Inspection on 07/08/07 for Audlem Country Nursing Home

This inspection was carried out on 7th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Audlem Country Home The Old Grammar School Audlem Crewe Cheshire CW3 0BA Lead Inspector Anthony Cliffe Unannounced Inspection 7th August 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Audlem Country Home DS0000069985.V348248.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. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Audlem Country Home Address The Old Grammar School Audlem Crewe Cheshire CW3 0BA 01270 811514 01270 812610 keenrickltd@btconnect.com 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) Keenrick Limited vacant post Care Home 41 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (41), Mental disorder, excluding learning of places disability or dementia (15), Mental Disorder, excluding learning disability or dementia - over 65 years of age (5) Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The registered person may provide the following category of service only: Care home only – code N To people of the either gender whose primary care needs on admission to the home are within the following categories: Dementia (code DE) Mental Disorder, excluding learning disability or dementia (code MD) (maximum number of places 15) The maximum number of people who can be accommodated is 41. Date of last inspection Brief Description of the Service: Audlem Care Home provides nursing care for 41 service users aged over 65 years of age diagnosed with dementia, or up to fifteen adults aged under 65 years of age diagnosed with mental disorder or dementia and five places for older people aged over 65 years of age diagnosed with mental disorder. The home does not offer rehabilitation services or specialist therapeutic techniques. The home provides accommodation on two floors though there is no passenger lift to the bedrooms on the first floor. There are 37 single bedrooms and two shared bedrooms of which two have en-suite facilities. There is one assisted bath and one assisted shower on the ground floor and a shower on the first floor. The home has a smoking area and three dining room/lounges. Additional food preparation facilities have been provided in one dining room/ lounge to afford residents the opportunity of preparing their own meals. There is a separate manager’s office/meeting room. The home has its own transport. The home is situated in the rural village of Audlem. Fees range from £417.00 to £ 562.00 per week. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 7th and 8th August 2007 and lasted fourteen hours. A regulatory inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. CSCI questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents, staff and visiting social care and health professionals were also spoken with and they gave their views about the service. What the service does well: What has improved since the last inspection? The opportunities for staff to undertake NVQ level 2 training had improved with twelve staff completing an NVQ level 2 qualification. The owner confirmed that Audlem would be providing a smoke free environment within the near future. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed prior to moving in so staff can provide appropriate care to them. EVIDENCE: The statement of purpose had been amended after the registration of Keenrick Limited had been completed. This did not have the conditions of registration as specified on the certificate. It referred to the activities coordinator being full time, which was inaccurate as there was no full time activities coordinator employed. A statement on acknowledging the equality and diversity of anyone wishing to move into Audlem care home had been added. This informed prospective residents that Audlem welcomed anyone with a disability, different ethnic or cultural needs, political affiliation or sexual orientation. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 9 Records were examined of two residents who recently moved into Audlem. The manager had and met with them and gathered information about their needs. Personal support plans and risk assessments were in place for both residents. Additional information had been obtained from the local council social services department and Partnership Care Trust (PCT), which placed the residents at Audlem. The two residents had pre admission assessments and copies of the local council and PCT assessment of need. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed records of care, liaison with health and social care professionals and good medicine management ensures residents’ health and welfare needs are met. EVIDENCE: The care records of four residents were examined. They all contained information with regard to continence, safe moving and handling, nutrition, and skin integrity. Personal support plans had been devised for the needs of the residents that identified the problem, the help and support needed and the desired outcome. Each support plan had information from the social worker or from the NHS hospital from where the resident moved. From looking at support plans, watching staff working practices and talking with residents, staff and two visiting social workers and district nurse the health of residents was cared for. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 11 There were good examples of records in place that monitored residents’ health. Support plans guided staff on how to support and provide care for residents. Records recorded residents` physical and mental health needs. There were good examples of personal plans reflecting positive outcomes for residents. A support plan to reduce the number of falls for a resident had recorded he had only one minor fall in three months. His support plan regarding personal care guided staff to provide prompting and assistance around reminding the resident to attend to his personal care. His support plans for personal care recorded staff were to prompt and guide where necessary and provide practical assistance with changing clothes, washing, dressing, oral hygiene and hair care as to remind him these needed doing. The support plans were referenced to best practice in dementia care to advise staff on the importance of recognising individuality, choice and promotion of independence. A resident’s diabetes was monitored weekly and guidance written into the support plan on management of hypoglycaemia. The support plan to monitor diabetes and nutrition for this resident described a weight increase of 2.4kg from June to July 2007. The support plan for continence management identified no problems initially but staff and the resident’s daughter were to review this each month. In June 2007 the resident was referred to the continence advisor when problems were identified. Another resident had support plans to monitor the effect of anti psychotic medication and her physical health. Other support plans were written to monitor physical/verbal aggression and supported by risk assessments. She had a care programme approach care plan in place from the local NHS trust. A general practitioner (GP) had visited the resident to register her as a patient. A GP from the local surgery visited each week and held a surgery to review residents that could not attend the practice. The district nurse visited to re dress a resident’s leg ulcer. She said it was healing well and staff were encouraging him to walk around which helped with healing. She said staff asked for advice on wound management and were managing the wound very well. Medicines management and administration were examined. No errors were seen on medicine administration records. A monitored dosage system was used in the care home. The management and administration of controlled drugs were checked and balances found to be correct. Arrangements were in place for the safe disposal of medicines. The manager had commenced checks on medicine management as part of the quality assurance system. During the checks the manager had found minor errors with recording administration of medicines. The checks highlighted problems but did not record who was accountable and responsible for addressing them. A registered nurse said she had raised the issue with the manager of reducing the medicine round so it Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 12 was smaller. Most items were prescribed daily but given in the morning. She felt this could reduce the mount of time spent dispensing medicines and make the approach to medicine administration more individual so suit residents’ choices. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents need more support in making choices in their lifestyle and the coordination and recording of activities could improve so residents have regular activities based on their choice and preferences. EVIDENCE: Limited activities were seen at the time of the site visit. One resident continually watched a music video but said this was her choice. Residents in the quiet/smoking area watched television or listened to music. In the main lounge in the extension the television or music was on. A staff member played draughts with a female resident. No group activities were seen. The senior carer on duty said, “one of the senior carers is responsible for activities, he really keeps staff motivated when he’s here. When he’s not they are not as motivated and don’t always take place”. An activities programme was displayed for activities to take place from Monday to Saturday between the hours of 2pm to 4 pm. Activities included singing to music, exercise, reading newspapers, board games, quiz and ladies day with beauty therapy. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 14 The manager said the staff member responsible for activities also worked as a senior care assistant and had caring responsibilities. His role of activities coordinator is not full time as described in the statement of purpose and there were no designated hours for this. Residents’ support plans contained activity profiles and information on their life but no detailed life histories. An activity of daily living assessment completed for a resident that had moved in and included a social and family history. This recorded she enjoyed singing in the choir, going to church, tai chi and working in a charity shop. The resident clarified this information but said, “all I’ve done since I got here is watch this music video and it worries me that is all I am doing. No one has asked me if I want to do anything”. Another resident’s review by her social worker said the resident didn’t have access to a culturally sensitive diet. She was unable to practice her faith as there were no local facilities and she would like more opportunities. The manager was liaising with a social worker of her faith on these matters. She was participating in daily activities but no personal history was recorded. This resulted in her being offered Holy Communion, which she refused. Catering and care staff confirmed she received a culturally sensitive diet. Residents said they were happy with their care. A resident said, “this place got me out of a tight spot and I’m so grateful for the help and care I’ve had. I was in trouble at the other home and not in a good state. I’m walking and eating better, I’ve improved so much since I’ve been here. I’m getting about much better and putting on weight. They treat me really well and look after me. I really like the place. It’s in a lovely quiet spot. I like my bedroom, and can ask for what I want. There’s always someone to help if I get lost or need anything. The staff are very nice and always asking me if I need help with anything. I have settled in very well and they made sure I knew where everything was”. A relative said, “I visit mum weekly at the same time before lunch so I can help her. Mum is usually sat in the lounge, sometimes sleeping. Other residents are usually sleeping. There doesn’t seem much to be going on. I know they have entertainers and music on in here but the music isn’t always on and mum enjoys that. The activities organiser lets me know when the entertainer is here but I can’t always make it, then again they’re not always advertised. Sometimes there are details on the notice board. There’s something on next week he said but no notice of this. When he’s not here activities don’t always happen.” A four-week menu was in place. At lunchtime there was no main meal choice other than a note on the main menu to say where they were required to ask the cook. There was a variety of choice for the evening meal including soup, sandwiches, a hot meal and hot savouries. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 15 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 this service. Complaints or concerns are consistently acted upon to safeguard residents from abuse but the complaints system needs to be revised so they are acknowledged so residents and relatives are confident they are listened to and acted upon. EVIDENCE: One complaint had been recorded since the last inspection visit. This was from a resident and had been acknowledged by the owner. The resident had acknowledged the owner’s response but was not satisfied with the overall reply. The previous manager had then been asked to look into it but these records were unavailable. A relative said she had raised concerns about the laundry and these had been responded to. She said, “my only concern has been around the laundry. I find her in other people’s clothes or clothes in her wardrobe we don’t remember buying but have her name on. I worried they had been donated. My brother raised it and we have seen an improvement”. Flow charts were in place to guide staff on how to recognize and report adult abuse. This referred to the completion of a trigger form. Staff spoken to said they understood the procedure. They said they would report any concerns to the manager or nurse in charge. The manager said he or one the owners was usually contactable but there were no formal on call arrangements. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 16 The information provided before the inspection visit recorded 26 referrals to the local authority had been made under protection of vulnerable adults. The manager confirmed that not all of these had resulted in the local council following them up under this procedure as most contacts were for advice. He said he was going to keep a record of all contacts made, advice given by the local council or decisions not to follow up on referrals so he could have a clear audit trail. A relative confirmed that he had been kept up to date with incidents regarding his wife and that she was safe and well. Training on protection of vulnerable adults had taken place in November 2006. A recently recruited staff member needed to complete this and clarified that training had been arranged. The training coordinator had been on sick leave and another senior carer had arranged training. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe environment but the lighting, carpets and equipment to aid residents’ independence need to be provided so they remain safe and as independent of need. EVIDENCE: A programme of maintenance was in place. The handyman had two and a half days a week on site for routine maintenance and repairs. The décor is good. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 18 Smoking arrangements were confirmed as not having changed. This was discussed with the owner and the manager. The owner said a smoking shelter would be provided. The manager clarified he had no budgetry responsibilities or decisions. The owner confirmed that the home had been awarded a large grant from the government to improve the environment and facilities and would be discussing with the manager what improvements he wanted to make. Generally the dcor had been maintained and bedrooms were redecorated as they became vacant. The library area looked dark and lighting could be improved. The main dining room had been rececorated and recarpeted. Corridor carpets on the ground and first floor had not been replaced and remain stained with use. The extension lounge had been recarpeted less than two years ago and now this is was heavily marked with stains. The sink unit with microwave in the extension lounge was not being used by residents that could make themselves a drink. A senior care assistant said the kettle had been removed when the one in the main kitchen had broken and had never been returned and the facilities were not used. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 19 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 this service. The numbers and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures that residents are protected. The training programme needs to be improved to provide a skilled workforce that protects residents’ welfare. EVIDENCE: There were sufficient numbers of staff on duty to meet the needs of residents and residents were supervised at all times. The manager provided information that twenty care staff was employed. Six staff held NVQ level 2 qualifications in care and twelve were working toward an NVQ level 2 qualification. Two staff recruitment files were looked at. They contained appropriate identification documentation and completed POVA (Protection of Vulnerable Adults) checks and Criminal Record Bureau (CRB) disclosures. They had two written references. There were copies of a new induction programme being used and a recently appointed staff member had commenced this. Staff files contained a draft contract of employment, job description, training certificates and confirmation of identity. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 20 Details of staff training were provided during the inspection visit. The registered nurses had undertaken training in dementia care, wound care, moving and handling and protection of vulnerable adults. A senior care assistant was responsible for staff training at Audlem as the training coordinator was on long term sick leave. She held qualifications in assessing staff to NVQ level standards. She was responsible for moving and handling training but had not done the moving and handling facilitator’s course. She said the owner had asked her to take on the role of training staff at Audlem and his other care home in moving and handling. She had taken this on even though she had doubts about it because she had only done the same moving and handling training as other staff. She confirmed that she was using training packs and DVDs provided by a national training company. She said she wanted, “to be confident I have the right training so I’m confident what I’m doing is safe”. Records were kept for training undertaken using the training packs. Each staff member had a training file with the training packs they had to complete in them. Two files examined didn’t have records for completing adult abuse training but confirmed it had been arranged. Staff training files contained training packs for adult abuse, Control of Substances Hazardous to Health (CoSHH), dementia care, fire safety, first aid, food hygiene, health and safety, infection control and moving handling practice and theory. A record of training provided had been kept. This included registered nurses, care staff, ancillary and catering staff. Training had taken place on adult abuse, dementia care, first aid, CoSHH and moving and handling theory and practice. The senior care assistant responsible for training confirmed that she planned training in advance and posted details for staff to attend. She said she planned training as she found the time so did it in advance to ensure she could set time aside as she had no set hours or training plan. Staff said they were supported to do training. A registered nurse said, “I have had the training I need. I recently had training on wound care and the right dressings to use on the wound. I would like to do more training on wound care and can ask”. A new staff member said she felt supported through training and support from the staff team. She said, “I had my induction supervised by a senior carer. I have had training on CoSHH, fire and moving and handling practical. I have a training file and we have training materials. The senior responsible will do a plan for a training day and we have to attend. I know she has arranged training on the protection of vulnerable adults and I need to attend. I’ve had no previous mental health experience or training but am keen to do so. In my previous job in the NHS and care homes I saw a lot of different standards of practice. The care here is better than the NHS. You have the time to provide care to residents. It may take longer to do and we don’t always have time in the mornings to sit and talk but the care is good. I wouldn’t say so if it wasn’t. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 21 I see hoists, transfer belts and aids used all the time. If I saw something I wasn’t happy with I would speak out and approach the manager or whistle blow”. The manager had not yet introduced a programme of supervision for registered nurses and care staff. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An enthusiastic manager has improved quality assurance and supervision of the staff team but an application to register as manager needs to be made so residents’ quality of life is enhanced and they are protected. EVIDENCE: An application for the manager to be registered with the Commission for Social Care Inspection had not been received. The timescale set at the last inspection visit for this requirement to be met had not expired. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 23 Since the last site visit the management of Audlem had changed with the registration of the company that owns Audlem care home. The previous manager had requested to step down and the deputy manager was appointed as the acting manager. He had commenced the registered manager’s award. He was aware of the timescale for the receipt of an application to register as manager but he hadn’t yet completed an application form to register. Improvements continued to be made and positive comments received from staff and visiting health and social care professionals. A nurse said, “in the past four years I have seen four managers all with their own style of management. This manager is a very approachable person who listens to you and asks for your advice and opinion on the care of residents’ physical health. He is still new to the job but he has a nice way about him and positive ideas. We now need to have more consistent things in place. We need regular staff meetings and qualified staff meetings at least monthly. At the moment we discuss things informally as we go along. The staff team are really good they work together and listen to advice and guidance. If you ask them to do things they do it. They also ask you for advice and guidance. A few years ago they would have challenged every decision you made and question everything you asked. They have moved on and are a really great team”. A visiting social worker said, “there is a very proactive approach to the care and management of residents. They always communicate with me about his health and social care needs. From the previous manager to this manager, the management has been consistent and supportive. They seek out advice and keep you up to date with any changes. They are very durable and will try different approaches with residents. For example if he needs a one to one to talk about his feelings I can do that and so can the staff here as they have the skills. We communicate about that and have tried several different things in managing his behaviour. He has settled in the last year and is more at ease with his care. They now have the district nurse dressing his legs and he is less worried about things. His family provide him with cigarettes sweets and drinks made up into packages of different days so he remembers he has this regularly. This has provided a more proactive approach to his care involving his family and professionals”. Another visiting social worker said, “we have seen a significant change. A lot of the change has been due to the support she has had from the staff at Audlem”. A quality assurance monitoring system was introduced in December 2007 when the manager completed an audit at the time. This included sending out satisfaction surveys to resident’s relatives. An action plan was completed in response to this and a review date set for March 2007. The current manager reviewed the quality assurance audit in June 2007. The quality assurance system was broken down into a number of monthly monitoring audits and these reviewed every quarter. The results of audits to June 2007 were looked Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 24 at. The health and safety audit identified that all staff had not completed health and safety training. The flooring in the dining room had been replaced but not in the hallways and stairs. In the welfare section of the audit the manager had recorded that the building required redecoration to improve the environment for residents and the results of a grant application was being waited for before this could be clarified. The health and safety audit for July 2007 highlighted the main issues as lighting in the library area, replacement of carpets and eleven residents using bed rails. The manager completed monthly care plans audits from a random sample of residents. This highlighted that one resident’s initial assessment upon moving in had not been reviewed and discussed with the registered nurse concerned. Not all care plans had yet been signed as agreed with residents or relatives. Checks on the management and administration of medicines were completed. A good standard of administration was found and the only matter to be followed up was when GPs altered medicine administration sheets. The action was the manager to address this to the GPs. Only one resident was being treated by the district nurse for a leg ulcer. From October 2006 to June 2007 200 accidents were recorded. A few residents had a high percentage of these and were slipping out of their seats. Slip mats were in use to reduce this. Monies held on behalf of residents were managed safely and securely. Information provided by the provider in a data set and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 8(1) Requirement An application for a suitably qualified and experienced manager must be submitted to the Commission for Social Care Inspection so residents’ quality of life is enhanced and they are protected. Timescale for action 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP12 Good Practice Recommendations The statement of purpose should be amended to include the correct information on categories of registration and employment of an activities coordinator. There should be a greater variety and choice of social activities and more opportunities for residents to engage in them. Facilities should be provided to enable residents to remain independent. Staff should be provided with the time, training and resources to provide a programme of activities based on residents’ choice. All expressions of dissatisfaction and complaints received should be recorded and accurate records maintained. DS0000069985.V348248.R01.S.doc Version 5.2 Page 27 3 OP16 Audlem Country Home 4. 5. 6. OP19 OP30 OP30 The carpets to the ground and first floor corridors, extension lounge and stairs should be replaced. Staff providing moving and handling training should be qualified to an appropriate standard. Regular meetings between the staff team and management should take place and a system of regular supervision of staff introduced to monitor all grades of staff performance. Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Audlem Country Home DS0000069985.V348248.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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