time spent with service users that they felt comfortable and at ease with staff and appreciated their friendly approach. Staff were observed throughout the inspection to be treating service users with courtesy, kindness and respect. Service users commented, The staff are very good to me. They have helped me such a lot and I am very grateful for what they have done for me. I have enjoyed my stay here, it has been a real tonic. Everyone is so friendly and helpful. I cant thank staff enough. All current service users have their own single bedrooms, thereby offering an opportunity to be on their own if they wish, or allowing privacy for any visitors DS0000003916.V342608.R01.S.doc Version 5.2 Page 15 or personal care needs. Service users commented, I can come and go as I please. We can do what we like here. DS0000003916.V342608.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. The home is flexible in its approach to the provision of activities and meals, encouraging service users to retain control over their lives wherever possible. EVIDENCE: For the majority of service users, activities are carried out on a one-to-one basis and tailored to meet the needs of the individual as part of their rehabilitation. This might include staff accompanying a service user on a walk, to the shops or to the pub or assisting them in making a cup of tea or a sandwich or learn to dress themselves and manage the toilet unaided as part of an assessment. Service users also have access to leisure activities, such as a range of board games, cards, dominoes, indoor ball games, television and a selection of music and videos. The mobile library visits each month. Staff also arrange occasional quizzes, reminiscence sessions and barbeques when the weather permits. Because service users are receiving only short-term care, every effort is made to maintain contact with family and friends and the wider community. Service
DS0000003916.V342608.R01.S.doc Version 5.2 Page 17 users and staff confirm that visitors are able to visit at any time and are always made to feel welcome. Relatives are able to remain involved in care provision if they wish. Encouragement is also given to retain links with friends, church etc, whilst staying at Auckland. Such contacts are recorded in the care documentation and visitors book. Within the short-term assessment framework, service users are encouraged to choose their own lifestyle within the home and make choices wherever possible. Service users are encouraged to be as independent as possible. This includes helping with their own personal care wherever possible. Service users are encouraged to choose when to get up or go to bed, what to wear, what to eat or drink and to come and go as they please. As part of the review process, service users are also encouraged to discuss their wishes about what they want to do in future. They can have access to their records whenever they wish. Although generally only in the home for a maximum of six weeks, service users are encouraged to bring some of their own possessions to personalise their bedrooms. Service users confirm that their individual preferences and routines are respected. Lunch on the day of inspection was a choice of chicken or steak pie, with boiled potatoes, cabbage, leeks, swede and carrots. (All fresh vegetables.) This was followed by chocolate sponge and custard or a variety of fresh fruit. Alternatives, such as omelettes, jacket potatoes with a variety of toppings and salads are also available to suit individual taste and preference. For the evening meal, service users are able to make a choice from several options on offer. On the day of inspection, the majority of service users selected cauliflower cheese, followed by a selection of home-made cakes, fresh fruit or yoghurt. A bowl of fresh fruit is available in the dining room and service users are encouraged to help themselves whenever they wish. As part of the assessment process, some service users are encouraged to help with the preparation of their own meals, e.g. laying tables, putting out their own cereal for breakfast or making toast. Other service users are encouraged where possible to assist with tasks such as buttering their own toast, pouring a cup of tea or putting milk on their cereal. Service users may choose where in the home they eat their meals but are encouraged to come to the dining room as part of their assessment. To aid this process, the tables in the dining room have been placed together and service users share mealtimes as a group. Those who are more able like to assist other service users where possible. Staff assistance is always available whenever needed. Mealtimes were seen to be relaxed, unhurried and flexible to fit in with daily living arrangements. DS0000003916.V342608.R01.S.doc Version 5.2 Page 18 We spoke with service users enjoying their lunchtime meal and all spoke highly of the meals provided at Auckland Residential Care. Service users commented, The food is home-made and you cant beat homemade. The food is excellent, very tasty. The food is excellent here, it couldnt be better. Other comments received include, The meals are always good and fresh fruit always available. The menu is varied and suitable for everyone. (Comment Card, service user.) The meals are always good, I can find no fault. They are varied and always nicely laid out. Very enjoyable. (Comment Card, service user.) DS0000003916.V342608.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. The systems in place provide service users with the confidence that their complaints will be listened to and acted upon and they are protected from possible abuse. EVIDENCE: The home has a complaints policy that is included in the Service User Guide available in every bedroom. Two complaints have been received by the home since the last inspection in July 2006. Both have been investigated and appropriate action taken. Service users spoken with say they have no concerns, I have no complaints about this place, quite the opposite. If I did have concerns, I would talk to the lady in charge.” If I had any worries, I would tell Nicky (senior care assistant) and she would soon sort things out. I find her very helpful with everything.” Auckland Residential Care has a comprehensive Adult Protection policy in place. All staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. The home provides information about advocacy services, where service users lack capacity or require independent support or advice. DS0000003916.V342608.R01.S.doc Version 5.2 Page 20 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, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. The home provides service users with comfortable, clean and well-maintained surroundings in which to live. EVIDENCE: Aucklands is domestic in size and character and provides safe, comfortable and homely accommodation. A stair lift is available to assist access between the ground and first floors. Equipment is regularly maintained. At the last two inspections it was reported that one bedroom had been completely refurnished and it was planned to provide new bedroom furniture for all bedrooms over the coming year. This has still to be achieved. However, some improvements have taken place since the last inspection. The lounge has been completely redecorated, including the provision of new armchairs and a large screen, wall mounted television with freeview channels.
DS0000003916.V342608.R01.S.doc Version 5.2 Page 21 New carpets have been provided in the lounge, dining room, hallway and three bedrooms. It is intended to provide new carpets throughout the home. New nonslip flooring has been provided in two ensuite bathrooms. One bedroom has already been refurbished and new furniture has now been ordered for a second bedroom. Replacement doors have been fitted to kitchen units and brighter lighting provided in the kitchen. Teak chairs and tables with sun umbrellas have been provided for use outdoors. The brick boundary wall has been rebuilt. The communal space at Auckland Residential Care consists of a lounge and separate dining room, both situated on the ground floor. The newly refurbished lounge overlooks the rear of the property. The dining room is situated at the front of the home and has a Welsh dresser, which accommodates a selection of books, games and magazines. There are small areas of garden laid mainly to lawn at the sides of the property, where service users may sit out if they wish. The garden is well maintained with a colourful display of flowers, hanging baskets and tubs all around the home. Service users commented, I like to look out at the flowers, they look lovely. The garden is very pleasant and the flowers would win a prize. The small internal laundry room accommodates a domestic washing machine. Tumble dryers are situated in a building adjacent to the main home. Service users expressed satisfaction with the laundry arrangements. The home is clean, although there is a slight odour problem in one bedroom. The senior care assistant is aware of this and is taking appropriate steps to deal with the situation. DS0000003916.V342608.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Auckland Residential Care. Systems are in place for the recruitment and training of staff to support the service users living at the home. However some shortfalls in recruitment practice remain and these must be addressed to ensure staff are thoroughly checked before commencing employment, to ensure the safety of service users. EVIDENCE: The staffing roster shows that two care staff are on duty each day between 8.00am to 2.00pm and 2.00pm to 8.00pm. The senior care assistant is one of these staff. No additional domestic staff are employed so the care staff are providing care, assisting with meals, carrying out cleaning tasks, laundry etc. This often leaves insufficient time for the senior care assistant to carry out additional duties such as care planning and pre-admission assessments etc. (See also Standard 31 re the management of the home.) Mr and/or Mrs D Hart are on duty from 8.00pm and sleep on the premises on call overnight, until 8.00am. Either Mr or Mrs Hart or a member of care staff provides a wakeful duty, to meet the needs of service users. The rota still does not currently identify which person is providing the wakeful duty. DS0000003916.V342608.R01.S.doc Version 5.2 Page 23 Although staffing levels are sufficient to meet the needs of the current service users, these will need to be reassessed if the senior care assistant takes on the role of registered manager as is being proposed. Of the six care staff employed at Aucklands, four have National Vocational Qualifications level 2 in care, so the target of 50 NVQ level 2 trained staff has been exceeded, helping to ensure that service users are in safe hands. The senior care assistant has recently completed NVQ level 4 training in care. Service users speak highly of the staff at Auckland Residential Care. A number of very positive comments were received including, The staff here are very capable. They can cope with anything. You can talk to them, they are good listeners and they really seem to care about me and my problems. The staff were so encouraging and always pleasant and helpful, ready to help when needed whilst encouraging me to be as independent as possible. (Comment Card, service user.) The staff have been very good to me. Nothing is too much trouble for them. (Comment Card, service user.) The staff I saw were always cheerful and welcoming. My relative was always pleased to see them. (Comment Card, relative.) The staff are very caring, understanding, kind and considerate. (Comment Card, relative.) Auckland Residential Care has a stable staff group, with some staff having worked in the home for a number of years. However, one new member of staff has recently been recruited and was in the home at the time of inspection undergoing supervised initial induction training. This staff file was examined and some of the required information was not available. This was discussed with Mrs Hart and the senior care assistant, who were able to provide certain details missing from the file. However, although a Criminal Records Bureau (CRB) disclosure and POVAfirst check had been requested, neither had been received. The registered persons need to be proactive in monitoring the progress of any CRB application. The senior care assistant followed this up during the inspection and the delay was blamed on the postal strike. Mrs Hart confirms that the new member of staff will be commencing a thirteenweek induction programme, four weeks of which link in to the Social Services induction programme. A staff training programme is in place, which aims to ensure that all staff receive appropriate training so they can fulfil the objectives of the home and meet the needs of service users. Training in 2007 includes first aid, basic food hygiene, Protection Of Vulnerable Adults, health and safety and nutrition. A moving and handling update is currently being planned. Copies of training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. DS0000003916.V342608.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Auckland Residential Care. The management arrangements at Auckland Residential Care must be improved, to ensure that the service users live in a home that is well managed on a daily basis. EVIDENCE: Mr J. Hart and his son, Mr D. Hart have experience of managing care homes over many years. Mr D. Harts wife has a full-time occupation but is also involved in the running of the home in her free time. She has successfully obtained her National Vocational Qualification (NVQ) level 4 in care and also in management. DS0000003916.V342608.R01.S.doc Version 5.2 Page 25 Mrs Hart confirms that Mr J. Hart now has very little involvement in the running of the home. Mr D. Hart is on the premises from 8.00pm until 8.00am but is generally not present during the day. Most of the day-to-day management is left to the senior care assistant, supported by Mrs Hart when she is not working elsewhere. It is important to ensure that the registered persons provide regular management support to staff and service users each day. It is not sufficient for Mr D Hart to only be contactable by telephone during the day if needed. Neither of the registered persons has a National Vocational Qualification level 4, nor equivalent, in management and care. However, since the last inspection, Mr D. Hart has undertaken training in health and safety, Protection Of Vulnerable Adults, basic food hygiene and first aid. At previous inspections, Mrs Hart has said it was her intention to retire from her present job and seek registration so that she could assume full-time management of the care home. The retirement date has been delayed several times and may not now take place for another two years. The senior care assistant is very experienced and recently completed a National Vocational Qualification (NVQ) level 4 in care. Mrs Hart confirmed that an application is now being made to the Commission for Social Care Inspection to register the senior care assistant as the manager of Auckland Residential Care. The senior care assistant is also intending to complete an NVQ level 4 in management. The care staff say they regularly spend time talking with service users to obtain their views and this was confirmed in discussions with service users during the inspection. A survey form is provided for each service user when they are ready to leave Auckland Residential Care, but many of these are never completed. A visitors book is available for comments from service users and relatives. This is more widely used by service users to record their views and recent comments include: From service users; I cannot think of anything that was not perfect. It was a real pleasure being here. Very kind and considerate staff, they should cook for the Hilton Hotel. From relatives; You all do a very important job and it is much appreciated. The encouragement received can only be described as wonderful and far above the call of duty. The whole atmosphere of the home is warm, comforting and welcoming, yet highly professional. Mrs Hart says that, in order to protect service users, it is the policy of the home not to have any involvement in their personal finances. Therefore, all service users who are unable or do not wish to handle their own affairs, have a relative or other representative to deal with their finances etc. At the present time the registered persons do not have any valuables for safekeeping and
DS0000003916.V342608.R01.S.doc Version 5.2 Page 26 service users are encouraged not to bring such items into the home. However, a lockable facility is provided in each bedroom for the storage of private papers, medicines, personal items etc. Information about advocacy services is available to service users within the home and policies are in place precluding staff acceptance of gifts or involvement in residents wills. From touring the premises, looking at records and discussions with staff and service users, it is evident that measures are in place to promote the health and safety of all persons in the home. Aids and equipment, such as a stair lift, grab rails, raised toilet seats and toilet frames are available to assist service users as necessary. Equipment is regularly serviced and maintained. All substances that could be potentially hazardous to health are handled and stored safely. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of service users and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and staff confirmed this. A fire risk assessment is in place. DS0000003916.V342608.R01.S.doc Version 5.2 Page 27 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 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 1 X 3 X 3 X X 3 DS0000003916.V342608.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1) Requirement Timescale for action 01/12/07 2. OP7 15(1) 3. OP8 17(1)(a) 12(1)(a) 4. OP27 17(2) Schedule 4 The registered persons must ensure that service users are admitted only on the basis of a full assessment. Pre-admission assessments undertaken by the home must be fully documented and contain the information detailed in this Standard. It is a requirement that a service 01/12/07 user care plan is prepared as soon as possible after admission, setting out in detail how all aspects of health and welfare are to be met. Health care needs must be fully 01/12/07 documented in each residents care plan. These should include detailed risk assessments, especially where risks have been previously identified in information supplied by the Local Authority or hospital prior to admission. The staffing roster must clearly 01/12/07 identify all staff working in the care home. This includes identifying who is wakeful and who is sleeping and on call at night.
DS0000003916.V342608.R01.S.doc Version 5.2 Page 29 5. OP29 19(1) and Schedule 2 6. OP31 8(1) 7. OP31 9(2)(b)(i) and 10(3) The registered persons must operate a thorough recruitment procedure ensuring the protection of service users. All staff must be properly checked before being employed. (Previous timescale of 31/10/06 not fully met). If the registered persons are not intending to be in full time dayto-day charge of the home, they must appoint a registered manager to manage the care home on their behalf. An application to register a suitable person as manager must be received. If no registered manager is appointed, it is required that one of the registered persons demonstrates that he has the qualifications and skills necessary for managing the care home, (for example, a qualification at NVQ level 4 or equivalent in management and care) and is in full time day-today charge of the home. Evidence of enrolment for such training must be forwarded to the Commission. (Previous timescale of 31/12/06 not fully met). 01/12/07 01/12/07 31/12/07 DS0000003916.V342608.R01.S.doc Version 5.2 Page 30 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 It is recommended that, wherever possible, information about Auckland Residential Care be provided to prospective service users prior to their admission to the home as part of the “Re-enablement” programme. DS0000003916.V342608.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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