Inspection on 21/11/06 for Aughton Grange Care Home

This inspection was carried out on 21st November 2006.

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

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

Other inspections for this house

Aughton Grange Care Home 24/11/05

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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 Aughton Grange Care Home 26 Granville Park Aughton Ormskirk Lancashire L39 5DU Lead Inspector Vivienne Morris Unannounced Inspection 21st November 2006 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 Aughton Grange Care Home DS0000062646.V312303.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. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aughton Grange Care Home Address 26 Granville Park Aughton Ormskirk Lancashire L39 5DU 01695 423564 01695 423564 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) Aughton Grange (EMI) Care Home Limited George Gilmore Care Home 27 Category(ies) of Dementia (27), Mental disorder, excluding registration, with number learning disability or dementia (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (13) Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 27 service users to include: Up to 27 service users in the category of DE - (Dementia). Up to 13 service users in the category MD (E) - (Mental Disorder excluding learning disability or dementia) aged over the age of 65 years. One named female service user in the category MD - (Mental disorder, excluding learning disability or dementia) aged 61-65 years may be accommodated at the home within the overall total number of registered places. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 24th November 2005 2. 3. Date of last inspection Brief Description of the Service: Aughton Grange Nursing Home is situated in the picturesque village of Aughton and is close to all local amenities. The home provides 24 hour nursing and personal care for up to 27 elderly people who have mental health needs or a dementia related illness. Accommodation is provided mainly in single bedrooms; although two twin rooms are available for married couples, friends or people who prefer to share. Some single rooms have en-suite facilities. Toilets and bathrooms are located at intervals throughout the home. A separate spacious lounge and dining room are available. However, service users are able to dine within the privacy of their own accommodation, if they prefer. A large conservatory is constructed at the rear of the premises overlooking the pleasant garden and patio area. The service users’ guide, which contains relevant information about the service, including the most recent inspection report, is given to people who are thinking about living at the home, so that they are able to make an informed choice about where to live. The scale of charges as at 21st November 2006 ranged from £410.50 - £490.50 per week. Additional charges were being incurred for hairdressing, newspapers/magazines and private chiropody. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced site visit, which formed part of the key inspection process, was conducted over one day in November 2006. During the course of the site visit to the home, discussions took place with service users’ relatives and staff and where possible service users themselves. Relevant records and documentation were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from eleven people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the pre-inspection questionnaire has also been taken into consideration when writing this report. The total key inspection process focused on the outcomes for people living at the home. Comments from relatives of those living at the home included, “staff are most helpful and concerned and I am happy that my relative lives at this home. The service users whose care was ‘tracked’ during the course of the site visit were directly observed for a period of time during the morning and over lunchtime so that the level of staff interaction could be determined. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was referred back to the provider to investigate using the home’s complaints procedure. What the service does well: Sufficient information was given to people thinking about moving into the home to enable them to make an informed choice about where to live, so that people were aware of the services and facilities available at Aughton Grange and could then determine if it was a suitable place to meet their needs. Enough information had been gathered about people before they were admitted to the home to ensure that the staff team could adequately meet their needs. The plans of care were very well written documents, showing that the personal and health care needs of people living at the home, including the management of medications were fully met and that the privacy and dignity of service users was maintained. These records provided clear, detailed guidance for staff as to how the assessed needs of people could be adequately met. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 6 Visitors were made welcome to the home and were able to see their relatives in private or in the communal areas of the home. The sitting rooms provided people with friendly, relaxed environments in which to spend their time. Sufficient information was given to people and was available within the home about the use of advocacy services, should they wish an independent person to act on their behalf. The home provided well-balanced, nutritious meals in accordance with residents’ requirements and choices and which were served in relaxed and pleasant surroundings. Complaints were well managed and appropriate investigations had been conducted when necessary so that people were assured that complaints were taken seriously and so that any shortfalls may be identified and rectified. The home was found to be warm and comfortable, providing a friendly and homely environment for people to live in. A lot of training was being provided for staff, including mandatory courses, a detailed induction process and training specific to the client group living at the home, which demonstrated that the staff group were competent to look after the people at the home. The manager was resident focused and led and supported the staff team who had been appropriately recruited, so that those living at the home were adequately protected. Systems were in place at the home to ensure that residents’ finances were adequately protected so that the possibility of any mishandling was minimal. The home was found to be free from hazards so that people were not at risk when moving around the home. What has improved since the last inspection? Before service users moved into Aughton Grange, a letter was sent to them or their relatives telling them that the home was able to meet their assessed needs. The recruitment procedures had improved since the last inspection and at this visit to the home three staff files were examined, which were found to contain all the relevant information and checks on staff to ensure that those living at the home were adequately protected. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 7 What they could do better: The home needs to be able to demonstrate that service users or their representatives have been given the opportunity to be involved in the assessment of needs and care planning process. The provision of activities could be improved by the employment of an activities co-ordinator so that those less able to participate could receive more 1:1 interaction from staff and a wider range of activities could be available for those more able to participate. The care records should contain more detailed information about how people can be supported to maintain their leisure interests. Some of the stair and landing carpets were badly stained and therefore were in need of either a thorough clean or replacement in order to enhance the environment for the residents. The laundry floor was in need of repainting to ensure health and safety for staff. A routine programme of maintenance should be developed which clearly identifies suitable timescales, so that renewal of fabrics and decoration of the home is a planned ongoing activity. The registered manager should be able to demonstrate that the home complies with the Water Supply (Water Fittings) Regulations 1999 in order to promote infection control measures. A system should be developed so that the numbers and skill mix of staff is calculated in accordance with the assessed needs of people living in the home. The registered manager needs to continue to work towards a minimum ratio of 50 of care staff having achieved a National Vocational Qualification at level 2 or above so that sufficient numbers of staff are appropriately trained to adequately meet the needs of people living in the home. The registered manager had not achieved a National Vocational Qualification at level 4 to demonstrate that he has undergone relevant management training for the position he holds. The systems within the home could be improved so that the quality of service provided could be effectively monitored. Questionnaires for residents, relatives, staff and stakeholders in the community would give the registered person people’s views on how well the service is meeting goals for those living at the home. Clear audit trails, conducted by the home and by outside professional bodies would allow the registered person to identify and to put right any shortfalls in the service. An annual development plan would demonstrate that the registered person has considered a more structured approach to forward planning so that the service consistently meets residents’ expectations. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 8 The record of accidents had not been retained in line with data protection in order to protect the confidentiality of people living at the 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. Aughton Grange Care Home DS0000062646.V312303.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 Aughton Grange Care Home DS0000062646.V312303.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): 3. Standard 6 did not apply to this service. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home were given up to date information about the service. Enough information had been gathered before admission to ensure that the home could meet the individual needs of residents. EVIDENCE: At the time of the site visit there were 24 people living at Aughton Grange. The care of three of these people was ‘tracked’ whilst the inspector was at the home. Comment cards received indicated that everone had received sufficient information about the home before moving in. One comment was, An informative booklet was given, which was accurate and helpful and another was I am happy that my relative lives at this home. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 11 The care records showed that detailed information had been obtained prior to admission in order to determine individual needs, so that the service was certain that the staff team could meet the needs of people admitted to the home. There was no evidence available to demonstrate that the service user or their relative had been given the opportunity to be involved in the preadmission process. This needs to be urgently addressed as a requirement in relation to this issue has been made on the previous three inspection reports. The Pre-inspection questionnaire showed that policies and procedures were in place at the home, so that staff were provided with guidance about the admission process. Records showed that people involved with the care of service users had conducted a periodic review of placements to ensure that the home remained a suitable environment to meet the continuing needs of people living at the home. Staff were appropriately qualified and had also received specific training in relation to dementia care to ensure that they were aware of the needs of people suffering from dementia. The assessed needs of those admitted to the home were consistently recorded within the care plan therefore staff were provided with detailed information as to how service users’ needs were to be met. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. Aughton Grange Care Home DS0000062646.V312303.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. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of those living at the home were being fully met and their privacy and dignity was consistently maintained. EVIDENCE: The pre-inspection questionnaire showed that an admission policy was in place, providing staff with clear guidance about the steps to take when admitting anyone to the home. Comment cards from relatives showed that they were kept informed of important matters affecting service users and that they were involved with their care. All comment cards received indicated that people were satisfied with the overall care provided for those living at the home. The care of three people was ‘tracked’ at the time of the site visit. The plans of care seen were very well written documents, showing any changes in circumstances and providing staff with clear, detailed guidance about how people’s needs could be fully met. However, service users or their relatives had not always been given the opportunity to make decisions about the care provided. This must be addressed as a matter of urgency, as a requirement Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 13 has been made about this issue at the previous three inspections and the service users’ guide tells people about the involvement of service users and their relatives in the care planning process. Records seen showed that a variety of support services and external professionals were involved in the overall care of service users to ensure that all their assessed personal and health care needs were adequately met. Comment cards received indicated that people received, in general the care and support, which they needed. One comment made by a relative was, staff are most helpful and concerned. A wide range of risk assessments had been conducted, which were found to be detailed, showing what systems had been put in place to reduce the possibility of injury. The pre-inspection questionnaire showed that policies and procedures were in place at the home to ensure the safe handling of medications. The inspector found that medications were being well managed so that the health and safety of those living at the home was promoted. The care records showed that people were treated with respect and that their privacy and dignity was maintained whilst personal and health care was being provided. The pre-inspection questionnaire showed that policies were in place in relation to the six principals of care, including privacy and dignity. The statement of purpose told people that the privacy and dignity of those living at the home would be respected and this was supported by the inspector’s observations. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home did not always match residents’ social and recreational needs. Residents received a healthy, varied diet according to their assessed requirements and choice. EVIDENCE: The care records seen showed that the wishes and feelings of people living at the home had been taken into consideration and that their preferences had been determined to enable them to have some control over their lives. The statement of Purpose included an explanation of the six principals of care, including rights and choices, showing that those living at the home were able to make decisions and informed choices. The pre-inspection questionnaire showed that policies were in place in relation to the six principals of care, including rights and choices. The home did not employ anyone to plan and organise activities for residents as it was down to the care staff to take on this role. However, the registered manager informed the inspector that he was in the process of recruiting an activities organiser so that care staff would be able to concentrate totally on caring duties, which the Commission considers to be good practice. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 15 Brief social histories had been obtained so that staff knew what residents’ interests were and so that they were able to form close bonds with the people living at the home and their families. However, more detailed explanations should be included within the plans of care to show how people could be supported to maintain their leisure interests whilst living at the home. During the period of direct observation it was noted that some staff interacted well with residents, but some missed opportunities were noticed where staff could have interacted in a more meaningful manner, which would have demonstrated a more positive approach to equality and diversity for this client group. During the afternoon period the inspector saw a few residents doing 1:1 activities with relatives and a small group playing cards. The communal areas provided friendly, relaxed areas for residents to spend their time and the inspector noted that there was a lot of laughter and enjoyment. One relative commented, ‘the staff are all lovely and all so friendly. I haven’t a bad word about any of them’ and another said, ‘you will not find another care home as good as this one’. One relative confirmed that religious ministers visited the home regularly to conduct services and the statement of purpose supported this information. The inspector saw that plans of care had been written in relation to individual religious beliefs, showing how people could be supported in meeting their spiritual needs. A visiting policy was in place and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. Comment cards received from relatives all indicated that they were made to feel welcome to the home and were able to visit service users in private. The inspector noted that personal possessions adorned individual rooms, where appropriate to create a homely environment and audits of service users’ belongings had been conducted on admission to protect the safety of individual’s personal possessions. Information was provided in the service users’ guide in relation to the use of advocacy services, so that people had the opportunity to have an independent person acting on their behalf, should they so wish. Leaflets were also readily available within the home; so that people were able to contact the local advocacy service them-selves if they preferred. Information submitted before the site visit showed that people were given a choice of menu and that special diets were catered for to ensure that everyone’s dietary needs were met. The pre inspection questionnaire showed Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 16 that a high percentage of staff had completed a training course to ensure that standards of food hygiene were maintained. The four weekly menus showed that a well-balanced diet was offered to ensure that those living at the home received a nutritious dietary intake and the food served appeared appetizing in order to aid nutrition. People were seen being supported with their meals if they needed, whilst independent eating was encouraged where possible. The dining rooms were found to be relaxed areas for people to eat in, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and appropriate investigations had been conducted. The policies, procedures and practices of the home sufficiently safeguarded those using the service. EVIDENCE: A system was in place at the home to ensure that complaints were recorded and investigated in a proper manner and a timely fashion so that people were kept informed of what stage their complaint was at. The Pre inspection questionnaire showed that a policy was in place in relation to concerns and complaints, which was clearly displayed within the home and was issued to each service user or their relative in the statement of purpose so that people were aware of how they could make a complaint, should they wish to do so. Relatives, who were spoken with told the inspector that they knew what to do should they wish to make a complaint about the service. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was referred back to the provider to investigate using the home’s complaints procedure. The pre-inspection questionnaire showed that a policy in relation to the safeguarding of adults was in place at the home, which had not been changed since the last inspection and which was found to be satisfactory at that time. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 18 The pre-inspection questionnaire also showed that a variety of additional policies were in place in relation to the protection of people living at the home. Staff spoken to confirmed that they had received training in relation to safeguarding adults and the training matrix seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Aughton Grange Care Home DS0000062646.V312303.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 and 26 Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. Residents lived in a clean, pleasant and safe environment, which was reasonably well maintained and was free from offensive odours. Satisfactory procedures were in place for the control of infection. EVIDENCE: The pre-inspection questionnaire showed that there had not been any changes to the premises since the last inspection. The inspector toured the building at the time of the site visit, viewing all communal areas and a randomly selected number of residents’ bedrooms. The home was found to be clean, tidy and generally well presented although the floor carpets covering the stairs and landings were in need of a thorough clean or replacement as they were very stained and marked. The skirting boards in these areas were also in need of painting in order to enhance the environment for those living at the home. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 20 The home had a routine programme in place to show that planned maintenance work had been arranged. However it was not clear which items of work had been addressed or any timescales for completion. The environment was free from any unpleasant smells and the grounds were maintained to a satisfactory standard, providing pleasant surroundings for those living at the home. The pre-inspection questionnaire showed that there had not been any changes to the infection control policies and procedures, which were satisfactory at a previous inspection. The laundry department was found to be tidy and well organised with sufficient machinery for the size of the care home and the needs of the residents. However, the laundry floor was in need of repainting in order to promote health and safety procedures for staff. The registered manager was not able to demonstrate that the home complied with the Water Supply (Water Fittings) Regulations 1999 in order to promote infection control measures. Aughton Grange Care Home DS0000062646.V312303.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. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Staff working at the home were trained, skilled and in sufficient numbers to fulfil the aims of the home and to meet changing needs of residents. EVIDENCE: There was a clear duty rota in place demonstrating which staff were on duty at any time of the day or night. A variety of assessments had been conducted so that any risks in relation to residents’ dependency levels could be identified and systems put in place to reduce the risk factor as much as possible. The records showed that a good skill mix of staff made up the staff team so that residents’ needs were being met. Visitors spoken to felt that their relatives’ needs were being fully met and that the staff worked well as a team and were very patient and understanding. There was no recorded evidence available to demonstrate that the staffing levels were being calculated in accordance with the dependency levels of those living at the home to ensure that the number and skill mix of staff was sufficient to meet people’s needs. At the time of the site visit there were 24 people living at Aughton Grange Nursing Home. Staff spoken to felt that there were always enough staff on duty to ensure that the needs of residents were adequately met. However, three comment cards received from relatives indicated that there were not always sufficient numbers of staff on duty. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 22 At the time of the site visit to the home the environment was found to be clean and tidy, providing a pleasant environment for people to live in. The personal and health care needs of residents were seen being met. The pre-inspection questionnaire showed that 28 of care staff had achieved a National Vocational Qualification (N.V.Q.) at level 2 or above, showing that staff training had improved since the previous inspection. The registered manager was aware that although a number of other staff were in the process of completing this award, that he needed to progress towards achieving a minimum ratio of 50 of care staff with a National Vocational Qualification to ensure that sufficient numbers of care staff were adequately trained to do their job. At the time of the inspector’s visit to the home the N.V.Q. assessor was on site and she confirmed that a lot of N.V.Q. training was provided for staff working at Aughton Grange. Three staff files were examined at the time of the inspection. It was found that recruitment procedures were being adequately followed in day-to-day practice and sufficient checks had been undertaken on staff to ensure that those living at the home were adequately protected. The staff application form showed that the service was an equal opportunities employer and this was confirmed by examination of the staff rota, which showed that the staff team was made up of people from different nationalities. A formal induction process had recently been adopted by the home, which involved working through a booklet appropriate to their role. This booklet provided some good information to help staff to understand their role and to enable them to perform the duties expected of them. The pre-inspection questionnaire was submitted to the Commission for Social Care Inspection prior to the site visit, which showed that a wide range of training was provided for staff and that future planning had been arranged, including training specific to the client group living at the home. This showed that people working at the home received adequate training to look after the people in their care. All staff completed mandatory core-training courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people in their care. The training coordinator was on site at the time of the inspector’s visit, who confirmed that a lot of training was provided for staff working at Aughton Grange. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 23 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. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect. However, the quality assurance process was not thorough enough to monitor the level of service provided, although the safety of people living at the home was consistently maintained. EVIDENCE: The manager of Aughton Grange Nursing Home has been registered with the Commission for Social Care Inspection since the last inspection. He has the required nursing qualifications and experience to run the home in a competent manner. Although the manager has undergone some training whilst managing the home, he has not yet registered to undertake a National Vocational Qualification at level 4. During the time he has been in post he has worked Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 24 hard to improve some aspects of the service and to provide an increased quality of life for residents. The manager is resident focused and leads and supports the staff team who have been appropriately recruited, so that those living at the home are adequately protected. Comment cards received from service users and their relatives provided very positive feedback about the registered manager. Staff spoken to felt supported by the manager and were happy with the overall management of the service. Surveys had not been conducted to show that residents and their relatives had been given the opportunity to provide their views about how the service was performing. Some meetings had been held and although only hand written minutes had been retained, these had been distributed to relevant personnel, so that people were kept informed of any important matters. The views of staff members and stakeholders in the community had not been sought so that the home could determine if the goals for residents were being achieved. The registered manager had put in place a variety of regular checks, within a risk management framework, so that any hazards could be easily identified and so that systems could be implemented to reduce or eliminate the risk factor. There was little evidence available to demonstrate that thorough internal or external audit trails had been conducted to monitor the quality of service provided and there was no annual development plan in place to demonstrate what the home is planning to achieve in the future. Systems were in place at the home to ensure that residents’ finances were adequately protected. The pre-inspection questionnaire showed that relatives were usually responsible for the management of residents’ money, where residents were unable or did not wish to manage their own affairs. The pre-inspection questionnaire showed that policies were in place for the management of service users’ finances, money and valuables. These policies had not been changed since the last inspection and they were found to be satisfactory at that time. The pre-inspection questionnaire showed systems and equipment had been appropriately checked so that the health, safety and welfare of those living at the home was protected. The environment was seen to be free from any hazards so that people were not at risk when moving around the home. The pre-inspection questionnaire showed that a variety of policies and procedures were in place, which provided staff with relevant health and safety guidance in order to safeguard those living at the home. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 25 Accidents had been well documented, although the records were not retained in line with data protection in order to protect the confidentiality of people living at the home. The training matrix submitted to the Commission for Social Care Inspection prior to the site visit showed that staff were provided with a lot of training, including health and safety issues so that they were appropriately trained to protect those in their care. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 27 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)(c) Requirement The registered person must not admit anyone to the care home unless, where possible, the service user or their representative has been involved in the assessment of needs prior to admission. (Timescale of 01.12.04, 30.06.05 and 31.12.05 not met) The plans of care must be drawn up with the involvement of the service user or their representative, unless it is impractical to do so, in which case the reason for not doing so must be recorded. (Timescale of 01.12.04, 31.08.05 and 31.01.06 not met) The registered person shall ensure that all parts of the home are kept reasonably decorated, including the laundry flooring, the stairwells and landing areas of the home. Timescale for action 31/01/07 2. OP7 15(1) 31/01/07 3. OP19 23(2)(d) 30/06/07 Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP12 OP19 Good Practice Recommendations More detailed information should be included within the plans of care to show how people can be supported to maintain their leisure interests whilst living at the home. It is recommended that an activities co-ordinator be employed so that residents are provided with a range of suitable activities for their individual needs. The registered person should develop a routine programme of maintenance which clearly identifies work completed with a time schedule so that the fabric and decoration of the home is kept to a satisfactory standard. The registered person should be able to demonstrate that the premises are compliant with the Water Supply (Water Fittings) Regulations 1999. The ratios of care staff to service users should be determined according to the assessed needs of residents, and a system should be operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. A minimum ratio of 50 of care staff with a relevant National Vocational Qualification at level 2 or above should be achieved. The registered manager should achieve a National Vocational Qualification at level 4. The registered person should implement thorough quality assurance checks so that the quality of service provided can be effectively monitored. The quality assurance checks should include questionnaires for residents, relatives, staff and stakeholders in the community, as well as clear internal and external audit trails. A more formal approach should be adopted in recording the discussions taking place during any meetings and these minutes should be readily available for all interested parties to read. The registered person should implement an annual development plan, which is resident focused and which shows that future planning of the service has been considered. DS0000062646.V312303.R01.S.doc Version 5.2 Page 29 4. 5. OP26 OP27 6. 7. 8. OP28 OP31 OP33 9. OP33 10. OP33 Aughton Grange Care Home 11. OP38 The record of accidents should be retained in line with data protection in order to protect the confidentiality of people living at the home. Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aughton Grange Care Home DS0000062646.V312303.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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