CARE HOMES FOR OLDER PEOPLE
Auckland Residential Care 2 Ken Road Southbourne Bournemouth Dorset BH6 3ET Lead Inspector
Marjorie Richards Key Unannounced Inspection 25th July 2006 10:10 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.V305541.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.V305541.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.V305541.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. 7th November 2005 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 is registered to accommodate up to ten older people, but two persons between the ages of 55 to 65 may also be accommodated for short-term care, as part of this number. 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 currently used as singles, unless two people request to share. All eight bedrooms are currently contracted to Bournemouth Borough Council Social Services in a scheme to provide service users with support during a time limited period of assessment and possible rehabilitation, before their longer term care needs are decided. Current fees are £525 per week. Auckland provides 24-hour personal care, all meals, laundry and domestic services. Some service users are encouraged to do as much for themselves as possible as part of the rehabilitation process. The home offers stimulation in the form of activities and assists service users, if they wish to make arrangements in accordance with their religious beliefs. DS0000003916.V305541.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7.5 hours on the 25th July 2006. The purpose of this year’s first key unannounced inspection was to review all of the key National Minimum Standards, review progress in meeting the requirement and recommendations that had been made at the previous inspection and to ensure that the service users living at Auckland Residential Care were safe and properly cared for. A tour of the premises took place and records and related documentation were examined, including the care records for five service users. Time was spent observing the interaction between service users and staff, as well as talking with six service users, the majority in the privacy of their own bedrooms. The daily routine was also observed during the inspection. Discussion also took place with Mr D. Hart, the registered person, Mrs Hart and the members of staff on duty. The Inspector was made to feel welcome in the home throughout the visit. What the service does well:
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. Individual care records are kept for each resident and 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 arrangements for storing and handling medicines in the home ensure service users safety. Some service users are able to look after their own medicines whilst others need the support and guidance of staff. Service users are treated respectfully and care is offered in a way that protects their right to privacy and dignity. Staff were observed throughout the inspection to be treating service users with courtesy, kindness and respect. Service users commented, I like it here. In many ways it is like being in my own home but with more friends about me. They are always polite, I am treated very well. DS0000003916.V305541.R01.S.doc Version 5.2 Page 6 Some recreational and social activities are made available so that service users are able to experience a varied life within the home. 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. This might include taking a service user to their own home, shopping or to the pub as part of an assessment. Every effort is made to maintain contact with family and friends and the wider community. Service users and staff say that visitors are able to visit at any time and are always made to feel welcome. Service users confirmed that their individual preferences and routines are respected. “It is home from home. Staff are thoughtful, they are there if needed.” A member of staff commented, We fit in with their lifestyle, especially if the service user is returning to their own home. Three full meals a day are offered at Auckland and prepared by the care staff. Service users commented, The food is good. We have plenty of choice. I enjoy my meals. We all sit together and have a chat, it’s really nice. We have good home made food, which is very tasty. A bowl of fresh fruit is available in the dining room and service users are encouraged to help themselves whenever they wish. A system is in place for dealing with any complaints. Service users are confident their complaints would be listened to and dealt with appropriately. Service users commented, I have no complaints at all. I am very satisfied with everything about this place.” If something was wrong, I would tell the staff and feel sure they would put everything right.” The home has an Adult Protection policy and procedure in place and staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. 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. The home provides communal areas, including a garden, that are attractive and accessible to service users. The home is clean and there are no unpleasant smells, making life within the home more pleasurable for all. Service users commented, The laundry service is very good, everything comes back very promptly. The home is kept spic and span. The staff always clean my room very thoroughly. Auckland has a dedicated team of care staff who work positively with service users to ensure their needs can be met. Of the seven care staff employed at Aucklands, four have National Vocational Qualifications level 2 in care, helping to ensure that service users are in safe hands. Service users spoke highly of the staff at Auckland Residential Care. A number of very positive comments were received including, This place is excellent, it couldnt be better. I have had so much help since I got here. The staff are
DS0000003916.V305541.R01.S.doc Version 5.2 Page 7 very kind, courteous and helpful. You only have to ask and they do their best to help. The home regularly reviews its performance and actively seeks the views of service users and relatives to ensure the home is run in the best interests of service users. Service users are assured of sound management of their financial interests. Measures are in place to promote the health and safety of all persons in the home. Suitable aids are available and equipment is regularly serviced and maintained. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of service users and staff. What has improved since the last inspection? What they could do better:
DS0000003916.V305541.R01.S.doc Version 5.2 Page 8 Auckland Residential Care has a care planning system in place. However, this does not always ensure that staff have access to all the information they need to meet the health and personal care needs of service users. Care must be taken to ensure that important information is always fully recorded to evidence that the care needs of service users are being met. Three of the home’s care plans examined demonstrated that improvements are needed with nutritional screening. Where service users are identified with potentially serious problems in relation to nutrition and fluid intake, care must be taken to ensure a detailed care plan is in place. 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. When employing staff, two written references must be obtained by the home as part of the recruitment process, to ensure the protection of service users. Although both of the registered persons have considerable experience of caring for elderly people, there is currently a lack of clear leadership in the day-to-day management of the home, which may not be in the best interests of service users. Mr Hart says he intends to put the most senior member of staff forward for registration as manager as soon as her current NVQ training is successfully completed. The recommendation that the registered person has a NVQ level 4, or equivalent, in management and care by 2005 has not been achieved and there is little evidence of periodic training to update knowledge, skills and competence. Until such time as alternative management arrangements can be made, it is important that Mr D Hart can demonstrate that such periodic training is taking place to ensure he has the necessary skills to manage the care home. 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. DS0000003916.V305541.R01.S.doc Version 5.2 Page 9 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.V305541.R01.S.doc Version 5.2 Page 10 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): 1 and 3 (Standard 6 is not currently applicable. See below) Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. Information provided about Auckland Residential Care and a thorough admissions procedure allows prospective service users to make informed decisions about admission to the home. The outcome of pre-admission assessments is confirmed in writing, so prospective service users are fully assured that their care needs will be met. 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. Individual care records are kept for each resident and 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
DS0000003916.V305541.R01.S.doc Version 5.2 Page 11 provided care plans to the home. On occasion, the home also visits the prospective service user prior to admission. The outcome of such assessments is confirmed in writing, so prospective service users are fully assured that their care needs will be met. Mr and Mrs Hart are still involved in discussions with Bournemouth Borough Council Social Services Directorate as the home wishes to return to the provision of Intermediate Care, rather than an assessment/short-term care/rehabilitation service currently being provided. The provision of Intermediate Care 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. At present, all eight bedrooms are being used to provide service users with support during a time-limited period of assessment (usually six weeks) and possible rehabilitation, before their longer term care needs are decided. Service users may come from hospital or the community to consider their care needs and the choices available to them, whilst at the same time being encouraged by the staff at Auckland Residential Care to maximise their rehabilitation potential. Currently, Auckland Residential Care is not providing Intermediate Care, although it still hopes to do so in the near future. This Standard will therefore be reviewed at the next inspection. DS0000003916.V305541.R01.S.doc Version 5.2 Page 12 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 and 10 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Auckland Residential Care. Auckland Residential Care has a care planning system in place. However, this does not always ensure that staff have access to all the information they need to meet the health and personal care needs of service users. The arrangements for storing and handling medicines in the home ensure service users safety and, where appropriate, service users are responsible for their own medication. Service users are treated respectfully and care is offered in a way that protects their right to privacy and dignity. DS0000003916.V305541.R01.S.doc Version 5.2 Page 13 EVIDENCE: All five of the care plans examined, including those of two past (deceased) service users, were based upon information provided on admission by care managers from Bournemouth Borough Council. The home then draws up its own care plan identifying the needs of each service user and how staff are to meet these needs. The home aims to maximise the potential of each service user, whether to return home, or move to long or short-term care or sheltered accommodation. Relatives are encouraged to be involved in the provision of care if they wish. Records demonstrate that care plans are reviewed and updated where necessary. A review of care takes place with care managers two weeks after admission. The review forms are currently being updated to include the signature of the service user or their representative. Records also demonstrate that service users have access to health care services. There was evidence of visiting health professionals e.g., GPs, district nurses, chiropodists, etc as necessary. This was later confirmed in discussion with service users and staff. Good information on daily care is maintained in individual service user’s records. However, daily notes for one service user showed that the District Nurse was contacted when an area of red skin was noted. Discussions with staff confirmed the involvement of the District Nursing service following eventual skin breakdown, but the notes/care plan did not evidence when the District Nurse visited and the subsequent actions taken as a result. Care must be taken to ensure that such important information is always fully recorded to evidence that the care needs of service users are being met. Three of the home’s care plans examined demonstrated that improvements are needed with nutritional screening. For instance, there was little information available in relation to one service user with a dietary assessment on admission stating “difficulty in swallowing.” Discussion with the service user and staff showed that food was being pureed whenever necessary, but the need for this was not recorded in a nutritional care plan. Where service users are identified with potentially serious problems in relation to nutrition and fluid intake, care must be taken to ensure a detailed care plan is in place. 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. It is also important to evidence that medical advice has been sought at an early stage if a service user continues to refuse food, or is eating or drinking very little. Discussion with Mrs Hart and the senior care assistant showed that these issues had already been identified and a Nutrition and Diet Training Pack
DS0000003916.V305541.R01.S.doc Version 5.2 Page 14 purchased. It is intended that all staff will undertake such training and documentation for recording food and fluid intake will be improved. The home has also purchased new, more detailed, care planning documentation and is arranging for staff to be trained in its use. This will help to ensure that important information is fully recorded and evidence that the care needs of service users are being met. During the present very hot weather, the home has a heatwave plan in operation. Service users are offered plenty of fluids to drink and jugs of water or juice were seen to be available in bedrooms and communal areas. Sunhats have been purchased for those wishing to go outside and service users advised not to sit out in the hottest part of the day. The medication system at Auckland Residential Care has recently been changed. Each service user now 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. Staff were observed to be interacting with service users in a friendly 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, I like it here. In many ways it is like being in my own home but with more friends about me. They are always polite, I am treated very well. All 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 or personal care needs. Service users commented, I can do whatever I want. If I want I can go out or sit in the garden or go to my room for a rest. I can choose what I want to do and when I do it. I go to my room to see my visitors in private. DS0000003916.V305541.R01.S.doc Version 5.2 Page 15 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, 13, 14 and 15 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. Some recreational and social activities are made available so that service users are able to experience a varied life within the home. Open visiting arrangements are in place, so service users are able to maintain contact with family and friends and retain links with the local community. Service users are encouraged to choose their own lifestyle within the home and their individual preferences and routines are respected. The home provides a balanced and varied selection of food that meets the tastes, choices and special dietary needs of service users. Meals are served at times and locations that are convenient to them. DS0000003916.V305541.R01.S.doc Version 5.2 Page 16 EVIDENCE: Service users have access to a range of board games, cards, dominoes, indoor ball games, television and a selection of music and videos. The mobile library visits each month with books and videos. Staff also arrange occasional quizzes, reminiscence sessions and barbeques. 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. This might include taking a service user to their own home, shopping or to the pub as part of an assessment. 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 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. Independence is encouraged. A member of staff said, We are here to make sure they get the very best from their stay at Aucklands. We want to help them to be as independent as they can be. This includes choosing 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 confirmed that their individual preferences and routines are respected. “It is home from home. Staff are thoughtful, they are there if needed.” A member of staff commented, We fit in with their lifestyle, especially if the service user is returning to their own home. Three full meals a day are offered at Auckland and prepared by the care staff. The daily menu is displayed on the dining room table and shows that alternatives, such as omelettes, jacket potatoes with a variety of toppings, pasta and salads are available to suit individual taste and preference. The three-course lunch on the day of inspection was as follows: - a choice of leek soup or pineapple juice, then beef casserole, with cauliflower, green beans and potatoes. Fruit cheesecake, ice cream or fresh fruit followed this. Service DS0000003916.V305541.R01.S.doc Version 5.2 Page 17 users commented, The food is good. We have plenty of choice. I enjoy my meals. We all sit together and have a chat, it’s really nice. We have good home made food, which is very tasty. 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. 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.V305541.R01.S.doc Version 5.2 Page 18 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): 16 and 18 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. A system is in place for dealing with any complaints. Service users are confident their complaints would be listened to and dealt with appropriately. The home has an Adult Protection policy and procedure in place and staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints policy that is included in the Service User Guide available in every bedroom. No complaints have been received by the home since the last inspection in November 2005. Service users spoken with say they have no concerns, I have no complaints at all. I am very satisfied with everything about this place.” If something was wrong, I would tell the staff and feel sure they would put everything right.” The lady who runs this place is always easy to talk to and very helpful. I feel sure she would want any concerns reported to her so she could put matters right straight away. 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.V305541.R01.S.doc Version 5.2 Page 19 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, 20 and 26 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to Auckland Residential Care. Service users live in a comfortable environment that is safe and well maintained. The home provides communal areas, including a garden, that are attractive and accessible to service users. The home is kept clean and smells fresh, making daily life for service users more pleasant. 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. Radiator guards have been fitted to ensure service users safety, with the exception of the radiator just inside the lounge door. It
DS0000003916.V305541.R01.S.doc Version 5.2 Page 20 is not possible to fit a guard without impeding this doorway so for the present the radiator has been turned off to minimise any risk. (There is a second radiator in the room.) Plans are being made to fit an alternative radiator with a low temperature surface. Equipment is regularly maintained, including gas and Portable Appliance Testing. At the last inspection 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. Mr Hart says he also intends to redecorate the lounge and rebuild the front garden wall during the autumn. The communal space at Auckland Residential Care consists of a lounge and separate dining room, both situated on the ground floor. The lounge overlooks the rear of the property and is a comfortable room with a television and a variety of seating. 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. Patio style tables and chairs are provided and the garden is well maintained with a colourful display of flowers, hanging baskets and tubs, particularly at the entrance area. Service users commented, I have met the gardener, a very nice man. He cares for the Dahlias like his own children. The gardens are lovely, it is a real treat to sit outside. The small internal laundry room accommodates a domestic washing machine. There is no wash hand basin where staff can wash their hands after handling soiled clothing etc. A risk assessment is in place and the infection control policy has been amended to take account of this. Tumble dryers are situated in a building adjacent to the main home. Staff training in infection control is currently being arranged to ensure safe practice. Anti-bacterial hand gel is available around the home as a means of minimising any risk of possible cross-infection. The home is clean and there are no unpleasant smells, making life within the home more pleasurable for all. Service users commented, The laundry service is very good, everything comes back very promptly. The home is kept spic and span. The staff always clean my room very thoroughly. DS0000003916.V305541.R01.S.doc Version 5.2 Page 21 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 and 30 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Auckland Residential Care. Auckland has a dedicated team of care staff who work positively with service users to ensure their needs can be met. The home has exceeded the target of 50 staff trained at NVQ level 2, therefore helping to ensure that service users are in safe hands at all times. Practices in relation to recruitment of staff still need some improvement, to ensure the protection of service users. A training audit has been completed and a training programme is now in progress. When this has been completed, staff will be equipped with the knowledge and skills necessary to meet the needs of service users. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated a sufficient number and skill mix of staff to meet the needs of service users. Staff duties include care, cooking, laundry and cleaning and separate domestic and catering staff are not employed. The staffing rota shows there is a minimum of two care assistants on duty throughout the day. Mr and/or Mrs D Hart are on duty from 8.00pm and sleep
DS0000003916.V305541.R01.S.doc Version 5.2 Page 22 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 does not currently identify which person is providing the wakeful duty but Mrs Hart agreed to rectify this. The staffing levels and arrangements at the home are such that, at present, all the necessary tasks are carried out satisfactorily. Staffing levels may need to be raised if care levels increase or if and when dedicated Intermediate Care is introduced. Of the seven care staff employed at Aucklands, four have National Vocational Qualifications level 2 in care, so the target of 50 NVQ level 2 trained staff by 2005 has been exceeded, helping to ensure that service users are in safe hands. One care assistant is currently undertaking NVQ level 3 and the two senior staff are undertaking NVQ level 4 training. A full range of policies and procedures is in place to offer advice and guidance to staff. Service users spoke highly of the staff at Auckland Residential Care. A number of very positive comments were received including, This place is excellent, it couldnt be better. I have had so much help since I got here. The staff are very kind, courteous and helpful. You only have to ask and they do their best to help. I did not really want to come here, but now I am glad I did. The staff have helped me a great deal. The home has a recruitment procedure in place, based on equal opportunities and ensuring the protection of service users. Staff files examined showed the necessary documentation, e.g., Criminal Records Bureau disclosures, two references etc, to be in place. Documentation is also available for Mr and Mrs Harts son who is currently employed as a care assistant in the home, including a Criminal Records Bureau check. Two written references must be obtained, but only one reference was available and this was addressed To whom it may concern and had not been requested directly by the home. Mrs Hart confirmed that this was an oversight, which would be rectified straight away. Auckland Residential Care has completed an audit of all staff training. New staff are recruited into a thirteen-week induction programme, four weeks of which link in to the Social Services induction programme. Care must be taken to ensure that all parts of the induction training record are signed appropriately. A staff training programme is now being developed, 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. Planned training includes first aid, food hygiene, diet and nutrition, infection control and a moving and handling update. DS0000003916.V305541.R01.S.doc Version 5.2 Page 23 Copies of all training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. All staff are given a copy of the General Social Care Council Code of Practice. DS0000003916.V305541.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Auckland Residential Care. Although both of the registered persons have considerable experience of caring for elderly people, there is currently a lack of clear leadership in the day-to-day management of the home. It is intended to appoint a manager, which will ensure the best interests of service users. The home regularly reviews its performance and actively seeks the views of service users and relatives to ensure the home for the benefit of service users. Service users are assured of sound management of their financial interests. Systems are in place to promote the health, safety and welfare of service users and staff within the home. DS0000003916.V305541.R01.S.doc Version 5.2 Page 25 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. Discussions with service users demonstrate that they believe either Mrs Hart or the senior care assistant to be in charge of the home. Service users were unaware that Mr Hart or his father were the registered persons. Mr D. Hart is on the premises from 8.00pm until 8.00am but is generally not present during the day. Mr D Hart says his duties include business, financial and strategic planning. Much 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 regular management support is always available to staff and service users each day. Mr and Mrs D Hart say they are always contactable by telephone if needed. The recommendation that the registered person has a NVQ level 4, or equivalent, in management and care by 2005 has not been achieved and there is little evidence of periodic training to update knowledge, skills and competence. Until such time as alternative management arrangements can be made, it is important that Mr D Hart can demonstrate that such periodic training is taking place to ensure he has the necessary skills to manage the care home. At the last inspection, Mrs Hart said it was her intention to retire from her present job by April 2006, at which time she would be seeking registration so that she could assume full-time management of the care home. The retirement date has been delayed and may not now take place until later in 2006, or 2007. The two senior care assistants are experienced and capable and are currently studying for NVQ level 4 in care. Mr Hart says he intends to put the most senior member of staff forward for registration as manager as soon as her current NVQ training is successfully completed. She will also enrol to study for NVQ level 4 in management. Mrs Hart and the senior care assistants 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 quality assurance programme has been developed and questionnaires are sent to relatives and other visitors to the home. A survey form is provided for each service user when they are ready to leave Auckland Residential Care. A visitors book is available for comments from service users and relatives. Recent comments include: DS0000003916.V305541.R01.S.doc Version 5.2 Page 26 From service users; Thanks for looking after me and getting me back to health. The care and service was excellent. Very sorry to leave and wished I could stay longer. Everything was more or less perfect. This was the happiest time of my life, I was looked after so well. From relatives; Home from home. Everyone is so kind and thoughtful. Angels of Aucklands. 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 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, such as gas and electrical appliances are 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. Because of the frequent changeover of service users, staff fire training and fire drills take place at monthly intervals to ensure staff are fully aware of what to do in the event of fire. DS0000003916.V305541.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 DS0000003916.V305541.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 OP7 Regulation 15(1) Requirement It is a requirement that the service user care plan sets out in detail how all aspects of health and welfare are to be met. Timescale for action 31/10/06 2 OP8 17(1)(a) and Schedule 3 (m) 19(1) and Schedule 2 It is a requirement that, where 31/10/06 necessary, a nutritional care plan be implemented and maintained with sufficient detail to ensure that care needs can be met. The registered persons must operate a thorough recruitment procedure ensuring the protection of service users. All staff must be properly checked before being employed. 31/10/06 3 OP29 4 OP30 18 The registered persons must ensure that the planned training programme is fully implemented to ensure staff have the skills they need to meet the needs of service users. This should include training related to meeting nutritional needs. 31/10/06 DS0000003916.V305541.R01.S.doc Version 5.2 Page 29 5 OP31 9(2)(b)(i) and 10(3) It is required that one of the 31/12/06 registered persons demonstrates he has the qualifications and skills necessary for managing the care home. This includes the previous recommendation to have a qualification at NVQ level 4, or equivalent, in management and care. (Previous timescale of 31/08/05 and 31/03/06 not met). 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 OP8 Good Practice Recommendations 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. Care must be taken to ensure that important information is always fully recorded in care plans, to evidence that the care needs of service users are being met. 2 OP8 DS0000003916.V305541.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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