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Inspection on 18/09/07 for Autumn House Nursing Home

Also see our care home review for Autumn House Nursing Home for more information

This inspection was carried out on 18th September 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Autumn House offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carer and resident. The establishment of a professionally accountability towards effective assessment, detailed care planning and review of resident`s needs are meaningful and robust, in formulating a good standard of care. This personable attitude and approach to care is appreciated and welcome by residents and visitors alike. Care assessment, planning, review and monitoring are efficient and meaningful. Maintenance of good staffing levels, staff training and development, are established in safeguarding the interests of residents. The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of the elderly. There is a continuing appraisal and review process of facilities and services to maintain that environment, by the Registered Provider and Care Manager

What has improved since the last inspection?

The Home has demonstrated a commitment to caring for the elderly with very high standards, which need to be maintained. In addressing care standards` recommendations, the Home has demonstrated a meaningful commitment to the ethos of continuing improvement of standards. Staff training, fire precautions, general maintenance and records management have been reinforced.

What the care home could do better:

The achievements have been recognised, areas of detail highlighted in recommendation will continue to play a part in the ongoing development and maintenance of an honest, solid, and yet a homely service. Continuing surveillance of medicine administration and staff recruitment procedures need reinforcement.

CARE HOMES FOR OLDER PEOPLE Autumn House Nursing Home 37 Stafford Road Stone Staffordshire ST15 0HG Lead Inspector Mr Keith Jones Key Unannounced Inspection 18th September 2007 03:27 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 Nursing Home DS0000022309.V343879.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 House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn House Nursing Home Address 37 Stafford Road Stone Staffordshire ST15 0HG 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) 01785 812885 01785 615506 lpowell@waverleycarehomes.co.uk Waverley Care Homes Limited Mrs Lesley Barbara Powell Care Home 67 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (31), Physical disability (31), Physical disability over 65 years of age (31) Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 1 Physical Disability (PD) - minimum age 50 years on admission Nursing Care 31 Physical Disability (PD) - Minimum age 60 years years on admission - Nursing Care 4 Physical Disability (PD) - Minimum age 50 years on admission Personal Care 14th August 2006 Date of last inspection Brief Description of the Service: Autumn House is a care home providing personal care, nursing care and accommodation for up to 67 elderly service users. The home is registered with the Commission for Social Care Inspection to care for service users with the following needs: - dementia, mental disorder (excluding learning disability or dementia), old age, (not falling within any other category) and physical disability. The home is owned by Waverley Care Homes Limited who also own the other care home located on the site. The home is located on the outskirts of the town of Stone in Staffordshire. Amenities, including those in Stone town centre are situated within walking distance. The home consists of two floors, the ground floor is home to service users requiring personal care and the first floor is dedicated to those needing nursing care. There is a passenger lift installed serving both floors. Most bedrooms have en-suite facilities, with some double rooms available. There is a patio area with tables and chairs and a substantial car-parking area at the front of the home. Information from the registered care manager identified that the fees for the service ranged from £357 to £540 per week depending upon individual need and other contributions from other agencies or individuals. Additional charges were also made for hairdressing facilities, newspapers, chiropody services and some transport costs. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted with the Care Manager, Deputy Manager, senior nursing and care staff. The last inspection report was discussed, and it was noted that outstanding requirements and recommendations from that visit had been, or are in the process of being dealt with. The Inspector acknowledged receipt of the prepared Annual Quality Assurance Assessment and 13 comment sheets, mainly complimentary, with some useful advice. “Always phone me and keep me informed, they respect my and mum’s wishes”, “I get good attention, Autumn House is fine”, “Always fresh and clean, staff kind and considerate”. Surveys were also received with comments about the home’s services, activities and décor, none were over critical, and all were shared with the management. On the day of inspection there were 63 service users in residence, of which 33 were categorised as requiring nursing care. There were five service users who were case tracked, which confirmed the establishment of a comfortable and well-run care home. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of service users, relatives and members of staff. Service users and staff took an active role in the inspection process and contributed to the subsequent report. The tour of the Home was carried out in a relaxed, courteous and professional manner; most of those approached expressed confidence in the atmosphere. Service users approached were generally complimentary of the care, service and attention they received from a willing, attentive care team. Relatives who were present were complementary of the approach to care, the freedom they enjoyed and the involvement that the providers, manager and her staff encouraged. Comments on how welcome they are made after a long journey were noted. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. A review of the administrative arrangements confirmed solid practice and effective management. A full verbal report was offered at the end of the inspection to the Provider and Care Manager. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. What the service does well: Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 6 Autumn House offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carer and resident. The establishment of a professionally accountability towards effective assessment, detailed care planning and review of resident’s needs are meaningful and robust, in formulating a good standard of care. This personable attitude and approach to care is appreciated and welcome by residents and visitors alike. Care assessment, planning, review and monitoring are efficient and meaningful. Maintenance of good staffing levels, staff training and development, are established in safeguarding the interests of residents. The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of the elderly. There is a continuing appraisal and review process of facilities and services to maintain that environment, by the Registered Provider and Care Manager What has improved since the last inspection? What they could do better: The achievements have been recognised, areas of detail highlighted in recommendation will continue to play a part in the ongoing development and maintenance of an honest, solid, and yet a homely service. Continuing surveillance of medicine administration and staff recruitment procedures need reinforcement. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 7 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 House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 9 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): 1,2,3,4,5 The quality in this outcome area is good. This judgement is based on the examination of the Home’s policies, procedures, practices and discussions with management. Autumn House ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. It is recognised that the Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live, through the Service User Guide. The provider ensures that the admission process is a reflection of a joint understanding that residents are aware, and that staff are able to meet expectations to realise a comfortable transition. Following an assessment the senior Nurse assessor determines the suitability of the application in view of the facilities available, and of the capacity of the home, to manage the individual and any special needs. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 10 The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a Home to meet individual needs. EVIDENCE: The Statement of Purpose continues to represent a description of the Home’s aims and objectives, philosophy of care and terms and conditions. It is recognised that the Statement of Purpose represents the foundation on which the Home operates upon, offering Service Users and their relatives the opportunity to make an informed choice about where to live. A separate and well-produced Service User’s guide serves as a readable summary of the Statement of Purpose and supporting information, widely used to inform all interested parties. Versions with larger print with more pictorial representation would be helpful. The Home continues to deploy a clear statement of contractual agreement. The Statement of Purpose clearly indicates the terms and conditions, which are discussed with service users and relatives prior to admission. Reference to the agreed bedroom of residence in the document would be recommended. Case tracking of five individual residents clearly identified that the Care Manager, or her deputy, at the point of reference, conducts the pre-admission assessment. The documentation was examined and found to be comprehensive, providing a solid foundation for progressive care planning. This assessment is produced with the full involvement of service users and family, allowing them to influence the direction of care. The assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. Following an assessment the Nurse assessor determines the suitability of the application in view of the facilities available, and at the capacity of the Home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Any special needs of the individual were discussed fully and documented, ensuring their individual needs would be met. There are two ‘rehabilitation beds available, each with a limited re-ablement design. Case tracking confirmed that a valuable exchange between Service User and assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 11 From discussions with staff and residents it was evident that prospective Service Users and their relatives are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. Service users are admitted for a trial period initially to enable all parties to evaluate whether the Home is an appropriate placement and mutual adjustment before any contractual agreement is signed. At all times relatives are involved in the process. There are several Service Users attending on a day care basis receiving valuable support. It has been recognised that services, resources and facilities are in place to meet up to four placements. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality in this outcome area is good. This judgement is based on the examination of five care plans, discussions with residents, staff, managers, general observations and the Home’s medication system. The care assessment, planning and review system is an organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The provision of medicines administration is managed efficiently, although reinforcement to improve storage and administrative procedures was advised. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care records and case tracking clearly showed that this standard is well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. A profile of the residents’ social, physical and psychological status offered an individual plan of care, based upon activities of daily living, to be implemented and frequently reviewed. Each residents’ health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including residents’ and relatives views, to reflect their changing needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. As is appropriate, a checking chart ensures that constant monitoring of high dependency residents is carried out. Evidence of fluid balance management controlled by the Care Manager was noted. A daily report is maintained to control monitoring, and offer a very comprehensive account of care and service given. Relatives’ involvement in the process was evident. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation. Case tracking confirmed the extent that the carefully prepared, and well-recorded care plans were appreciated by residents and relatives alike. Tissue viability, continence, psychological and special needs are assessed and documented, along with nutritional screening, hearing and sight tests as appropriate. The GP service is supportive on request; through this service, arrangements are made to provide professional support. Continence is assessed on admission and promoted within the plan of care, and there was evidence that service users nutritional needs, and residents’ weights were frequently reviewed. Care staff maintain all aspects of service users personal care, overseen by trained nurses on a daily basis. The administration of medicines generally adhered to procedures to maximise protection to service users. The storage was secure, with satisfactory added security for controlled drugs. The record of administration of systemic medicines was inconsistent, with occasional omissions observed. A controlled drug register was examined and found to be up to date. A discussion over the frequency of some medicines presenting a distribution and storage problem concluded that alternative prescriptions could be arranged. Using a stock bottle for administrating medicines is to be discouraged. The continued use of a ‘Homely Remedy’ process would require updating. Oxygen stored is secured by Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 14 chain to the wall. A resuscitation trolley is stationed on the main corridor and is kept up to date. Staff were reminded to ensure secure and safe practices in relation to control of sharp boxes and of medicine trolleys when administering drugs. There was no resident self-medicating at the time of inspection. Each service user has the opportunity of their own lockable facility in their bedrooms on request. The residential arrangements on the ground floor were examined and found to be satisfactory. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. These policies are reinforced with a staff induction programme and supervised practice. Case tracking confirmed that the policies were implemented, with all service users spoken with being complimentary of the degree of respect given, by each and every member of staff. The inspector observed the free, courteous interaction between service users and staff based on a level of confidence of mutual trust and respect. There was also an observed knowledgeable, and positive attitude towards residents and feedback from the residents: “Always fresh and clean” and “ Autumn House is fine, the staff are really friendly” and “staff are not always available”. Visitors revealed: “Excellent working relationships”, “We are made very welcome after a long journey”, “Matron took me to see my ill wife”. Relatives have freedom of visiting, emphasising on the importance of maintaining social contact. Adequate privacy policies exist for all toilet/bathroom areas and bedrooms. Individual spiritual persuasions were documented and individual diversity respected at all times. There are C/E services held on each 5th Sunday, and a R/C priest attends on request. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is good. This judgement is based on discussions with service users, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. Residents informed the inspector that they were generally satisfied with the way the Home met their social needs, encouraged their family and friends to visit, allowed them to take decisions that affecting their lives. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Residents’ life-styles and interests are recorded in their care plan, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Choices were available for every aspect of daily living and menus provided a varied and good choice of food available on a four weekly programme. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 16 EVIDENCE: From talking to service users and staff it was pleasing to report a continuing daily routine that is flexible and non-institutionalised, offering choice for meal times, personal and social activities including recognition of varied religious needs. At pre-admission the service user’s personal interests and customs are determined, and where possible accommodated within the routine of the Home. That routine is seen as flexible; to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Discussions with residents and staff clearly identified a relaxed and informal atmosphere in which the service user’s needs were paramount. Regular cheese and wine meeting with residents and families are established. The Home employs an activity coordinator working between Autumn and The Manor Houses, with an expectation that each member of care staff to participate in social activities as an integral part of care. This is applied within the care planning process as an integral aspect of care, as evidenced in examination of records and discussion with staff. The Home continues to operate an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. At the time of inspection several relatives were spoken to who expressed their appreciation for the flexibility in management of the service user’s day. Several families travel long distances to visit, and had remarked on how welcoming staff were, including providing a meal and drinks. Service users are encouraged to exercise choice and control over their life as far as is possible. Service users are encouraged to bring into the home personal possessions. Each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. Anyone who is able and wishes to handle their finances, or self-medicate, they do so, although there were no one identified on the day. Each resident has a lockable facility available in their rooms if they wished to handle their own accounts. Service users expressed their preference for their family to retain control, and Power of Attorney. Only small amounts of service users’ cash was effectively handled through the administrator’s office, which are subject to ongoing audit by the Provider. An annual external audit was advised Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 17 On many other matters residents were complementary over the level of choices, but respected the advice and guidance given by their nursing staff. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. One resident with extreme immobility and unable to communicate directly, had a ‘Possum’ system controlled by movement of a single finger. The system was constantly refined to meet changing circumstances. It was pleasing to see the continuing good standards of catering at Autumn House, offering a very acceptable service, to which residents spoken to were complimentary of aspects of quality and quantity. A menu on a four weekly cycle offered a wholesome, varied and excellent choice. Although one resident said they ‘lacked imagination’ the menus showed flair in the choices available. Individual preferences were recorded in assessment and conveyed to cook, who met with, and discussed their requirements. It was confirmed that the cook knew each resident, and some of the relatives. An excellent lunch was served during inspection, served in a well-furnished and clean dining room. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. The kitchen was inspected with the cook and found to present a well equipped and organised area. One Freezer was found to be defective and due to be replaced. All other fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place and seen to be up to date and accurate. Staff were advised to provide suitable protection for visitors to the kitchen area. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 The quality in this outcome area is good. The home had a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. No formal complaint had been received via the Commission since the last inspection. Service users’ legal rights are protected by the systems in place. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. EVIDENCE: The complaints policy was seen and records examined. There were few complaints, one recent, having been satisfactorily by the Care Manager. All residents had received information on the procedure to complain, including reference to the CSCI. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. A ‘complaints’ book would enhance quality control on this issue, with clear recognition of concerns, complaints and allegations. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 19 Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to service users needs and readiness to test the robustness of their information and report structures. Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. This process was evidenced on examination, and case tracking as previously reported upon. The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes led by the Care Managers, clarified the responsibilities of all staff in their daily contact with residents, especially their privileged position in protecting service users from abuse, of all natures. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 The quality in this outcome area is good. The external state of repair and maintenance is generally very good. The grounds are kept tidy, safe and are tended regularly, offering pleasing patio areas for service users. The Home is well equipped to meet the demands of the elderly, with appropriate movement and handling facilities, hand and grab rails, ramps and call alarms. The interior state of repair is at a good standard; bedrooms are well appointed, of a good size and accessible for wheelchairs and walking aids. Communal areas are furnished and decorated to a good standard to present a homely and comfortable environment. Service users live in a safe and well-maintained environment with a planned preventative programme designed to sustain the high standards. The home complies with the fire service requirements, staff receiving two fire lectures/drills per year. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odour-free. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 21 EVIDENCE: External access is satisfactory for visitors. Service users take advantage of attractive grounds; pathways were safe and frequently used throughout the summer. It is expected that the area around the ‘gazebo’ will be block-paved to encourage use by residents. Certain areas of the garden are recognised as certain residents’ little patches. Internal access was facilitated with ample fittings of hand and grab rails in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. The Care Manager confirmed a willingness on the part of management to meet any reasonable demand for special needs. Bedrooms were well maintained to meet service user’s personal preferences. It was pleasing to see that ongoing maintenance has continued to enhance the presentation of the Home with recent up-grades inspected, and found to be of a high standard. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration. A development plan for 2008/09 is presently being drawn up and will be presented to CSCI on finalisation. The Care Manager will arrange for a full unit risk assessment appraisal to be undertaken by the next inspection. There are adequate numbers of variable height beds available. There was evidence of individual arrangements to meet needs, sleeping chairs, fridges, oxygen supplies, etc. All rooms were of a good size and accessible for wheelchairs and walking aids. On inspection bedrooms were personalised, with some displaying residents’ own furniture, and most with personal belongings. It was noted that a substantial number of furniture items were coming to the end of use stage, needing replacement. Overall the attention to detail has not detracted from presenting a homely and comfortable environment. The nurse-call alarm system was satisfactorily tested, and service record checked. All personal electrical equipment where seen to be PAT tested. There is an adequate lighting, and bedside lamps are available where risk assessed. Radiators are safeguarded, although at least one was found to have and unguarded earth wire attached, smoke detectors are fitted and adequate electrical sockets available. TV and telephone points were available in each bedroom; some equipped with large keypad telephones for residents’ personal use. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. Several residents spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 22 Water supplies are checked to confirm protection from, and prevention of Legionella. Water temperature were randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm. Ventilation is by direct door and window airing. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the home. The lounge areas provide comfortable, odour free and a popular centres for socialising and relaxation. The furnishings are of a good quality compatible with the needs of the elderly. The areas offer options for sections, whether to either socialise or seek a little peace and quiet. An activity co-ordinator ensures a programme of events and meaningful diversions, in which social activities have a direct influence in the care reporting and evaluation process. The dining areas offers clean and pleasant environments. For those who prefer to eat alone can do so in the lounge or their own rooms. Staff were seen in attendance, providing attentive personal care in a respectful, yet friendly manner. A new carpet for the dining areas is on order. Communal areas were equally well served with utilities. Servicing records of PAT testing, fire officer’s report and gas certificate were examined and found to be up to date and accurate. An awareness of health and safety issues was high on training and supervision priorities. There is a recreation room, which doubles as a hairdressing area, used once a week. Service users have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odourfree. There is a need to upgrade two baths damaged through wear and tear that had worn enamel. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. Two of the bathrooms were used as storage areas, reducing available options. Advice was offered to secure alternative storage areas. There are adequate sluice facilities, each having suitable arrangements to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate COSHH posters and information charts. It was noted that none of the sluice areas are protected by smoke alarms. It was recommended that all storerooms, including sluices, be safeguarded when not in use. The domestic services in the home were seen to be of a very high standard. The residents and relatives spoken to remarked that they find the environment always very clean and conducive. There was no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection, much to the credit of all staff concerned. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 23 Procedures were in place for coping with soiled/infected linen with the provision of alginate bags to minimise handling and cross-infection. All laundry was transported in a safe and well organised manner. Infection control figures highly within the staff induction and supervisory training programmes. Chemical cleaners were used appropriately throughout the home, and were seen to be secure and under COSHH recommended practices. It was identified that the small stock of communal clothing be discontinued. There had been some discussions with neighbours regarding the long-standing arrangement of drying sheets on lines open, opposite to several houses. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place, up to date and accurately reflecting the observed standards. Autumn House Nursing Home DS0000022309.V343879.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): 27,28,29 and 30 The quality in this outcome area is good. Staffing stability has been maintained with consistent levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving experienced staff. Care bank are occasionally used, with agreed overtime and flexible rostering to accommodate shortfalls. The management have established a procedure for interview, selection and appointment of staff, although in need of review. It is understood that the thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of service users. All staff receive training in care issues within the home from registered nurses and external trainers. EVIDENCE: Three weeks of off-duty were examined, and showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. The Care Manager works supernumerary and is supported by a Deputy and a team of Registered Nurses and Carers. Bank coverage has been used Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 25 occasionally to support shortages of care staff, in tandem with overtime and flexible rostering to meet shortfalls. At the time of inspection the duty rotas confirmed a staff coverage as thus: First floor Ground floor 0800 - 1400 - 2 trained 7 carers 2 Senior 4 carers 1400 - 2000 - 1 trained 5 carers 1 Senior 4 carers 2000 - 0800 - 1 trained 4 carers 1 Senior 1 carer The Care Manager is supernumerary to shift patterns. The catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of the residents. The Home has an activity coordinator shared with the Manor House. There are also Cadets and student nurses attached. The care manager emphasised the home’s commitment to training and to achieving targets for NVQ level 2. There are 27 staff with NVQ level II and level III, representing 60 achievement. Six staff are presently undergoing NVQ training. There are 22 certificated first-aiders on the Home’s staffing establishment. Six staff files were sampled and found to be inconsistent in the process of appointing staff. It was evidenced that POVA and CRB checks have been made. The management have a new procedure for interview, selection and appointment of staff, that as yet has to be proven. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of service users. Staff photographs on file would be advised. The Care Manager will establish a thorough application of a consistent staff recruitment policy. Two on-duty members of staff were interviewed, each expressing their working conditions openly and with confidence. Each individual was complementary as to the level of training they receive, and the management arrangements. Supervision was seen to complement an effective induction and training programme. Diversity issues with staff were discussed and confidence expressed as being recognised and accommodated. The Registered Care Manager remains steadfastly committed to a learning environment. Staff induction programmes have been consolidated on a standard approach and have proven to be effective, forming the base upon which in-service supervision and training are planned. Overall the evidence shows a comprehensive account of a meaningful and important schedule of training to meet internal and external demand. Mandatory training is provided for all staff, and that other training had been undertaken, including: fire safety awareness, feeding and swallowing, food hygiene, abuse and movement and handling. Consideration needs to be given into the implications of the Mental Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 26 Capacity Act 2007, for all senior staff initially, to all staff through cascaded programme. Autumn House Nursing Home DS0000022309.V343879.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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good. This judgement was based on discussions with the Registered Provider and Care Manager, the examination of the Home’s policies and procedures, with regards to the effective management of the home, general observations during the process of the inspection and discussions with residents and staff. The Care Manager has consistently demonstrated the appropriate skills and experience to effectively manage the Home. There is a confidence apparent in the interaction of residents, staff and management, that demonstrated a highly positive relationship that pervades throughout the Home. EVIDENCE: The Care Manager Lesley Powell has demonstrated evident competence over many years in running Autumn House, in establishing a solid professional Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 28 policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. An experienced Registered Nurse with a professional portfolio of practical and managerial experience, ably supported by a well qualified, experienced deputy, Registered Nurses, and a solid foundation of able carers, whom represent an effective care management team The inspector was impressed by the openness, professional and pleasing confidence in the observed interactions of staff, relatives and residents. The relationships were seen to be of mutual trust and respect. Appropriate risk assessments are in place for residents, through care planning and recording, staff selection and the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, although the use of institutional instructions would be more appropriately situated in more discrete places. The Registered Provider presents a high profile in Direction and managerial involvement in the smooth running of the Home, delegating a wide range of management responsibility to good effect. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. This programme is to be forwarded to CSCI for further reference. The home has an open door policy and a commitment to equal opportunities. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were generally found to be well maintained in ensuring that the residents’ rights and best interests are safeguarded. The Manager offered evidence of safe working practices including: - accident management, abuse awareness, COSHH management, and disposal of clinical waste. Training on infection control is also undertaken and the policies and procedures for this subject are working documents in the Home. Relevant legislation was discussed and is fully understood by the management, i.e. changes from CSCI, updates on Health and Safety issues, diversity, etc. Attention needs to be focussed on the implications of the Mental Capacity Act 2007 for all senior staff, who are to be expected to cascade the information to all staff. The health and safety of residents and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of electrical and gas appliances and regulation of the water system. Records inspected included, fire officer’s report, gas and PAT certificates, and found to be satisfactory. The accident book was seen and found to be in order for staff, service users and reporting arrangements to Riddor. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 29 Autumn House Nursing Home DS0000022309.V343879.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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 3 2 3 Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 (1)(b) (i) Requirement For all staff files to contain all required elements as detailed in Schedule 2 of the Care Homes Regulations 2001. That all instances of nonadministration of medicines be recorded to determine reason for non-administration. Timescale for action 01/11/07 2 OP9.3 13.2 01/10/07 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 OP24 2 3 OP38 OP38 Refer to Standard Good Practice Recommendations Review bedroom and communal furniture for repair/replacement. Replace damaged baths and cease using bathrooms as stores. Isolate earth wires from thermostats on radiators. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 32 4 5 6 7 8 9 10 11 12 13 14 OP33 OP26 OP16 OP10 OP24.6 OP19 OP38.2 OP10 OP38 OP36 OP2 Provide a development plan for 2008/09 Access to the kitchen area to have readily accessible overclothing available. A concerns, complaints and allegations book be established. That Home notices are placed more discretely in residents’ bedrooms That a full unit risk assessment inventory be established. All service area doors to be secured when not in use. All sluice areas to have smoke alarms fitted. The practice of using communal stocks of clothing will cease forthwith. Sharp boxes will be securely stored Supervision of all staff is to be formally documented six times a year. That each resident has a contract clearly indicating the agreed bedroom identifier. Autumn House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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 House Nursing Home DS0000022309.V343879.R01.S.doc Version 5.2 Page 34 - 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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