Inspection on 13/08/08 for Aynsley Nursing Home

This inspection was carried out on 13th August 2008.

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

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

Other inspections for this house

Aynsley Nursing Home 05/06/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Aynsley Nursing Home 60-62 Marlowe Road Wallasey Liverpool CH44 3DQ Lead Inspector Julie Garrity Key Unannounced Inspection 13th August 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aynsley Nursing Home DS0000069375.V370259.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. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aynsley Nursing Home Address 60-62 Marlowe Road Wallasey Liverpool CH44 3DQ 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) 0151 6384391 0151 6384402 S.J. Care Homes (Wallasey) Limited Julie Catherine Rossiter Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 28 Date of last inspection 5th June 2007 Brief Description of the Service: Aynsley Care Home with Nursing is a two storey converted house situated in the residential area of Wallasey. It is registered to provide nursing care and support for up to 28 older people. There are three main lounges and a conservatory attached to the dining room. Bedroom accommodation is provided in both single and shared rooms, some of the bedrooms have en-suite facilities. There is a passenger lift that services all the floors and assisted bathing facilities and shower facilities available. The front garden area is paved with shrub borders and there is a secluded garden to the rear of the home. Parking is available at the front of the building. The home is close to the town centre, which has shops and other community amenities. Public transportation links such as the bus service are close to the home, rail links are a 10-minute drive away. The home is not far from the Wallasey tunnel and is easily accessed from Liverpool. Main motorway links to the rest of the Wirral area are a 5-minute drive away. Fees for the home are £561.76 to £581. 76 (this includes the component paid for nursing care”. Fees cover all spending of people who live in the home including hairdressing and toiletries as examples. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The site visit was carried out over a period of one day, starting at 10:30 and left at 18.00. The inspector spoke with 8 people who live in the home, 2 relatives, 7 staff and the deputy manager. The manager was not available for the site visit. Feedback was given to the deputy manager. Telephone feedback additional to that given to the deputy was undertaken on the 14th of August 2008 for approximately 50 minutes. We completed the inspection by a site visit to Aynsley Nursing Home, a review took place of many of the records available in the home and our offices. These included individuals care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff rota, questionnaires, staff training, medications, information sent to us by Aynsley Nursing Home and a self-audit completed by the home known as an AQAA. This site visit included discussions with people who live in the home, staff and management. Surveys were sent to people using the service and their doctors before the sit visit. Seven completed surveys were returned from individuals who stayed in Aynsley Nursing Home. Two were returned from local doctors. We followed an inspection plan that was written before the start of the inspection to make sure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report, additional standards were identified before and during the inspection these were also reviewed and detailed in the report. Feedback was given to the deputy manager during and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service has not addressed all the requirements from the last site visit. In particular those relating to care plans, which do not describe to staff how to meet the identified needs of individuals. Care plans are not accessed by individuals living in the home or care staff in those views inaccurate information was noted and assessed needs not addressed. Without clearly written records staff will be unable to deliver consistent support that meets individual needs. Although medication practice is still improving a number of issues were noted at this site visit that are to do with the accurate recording of medications. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 7 Some of the practices identified prevent the service from being able to carry out proper audits in order to make sure that individuals are receiving their medications correctly. A recent adult protection identified a number of action that the service needed to take including updating their management of pressure ulcers, moving and handling, care planning, communication with families and equipment in the home. The service did address the inappropriate actions of two staff members but has not addressed the other issues identified. On the day of the site visit a potential adult protection issue was identified that had not been addressed by the service. It was noted that the home did not have as policy and procedure in place as to how staff were to deal with issues of this nature. Although a quality audit is in place this is not effective and has not impacted on the quality of the service in place. No plan that identifies how the home can increase the service it provides is available. As such there has been limited progress in meeting regulations or increasing the quality. 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. Aynsley Nursing Home DS0000069375.V370259.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 Aynsley Nursing Home DS0000069375.V370259.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): Standards 1, 2, 3 and 4 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are supported to move into the home by an assessment process that has the scope to look at all their needs. Information in the home does not fully support to decide if home can meet their needs. EVIDENCE: We looked at four assessments of people living in the home. All had had an assessment done that had the potential to look at their needs. Of the assessments viewed not all had had their social or psychological needs assessed. This was particularly relevant for one person who was identified as having mental health needs before they moved into the home. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 10 The impact of this or the skills that staff would need was not determined in order to make sure that staff were able to meet the individuals needs. Care records for this person showed that they continued to be unsettled in the home. Of the assessments viewed none had evidence that the person themselves or their family member had been involved in the assessment. The homes policy is available for assessments but is out of date and does not reflect the current practice. Staff spoken with said that they are always told about anyone moving into the home, but do not always read the assessments relying on the verbal information that they are given. It is good practice that all staff are told about new people and given the opportunity to discuss what their needs are and how to meet them. It is better practice if good written records are available and accessed that would make sure that staff were fully aware of individual needs and that these were agreed with by the individual or their supporters. Ten surveys were sent to the home before this site visit. Five of these were completed and returned to us. Of the five returned four people had not received a contract. This was confirmed in the AQAA returned by the manager which stated “a new contract and statement of conditions is being developed”. Three of the returned surveys said that had received good information before they moved in two said that they had not had sufficient information. We looked at the information in the home. At the time of the site visit a document known as a statement of purpose was not available. The home did have information called the service users guide available in the office. This was not available in individual bedrooms in any other area of the home. Individuals living in the home had not seen this information. Comments included “I wasn’t able to look around before I moved in. I don’t remember getting any information about the place” and “I didn’t choose the home my niece did but I think she made a good choice”. Relatives spoken with said that they had been given an opportunity to look around the home and speak to staff before their relative came to live there. They found the home “welcoming”, “staff were so friendly and kind it looked ideal” and “I liked the look of the place, I knew my mum would be happy here”. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8 and 9 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Medical care needs are meet, with the service accessing individuals doctors as needed. Information for staff is not always clear and prevents them from being sure that they are supporting individuals in a manner to meet their needs. Individuals receive their medications as prescribed. There are a number of areas of practice that need to be improved in order to maintain the safety of individuals. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 12 EVIDENCE: Medications were reviewed. There are areas of good practice that includes photographs available of individuals. There are other areas that need to be progressed this included, staff using external creams and fluid thickener without clear instructions. One medication for an individual had run put and had not been recognised as not being available by the staff. It was also noted that none of this medications added up properly for people receiving this. This suggests that staff are not using the bottle for that person but any of the same medication bottles available. Audits had not regularly taken place the deputy had undertaken a drug count on several occasions and on one occasion identified a significant discrepancy in the medications. This was not investigated. It was impossible to review a number of medications as those left over from the previous month had not been recorded and as such it was not possible to determine how much of each medication individuals had available at the beginning of the month. Those medicines that were looked at showed that in general the medications were given accurately. The issues regarding recording medications left over from the previous month and the recording of creams were highlighted at the previous site visit. Surveys returned showed that two individuals said they always receive suitable support “they are very nice carers and will do anything that I ask they are also very caring”. Two people said they usually receive appropriate support “ 75 are good sometimes better than others”. One individual indicated that sometimes they received appropriate support. When asked do staff listen three said yes two said. “Sometimes not always. Surveys also asked do they get the medical support as needed. Four individuals said always and one said usually. Surveys were also sent to local doctors, two of which replied. Both said that the home does contact them as needed. Records within the home showed that in general the staff access medical professionals such as doctors, chiropody and opticians as needed. Staff observed during the day were respectful and very kind to the people who live in the. The individuals spoken with were very positive about the staff and the care that they received. One resident said “staff are wonderful”. In general there is a pleasant relaxed atmosphere and many of the people living in the home were comfortable with the staff and able to respond very well to light hearted banter. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 13 Each individual has a care plan, of the four care plans viewed none of these were individual, specific or up to date. The care plan as to how to meet the needs for hygiene was identical for two of the individuals and did not detail how to meet their specific needs. Staff spoken with were able to detail significant actions that were not covered in the care plan. One care plan state that a monitoring of an individuals medical condition needed to be done three times a day, records showed that this was not being done. The deputy manager said that the care plan was inaccurate and in fact it needed to be monitored in a different way. A lack of clear instructions on how to monitor medical condition places individuals at risk of not having their health care needs meet. Of the care plans viewed none had evidence that they been agreed with either by the individual living in the home or their relatives. A number of risk assessments identified risks such as falls there was no care plan or instructions as to how to reduce the risk available. Care plans sand risk assessments had been reviewed monthly but not updated, as individual needs changed. Wound Care records, did not have photographs, wound mapping, grade or depth and did not assist the staff to monitor that wound care treatment is effective. Care plans did not detail what dressings were to be used. A recent issue highlighted that staff do not always access external professional such as tissue viability advice. There is no policy or procedure in the service that would support them to make this decision. With out clear monitoring, planning or professional advice staff would be unable to know what are the correct treatment to be used. Issues with care planning and management of wounds was identified at the last site visit of the service. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 and 17 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is available within the home and community mean the individuals do have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and are an enjoyable, social occasion for all of the people. All individuals are not aware of the choices available and as such not always supported to have their choices actioned in a manner that meets their diverse needs. EVIDENCE: Two visitors spoken with said, all said that “it’s a very nice home”, “I am happy with the care here”, “these are really lovely staff, very helpful” and “I can visit whenever I need”. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 15 We looked at records in each care plan, this showed what activities each individual had taken part in. There was no particular plan in place that detailed individual’s likes and dislikes. There was a social assessment available in assessments but of those views none had been completed or up to date. We discussed with five individuals if they were aware of an activities programme all said that they had not seen a programme or a newsletter but were aware that there were activities available. Two said that they “really enjoyed” the activities”, one said “would like a little more variety”. A shopping trip was undertaken that morning and bingo was in place in the afternoon. Two staff spoken with said that they would like to be able to spend more time on an individual basis with the people who live in the home. Both said that they felt that the levels of activities had significantly improved in the home. The managers AQAA said that the activities co-ordinator needed better skills and wanted additional training there are no plans for this to be in place. Records of “residents” meetings could not be found but were asked for to the deputy manager. Staff spoken with said that there has not been any meetings staff or residents for several months. There was no written evidence that individuals contributed to the activity programme. Throughout the morning of this visit individuals were occupying themselves by reading, watching TV or knitting. Menus were did not show alternatives for specialised diets. Two people were asked what the meal was both said “egg and chips” one said “its always egg and chips on a Wednesday”. When asked if the wanted something other than egg and chips could they have it both said “probably but never asked”. One individual when asked what was for tea said “I don’t know its always a surprise”. Menus available in the kitchen did show a choice. Staff were keen to say that if someone does not like something they can be given a choice. Care staff and the kitchen assistant said that someone goes around the day before and asks people what they want. Records reflected that this was correct and also showed different choices given out. There is no record of individual likes and dislikes regarding food so it is not possible to determine what input individuals have had into determine the meals available. A copy of the menu is not available for the people who live in the home. The only copy being handwritten in the kitchen. A note was found on three chickens asking the night staff to cook the chickens overnight. None of the night staff have training in cooking or food hygiene certificates. The mealtime was reasonably relaxed people were assisted to eat as needed. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints management is in need of development in particular recognising and dealing with some concerns. This has the potential to result in some individuals not being adequately safeguarded. EVIDENCE: A complaints procedure was available and this was included in the Information available in the main office. All people spoken with said that they felt safe, listened to, and able to speak to the staff and manager if they were not happy about anything to do with their care. Individuals spoken with said, “If I have a problem it is dealt with” and “good staff sort anything”. Surveys sent to individuals in the home received four replies three individuals said they did know how to make a compliant one said they did not. Not all individuals are aware of how to raise concerns. A copy of how they do this is not readily available for them. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 17 Staff spoken to were not sure where to find the complaints procedure but were able to give examples of complaints they had received and how they had been dealt with. All thought complaints policy was in the office but they had not looked at it. Three staff did detail minor concerns that they dealt with on a daily basis. Such as “my jumper is missing in the laundry”. They resolve this such as going to the laundry and getting the laundry assistant to find it. None saw these as a complaint as such they rarely reported them to the manager. The service did not have safeguarding adults policy was available. The policy from social services regarding how they deal with safeguarding referals was available. Without their own policy staff in the home will not know how concerns regarding the protection of adults needs to be dealt with. Safeguarding adults training had been done for all staff. Four staff spoken with said that they had training. Records on staffing files reflected that all staff have received in this area. Staff spoken to had a basic understanding of the action to be taken if an allegation was made but there were some gaps in their knowledge of this subject. We looked at records of people living in the home, within the records we noticed an incident that should have been referred to social services to be investigated as a potential allegation. This had not been undertaken and the records as to why this had happened were unclear. Management within the home had not acted in the best interests of the individual and had not taken any action to prevent further incidents. This was referred to social services was made by us following the site visit and the home asked to do this as well. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 22, 23, 24, 25 and 26 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Aynsley is presented as a homely environment decorated in a style in keeping with what individuals would have in their own home. Some areas are in need of redecoration in order to make sure that a reasonable standard is maintained. The manager has not made sure that previously identified issues with equipment that caused an injury has been addressed and as such may have placed other people at risk. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 19 EVIDENCE: Staff thought the home was nicely presented and in style in keeping with the way that individuals in their own home would have. Individuals spoken with said that they liked the home and were happy with the decorations in place. One said “its very comfortable”, “I really like my room, its full of everything I need. Its not like my home but I do like the way it looks, its one of the reasons I chose it”. There is a lounge dining room that incorporates the conservatory that has dining tables in used for activities and dining. In total there are three lounges and this supplies people with a choice as to where they would prefer to spend their time. We looked at four bedrooms with permission and spoke to one individual in her room. Individual bedrooms were viewed and all were clean and tidy. Individuals are encouraged to bring in their own items and this makes the bedrooms appear very homely and comfortable. All the bedrooms are decorated differently and vary in size, some of the rooms are very bright and airy. The design of the home has taken into account some of the residents diverse needs. There are handrails and ramps as appropriate and equipment designed to assist in the moving and handling of residents as appropriate. The shower unit has a step on it that some residents cannot step over. Staff say they have to lift the shower chair over this step for some residents and this can be difficult. The shower facilities available are not suitable for all the residents. The equipment involved in a recent incident that resulted in an injury is still in use. The manager was advised at the time to check with the Health and safety Executive in order to check that the correct bedrail was used. Three other bedrails were checked at the site visit. One was integrated in the bed and as such is suitable. Two others were in use with a specialised mattress, assessments for bedrails did not determine if the correct bedrail was in use for the bed or specialised mattresses. Staff have not had training in infection control and no policy or procedure was available for this. It was noted that all bathrooms had suitable hand washing and hand drying facilities. A number of maintenance areas were noted. The shower identified in the last site as having a lip and staff having to lift individuals in the chair is unchanged. Between the ground floor and first floor is door labelled fire door keep shut this was wedged open throughout most of the day. General maintenance issues included damaged wallpaper on the corridors, damaged paintwork and peeling wallpaper in some areas. Furniture in some bedrooms was damaged. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 20 There was no maintenance plan available that would detail what areas of the home were to be redecorated or refurbished or that would tell people living in the home when their bedrooms were to be redecorated. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are properly recruited to the home in order to make sure that they are suitable to work with the people living in the home. Training has not been developed and training specific to the needs of individuals is not always available. Both staff and people living in the home feel that there is sufficient staff available to meet their needs. EVIDENCE: We looked at four staff files and noted that all staff had had proper checks in place before they started working in the home. This included references and a police check and helps the home make sure that staff are suitable to work in the home. Induction records were available in some of the files seen. These were very brief and did not cover the needs of individuals living in the home. Each was signed by the manager and staff member and gave the impression that they had been completed in a single day. A full induction that covers training and orientation to the home that provides staff with good knowledge is anticipated to be four to six weeks in duration. Training records were unclear and detailed staff training in the last 12 months as moving and handling and the protection of vulnerable adults. Assessed Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 22 needs of people living in the home include epilepsy, diabetes, infection control, development of pressure ulcers, mental health needs as examples Records do not show that staff had received training in these areas. Staff spoken with detailed that they had received training in health and safety and the prevention of abuse. Fire safety and health and safety had no records available that they had been undertaken, staff spoken with did not recall doing training in this area. Two individuals spoken with said, “they are very nice carers and will do anything that I ask they are also very caring”, “staff were wonderful” and “lovely girls, so good” Staff said that in there opinion at the moment there was enough staff as the numbers of people living in the home had reduced and the staffing levels had not been cut accordingly. Although three of the staff (care) were spoken with two said that they thought more time with service users was needed and when the home was full this was an issue. A relative spoken with said “this is a very good home, I feel happy leaving my mum her. She’s safe, well cared for and comfortable. What more is needed”. The service has several members of staff that assist the care staff to support the people living in the home. This includes an activities co-ordinator, handy man, administrative assistant, kitchen, cleaning and laundry staff separate to care staff. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 37 and 38 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is insufficient arrangements regarding health and safety, protection of vulnerable adults and quality assurance to always maintain the safety of people living in the homed. The management team are well thought of by individuals, relatives and staff. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She has many years of nursing and management experience. Both individuals living in the home and staff and staff were complimentary about the manager and the rest of the senior management team. Staff spoken with thought that the manager and deputy were “very good, can talk to them at anytime and do know what they are doing”, “are supportive try very hard to make sure everything is done properly”. People living in the home and their relatives spoken with said “can ask them anything try to get it right”, “manager is very pleasant”, “generally they are friendly and supportive”. The home operates its own internal audit system through the use of questionnaires sent to individuals and their families on an annual basis. The last audit available was done February this year by the manager. Very few comments were made in this other than satisfactory and no identification of what had been audited, how or what the findings were was available. The policies and procedures available that inform the staff how to work within the home are dated 2003 with several not reflecting changes in the law or best practice. A number of polices such as safeguarding were not available. The home does not have legal responsibility for money belonging to the individuals, they hold small amounts left by relatives for the people who live in the home. Records regarding these funds are held by the home on behalf of the individual and were clear and individuals were signing to say that they had received their money. It was not possible to determine if environmental checks for fire equipment, call systems and emergency lighting had not been done. Staff fire training could not be determined as there were no records in this area. Staff spoken with did not recall if they had training in fire. Records on staff files showed no record of fire training for three staff. One member of staff had a certificate dated earlier this year. The home had a serious concern in recent month out of this a number of issues were recognised and acknowledge by the home this included the need to review moving and handling assessments, staff training, care planning, arrangements for accessing external professionals and contact the health and safety executive regarding re bed rails. None of this been progressed. Additionally management had not recognised and dealt with an issue of adult protection Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 25 A number of risk assessments are in place such as falls, moving and handling and risk of developing pressure ulcers. Moving and handling assessments do not make any mention of transfer from bed to chair as example and as such do not detail equipment or arrangements need for staff to maintain safety. Falls risk assessments available and do identify in some instances high risk of falls. Although this risk has been identified no plans are in place that detail how the service will reduce the risk or what actions staff need to take. Questionnaires to service users or minutes of meetings for staff and residents could not be located. Staff said that they had not had a meeting for a long time. There was no supervision records available, staffing files were not locked on arrival in the home. One staff file had an approval but this was several months ago, none were located in other files. No supervision records are available nor is there a supervision policy available. Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 26 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 2 1 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 2 3 2 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) (a) (b) (c) (d) Timescale for action Resident’s individual Care plans 13/10/08 need to be kept up to date and accurate. The care plans need to detail what individual care needs are and give clear instructions to staff how to meet those individual and specific needs. Outstanding from 05/08/07 Management needs to develop 13/09/08 and implement a policy as to how it deals with safeguarding situations. These needs to include what actions need to be taken when concerns are raised. Staff training needs to be given 13/10/08 to meet the specific and individual assessed needs of the residents. A programme of training that clearly identifies the needs of the individuals, what skills the staff have and how they will be trained to develop the skills that they require to meet the needs of the individuals is essential. Outstanding from 05/08/07 Requirement 2. OP18 13 (6) 3. OP30 18 (1) (c)(i) (ii) Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 28 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 OP1 Good Practice Recommendations Information in the home such as complaints, care plans, activities and menus should be written in formats that are easily accessible by the residents and relevant stakeholders. A service users guide and statement of purpose need to be developed that includes all the areas as detailed in the Care homes regulations 2001. Assessments for prospective clients need To remove the section related to resuscitation this needs to include a clear understanding of the mental capacity act and in its current wording fails to acknowledge or deal with this legislation. The service needs to review its current medication practices and update the policy and procedure. This needs to include how it intends to check the competency of the staff and make sure that all individuals receive the medications they need. Records regarding wounds, need to include best practice, such as depth and grade of wound, The shower that has a step to get in and out should be assessed to make sure that those residents who like to use the shower are not lifted in and out. Policies and procedures within the home should be reviewed, up dated and brought in line with the practices in the home and best practice guidance available. The manager needs to put into place a development plan that details how the quality of the service will be reviewed, what the service will do to increase quality and how this will be done. 2. OP3 3. OP9 4. 5. 6. 7. OP8 OP22 OP33 OP33 Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Aynsley Nursing Home DS0000069375.V370259.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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