Inspection on 11/10/07 for Autumn Gardens

This inspection was carried out on 11th October 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Autumn Gardens 25/04/09

Autumn Gardens 21/05/08

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

CARE HOMES FOR OLDER PEOPLE Autumn Gardens 73 Trent Gardens Southgate London N14 4QB Lead Inspector Brian Bowie Key Unannounced Inspection 11th October 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 Autumn Gardens DS0000069167.V345681.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. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn Gardens Address 73 Trent Gardens Southgate London N14 4QB 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) 020 8344 2600 020 8344 2610 Ourris Properties Limited Eleni Constantinou Care Home 36 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 36. New Home-First inspection 2. Date of last inspection Brief Description of the Service: Autumn Gardens is a registered care home for 36 older people including people with dementia. The home opened in April 2007. Autumn Gardens is located in a residential area in Southgate, North London, and is close to community resources and facilities such as a supermarket, local shops, places of worship and public transport. There are 36 single rooms on three floors, all with ensuite facilities. 8 bedrooms also have their own shower. The home has 3 lounges and a separate dining area. There is a large garden at the back of the home that is in the process of being landscaped and made suitable for the residents. Autumn Gardens has been set up to provide a home primarily for older people from the Cypriot community. At the time of the inspection the residents were all Greek-Cypriots. Fees range from £520-£540/week. Residents and relatives are to be informed of the findings from inspections. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted 9 hours. The inspector was assisted throughout by a regulation manager from CSCI. The son of the owner and the manager were both interviewed and assisted with the inspection. A tour of the home was made and most of the 21 people resident in the home at the time of the inspection were seen. An interpreter helped with the interviews of 10 of the residents. We also interviewed staff to get their views and comments on the home. Relatives provided written feedback on what they thought about the home. We would like to thank all the residents and relatives who gave helpful and detailed comments about Autumn Gardens. A wide range of records, including care plans, staff files and health & safety documents, were also looked at. The overall impression from the inspection was of a home that is providing an adequate standard of care within a very friendly, homely and supportive environment. This was confirmed by the amount of positive feedback, written and verbal, that was received from residents, relatives and professionals involved with the home. A comment from one relative being: ‘On the whole I am very happy with the care my relative receives from Autumn Gardens. My expectations and standards of care are high. This home is, I believe a work in progress- if it has achieved what it has in this short period of time-then all credit to the staff & management team.’ The home has grown quickly since it opened in April 2007. As a result current management arrangements are insufficient and must be improved quickly to ensure the home is run well and safely at all times. What the service does well: ‘This is my home and I like it very much.’ My mother needs not only practical support in caring for herself but emotional and psychological support too. It is a massive transition from home to a care setting and this was managed very well so that neither my mother or her family were isolated. She is less withdrawn and less isolated than when she was at home, therefore communication has improved.’ Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 6 Residents feel at home and relaxed at Autumn Gardens because staff pay close attention to meeting their individual needs. Residents themselves said they enjoy living at Autumn Gardens and are happy with the quality of care they are getting. Relatives were also very positive about the quality of care in the home and emphasised that they appreciated being able to visit whenever they wanted. The home is particularly good at responding to the religious and cultural needs of older people with dementia from the Cypriot community. A priest from the Greek Orthodox Church visits the home regularly and residents are supported to go to church if they wish. A variety of Greek dishes are regularly served and available to residents. The owner has provided for the residents a selection of Greek television and radio channels so that they have more choice about what they watch and listen to. As a result residents feel more at home at Autumn Gardens. The home has an experienced manager, a committed and caring staff team and has been furnished and decorated to a high standard. As a result the residents benefit from living within a supportive, attractive and comfortable living environment. What has improved since the last inspection? What they could do better: The home is still getting established having been open six months. However the key issue to be sorted out is making sure the management team within the home is large enough to ensure that the home is at all times run effectively. At the time of the inspection the manager was in effect overloaded resulting in a number of failings in the way the home is run. This needs to be addressed urgently so that the staff team can fully meet the needs not just of existing residents but those additional residents moving in over the next 6 months. There are 16 specific areas to be improved: • • When someone moves into the home all key information must be recorded so that the needs of that resident are met Care plans must contain all necessary information and must be kept updated so that residents are fully safeguarded at all times DS0000069167.V345681.R01.S.doc Version 5.2 Page 7 Autumn Gardens • Recordkeeping and safety procedures in the home must improve quickly to ensure all residents are properly looked after at all times and that there is written evidence to support this Daily readings must be made of the temperature of the fridge that stores medication More activity sessions need to be provided with a greater variety of activities on offer so that the residents have as many stimulating opportunities as possible The activities coordinator must have specialist training in the area of activities for older people with dementia A form to be available so that complainants are able to make their complaint The garden must be made accessible and attractive to residents Effective systems and procedures must be in place to prevent mistakes being made in relation to the residents’ laundry There must be at least one member of staff on each night shift who is Greek-speaking All staff must have further more advanced training in dementia care so that they can implement best practice in this area and more fully meet residents’ needs The owner of the home together with the manager must review and improve existing management arrangements so that the home is run effectively and safely at all times Written surveys must be used to gather the views and comments of all key parties involved with the home so that Autumn Gardens is able to continuously improve its practice and the standard of care provided Records kept of residents’ monies must be signed by 2 members of staff to ensure residents’ monies are properly safeguarded The manager must ensure all staff have at least 6 supervision meetings each year in order to improve their practice. • • • • • • • • • • • • Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 8 • • The fire alarm must be checked every week Regular health & safety checks of the premises must be carried out and recorded All the areas for improving the service were discussed and agreed with the manager. 6 recommendations are made to improve further care practice in the home: • • • The coordinator would benefit from the assistance of a member of staff throughout an activity session The complaints book to have an ‘outcome’ column added so that the results of complaints can be seen more easily Further training in safeguarding adults to be taken by all staff so that they are up to date and aware of current issues and best practice in relation to the protection of vulnerable adults Specialist advice to be obtained in order to ensure the home is made as accessible and enabling as possible for the residents Paper dispensers for use by staff to be supplied in residents’ bedrooms in order to improve hygiene arrangements The lounges to be furnished with chairs of different heights to reflect the different needs of residents • • • 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. Autumn Gardens DS0000069167.V345681.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 Autumn Gardens DS0000069167.V345681.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (NMS 6 does not apply to this home) People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. • When people move into the home the manager works out what they want and need so that the home is sure it can meet these wishes and needs. However residents do not have the benefit of all their needs being properly recorded when they move into Autumn Gardens. EVIDENCE: ‘I was invited to spend the day at the home and meet the staff, other residents and to see the room I would be moving to. I participated in the activities and had a nice lunch.’ Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 11 ‘We are very happy and more importantly my dad is settled comfortably and seems very secure.’ ‘On admission to the home we had a meeting to draw up the care plan for my mother’s care and I have been part of the care process all along.’ These comments from a resident and relatives show that the home takes care to get to know people before they move in and works hard at settling them in. As a result feedback from residents and relatives was positive about their move to Autumn Gardens. One resident had moved in the day before the inspection. The pre-admission assessment contained most, but not all, key information relating to their needs. The person’s skin condition had not been recorded on admission. This is important so that any pressure areas or bruising of any kind can be noted and followed up. The manager must make sure that when a resident moves into the home all key information is recorded. Autumn Gardens DS0000069167.V345681.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. • The individual plans of care for each resident reflect the needs and wishes of the resident. However residents do not have the protection of comprehensive and up to date records. Residents benefit from the close attention paid by staff at Autumn Gardens to meeting their health needs. The home is good at ensuring there are safe and effective arrangements in place in relation to medication. However the home’s arrangements for storing medication are not as safe as they should be. Staff are good at treating residents with respect • • • Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 13 EVIDENCE: ‘My mother needs not only practical support in caring for herself but emotional and psychological support too. It is a massive transition from home to a care setting and this was managed very well so that neither my mother or her family were isolated. She is less withdrawn and less isolated than when she was at home, therefore communication has improved.’ This was the view of one relative and was supported by written feedback from other relatives. Residents spoke positively to the interpreter about their experience of living at Autumn Gardens. One person said: ‘This is my home and I like it very much.’ The records for four residents were looked at and indicated that for each one there was a current plan of care which set out the needs of the resident and how they were to be met by the home, with evidence that these were being reviewed regularly. In addition each file contained an assessment of any areas where there was considered to be any risk to the resident and how these risks were to be dealt with and reduced as far as possible. However in some cases key information, such as medication profiles was not on the file or a risk assessment had not been updated. The manager must make sure that care plans contain all necessary information and this is kept updated so that residents are fully safeguarded at all times. ‘The district nurses call daily and give me my insulin- the carers dress my leg ulcers if necessary.’ This was the comment of one resident. Feedback from relatives was in general positive about the commitment of the home to keeping residents as well as possible. The records confirmed that residents see dentists, opticians, chiropodists, district nurses and doctors. The manager confirmed that the continence advisor had been into the home twice to give information and advice about how best to promote continence. Specialist input from mental health or psychogeriatric services was obtained when needed. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 14 The medication administration records were up-to-date and accurate. The monitored dosage system is used which means errors in giving out medication are less likely. Staff who administer medication have been trained in how to administer medication safely and effectively so that residents are fully protected in this area. Medication has to be stored at the correct temperature. The fridge used for storing medication was having its temperature recorded, but not every day as needed. The manager must ensure daily readings are made of the temperature of the fridge that stores medication. ‘The carers who look after us are all very nice and kind to me. They also show me a lot of respect.’ ‘She is treated with kindness & respect.’ My relative has their own room with private en-suite facilities allowing them to maintain their dignity. These comments from a resident and relatives show that the home is good at treating residents with respect and dignity. This is particularly important when many residents have dementia and are therefore particularly vulnerable. Throughout the inspection staff were observed to have a caring approach that enabled people to maintain their dignity. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. • Autumn Gardens is good at making residents feel at home and comfortable and that their cultural & religious needs are met. Residents are benefiting from a stimulating range of activities. However residents would benefit from a more substantial and varied activities programme that responds to their specialised needs and interests. Autumn Gardens is good at welcoming and encouraging relatives to be actively involved with the residents at the home. Residents benefit from having choices about how they lead their life at Autumn Gardens. Residents have nice food in nice surroundings with their individual and cultural preferences catered for. • • • Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 16 EVIDENCE: ‘I am very grateful that Autumn Gardens offers my mother a home with people from the same background who understand her language, customs and religious needs.’ Staff are good at treating people as individuals, for examples residents’ birthdays are celebrated in the home. The owner has provided for the Greek residents a selection of Greek TV and radio channels so that they have more choice about what they watch and listen to. Some residents go to the Greek Orthodox church to attend services. A priest from the Orthodox Church regularly visits residents at the home and conducts ceremonies. Residents and relatives made it clear that they really valued and appreciated this aspect of life at Autumn Gardens. We observed and a poetry enjoyed the assistance of commented: the afternoon activity session involving dancing, throwing a ball reading which really engaged the residents. Residents clearly activities on offer. The coordinator would benefit from the a member of staff throughout an activity session. One relative ‘I understand that it is early days yet at Autumn Gardens and I understand they have an activities coordinator coming in one or two days a week. It will be a good idea if they have planned activities every day for those who are willing and able to participate. It keeps them active and stimulates their minds.’ Autumn Gardens has made a good start in this area. However more sessions need to be provided with a greater variety of activities on offer so that the residents have as many stimulating opportunities as possible. In addition the coordinator must have specialist training in the area of activities for older people with dementia. ‘We are encouraged to visit as often as we can and to participate in all social activities and parties that have been held. I can still participate in caring for my mum if I choose to like washing her hair or cutting her nails.’ Residents and relatives both appreciated the welcoming atmosphere in the home that helps to put everyone at ease. Nearly all residents had family members visiting regularly. Residents are offered choices in how they spend their time. One person likes to spend much of their time in their room, and the family had noted: Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 17 ‘We do appreciate that this is her choice and the home are respecting this.’ The approach in the home is to promote independence and choice. For example one resident likes to go out on their own from the home and keeps in touch with staff by mobile phone. ‘I enjoy the meals very much. I enjoy that they are Greek meals like I would have at home.’ ‘The food is good, wholesome cultural food. I have visited many times at lunch or supper time and have been happy with what has been served. Residents and relatives said the food was good in the home. The cook was interviewed and confirmed that she had a food hygiene certificate. The lunchtime arrangements and meal were observed with residents given a choice of appetising food presented in a warm and friendly way. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. • The residents benefit from complaints procedures that make sure that they are safe and secure whilst at Autumn Gardens However the home has not been so good at enabling people to make a formal complaint if they wished to. The residents benefit from safeguarding adults procedures that make sure that they are safe and secure whilst at Autumn Gardens • EVIDENCE: ‘I would tell the manager.’ ‘We were told of the complaints procedure.’ Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 19 ‘Thankfully we have not had to complain. The only issue I raised with the home was dealt with the next day and put right.’ These were the comments of a resident and relatives. However in one case a relative had remained dissatisfied with how the home had responded to its complaint. A full investigation is being undertaken into this complaint. The home has a complaint procedure that indicates there is a complaint form available for complainants to use. However this form has not yet been devised. It is important that a form is available so that complainants are able to make their complaint. In the complaint record book it is recommended that an outcome column is added so that the results of complaint can more easily be seen. ‘Thankfully my mother has had only one fall since being at Autumn Gardens. I was contacted the next morning and told. Before her admission my mother had many falls so one fall in 3 months has been great for us.’ Written feedback from relatives was positive about how their relative is being looked after at Autumn Gardens. Care staff have had training in safeguarding adults policies and procedures. It is recommended that further training in safeguarding adults is taken by staff so that all staff are up to date and aware of current issues and best practice in relation to the protection of vulnerable adults. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. • Residents at Autumn Gardens enjoy an attractive and comfortable living environment that adds considerably to their quality of life. However residents do not yet have the benefit of an attractive and accessible garden or effective laundry arrangements for their clothing. Residents benefit from, and are protected by, the high standard of cleanliness and hygiene in the home. • EVIDENCE: Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 21 Autumn Gardens opened in April 2007 and is very spacious and comfortable. All areas of the home have been furnished and decorated to a high standard. All bedrooms have en-suite facilities, with some having a shower as well. There are 3 lounges so residents have a choice about where they sit & relax. As a result residents feel more comfortable and less anxious about living at Autumn Gardens. All residents have some degree of dementia so it is important that the environment in the home is as easy and clear as possible for people to move around in. It is recommended that specialist advice is obtained in order to ensure the home is made as accessible and enabling as possible for the residents. It is further recommended that the lounges contain chairs of different heights to reflect the different needs of residents. The substantial garden area is still in the process of being improved and represents an opportunity to make the outside area as attractive as possible for residents. The garden must be made accessible and attractive to residents. ‘We have been allowed to add personal touches to the room she has her reclining armchair.’ Bedrooms contained personal items and effects so that they are more homely for the resident. It is recommended that paper dispensers for use by staff are supplied in residents’ bedrooms in order to improve hygiene arrangements. ‘More care needed when clothing put back into resident’s bedrooms- on occasion I find other residents’ clothes in the drawer or cupboard.’ The laundry area needs to be better organised so that clothing is correctly returned to its owner. The manager must make sure there are effective systems and procedures in place to prevent mistakes being made in relation to the residents’ laundry. ‘The home is always clean & fresh-smelling, including my room. The carers also look after my plants for me.’ ‘The home has always appeared clean & fresh with no mal odours which cannot always be easy if residents are incontinent. Throughout the inspection the home was found to be clean and hygienic. Comments during the inspection from residents and relatives indicated that they considered a very good standard was being achieved in this area. Continence issues resulted in two of the occupied bedrooms having an underlying unpleasant odour, which staff are working hard to eliminate. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. • Residents’ needs are met by the committed and experienced team of staff at the home. Residents do not have the benefit of a Greekspeaking member of staff on each night shift. Residents benefit from the support provided by competent and caring members of staff. Residents are protected by the home’s rigorous recruitment procedures for new staff. Residents enjoy a good quality of life because staff have the training they need to support people well. However residents do not have the benefit of staff with an advanced knowledge and understanding of supporting people with dementia. • • • EVIDENCE: Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 23 ‘The girls are good.’ This was the comment of one resident about the staff, but was typical of the considerable amount of positive feedback about the staff team at Autumn Gardens. As a result the residents’ experience of the home is of a caring environment where they feel they will be looked after and allowed to make choices. Staffing levels have increased as the number of residents at the home has risen in order to ensure residents’ needs continue to be met. At the time of the inspection 3 care staff worked on the early and late shifts. At night 2 staff are on waking duty. The home has had difficulty recruiting a member of night staff who speaks Greek. However the manager must ensure that at least one member of staff on each night shift is Greek-speaking so that residents can be properly responded to at night. ‘The carers are very tolerant & supportive of my mother and whenever possible communicate with her in her own language.’ ‘They always answer the bell when I ask them.’ ‘Staff are respectful to us as well as my relative, and always appear to be working hard.’ Feedback from residents and relatives was very positive about the staff at the home. Most staff are undertaking NVQ Level 2 training in caring for older people to improve their skills further. As a result residents get a good quality of support and care from the staff at the home. Staff files were looked at and contained all of the information needed to confirm that staff have had the appropriate checks made. Before a new member of staff starts working at the home a new and satisfactory CRB (Criminal Records Bureau) disclosure is obtained. These procedures help to ensure that residents are protected from unsuitable staff. The owner of Autumn Gardens had used the Greek radio channel as a successful means of recruiting staff. Staff files showed that staff had done training in essential areas, such as food hygiene, health and safety, infection control, administering medication, dementia awareness, first aid and safeguarding adults. Staff had also completed a comprehensive induction programme so that they were well prepared for their caring role and responsibilities. Given that current and future residents will all have varying degrees of dementia, in some cases with associated challenging behaviours, it is important that all staff have further more advanced training in dementia care so that they can implement good practice in this area and more fully meet residents’ needs. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. • Residents benefit from having the home run by a manager who is very experienced and qualified to manage a care home. However residents do not have the protection of a home that is managed well at all times. The home needs to be better at gathering feedback from residents, their families and other key parties so that Autumn Gardens is able to continuously review and improve the care it provides. The home makes sure that residents’ monies are looked after. However these procedures need to be even more rigorous. Staff do not have the benefit of sufficiently regular supervision meetings DS0000069167.V345681.R01.S.doc Version 5.2 Page 25 • • • Autumn Gardens with the manager • The home needs to improve its safety procedures to ensure the residents are kept safe and secure at all times whilst living at Autumn Gardens. EVIDENCE: The manager, Eleni Constantinou, has considerable experience of working with older people, particularly those with dementia. She has completed the Registered Managers (NVQ 4) Award course for running a care home and is approved by CSCI as the registered manager for Autumn Gardens. The manager demonstrated throughout the inspection her knowledge and understanding of the residents. The manager acknowledged that the past year had been a challenging one with the demanding task of setting up a new home, recruiting the staff team and then supporting all the new residents in the home. We found that there had been an over reliance on the manager during this critical period so that if the manager was away some standards were not maintained- for example the weekly testing of fire equipment did not take place. In addition some areas of the home were not being properly managed- for example staff were not being supervised as regularly as they should be, feedback surveys for residents and relatives had not been produced, health & safety procedures were not as rigorous as they needed to be. As a result there were significant overall failings in the current management arrangements in the home. It is essential that this is corrected since the issues may worsen as more residents are admitted into the home. The owner of the home together with the manager must review and improve existing management arrangements so that the home is run effectively and safely at all times. Feedback from both residents and relatives was positive about the home and indicated that they feel able to raise concerns. A meeting with relatives had been held that had given people the opportunity to make comments about the running of the home. However it is important that written surveys are also used to gather the views and comments of all key parties involved with the home so that Autumn Gardens is able to continuously improve its practice and the standard of care provided. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 26 In most cases families manage the finances of residents. Where the home is dealing with residents’ monies, for example spending on chiropody or hairdressing, then the records were seen to be accurate and up-to-date. Records need to be signed by 2 members of staff to ensure residents’ monies are properly safeguarded. The manager acknowledged that she was not able to supervise all staff as often as required. The manager provides much informal advice and support to staff on an ongoing basis. However it is particularly important with a new staff team and a number of less experienced and qualified staff that each member of staff has regular supervision meetings to improve their care practice. The manager must ensure all staff have at least 6 supervision meetings each year. Health and safety and fire safety records were looked at. The home had valid certificates for key areas, including gas, electricity, emergency lighting, the lift, hoists and fire systems. However safety procedures need improving. There were gaps in the record for the weekly testing of the fire alarm and there was no ongoing recording of health & safety issues in relation to the building. Safety records and procedures must be comprehensive and reliable throughout the year. Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 3 3 x 3 3 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 2 X 2 X 2 2 X 2 Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 (1) (a) Timescale for action When someone moves into the 31/10/07 home all key information must be recorded so that the needs of that resident are met. Care plans must at all times 31/10/07 contain all necessary information and they must be kept updated so that residents are fully safeguarded at all times. Daily readings must be made of 31/10/07 the temperature of the fridge that stores medication to ensure residents are protected. An extended and more varied 31/12/07 programme of activities must be provided so that the residents have as many stimulating opportunities as possible. The activities coordinator must 31/12/07 have specialist training in the area of activities for older people with dementia. DS0000069167.V345681.R01.S.doc Version 5.2 Page 29 Requirement 2 OP7 15 (1) 3 OP9 13 (2) 4 OP12 16 (2) (n) 5 OP12 18 (1) (c) (i) Autumn Gardens 6 OP16 22 (1) It is important that a form is available, as indicated in the service user guide, so that complainants are able to make their complaint. 31/10/07 7 OP19 23 (2) (o) The garden must be made 30/04/08 accessible and attractive to residents. Effective systems and 31/10/07 procedures must be in place to prevent mistakes being made in relation to the residents’ laundry. At least one member of staff on 31/12/07 each night shift must be Greekspeaking so that residents’ needs can be responded to at night. All staff must have further advanced training in dementia care so that they can more fully meet residents’ needs. 31/10/07 8 OP21 16 (2) (f) 9 OP27 12 (3) 10 OP30 18 (1) (a) 11 OP31 18 (1) (a) 12 OP33 24 (1) (a) (b) The owner of the home together 30/11/07 with the manager must review and improve existing management arrangements so that the home is run effectively and safely at all times Written surveys and 31/12/07 questionnaires must be used to gather the views and comments of all key parties involved with the home so that Autumn Gardens is able to continuously improve its practice and the standard of care provided. Records kept had to be signed 31/10/07 by 2 members of staff to ensure residents’ monies are properly DS0000069167.V345681.R01.S.doc Version 5.2 Page 30 13 OP35 17 (2)` Sch 4 (9) Autumn Gardens safeguarded. 14 OP36 18 (2) All staff must have at least 6 31/12/07 supervision meetings each year so that their care practice can be improved. The fire alarm system must be 31/10/07 checked weekly in order to ensure the safety of the residents. Health & safety checks of the 31/10/07 building must be made and recorded regularly so that the safety of residents is maintained. 15 OP38 23 (4) (c) (v) 13 (4) (a) 16 OP38 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 OP16 OP18 Good Practice Recommendations The coordinator would benefit from the assistance of a member of staff throughout an activity session. An outcome column to be added in the complaints book so that the results of complaint can more easily be seen. Further training in safeguarding adults to be taken by staff so that all staff are up to date and aware of current issues and best practice in relation to the protection of vulnerable adults. Specialist advice to be obtained in order to ensure the home is made as accessible and enabling as possible for the residents. The lounges to be furnished with chairs of different heights to reflect the different needs of residents. Paper dispensers for use by staff to be supplied in DS0000069167.V345681.R01.S.doc Version 5.2 Page 31 4 OP19 5 6 OP19 OP26 Autumn Gardens residents’ bedrooms arrangements in order to improve hygiene Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Autumn Gardens DS0000069167.V345681.R01.S.doc Version 5.2 Page 33 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!