CARE HOMES FOR OLDER PEOPLE
Aughton Park Residential Home Aughton Park Drive Aughton Ormskirk Lancashire L39 5BX Lead Inspector
Deborah Westhead Unannounced Inspection 15th January 2006 09:15 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 Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 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 Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Aughton Park Residential Home Address Aughton Park Drive Aughton Ormskirk Lancashire L39 5BX 01695 576996 01695 570170 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) home.fxg@mha.org.uk Methodist Homes for the Aged Ms Michelle Morris Care Home 48 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (35) Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The home is registered for a maximum of 48 service users to include: Up to 35 service users in the category OP - (Old Age not falling within any other category). Up to 12 service users in the category of DE(E) (Dementia over 65 years of age). Up to 1 service user in the category of DE (Dementia). The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 19th August 2005 6. Date of last inspection Brief Description of the Service: Aughton Park Care Home is a new purpose built home providing 24-hour personal care for up to 48 older people. The home is situated in a residential area of Aughton, West Lancashire, and provides accommodation on two floors. The dementia unit is self -contained within one wing on the ground floor. All of the bedrooms have a shower en-suite facility, have at least 12 sq m of space and are for single occupancy. The home has four lounge areas, which are situated throughout the two floors. There is one main dining area and the dementia unit has its own small dining area. Access to the first floor of the home is by a passenger lift. The home has private grounds to the rear with the dementia unit having its own secure garden. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9.15am and took place over 6 hours. The Inspector spoke to the manager of the care home, four staff members, seven residents, one visitor and one visiting professional. Comment cards were completed by fourteen residents providing their views about the home. Staff and care records were also examined and a tour of the premises undertaken. What the service does well:
This is a care home where residents are well looked after. The staff team work well together and show a good understanding of the needs of the people living at the home. Those residents spoken to said they liked living at the home and felt they were being well cared for by the staff. One resident said, “ I am very happy here and the staff are very helpful.” The visiting professional said, “I have always found the staff to be very organised and this is one of the best homes I visit.” The visitor to the home said, “I have always found that staff treat residents with respect.” Procedures in the home in relation to employing staff and through good staff training also ensure that residents are kept safe. The manager is very qualified and leads the staff team. Staff said they found the manager to be “very helpful” and that if they raised concerns they “felt confident that something would be done.” Activities in the home are varied to try and suit all tastes. The home employs a dedicated person to organise events and they are helped by a number of volunteers. One resident said, “we go on trips and we are going to a Pantomime next week.” Meals served at the home are good with a choice available. Specialised diets can also be met. One resident said, “We always get a choice” and “can have what we like.” The home is well maintained and was clean and tidy. One resident said they liked the fact that the home was kept clean and that “they had never found a dirty toilet or bathroom.” Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 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 Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10 Resident’s health and personal care is met by the home’s care planning process. Residents feel respected by the staff team and their right to privacy is upheld. EVIDENCE: The files of two residents were looked at. One resident lived on the dementia unit and had recently been admitted to the home. The second resident had lived at the home for a number of years but health needs had recently deteriorated. The pre admission assessment for the resident recently admitted was very detailed and information had been carried over to the care plan. Alongside the care plan there were detailed risk assessments that took into consideration all the health, and personal care needs. Reviews had been completed. The daily records also showed good liaison and communication with both the Doctor and community nurses, who visited this resident on a daily basis. The key worker was also spoken to and through discussion it was clear they were fully aware
Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 10 of needs and participated in the care planning process, as did the family. The key worker said, “I have read the file and now know the past history which helps plan care.” The second care plan seen was also very detailed and showed how this residents health care needs had declined and the interventions needed to maintain as much independence as possible. This resident also continued to play a big part in the care planning process which meant they still felt a part of what was going on. Daily records were also thorough and used at handover to pass information onto the new staff team. It is recommended that references to resident’s conditions in the ‘diary’ kept on the dementia unit be removed to ensure confidentiality. The storage of medication was in a dedicated room and all medicines being retained for residents were stored appropriately. The medication round both at breakfast and lunchtime was discreetly observed. Practices were safe and good records had been maintained. Residents are also encouraged to self medicate with one fully self-medicating and several others part selfmedicating. Residents spoken to said they liked living at the home and were well treated by staff members. Five residents said the staff team respected their privacy and they could spend time on their own if that was their wish. Two residents were seen watching television together. Each resident had their own storage for clothes and one said “I choose my own clothes in a morning and have a shower by myself.” Staff members spoken to have a good understanding of the needs of residents and felt they were able to respect the rights of residents at all times. Two new staff members spoken to said that peoples right to privacy had been covered during their induction period. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 The homes procedures enable residents to exercise choice and control over their lives. Social activities are varied and individual to ensure resident’s needs are met. EVIDENCE: Examination of the two residents’ files confirmed that information is recorded about social, cultural, religious and recreational interest and needs. Residents spoken to said routines within the home were flexible and they were able to make their own decisions about how to live their lives. Care plans seen clearly identified that autonomy and choice was an integral part of the homes ethos. When visiting residents in their bedroom it also became clear that they had been encouraged to bring their own personal possessions with them on admission to the home. One resident took great delight in showing their certificates of education, proudly displayed on the wall. Observations throughout the day’s inspection also evidenced that residents could choose how to fill their day. Some were in the lounges, others in their bedrooms. One resident was also seen going out for a walk after lunch and this was a regular occurrence. Two other residents also like to help clear the
Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 12 dining room after meals and felt this to be an important part of their life at the home. Most residents at the home handle their own financial affairs or these are handled by their relatives/representatives. Records being kept by the home in respect of residents unable to manage their own finances were being well maintained. Activities in the home are very varied and also tailored to meet individual needs. There have been seven outings since the last inspection. This is possible as the home employs a part time activities coordinator who also has the support of a number of volunteers. Some of these volunteers also act as advocates for the residents who have no family. One resident said they enjoyed playing cards and others spoke of their enjoyment of the craft sessions. Another said, “I still like to go to the exercise class even though I can’t do as much as I used to. Religious needs of residents are also met. A number of different services are held at the home to ensure all denominations are catered for. Two residents were seen attending the local services in the community helped by either family or volunteers. Residents spoken to felt this was an important part of their life and many attended the service held in the home on the day of the inspection. Both breakfast and the lunchtime meal were observed. Choices were offered at both. Tables were set appropriately and residents who required assistance were afforded this discreetly. Residents said the meals were good and hey “were always offered a choice.” The chef was spoken to and was aware of resident’s individual likes and dislikes. The chef was also seen to mix with residents and said, “I always do this as I can encourage people to eat and also see if they like what I have prepared.” Home baking is also a prominent part of the menu as is fresh produce. The chef said “whatever I ask for I get. The other day I made homemade watercress soup.” Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 13 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, & 18 Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Procedures to ensure residents feel safe and protected are robust. EVIDENCE: Since the last inspection the home has actioned the requirement made in relation to responding to complaints. The Commission received one complaint since the last inspection and this was dealt with appropriately by the home. Good procedures were in place in relation to responding to or evidence of abuse. The Inspector spoke at length to the manager and through the conversation was able to evidence they had knowledge of the Adult Abuse Procedure and POVA (Protection of Vulnerable Adults). Staff spoken to said, they were also aware of these procedures and they “felt confident the manager would do something if an incident were to be reported.” Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 14 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): 26 The home is maintained to a high standard to ensure residents live in a comfortable, homely and clean environment. EVIDENCE: During a tour of the home all parts of the accommodation were found to be clean and free from offensive odours. The laundry area is separate to the communal and living areas and the equipment provided ensures clothes can be washed at appropriate temperatures. This ensures a safe and hygienic environment is maintained. Separate laundry and domestic staff are employed for the purposes of maintaining cleanliness. One resident said that this was important to her and they liked the fact that the home was “very clean.” Staff were also observed wearing appropriate clothing when carrying out personal tasks and serving meals to prevent the spread of infection. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staffing ratios should continue to be monitored to ensure resident’s needs are met. Recruitment procedures are robust for the protection of residents. Staff training ensures staff are competent to care for vulnerable people. EVIDENCE: Daytime staffing levels were sufficient for the number and needs of residents living at the home. This was evidenced by the weekly roster and observation of working practices. Staff spoken to said staffing levels had improved and they were now able to spend more time with residents. It was also apparent that new staff had been employed and although still some shortfalls the manager was actively seeking to fill vacant posts and this included staff from overseas. The home also had dedicated domestic and laundry staff. Residents said they were happy with the care they receive from the home and were well treated by the staff. One area of concern is the night time staffing levels. The dementia unit now has full occupancy and as such the home must review the numbers of staff on duty. The manager was able to show evidence that the organisation had approved another full time member of night staff and that recruitment procedures were underway. However in the interim it is suggested that either agency or bank staff are offered extra shifts to ensure the well being of residents during this period of time.
Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 16 Staff training continues with all new staff undergoing a full induction period. Two new staff interviewed confirmed this induction, as did records examined. More formal training such as NVQ (National Vocational Qualification) is also continuing and 42.9 of staff have now achieved Level II or above. Eight staff had left the homes employment since the last inspection and this has accounted for the shortfall expected of 50 . One new staff member spoken to said, “I have just signed up for my NVQ” and another said, “I am going to do my NVQ.” Other mandatory training is also regularly updated and the matrix evidenced that this is regularly reviewed. The home operates a thorough recruitment procedure for all new staff. Three staff files were viewed and all contained the necessary documentation required before offering a start date. Volunteers at the home are also screened before they have contact with residents. These procedures ensure that residents are in safe hands at all times. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The home is well managed and run in the best interests of the residents. EVIDENCE: The registered manager of the home has a number of years experience and holds all required qualifications for this role. Records examined also show they undertake regular training to update knowledge and skills. This is important as staff and residents benefit from a clear leadership. Residents spoke positively of the manager as did staff. One staff member said, “management support is good” and another “I feel confident in the manager.” There are also clear lines of accountability within the management structure to ensure standards in the home are maintained. This ensures that the manager feels well supported. However, the internal monthly monitoring form
Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 18 completed by the external representative must be extended to include residents and staff views and a copy sent to the Commission. This will ensure a full quality audit is undertaken. Inspection of records for resident’s finances were well maintained and up to date. This ensures that resident’s financial interests are safeguarded. The reporting of incidents has been addressed since the last inspection to ensure that none go unreported. The senior staff on duty confirmed they know what to report to the Commission and where the documentation is kept. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 20 No Are there any outstanding requirements from the last inspection? 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 OP27 Regulation 18(1)(a) Requirement The registered person must ensure that night time staffing levels are regularly reviewed and increased. The registered person must ensure that the visits by the person carrying out the monthly quality checks include discussions with residents and staff. A copy of this must also be sent to the Commission. Timescale for action 31/01/06 2 OP33 26 31/01/06 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 OP7 OP28 Good Practice Recommendations The manager should ensure that any personal entries made in the ‘diary’ on the dementia unit are removed. The registered person should ensure that 50 of staff are trained to a Level II NVQ in care. Aughton Park Residential Home DS0000038560.V267237.R01.S.doc Version 5.1 Page 21 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
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