Inspection on 19/10/05 for Autumn House

This inspection was carried out on 19th October 2005.

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

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

Other inspections for this house

Autumn House 23/09/08

Autumn House 11/10/07

Autumn House 30/11/06

Autumn House 27/04/06

Autumn House 29/04/05

Autumn House 18/11/04

Autumn House 12/05/04

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

CARE HOMES FOR OLDER PEOPLE Autumn House 25 - 27 Avenue Road Sandown Isle Of Wight PO36 8BN Lead Inspector Annie Kentfield Unannounced Inspection 19th October 2005 11.00 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 House DS0000012463.V250831.R01.S.doc Version 5.0 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 House DS0000012463.V250831.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Autumn House Address 25 - 27 Avenue Road Sandown Isle Of Wight PO36 8BN 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) 01983 402125 Mrs Janet Holmes Mrs Debra Ann Young Care Home 34 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (34), Physical disability over 65 years of age (3) Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home accommodates one person under the age of 65 years. MD(E) applies to specifically named residents and will cease upon those residents no longer being accommodated at the home 29th April 2005 Date of last inspection Brief Description of the Service: Autumn House is a large period property situated in a busy part of Sandown. The property has been extended in recent years and provides accommodation on the ground and first floors for up to 34 older people and is registered to provide care for up to 20 older people with dementia. The first floor can be accessed via a passenger lift, though there are parts of the first floor that are only accessible for those residents who are fully mobile. There is limited parking in the street and staff park in the courtyard area of the building. There is a very small area of garden to the rear of the property. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection and took place between 11.00 am and 4.00 pm, with two inspectors. The inspection covered a tour of the premises, inspection of some of the home’s records, and discussion with some of the residents, staff, and a visitor who was in the home at the time of the inspection. Many of the residents are not able to give feedback to the inspectors about living in the home due to varying levels of cognitive impairment, however, the visitor spoken to said that they were “very happy with the care provided to their relative”. The inspection was also an opportunity to monitor the home’s compliance with requirements and recommendations from the previous inspection that took place in April 2005. At the time of the inspection there were 31 residents with 5 care staff on duty until 1.00 pm with the manager, cook, housekeeper and maintenance person in addition. There are usually 3 or 4 carers on duty between 1.00 pm and 8.00 pm. The home also offers occasional day care to some local residents and can offer residential respite care if there is a room available. What the service does well: What has improved since the last inspection? There have been significant improvements to the physical environment of the home since the last inspection: The exterior of the building has been painted. All of the windows have been replaced with UPVC double glazed windows. Some of the bedrooms have been decorated and refurbished. The seating area in the garden has been extended and the outside area improved to make it more attractive for the residents. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 6 The home is in the process of installing better laundry facilities. In addition, the home has worked hard to meet the previous requirements for developing and improving care plans and risk assessments and staff training. Further details of all the improvements are included in the body of the report. The home has also taken action on the previous recommendation to review the menus and meals provided and there have been positive changes for the benefit of the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 All prospective residents have an assessment of their care needs before moving into the home. Previous requirements are being addressed and there is an ongoing staff training programme in dementia care to ensure that staff have the skills and experience necessary for the care that the home offers to provide. EVIDENCE: Since the last inspection the manager and senior care staff have worked hard to review the initial care assessment and put into place a system that records all of the social, health care and psychological care needs of residents moving into the home. This information forms the basis of the individual care plan and information for care staff on the care to be provided. A requirement that has been made over several inspections is now being met and staff are currently undertaking a distance learning course in dementia care and looking at all aspects of good practice in the care of older people with dementia. This training is evaluated and staff given a credit when the training is completed. This is essential training for care staff in a care home that is Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 9 registered to care for up to 20 older people with varying levels of dementia and the training demonstrates that staff will have the skills and experience needed to meet the assessed needs of people admitted to the home. The registration certificate for the home is now displayed in a prominent place in the entrance of the home, as required by regulation. The manager confirmed that the home’s Statement of Purpose provides the information about the home needed by residents and/or their families before deciding to move into the home. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The information contained in the individual plans of care has significantly improved since the last inspection. The home has efficient policies and procedures for the handling and storage of residents’ medication. There is evidence that residents are always treated with respect and dignity and their right to privacy maintained. EVIDENCE: The inspectors looked at a sample of individual care plans and there was evidence that the care plans, risk assessments and risk management plans have greatly improved and contained clear guidance for care staff on the care to be provided. Some further recommendations were discussed with the registered manager and it is hoped that where practicable, care assessments and care plans will be agreed and signed by the residents. The manager and a senior carer explained that they are developing a ‘care mapping’ approach to providing care to residents with dementia and this includes a risk management plan, a life history and details of residents’ likes and preferences as well as details of the specific health care and psychological Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 11 care needs. It is hoped that the new format for care plans will develop the home’s commitment to providing a co-ordinated approach to providing care for residents with dementia. Medication storage, recording and dispensing was inspected and it was noted that the Community Review Pharmacist recently inspected the home and all was recorded as satisfactory. The storage and recording of controlled drugs was satisfactory with one exception. The registered manager is required to ensure that all unused medication is returned promptly when no longer being used. Since the last inspection, action has been taken to fit locks to bedroom doors and residents are provided with keys where the risk assessment indicates that this is appropriate. There is evidence from the visitor spoken to, and from the cards and letters on display, that residents are treated with respect and dignity. During the inspection, care staff were seen to engage with residents in an appropriate and gentle manner. It was evident that staff have the skills and experience to engage with residents who sometimes present challenging behaviour due to their cognitive impairment. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Residents are offered a range of social activities. The menus have been reviewed to ensure that residents are offered a wholesome and balanced choice of meals and snacks. The friends and families of residents are welcome to visit the home at any reasonable time. EVIDENCE: On the day of the inspection residents were being offered a music session in one of the living rooms and other gentle activities are offered by the staff or by arrangement with a local organisation. Some of the residents are very independent and able to go out and undertake activities of their choice. For the residents who need more support, staff try to encourage participation in activities suited to their abilities and preferences such as games or listening to music or creative activities. Since the last inspection the manager has taken action to review the menus and different meals are being offered to encourage residents to enjoy a wider variety of nutritious main meals. Some of the residents are able to express choice and preference but where residents are not able to do this, staff carefully note what dishes are enjoyed more than others and review the menu accordingly. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 13 Since the last inspection, the Environmental Health Officer for Food Safety has inspected the home, and the inspection was satisfactory with no recommendations or requirements. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The employment procedures in the home are not sufficiently thorough to ensure that residents are protected from possible abuse. EVIDENCE: The requirement from the last inspection has not been met and the registered manager must review employment procedures. New staff must only start working in the home when all the required checks are in place and are satisfactory. Inspection of three staff files found serious gaps in the information required by regulation and further clarification of the requirements have been set out in a separate letter to the registered manager. The manager must also ensure that new staff only receive their initial training and induction from a qualified and senior member of staff. Records showed that new staff were being inducted into the home’s policies and procedures by relatively new and unqualified staff and were not being supervised by the manager or senior care staff. The manager explained that there have been no complaints about the home since the last inspection, however, the complaints record book was not available and in discussion, the manager agreed that the record book would be available for future inspections. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 There have been considerable improvements to the home environment since the last inspection. The home was found to be clean and tidy and comfortable for the residents. EVIDENCE: Since the last inspection most of the windows in the home have been replaced with UPVC double glazed units and the exterior of the building has been painted. A new outdoor wooden building has replaced the old laundry shed and new laundry facilities were in the process of being installed with greater space and capacity for the large amount of laundry that the home generates. The garden area has been re-arranged to provide greater space for residents to sit outside and an outside dining table and chairs have been provided. Wooden gates have been installed to ensure that the garden is safe and secure for residents. There have been further improvements to the inside of the building and some of the bedrooms have been decorated and refurbished. The inspection Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 16 particularly noted that two ground floor bedrooms have had lino flooring replaced with carpet and some of the commodes and other equipment have been replaced. The inspection also noted that old furniture and rubbish waiting for disposal is no longer stored in areas that are visible to the residents and this is a major improvement. Some minor defects that were noted during the inspection have either been addressed or there are plans for these to be addressed in the near future. Some of the bathrooms are currently in need of new fittings and flooring and the home’s owner explained that there are plans to upgrade the bathrooms and provide a new sluicing facility as part of the home’s ongoing programme of maintenance and refurbishment. The home employs a housekeeper who has worked in the home for a number of years and clearly has an efficient routine to ensure that all areas of the home are always clean and tidy. In discussion with the manager and staff some recommendations were made to improve infection control procedures, particularly in bathrooms where soiled items and paper hand towels are being disposed of in the same bin. The sluicing facilities are currently in a ground floor shower room. Staff explained the home’s infection control procedures and confirmed that gloves and aprons are always provided. It was recommended that a chain on the sluicing sink plug would improve infection control procedures. All shared washing areas have liquid soap and paper towels provided. It was also recommended that pads could be stored discreetly wherever possible in bathrooms or residents’ bedrooms. The inspectors viewed the premises including residents’ bedrooms and on the whole all areas of the home were found to be free of any unpleasant odours. Where this was not the case, the manager and staff were aware of the problem and were taking steps to address this. Individual bedrooms were comfortably furnished and personalised with residents’ own possessions. Locks have been fitted to bedroom doors and the maintenance person was in the process of ‘making good’ all of the bedroom doors. The home has a range of equipment available to assist residents with mobility including grab rails, hoists and bath hoists. The manager confirmed that all equipment is regularly checked and maintained. There is a call alarm system and residents confirmed that the alarm system works. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 There were sufficient numbers of staff on duty to meet the needs of the residents. The staff training requirements from the previous inspections are in the process of being addressed. Recruitment procedures are not sufficiently thorough to meet the requirements of the Care Homes Regulations and these must be reviewed. EVIDENCE: The requirement to ensure that checks are in place before staff start working in the home has been discussed under Standard 18 and addressed in a separate letter to the registered manager. The manager has developed new application forms and a checklist for recruiting new staff but this has not yet been put into practice. The manager has organised the staff rota to provide extra staff in the mornings when residents need most support and there are usually 5 care staff on duty with the manager, cook and housekeeper in addition. Between 1.00 pm and 8.00 pm there are usually 3 or 4 care staff on duty and two staff on duty at night. The home employs 3 cooks who between them cover each day of the week and prepare the lunchtime and evening meals. Since the last inspection, all of the care staff have been following a distancelearning course in dementia care and feedback from staff during the inspection Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 18 said they were finding the training very helpful. This was a requirement from previous inspections. The last inspection also required the registered manager to ensure that staff receive training and regular updates in all aspects of safe working practice and the manager confirmed that this is being addressed and training is planned for staff in safe moving and handling in the very near future and training will be arranged in all of the mandatory areas of safe working practice as soon as possible. Although this standard is not yet fully met, a requirement has not been made, as there is evidence that the home is working towards meeting this requirement. It is recommended that the manager produce a stafftraining matrix so that checks can be easily made to see when training needs to be arranged for new staff or updated for existing staff. Some of the care staff are in the process of achieving either NVQ level 2 or 3 in care. New staff follow a recommended induction-training programme but the manager must ensure that new staff are supervised in the induction process by qualified and experienced staff and not by new or unqualified staff. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38 The manager and staff clearly work hard to ensure that residents receive a high standard of care and attention and to provide a relaxed and comfortable home environment. However, this commitment to the health and welfare of the residents must be supported by a commitment to protecting the residents through the home’s recruitment procedures. The home has started to develop an organised approach to staff training and development and is developing a planned approach to good practice in dementia care and this is seen as a very positive development. EVIDENCE: The registered manager is currently enrolled to achieve the NVQ level 4registered manager award. Current guidance recommends that where registered managers do not yet have the minimum qualification requirements, these should be achieved by 31 September 2007 (NVQ level 4 in care and NVQ registered manager award, (or equivalent). Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 20 The manager has a positive and energetic approach to managing the home and is always available for residents or staff to discuss any issues that arise in the day-to-day running of the home. Comments have already been made about the need to safeguard residents best interests through the home’s record keeping, policies and procedures and since the last inspection these have improved in the area of care assessments and care planning. Following the inspection, the manager has taken further action to ensure that the home’s recruitment procedures meet the regulatory requirements. The manager also needs to plan an effective system of quality assurance based on seeking the views of residents or their representatives in order to measure success in meetings the aims and objectives and statement of purpose of the home (National Minimum Care Standard 33). Other records seen during the inspection demonstrated that the manager maintains checks and records to comply with the relevant health and safety legislation and it was noted that a review of the fire safety risk assessment was completed in September of this year. The fire safety logbook was up to date on tests of the fire alarm and emergency lighting. Training is being planned to ensure that all of the staff have regular training in all areas of safe working practice and all of the staff have completed training in the safe dispensing and recording of medication and in fire safety. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 21 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 3 3 X N/A 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 X 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 22 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. 2 Standard OP9 OP29OP18 Regulation 17 & Schedule 3 19 and Schedule 2 Requirement The registered manager must ensure that any unused medication is returned promptly. Staff must not be employed in the home unless all checks required by legislation have been carried out and are satisfactory. This requirement has not been met from the inspection of April 2005. FURTHER FAILURE TO COMPLY WILL RESULT IN ENFORCEMENT ACTION. The manager must meet the minimum qualification requirement for registered managers. Timescale for action 19/10/05 30/11/05 3 OP31 9 30/09/07 Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 23 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 Refer to Standard OP33 Good Practice Recommendations It is recommended that the service satisfaction questionnaire that the home has introduced be developed as part of the home’s quality assurance and quality monitoring system. Autumn House DS0000012463.V250831.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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