Inspection on 29/04/05 for Autumn House

This inspection was carried out on 29th April 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 19/10/05

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 29 April 2005 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 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 H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 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 DE/E (20), MD/E (3), OP (34), PD/E (3) registration, with number of places Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18/11/04 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 H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection with two inspectors and took place between 11:00 am and 4:00 pm. The inspection included a partial tour of the premises and inspection of some of the records, and the inspectors spoke to 8 of the 29 residents, 2 of the 6 members of staff on duty that included the cook and the manager, and 3 visitors. The proprietor was available later in the afternoon. It was not possible for the inspectors to engage with all of the residents; some have communication difficulties due to cognitive impairment. Comments from residents and visitors were positive and expressed satisfaction with the care provided. There were 11 requirements and 2 recommendations from the last inspection and not all of the requirements had been met, or met within the agreed timescale for action. Failure to meet the requirements and to comply with the Care Homes Regulations 2001 has the potential to put at risk the health, safety and welfare of the residents and staff. What the service does well: What has improved since the last inspection? Previous inspections have required the registered manager to ensure that the grounds of the home are kept free from rubbish and old furniture at all times. At this inspection, although the furniture had been cleared from the central courtyard, the other two courtyards had piles of rubbish and a fridge freezer and a washing machine left in full view of residents’ bedrooms. However, since the inspection, the proprietor has confirmed by letter that this has been cleared and that in future, rubbish for disposal will be stored out of sight of the residents’ accommodation and communal rooms. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 6 Some of the rooms have been refurbished since the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 standard(s) 1 and 4 The information provided for prospective service users and their relatives is not up to date. The home is unable to fully demonstrate that it can meet the assessed needs of service users with dementia. The Registration Certificate must be displayed in a prominent place. EVIDENCE: The home’s Statement of Purpose is available in the entrance hall, however, some of the information needs to be reviewed and updated about the organisational structure of the home. Information that must be included in the Statement of Purpose is listed in Schedule 1 of the Care Homes Regulations. The requirement made at the last inspection, and at an extra inspection visit last year was to ensure that all staff receive training in dementia awareness. At the last inspection the manager said that an introductory session in dementia awareness had been arranged with a member of the Community Mental Health Team. However, very few of the staff actually attended the Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 9 training session. A further course of training for staff in dementia care is in the process of being arranged and the registered manager must provide evidence that all staff working in the home have done this training and that it is regularly updated. The home is registered to provide care for older people with dementia and must demonstrate that staff in the home have the skills, experience and qualifications to meet the assessed needs of people admitted to the home. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 standard(s) 7 and 8 The individual plan of care does not contain sufficient information to guide staff on the care to be provided. The care plans do not demonstrate that service users health care needs are being fully met. EVIDENCE: Three individual care plans were inspected and contained the initial assessment and care plan but lacked some essential information such as falls risk assessment and guidance on how care staff should assist with mobility, a detailed risk assessment where particular risks have been identified, a continence assessment and management plan, dietary assessments and nutritional and weight charts and where appropriate, the diagnosis and the risks associated with particular behaviour. The manager must demonstrate that professional advice has been sought about the promotion of continence and is acted upon and aids and equipment provided. The manager must also demonstrate that professional advice is sought for those residents with a sensory loss or who have particular mobility needs and action is taken to assess for, and prevent falls. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 11 Staff were observed assisting residents to move around the home and examples of practice that could put residents and staff at risk were discussed with the manager. Some identified care needs were not sufficiently recorded in the care plans with clear guidance for staff. Discussion with the manager and staff showed that there is a good awareness of residents’ health care needs but a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems but residents are at risk if these informal systems break down. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 standard(s) 13 and 15 Visitors are always welcome in the home. The menu should be reviewed to ensure that residents are receiving a wholesome and balanced diet and meets nutritional requirements. Staff in the home provide some of the social activities for residents. EVIDENCE: At the time of the inspection, some of the staff were doing a music session with the residents in one of the sitting rooms. The menus provided show that most of the main meals of the day are processed food such as beefsteaks, meat pie, fishcakes, sausages, corned beef hash and minced beef. This was discussed with the manager and cook at the previous inspection. In discussion with the cook it is clear that alternatives such as omelette, or salad are always available but the cook who prepares the menus was not available. Two of the residents spoken to said that they felt that the meals had recently improved but it was not possible to get the views of other residents. The registered manager must ensure that residents’ choices and preferences are regularly sought and ensure that the diet meets the nutritional needs of the residents in the home. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 13 It was evident that visitors are always welcome in the home and visitors told the inspectors that staff are always friendly and welcoming. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 standard(s) 18 The employment policies and procedures in the home are not thorough enough to ensure that residents are protected from possible abuse. The registered manager must acquire the Department of Health Guidance about the requirements of employers with regard to the Protection of Vulnerable Adults Scheme that was introduced in July 2004 and the amendments to the Care Homes Regulations 2001. EVIDENCE: Shortfalls in the home’s employment procedures were identified at the last inspection and will be outlined under Standard 29. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 standard(s) 19,20,24,25 The building is poorly maintained in parts and there is no evidence that maintenance is planned and prioritised to ensure that the safety and welfare of the residents is made a priority. The poor decorative condition of the home was commented upon at the last inspection by health and social professionals who work with the home and by a visitor. EVIDENCE: A planned programme of maintenance and renewal for the building has not been produced. Some of the requirements that have not been met affect the health and safety of the residents. Other requirements with regard to meeting the minimum standards for individual bedroom furnishings have not been met. In addition this inspection identified concern about the lack of maintenance on the glass porch roof at the front of the house, a raised and loose floorboard in room 21, no window restrictor in room 14, no radiator cover in room 15, upstairs carpet very faded and stained, bedroom doors without locks fitted, Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 16 two bedrooms without headboards on the bed, refurbishment needed to room 30, and bags of rubbish and a fridge freezer and washing machine left outside in view of residents’ bedrooms, peeling paint and rotten windows to the outside of two ground floor bedrooms, dilapidated paintwork on the windows at the front of the building. Two of the bedrooms do not have carpeting or bedside lights and the commodes were old and dilapidated. Enforcement action with regard to the large amount of rubbish left in the courtyards was being considered but the proprietor has now confirmed by letter that the rubbish has been cleared. However, this requirement was not met within the agreed timescale for action. The maintenance programme for the building must prioritise those repairs that are essential to the health, safety and welfare of the residents and all bedrooms must meet the National Minimum Standards with regard to decoration and furniture and fittings. Because of serious concern about one bedroom that was very poorly furnished, had lino on the floor, no bed headboard, and rubbish stacked outside the window, the care manager for this resident was asked to look at the room and requirements will be made to ensure that the room meets the needs of this resident for comfort and privacy and attractive and cosy surroundings. The last inspection recommended that consideration should be given to creating enough accessible outdoor space to meet the needs of the residents and that consideration should be given to providing a separate and accessible area for those residents who smoke. These recommendations have not been addressed by the registered manager. Residents who smoke can do so in the area of corridor outside of the dining room, however, chairs that were there previously, have been taken away. Some of the rooms have been refurbished and one bedroom was in the process of being renovated at the time of the inspection. It is recommended that pads are stored in bathrooms and individual bedrooms discreetly and attractively rather than on the floor of bathrooms, or in full view of people using the bathroom. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 & 30 The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. Staff have not received training in all aspects of safe working practice. EVIDENCE: Two staff files were looked at, one contained the application form, two written references and evidence of a Criminal Records Bureau Check, but the other file only had one written reference. One member of staff who has been working in the home for over a year does not have a CRB check. It is also recommended that the application form is developed to ensure that enough information is requested from prospective members of staff to demonstrate a full employment history that can be checked by the manager. The manager has recorded in a notebook the training that all members of staff have done, it is recommended that a staff training matrix is produced so that the manager can check when staff training and updates are due in all of the mandatory parts of training in health and safety and safe working practice. The manager’s records show that not all staff have done training in safe lifting and moving, infection control, health and safety awareness, first aid, etc. Very few of the staff have done any training in dementia awareness. Although this is being arranged as a distance learning course for staff in the home, this should have been part of the training plan for all staff in a home that is registered to provide care to older people with dementia. There is ongoing training for staff to achieve the NVQ level 2 or 3 in care. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 38 The manager still has to achieve a relevant management qualification. The poor maintenance of the premises has the potential to put the health and safety of residents at risk. Lack of training for staff in safe working practice has the potential to put the health and safety of residents and staff at risk. EVIDENCE: It is recommended that advice be sought on the requirements for the storage of food and checking freezer temperatures. Some of the staff have not received training in all of the mandatory aspects of staff training in safe working practice such as health and safety, safe lifting techniques, infection control, first aid and fire safety. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 19 The fire safety log book was up to date but there were no records of fire drills. A process for doing suitable and sufficient risk assessments including individual risk assessments must be developed. Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 1 x x x 1 1 2 STAFFING Standard No Score 27 x 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 x x x x x x 1 Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 21 Yes 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 1 Regulation 4& Schedule 1 Timescale for action The Statement of Purpose and 30 June Service User Guide must meet all 2005 of the requirements as set out in Schedule 1. The organisational structure of the home should be included. All care staff must have received 30 training in dementia December care/dementia awareness. 2005 The manager must ensure that 30 June risk assessments are sufficent 2005 and suitable for any significant risks to residents or staff. Care plans must reflect that 30 June professional advice has been 2005 requested with regard to particular or specialist care needs such as mobility, continence etc. Staff must not be employed in With immediate the home unless all checks required by legislation have been effect from carried out and are satisfactory. 29 April 2005 The registered manager must 30 June acquire the Department of 2005 Health guidance on the Protection of Vulnerable Adults. The outside of the home must be 30 decorated and maintained in a December good state of repair. 2005 Version 1.30 Page 22 Requirement 2. 3. 4 7 18 15 4. 8 13 5. 18 19 6. 18 19 7. 19 23(2) Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc 8. 20 23 9. 30 18 10. 31 9 11. 38 23(5) 12. 38 17(2) Schedule 4(14) Bedrooms identified in the report as not meeting the National Minimum Standards for health and safety and minimum furnishings must do so within the agreed timescale. All care staff must receive training and regular updates in all aspects of safe working practice such as moving and handling, infection control, fire safety, first aid and health and safety. The registered manager must meet the minimum requirements for a qualification in care and management. The registered manager must consult with the Environmental Health Department to ensure that the home meets all of the requirements for the storage of food including freezers. A record must be kept of every fire practice or fire drill with the names of staff who were there on each occasion. 31 July 2005 30 December 2005 Timescale to be agreed 31 July 2005 1 June 2005 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 15 Good Practice Recommendations The registered manager must demonstrate that residents are regularly consulted about their preferences and choices for meals and that the meals provided are wholesome and nutritious. Consideration should be given to making the garden bigger and accessible to all residents. Consideration should be given to making a separate and accessible area for those residents who smoke. 2. 3. 4. 20 20 Autumn House H55_H04_S12463_Autumn House_V218250_290405_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Mill Court Furrlongs Newport Isle of Wight, 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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