Inspection on 21/05/08 for Autumn Gardens

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate service.

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

Autumn Gardens 25/04/09

Autumn Gardens 11/10/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Autumn Gardens 73 Trent Gardens Southgate London N14 4QB Lead Inspector Jane Ray Unannounced Inspection 21st May 2008 09:00 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 Autumn Gardens DS0000069167.V364181.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.V364181.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 info@autumn-gardens.com 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.V364181.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. 11th October 2007 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. Fees range from £540-£560/week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place on the 21 May 2008 and was unannounced. The inspections took eight hours to complete. The inspector looked around the home and with the assistance of an interpreter, spent time speaking individually or in groups to many of the thirtytwo people living in the service. She also interviewed two of the care staff who work in the home and two relatives who were visiting the home at the time of the inspection. A pharmacy inspector also carried out a separate inspection. The inspector also looked at all the relevant records including resident records, staff files and health and safety information. The home also prepared a self–assessment (AQAA) and this was submitted to the Commission for Social Care Inspection in May 2008. This information was used as part of the inspection. The inspector also received eleven surveys completed by residents mainly with the support of their relatives providing feedback on the service and two surveys from members of staff. The inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Older People. The inspector would like to thank the residents, staff and relatives for their assistance with the inspection process. What the service does well: Many of the residents and their relatives were full of praise about their lives at Autumn Gardens and the care they receive from the staff. One resident said during the inspection “Thank God we are very happy here with everything”. Another relative said, “I am absolutely one hundred percent delighted with the home”. The atmosphere in the home was friendly, with the residents enjoying each other’s company and chatting with the staff. The individual staff were observed to be providing a high standard of personal care. The staff were very positive about their work and when they spoke to the residents they demonstrated a good knowledge of their individual needs and a Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 6 caring approach. They take care to promote the residents privacy and dignity at all times. 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 was tidy and homely and residents are encouraged to bring personal items with them to make their bedrooms familiar and comfortable. What has improved since the last inspection? The last main key inspection took place in October 2007 but there was also an additional random inspection in January 2008. There have been a number of improvements since the last inspection that has contributed to improving the quality of the service received by the residents. In terms of the direct support given to the residents, the activity co-ordinator is now providing more activity sessions for the residents and has attended training on dementia that has helped her to make the activities more suitable to reflect the needs of the residents. Care staff also assist with activities where possible. When new residents move to the home all their key information is recorded to ensure their needs will be met. Care plans are being reviewed and updated regularly to reflect any changing care needs. Staff have been employed to assist with the laundry and this has helped to prevent laundry getting lost. Staff have received training on dementia to help them understand the needs of the residents and how to support them more effectively. Two staff sign when handling resident’s personal monies to ensure these are safeguarded. Staff have either received or are booked to have training on safeguarding vulnerable adults to help ensure they know how to recognise and respond appropriately to any suspected abuse. The environment has also continued to improve, although at the time of the inspection an extension was being added to the home and so the external environment did not appear very attractive. A rear terrace and back garden area leading out from the lounge has been created. Advice has been sought for individual residents in terms of any equipment or adaptations necessary to meet their individual needs. The management of the home has been developed further with the appointment of a deputy manager. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 7 Safety in the home has been improved by securing the front door to ensure nobody can wander outside. The fire alarm is being checked weekly to ensure it is working properly and fire notices have been displayed telling everyone what to do in the event of a fire. A health and safety checklist has been devised to help the staff ensure everything is safe. Risk assessments are in place to identify the steps needed to keep everyone safe during the building works. What they could do better: A number of requirements and recommendations have been made as a result of this inspection. The most serious requirement links to a safeguarding issue and is for the manager to receive updated safeguarding vulnerable adult training so she is familiar with local procedures and can recognise and notify serious incidents appropriately so that the correct professional support can be made available to the residents and service. In terms of the residents it was also recommended that their assessments are reviewed to ensure they are completed fully as these act as the basis for each persons care plan. The care plans would also benefit from being more person centred, holistic, with clear goals and incorporating the actions agreed at the last review meeting to ensure each residents needs are being fully met. The key worker role would also benefit from being extended to include attending review meetings and healthcare appointments with the resident, where the relatives do not take them. The medication systems also need to be reviewed to reflect the guidance given by the pharmacy inspection. In terms of the environment it is recommended that the building is reviewed to ensure it is as user-friendly as possible for people with dementia. The lounge furniture should also be reviewed to ensure it is comfortable and homely. Infection control also needs to be considered in terms of hand towels particularly in communal toilets. Administrative staff must be provided in the home to answer the phone, greet visitors and help with administrative tasks to free up the manager and care staff to perform their roles. There must also be access to a computer and the internet. The home needs to continue working towards recruiting more staff who speak Greek especially at nights. They should also check that everyone who needs permission to work in the UK has this visa in place. Some staff need to complete their induction and this must take place to ensure they have the appropriate training to work effectively. Staff also need to be supported to have regular individual supervisions to monitor their performance and ensure they can discuss any concerns. The manager needs to ensure that she has the time to manage the service pro-actively rather than reactively and must get the correct balance between hands-on work and undertaking managerial tasks. She must be supported by Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 8 the provider, who needs to conduct monthly regulation 26 visits to monitor the progress of the service. The quality assurance exercise conducted by the home must also seek the views of care professionals and other stakeholders to continue to review and improve the home. To improve health and safety, the home must ensure all staff have completed fire safety training, the portable electrical appliances need to be serviced and regular health and safety checks must take place. 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.V364181.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.V364181.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): Standards 1,2,3 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed as part of their admission process and that the manager of the home will establish if the staff have the skills and ability to meet these needs. New people moving to the service will have access to information in an appropriate format to tell them about the home and will be offered opportunities to visit the home. Contracts between the home and residents are not yet fully implemented. EVIDENCE: The statement of purpose and service user guide, were inspected. Both of these documents were in a user-friendly format and were clearly written in Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 11 both English and Greek, were accurate and contained all the necessary information. I spoke to one relative who said that they felt they had received enough information about the service before their relative moved in both in terms of the written guides and verbal information given during visits. The seven questionnaires received prior to the inspection all said that the residents and relatives felt they had received enough information from the home prior to moving in. Four case notes for people living in the homes were inspected and these all contained assessments as part of the resident’s information prepared by the home. Information provided by an appropriate care professional is also available if the resident is placed by social services. The assessments contained all the necessary information but in some cases this needed to be recorded in greater detail to act as a good basis for the care plan. For example in one persons assessment it stated that they were incontinent but did not say how this was being addressed. The staff interviewed explained how they are very aware of new residents moving to the home and the need to make them feel welcome and be very attentive whilst they are settling in. One resident in the survey said, “it was very hard for me at the beginning of my stay, but with the help of the staff, residents and my family it now feels a little more like my home”. The feedback from relatives in the surveys has been very positive about the home. One person said, “I truly believe this is the best place for my mother to live her remaining years”. Another relative said, “the service is first class and I believe I could not find anywhere as good”. The inspector discussed the current needs of the people living in the home with the care staff and observed the care they were receiving. The staff felt confident that they were meeting the needs of the residents and this was reflected in the care that was observed. Most of the staff have completed training on supporting people with dementia and training is arranged for those people who still need the training. The contracts between the home and the residents were discussed with the manager. A comprehensive contract is available and a copy with a detailed explanation is available in the homes statement of purpose. The manager explained that these had not been completed for the residents in the home, as there was a contract with social services. It was explained that these documents need to be completed for everyone so the residents and relatives have clarity about what the service provides. Autumn Gardens DS0000069167.V364181.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): Standards 7,8,9 and 10 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to access the healthcare treatment they need. Their individual plans of care reflect their needs. The staff are good at maintaining the dignity of residents. Further improvements are needed to ensure the medication administration is safe at all times. EVIDENCE: The care plans for three people living in the home were inspected. The forth person had only moved into the home in the last fortnight and a care plan was not yet prepared. These documents covered all the areas where care and support were needed. They provided guidance to staff on what action they needed to take to meet each persons needs. The care plans had all been reviewed on a monthly basis. Two of the residents whose care plans I looked Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 13 at had complex emotional needs as one person had suffered a recent bereavement and another had a record in a review saying there were concerns that the person might be depressed. The care plan contained very limited guidance on how staff might wish to support the person with these emotional needs. The care plans did not have any clearly identified goals for each person based on their individual needs and wishes, but were focused more on ensuring people received the right care. The care plans would benefit from being more person centred. All of the residents whose care plans were inspected had been supported to attend a review meeting with their care manager and relatives. For most people this meeting was linked to reviewing how they were settling into the home. A member of staff was interviewed about her role as a key-worker. She explained that she key-works five residents. She explained that for the residents she key-works she helps to keep their drawers tidy, keeps in contact with relatives and lets them know if anything is needed and keeps the residents records up to date. She said that she had not yet attended a review meeting and that she has not yet taken a resident for a healthcare appointment, as the relatives or the manager often does this. The case notes that we inspected showed that areas of risk were assessed. These always included moving and handling and then any other significant risks for that person. For example one person had a risk assessment related to his heart disease and pacemaker. The manager explained that at the time of the inspection none of the residents had a pressure sore, although pressurerelieving equipment was used when needed. The home also keeps a record of each persons weight on a monthly basis. The case notes showed that the home has a separate record of healthcare appointments for each resident. These showed that the residents were receiving primary healthcare input and being referred for specialist input as needed. Residents who had been living in the home for more than a few months had been supported to see the optician and dental hygienist. They had also received chiropody input where needed. They had also been assisted to go to hospital appointments such as the diabetic clinic or to see the psychiatrist. The manager explained that relatives often help to take the residents to these appointments. One resident said, “they listen to me and they arrange a doctor if I need it”. A relative wrote in the survey, “they often take my parent to the doctor for check ups or there have been times when they have called the doctor out”. Throughout the inspection the staff were observed supporting the people living in the home with their personal care, meals and moving around the home. This was done in a manner that respected the residents’ privacy and dignity. It was observed that the staff were very aware of the mood and comfort of the Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 14 residents and responded to any sign of distress, including non verbal indications. One relative wrote in the survey, “I find the staff are all very helpful and truly meet my mothers needs”. It was also observed that the residents appeared very well presented. Several of them told the inspector about the hairdresser who visits the home. One of the relatives said, “whenever we come to the home mum is always clean and changed”. Another relative in the survey said, “I do not think they take my mum to the toilet enough times during the day…I also think she should be showered daily or every other day, rather than every three days”. Other residents during the inspection said that they could have a bath or shower as often as they wanted, but they were able to make this request for themselves. Standard 9 - Lawrie Allum, Pharmacist Inspector report 27/30 May 2008, Pharmacist’s Inspection: On 27 May 2008 at 10:35 and continued on 30 May 2008 I conducted an unannounced pharmacists specialist inspection of the home when I was accompanied by Eleni Constantinou, the home’s manager. The medicines storage room was small but secure and located beneath a stairway. Recent alterations involved a bricked closure of a window to the room with ventilation now provided by 2 ventilating bricks to an adjacent outside wall. The ventilation appeared to be inadequate with the room temperature being 250C. despite being cool outside. Although the heating radiator in the room was turned off, hot pipes supplying the heating ran the length of two walls of the room. The service provider informed me of plans to lag the pipes to reduce the heat. With the imminent onset of summer this issue requires urgent attention in order to ensure that medicines are stored within the licensed temperature range to maintain their therapeutic effect. Any steps taken to improve the storage temperature should be monitored and further steps taken, if storage temperature requirements are not met. To improve the health and safety of treatment with medication some prescribed medicines required additional information to be included with the medicines administration record (MAR) chart as a protocol to support the conditions relating to the administration. This included items such as diazepam 5mg. tablets – 1 or 2 at night, where care staff require guidance on the circumstances to decide on the appropriate dose to be given. Another example included the arrangements for administering insulin whereby on occasions the resident’s son would perform this function as opposed to the district nurse. Other examples included pain-killers prescribed on a when required basis that, unless already stated, required guidance as to the nature of the pain for which prescribed, the interval between dosing and the maximum dosage to be given in a 24-hour, or other stated period. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 15 In order to provide access to a suitable broad range of medicines information it is recommended to provide a recent copy of the BNF. Details were provided for the supply. The accountability of medicines records required improvement to ensure that medicines can be effectively audited as a check that medicines are being administered as prescribed. This includes full and accurate records of receipt and/or carry forward of medicines onto the medicines administration record (MAR) chart at the start of each 4-week prescribing cycle. Any hand-written medicines entries or additional instructions are to be complete and accurate with the signature/signed initials and date of entry. Dose administration or omission is to be recorded, including the dose given where a dosage range is prescribed e.g. 1 or 2 tablets. Reference to when administration is recorded on a secondary medicines administration record (MAR) chart located away from the primary chart, e.g. in a resident’s room for recording a cream/ointment applied by a trained carer. On one occasion, where the medicine records supported audit, the quantity of medicine was in excess of that recorded, i.e. omeprazole 20mg. capsules where there were 3 capsules in excess of the 19 indicated by the records. A dedicated and lockable medicines fridge was provided with an integral maximum/minimum thermometer. Although the current fridge temperatures were recorded twice a day, it is important to also record the maximum/minimum temperatures on a daily basis to ensure medicines requiring cold storage are meeting the correct storage at all times, to maintain therapeutic effect. The home’s care staff had received medicines training provided by a pharmacist in March this year and advanced training provided by Haringey Council for a few selected staff with more involvement with medication. Following an incident involving an error in insulin administration by a district nurse in April 2008, I am informed that the care staff have received training on diabetes provided by Judith Monk, a senior district nurse, a few days after the incident. There were currently no Controlled Drugs (CD) within schedules 2 or 3 prescribed in the home. I am informed that a CD cupboard was removed during recent alterations to the medicines storage room and will be replaced in the event of a CD being prescribed. The homes policies & procedures on medication required some updating and would provide more robust guidance for dealing effectively with medication errors by including direction to NHS Direct when unable to contact a resident’s GP. Reference to Controlled Drugs (CD) was made in several sections of the document but this could be improved with a separate section on CDs. A section on the self-administration of medicines was included however, there Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 16 was no detail of the assessment procedure. The requirement to retain medicines for 7 days following the death of a resident required inclusion. The home had none of the CSCI professional advice documents pertaining to medicines or that of the Pharmaceutical Society. Information was provided on accessing this information, which will assist in addressing the findings of this inspection and dealing with other medication issues. To avoid the risk of cross-contamination of blood-borne infections e.g. Hepatitis, the home requires disinfection facilities and a documented procedure that includes granules containing sodium dichloroisocyanurate (Presept or equivalent) to deal effectively with any blood spillage. Further information is available from the Department of Health or from the local PCT. The tables at the end of this report include some of the above issues arising from the pharmacist inspector’s inspection in requirements 12 to 14 and recommendations 10 to 14. From the findings it is concluded that the handling of medicines in this service is adequate. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 17 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): Standards 12,13,14 and 15 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices in all areas of their daily lives. People who use the service are able to enjoy a stimulating lifestyle and can enjoy the activities that are available. The meals are balanced and nutritional and reflect people’s cultural wishes. EVIDENCE: The staff supporting the people living in the home were observed throughout the inspection. The residents are able to exercise choice in terms of when they want to get up and eat breakfast. One resident said “I like to go to bed later and in the afternoon I have a rest on my bed”. A member of staff talked about two residents who like to stay up late to watch films on the television. They can also ask for a drink whenever they want, although drinks are offered throughout the day. It was also observed that residents can choose whether to be in the lounge or remain in their bedrooms. Residents are also encouraged to Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 18 maintain their independent living skills. One resident said, “I like to make my own bed”. Since the last inspection the home has made considerable progress in providing a range of activities for the residents. The activity co-ordinator works in the home six days a week and provides a programme of activities. These include large group activities and other small group or individual activities. The activity co-ordinator has attended training on dementia since the last inspection and she said this had helped her to focus on the interests and needs of each of the residents. I observed a large group game, taking place in the morning and most of the residents joined in and appeared to enjoy the session. The care staff assisted with the activity. One resident said, “I like the activities, it makes the time go quickly”. Another resident said, “if we want the staff take us out”. The activity co-ordinator explained that she arranges for the residents to go out shopping or for a walk in the local area. The activity co-ordinator organises social activities. On the day of the inspection there was a “name day” celebratory party, taking place. The residents were enjoying the Greek music and dancing. One relative in the survey said, “they made a lovely birthday party for my mother and this was quite unexpected”. The residents are supported to practice their religion if they wish to do so. The priest from the church visits the home and conducts ceremonies. The staff also help the residents to go to the Greek Orthodox church. One resident said, “I like going to church and I go often”. It was very evident that the resident’s really enjoy being able to continue their Cypriot traditions and that this makes a significant difference to the quality of their lives in the home. This is promoted by being able to communicate with the staff and each other. The staff explained that where they do not speak Greek they have learnt some basic vocabulary to improve their communication. There is music, newspapers, radio and television available in Greek. The activity co-ordinator also explained that they do certain traditional activities such as weaving that many of the residents would have enjoyed in the past. The manager explained that most of the residents have close contact with their relatives, extended families and friends and it was observed that visitors to the home are made welcome throughout the day. One relative said, “I can visit whenever I want”. Several of the residents talked about how they had made friends with each other since they moved to the home. It was observed that three Turkish residents enjoy sitting together as they can talk to each other. The home has a cook and during the inspection lunch was prepared. The home has a four-week rolling menu and this was observed to provide a mixture of English and Greek food. Several of the residents commented on how much Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 19 they enjoyed their meal. One relative in the survey said, “they cook fresh food every day and there is plenty on every-ones plate. Infact they eat better than us and always have fresh fruit”. One resident explained that if you don’t like what is on the menu you can ask for an alternative. One relative in the survey said, “I do think their supper is a bit on the small side, especially as they eat at 5pm”. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 20 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): Standards 16 and 18 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are able to access an appropriate complaints procedure and the manager is developing the skills to respond appropriately to complex complaints. The staff appear to understand the principles of safeguarding vulnerable adults but the manager and staff may benefit from additional training. The failure to notify significant events in a timely manner could have an adverse affect on receiving professional advice on how the issue might be addressed and could potentially compromise the safety or wellbeing of the residents. EVIDENCE: The complaints procedure is available in the service user guide and includes details of who complainants can contact. Two residents spoken to during the inspection said they would speak to the manager if they had any complaints. The surveys all indicated that everyone knew how to make a complaint. One relative said, “I have no complaints only compliments but if necessary I would speak to the manager or the owner”. One member of care staff who was interviewed during the inspection showed a good understanding of how to respond if she received a complaint. Within the home complaints are recorded Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 21 and this includes the action taken as a result of the complaint. Since the last inspection there has been one serious complaint received by the home. This had not yet been recorded in the book as the manager said there were still a few actions to be completed. The manager acknowledged that dealing with the recent complaint has been a learning experience that will improve her understanding and practice in the future. Since the last inspection there have been three safeguarding issues that have arisen. The first was not substantiated. The second related to a resident who wandered away from the home and was missing for several hours. This led to the random inspection, taking place in January 2008 to ensure that issues arising from that incident were being addressed such as the security of the building. The most recent safeguarding issue occurred towards the end of April but was not notified to the Commission until nearly a fortnight later. The incident related to an insulin injection being administered to the wrong resident. The manager had ensured the resident had received the appropriate medical treatment immediately but had not recognised that this was a potential safeguarding issue. When the manager was advised by the inspector to make an adult alerter referral the manager had not known the process for this and had contacted the wrong social services department. This has clearly indicated the managers need to undergo training in this area, which she acknowledges. It also raises the need to notify incidents that adversely affect the wellbeing or safety of any resident in a timely manner, which was also a requirement in relation to the previous safeguarding incident. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 22 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): Standards 19,20 and 26 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home have access to an environment that is clean, attractive and comfortable. EVIDENCE: 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. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 23 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. The manager explained that they have numbered all the bedroom doors and that this helps the residents to find their way around the home. She did however agree that further steps could probably be taken to help the residents with dementia move around the home as independently as possible. It was observed that the front door of the home is now secured so that residents who wander cannot leave the home without assistance. Since the last inspection an attractive patio and lawn area has been created outside the lounge area. The manager explained that new garden furniture has been purchased so the residents can sit outside and this is being delivered shortly. There is however still a significant area of the garden that needs to be developed and is currently covered in rubble. The manager explained that at present there always must be staff with the residents in the garden to ensure they are safe. Since the last inspection a member of staff has been employed to assist with the laundry. The residents and relatives spoken to during the inspection said they were satisfied with the laundry service. One relative said, “they hadn’t lost anything and the clothes come back lovely and clean”. The staff interviewed during the inspection described how the laundry system works and how they handle soiled laundry. The inspector asked the manager if they used a system of red bags which dissolve in the wash for the soiled laundry, but she said that they had not yet felt this was needed but would look into these bags for future use. The home employs three domestic staff and they were observed working during the inspection. The home was very clean. One relative said in the survey “every time I go I see them cleaning and at all times the place is immaculate”. Another relative said during the inspection “we like the fact that there are no smells”. One relative in the survey commented that she felt the residents communal toilets could be kept cleaner, although the bedrooms are always clean and fresh. The inspector spoke to the manager about the use of paper towels in the home. The manager explained that each resident has their own towels and flannels in their own bathroom and that she was concerned some residents would flush paper hand towels down the toilet. The inspector acknowledged this issue but felt that in communal toilets an alternative to towels would be beneficial to prevent the transfer of any infections. It was noted in the lounge that the chairs are all the same and are mainly arranged in a large circle, which gives it rather an institutional appearance. The manager said that new seating has been ordered particularly for the conservatory. They are planning further work in the lounge. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 24 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): Standards 27,28,29 and 30 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a caring and committed team of staff. Where possible the home recruits staff who can speak Greek. The absence of permanent administrative support in the home affects the ability of the manager and care staff to focus on their main roles. The resident’s quality of life is enhanced by the staff having access to an ongoing programme of training although some staff need to complete their induction. EVIDENCE: The staff rota was inspected. This showed that during the day there are four care staff working in the home and at night there are three waking members of staff. The staffing structure consists of the manager who is supernumerary, a deputy manager who has been in post for four weeks, four senior carers who help to lead the shifts and eighteen other full and part-time care staff. In the past year two staff have left and one has gone on maternity leave. The staff team has gradually grown as the resident numbers have increased. Five of the day staff and one of the night staff speak Greek, although several of the Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 25 staff commented on how they are learning a few key words. The manager explained how they have tried to recruit more staff who can speak Greek especially to work at night. They have advertised on the Greek radio station and in the local papers but not had any success. Most of the surveys and relatives spoken to said they felt there were enough care staff available. One relative said in the survey “staff are always available”. One resident did however say, that “in the morning I have to wait a long time for them to come”. The owner’s son did however explain that the recent increase in waking night staff had meant there was more help now available for people who wanted to get up earlier. One relative commented that “most of the people who work in the home are friendly and approachable, however there are a couple of people who work there who need more training”. The manager explained that she has no regular administrative assistance and it was observed that she often needed to answer the phone or deal with a number of queries. The manager explained that a lack of time had been the main reason why she had failed to notify the recent incident to the Commission for nearly two weeks. The manager needs to have regular administrative support to answer the phone, answer the door and greet visitors and deal with administrative tasks. This post holder also needs access to a computer with an internet connection. The AQAA completed by the home identifies that three staff have completed an NVQ in care and that sixteen are working towards the qualification. Six staff records were inspected and they had all completed the necessary recruitment checks including a POVA check (protection of vulnerable adults), a CRB disclosure (criminal record bureau) two references and a copy of photo identification. It was however noted that two staff had an out of date record of their permission to work in the country, in their staff record. The staff training records were inspected for six of the staff and show that most of the staff have started their induction training using a comprehensive checklist prepared by the home. The staff who were interviewed were able to explain how they had been inducted including a period of shadowing an experienced member of staff. It was however seen that most of the induction checklists needed to be completed. The staff training records for six members of staff were inspected. The manager had also completed a summary of all the staff training. The manager explained that quite a bit of the training is undertaken by staff attending training provided by Haringey Social Services. Trainers employed directly by the home provide other training. An example of this is medication training. Staff team meetings are taking place about every two months and the minutes were inspected. These discussed a wide range of operational issues. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 26 Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 27 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): Standards 31,33,36 and 38 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from having the home run by a manager who is very experienced and qualified. The management role must however be performed appropriately with the correct support to ensure that the residents can benefit from living in an environment that is as far as possible safe and where staff are appropriately supervised. 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 Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 28 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 explained that the deputy manager only came into post four weeks ago and is already starting to help manage the service. The manager also explained that whilst there are four senior staff, she has used them to lead shifts and has not wanted to burden them with additional responsibilities whilst they have been learning about the residents and the daily operation of the home. The pressure of managing all the aspects of the service on a daily basis has meant that she has not had time to monitor the service and staff team to ensure they are working as effectively as possible. This is reflected in the fact that staff are not being supervised as regularly as they should and health and safety checks are not as frequent as necessary. Since the previous key inspection the annual quality assurance exercise seeking the views of the service users and relatives has taken place. The completed questionnaires were inspected and were very positive. The exercise needs to be extended to care professionals and other people associated with the home to get some broader feedback. The manager explained that the owner regularly visits the home and checks what is happening. This needs to be formalised through the use of a checklist designed to meet the requirements associated with regulation 26 of The Care Home Regulations. This will ensure the performance of the home is properly monitored and that issues that need to be addressed by the manager are completed. The staff supervision records were inspected for six staff. The manager explained that the deputy manager has started to supervise some of the staff. The records show that supervisions are not yet happening regularly and there needs to be a clear structure showing who will supervise each person. Progress with supervisions needs to be monitored to ensure they are all happening at appropriate time intervals. The manager explained that in most cases families manage the finances of residents. The home just holds some cash for some residents to spend for example on chiropody or hairdressing. The records for this cash expenditure were inspected and they are now signed by two staff whenever money is withdrawn. The cash is held in the safe and each resident’s money is stored in a separate pouch. The manager explained that only herself and the owner and his son can access this cash. The current certificates were available to confirm the maintenance for the electrical appliances, gas appliances, fire alarm and extinguishers, lift, hoists, nurse call and water system. The portable electrical appliances now need a maintenance check. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 29 The fire records show that the fire alarm is being checked on a weekly basis and fire drills are taking place quarterly. Fire notices are now displayed stating what people should do in the event of a fire. The staff training records show that for most areas of health and safety including food hygiene, first aid, moving and handling and infection control the staff have either received the training or are booked to attend training. The exception to this is fire safety training where only nine staff have received or are booked for the training. This training is essential to ensure staff can help the residents in the event of a fire. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x 1 x 2 Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 31 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 OP2 Regulation 5(1)(b) Requirement The registered person must ensure each resident has a contract between themselves and the home, which is signed by both parties. The registered person must ensure the manager has refreshed her training on safeguarding vulnerable adults and is familiar with local safeguarding procedures to help prevent service users being placed at risk of harm or abuse. The registered person must ensure there are adequate numbers of staff available in the home by providing regular administrative support to assist the manager and the care staff so they can perform their roles. The registered person must ensure all the staff have received the training they need to perform their work including the completion of their induction. The registered person must ensure the quality assurance exercise also seeks the views of care professionals and other DS0000069167.V364181.R01.S.doc Timescale for action 30/06/08 2. OP18 13(6) 30/06/08 3. OP27 18(1)(a) 31/07/08 4. OP30 18(1)(c) 31/07/08 5. OP33 24 (1) (a) (b) 30/08/08 Autumn Gardens Version 5.2 Page 32 6. OP33 26 7. OP36 18 (2) 8. OP38 37 (1) (e) 9. 10. 11. OP38 OP38 OP38 23(4) 13(4) 13 (4) (a) 12. OP9 13(2) 13. OP9 13(2) stakeholders. The registered person must complete regulation 26 visits that are recorded and provide a thorough inspection of the service. The registered person must ensure that all staff must have at least 6 supervision meetings each year so that their care practice can be improved. This requirement is restated. Previous timescale of 29/02/08 was unmet. The registered person must ensure that all events in the home which adversely affect the wellbeing or safety of any resident must be reported to CSCI without delay. This requirement is restated. Previous timescale of 11/01/08 was unmet. The registered person must ensure all staff have completed fire safety training. The registered person must test the portable electrical appliances to ensure they are all still safe. The registered person must ensure that regular and systematic health & safety checks of the premises, both inside and outside of the building, must be made so that residents are kept safe. This requirement is restated. Previous timescale of 11/01/08 was unmet. Medication records are required to be complete and accurate to account for the administration of medicines to users of the service in accordance with prescribed directions. The medicines storage room temperature is required to be maintained below 250C. DS0000069167.V364181.R01.S.doc 31/07/08 31/07/08 15/06/08 30/08/08 31/07/08 31/07/08 03/06/08 03/06/08 Autumn Gardens Version 5.2 Page 33 14. OP9 13(2) Additional documented information is required with the medicines administration record (MAR) chart where further guidance to the prescribed directions is required. 03/06/08 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. 4. 5. 6. 7. 8. 9. Refer to Standard OP3 OP6 OP6 OP19 OP19 OP26 OP27 OP29 OP31 Good Practice Recommendations The assessments completed by the home, should be reviewed to ensure they contain the necessary detailed information. The care plans should continue to be reviewed to ensure they are person centred, holistic, have clear goals and reflect decisions made at review meetings. Key-workers should be enabled to attend review meetings and support the residents to attend healthcare appointments. The environment of the home should continue to be reviewed to ensure it is user-friendly for people with dementia. The furnishings in the lounge should continue to be reviewed to ensure it is comfortable and homely. The hand drying arrangements in communal toilets should continue to be reviewed to ensure they provide appropriate standards of infection control. Ongoing efforts should be made to recruit Greek-speaking staff, especially at night. Staff records should be checked to ensure all staff have current permission to work in the UK if needed. The manager must ensure she has the correct balance in terms of the time taken in participating in direct care and performing managerial responsibilities to ensure the service is managed in a proactive rather than reactive manner. To avoid the risk of cross-contamination of blood-borne infections, disinfection facilities and a documented procedure that includes granules containing sodium dichloroisocyanurate should be provided for dealing effectively with any blood DS0000069167.V364181.R01.S.doc Version 5.2 Page 34 10. OP26 Autumn Gardens 11. 12. OP9 OP9 13. OP9 14. OP9 spillage. To meet the home’s access to medicines information it is recommended to keep a recent edition of the British National Formulary (BNF). To keep a record of the maximum/minimum temperatures available using the medicine fridge thermometer to provide accountability of meeting the medicines licensed storage conditions. To update the home’s medicines policies & procedures with respect to dealing with medication errors, Controlled Drugs, self-administration and retention of medication following the death of a resident. To reference documentary guidance on medicines provided by the CSCI and the Royal Pharmaceutical Society of GB as an aid to the safe usage and control of medicines. Autumn Gardens DS0000069167.V364181.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V364181.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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