Inspection on 23/05/05 for Nottingham Neurodisability Services Aspley

This inspection was carried out on 23rd May 2005.

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

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

Other inspections for this house

Nottingham Neurodisability... 07/07/08

Nottingham Neurodisability... 19/12/07

Nottingham Neurodisability... 28/08/07

Nottingham Neurodisability... 29/08/06

Nottingham Neurodisability... 06/12/05

Nottingham Neurodisability... 13/07/04

Nottingham Neurodisability... 10/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Aspley Neuro Disability Unit Robins Wood Road Aspley Nottingham NG8 3LD Lead Inspector Gail Kirby Unannounced 23 May 2005 10:00 rd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Aspley Neuro Disability Unit Address Robins Wood Road Aspley Nottingham NG8 3LD 0115 942 5153 0115 942 5154 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Four Seasons Homes (Ilkeston) Ltd, Emerson Court, Alderley Road, Wilmslow, Cheshire, SK9 1NX Mr Akinwumi Olusegun Akinpelu Care Home (CRH) 32 Category(ies) of Physical Disbility (PD) 32 registration, with number of places Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13 & 14 July 2004 Brief Description of the Service: Aspley Neurodisability Unit is a purpose built unit situated in the inner city area of Nottingham in Aspley. The home is within access to local shops, library, healthcentre, churches and a pub. The communal lounges of which there are two and a designated dining area are situated on the first floor. Residents rooms are both on the ground floor and the first floor. All personal rooms are of single occupancy and fitted with an ensuite facility. A passenger lift facilitates access to the first floor. Four Seasons Healthcare Limited was registered in February 2004 with the Commission for Social Care Inspection as the registered providers. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first of two inspections the Commission is required to make in the Inspection year between April 2005 and March 2006. It was carried out throughout the day over a 8 hour period. The core standards were assessed on this occasion. For an in depth record of the overall standards reference must be made to the published inspection report following the announced inspection on the 12th November 2004. The main method of inspection used was called case tracking which involved selecting three service users (residents now) and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. The deputy manager was present throughout the inspection; 3 staff, 5 service users and 1 relative were also spoken to. A partial tour of the accommodation took place. The inspection found not all requirements set at the last inspection have been addressed. What the service does well: The deputy manager has excellent knowledge of the resident’s individual needs. Staff members interact with service users in a caring and sensitive manner. The activities organiser provides a valuable role to ensure residents social needs are addressed. Residents living at the home provided positive comments on the care provided and felt their privacy was respected and their dignity was upheld. Relatives provided positive feedback on the professional support offered and the commitment of all the staff working at the home. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home is registered for young physically disabled but the focus on maintaining independence and promoting living skills is very limited and not resident focus. The independent living skills kitchen does not address its title and requires a plan of action to meet its purpose. The accommodation with particular reference to the dining area needs to be re-assessed to maximise the resources available and to minimise residents being cramped into one area. The bathrooms also need to be revised to ensure adequate facilities are offered by the home to meet the needs of the resident. Residents assessments need to be fully completed and the information obtained needs to be accurately reflected in the individual plan of care. The care planning is based on practice issues and not on the individual. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 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. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 Prospective residents and relatives have information about the home to enable them to make an informed choice about where they live. Full assessments are not being carried out prior to admission to ensure that resident’s care needs will be met. The lack of a multidisciplinary assessment for some residents has not supported their need for rehabilitation to help maintain or achieve their optimum level of physical and mental capacity. EVIDENCE: One relative spoken with reported the home provides an exceptional service, which confirms with the initial reports made by other health care professionals, which was given to them prior to admission. One relative expressed their gratitude to the staff and stated they felt fully informed and totally included in the process. A Statement of Purpose has been produced to reflect the services offered by the home. The Responsible Individual reported the current version is being updated by the Company’s Headquarters. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 10 Individual records are kept for each of the residents. A needs assessment is in place along with relevant Care Management assessments. The same documentation is used for both long-term residents as those for short-term care. Inspection of the two most recent admissions did not have completed assessments recorded in them. There was no evidence to support a rehabilitation programme for one resident wishing to return to the community. No assessment had been carried out and their care plan did not reflect any rehabilitation or long-term goals. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9, Residents and relatives are aware of the assessment process and the formulation of a plan of care. Decisions about their lives is not always respected and or recorded. Information recorded in the care plans do not reflect personalised care and do not meet with individual needs and aspirations. Resident’s safety is potentially compromised. EVIDENCE: One relative reported of their full involvement with the initial assessment and on subsequent reviews. However one resident reported how their individual preferences were expressed prior to admission but were not being upheld. From the files inspected, one file provided conflicting information of their assessed needs. Areas identified in the initial assessment have not been addressed in the residents risk management to ensure their health and welfare. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 12 Risk assessments that have been completed do not provide staff with the intervention to be taken to maintain residents safety. Care plans examined are not updated to reflect residents changing needs. Information recorded in the running daily notes is not reflected in the care plan. In addition on discussion with staff they reported individual residents needs but no reference has been made in the residents individual care plan. One resident spoken with expressed their concern that those that are able to communicate have their individual needs met but stated those that are unable are not necessarily met. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 15, 16, 17 There is limited opportunity to maintain and develop social, spiritual and independent living skills. Resident’s nutritional needs are well managed but the emphasis is based on the company’s decision making rather than the residents choice. EVIDENCE: There is a designated independent skills kitchenette for the use of both staff and residents. On inspection the facilities are not accessible for residents in a wheelchair. The fridge is worn, door seals have perished and rust is present along its base. No monitoring is in place to ensure food is stored at the correct temperature. One resident reported that they are unable to make a cup of tea because they are unable to reach the tap to fill the kettle. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 14 A number of people living at the home were spoken with and reported the daily routines to be flexible according to their own wishes. Residents were observed to freely come and go from the home. Relatives reported the staff to be very friendly and always made to feel welcome. Staff was observed on the day of inspection to respect residents privacy. Residents spoken with confirmed this was standard practice. The main kitchen was inspected. A programme of refurbishment with stainless steel fittings and new fridges and freezers has been completed. The cook reported the new facilities have improved how food is prepared and served. On discussion with the cook it was reported that no training has been received in food and hygiene. This matter was discussed with the responsible individual on the day of inspection. The cook stated the existing menus are old and are being reviewed by the catering manager employed by the company. There is no evidence to support residents are to be involved in this process. In addition there is no evidence to provide support to residents so that they are actively involved in preparing and serving of food. The dining area was observed during lunch; staff were observed to provide appropriate assistance with residents that required help. Residents are weighed monthly and professional advice is actively sought from the dietician. Residents that are fed artificially have records maintained to support intake and out put and is re-assessed on a regular basis. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, Procedures for residents to self-medicate are not being followed. EVIDENCE: One relative spoken with reported their overall satisfaction with the service and felt the standard of care to be very good. A pro-forma has been devised by the home for self-medication but the information was not completed in one residents file despite the resident choosing to self medicate. One resident self-medicating was not appropriately completed and did not reflect the medication prescribed. The medication system on the day of inspection was been transferred over to the blister pack system from a new dispenser. The overall standard was therefore not inspected on this occasion. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The complaints procedure is not being adhered to and does not empower residents to raise concerns with the assurance that they will be listened to and acted upon. EVIDENCE: A complaints procedure is displayed in the home but the information recorded needs to be updated to reflect the changes in the company structure and that of the Commission for Social Care Inspection. The home retains a complaints log but concerns recorded have not been acted upon. Despite one relative reporting the staff to be very pro-active and always willing to listen to any concern there is no recorded evidence in the homes complaints log to support the concern raised or the action taken. However the relative confirmed that issues raised have been dealt with promptly and in a professional manner. One relative reported the deputy manager to be extremely helpful. The home has had to utilise the adult protection procedure. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 29, 30 The ongoing redecoration and refurbishment programme has provided the people living at the home with safe, comfortable surroundings. The bathing facilities however do not afford residents choice or intended purpose. The communal areas are not being maximised as a result resident’s personal space is compromised during meal times. EVIDENCE: The company took over Aspley Neurodisability Unit in February 2004. A programme of redecoration and refurbishment has since been put in place. Residents rooms viewed have been redecorated and new beds have been purchased to meet service users complex needs. One relative spoken with confirmed the floor covering was agreed and reported satisfaction with overall room. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 18 The home has one shower. Other bathrooms are not used as they do not meet resident’s individual needs and or are not accessible. One bathroom currently out of order is to be repaired or consideration is to be made to alter this facility with a ‘wheel in shower’. Service users spoken with reported that they were able to access the toilets with minimal help but the staff respected and upheld their privacy. The home has two lounges and a designated dining area. The dining area observed at meal times was very restrictive with the number of residents and wheelchairs with dining tables placed directly against the wall. However the large lounge was observed being used only by two residents throughout the inspection. The home has one Hoist. The responsible individual signed a completed invoice request for a new stand aid hoist on the day of inspection. Residents have there own wheelchairs; facilities are provided for storing and recharging wheel chairs in a separate area. However one resident reported how they wish to remain independent and recharge their wheelchair in their own room. Staff spoken with reported the home has improved since the new owners took over and feel the standard of cleanliness has also improved. The laundry room was inspected. New industrial appliances have been purchased to meet the demands on the service. The machines were observed to make a high volume of noise secondary to the excessive vibration. This needs to addressed to ensure there is no disturbance to residents when used at night. Staff spoken with reported how they manage infected linen. Staff was observed to handle linen appropriately to control infection. Bins for clinical waste are not fitted with lids; this needs to be addressed. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, The staff morale has improved and individual members feel valued. The Registered Providers have failed to take adequate precautions to protect residents by undertaking Enhanced Disclosures with the Criminal Records Bureau and obtaining necessary checks to prove registered nurses are currently registered with the Nursing and Midwifery Council. EVIDENCE: The duty rota was inspected. The hours worked by the manager from Monday 16th May to the 22nd May 05 are not recorded. Staffing levels are maintained and the turnover of staff has reduced. Staff spoken with reported regular staff meetings are held which are recorded by the deputy manager. Staff reported they always work together in two’s and acknowledged for their work at the end of the day. The home uses agency staff only as and when the home is not able to cover with their own staff. A written protocol is available for reference. The home uses an employment agency to appoint overseas nurses. One file inspected did not provide evidence of a Protection of Vulnerable Adults check or an enhanced disclosure with the Criminal Records Bureau or an initial Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 20 application form to the home or agency. Another file inspected did not provide evidence of a registered nurses current registration with the Nursing and Midwifery Council. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These set of standards were not inspected on this occasion. Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 x 3 3 Standard No 11 12 13 14 15 16 17 2 x x x 3 2 2 Standard No 31 32 33 34 35 36 Score x x 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Aspley Neuro Disability Unit Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 12 Requirement The Registered Person must identify within the care plans what specialist support services are being offered to support any service user receiving rehabilitation The Registered Person must ensure assessments are complete to ensure holistic needs are addressed The Registered Person must ensure that care plans set out how the current and anticipated specialist requirements will be met, for example rehabilitation and therapeutic programmes The Registered Person must ensure care plans are updated to reflect residents changing needs The Registered Person must ensure risk assessments inform staff how to meet residents needs The Registered Person must provide adequate facilities for residents to prepare own food within the independent skills kitchen The Registered Person must ensure that residents are actively supported to help plan, C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Timescale for action 30 September 2005 2. 2 14 30 September 2005 30 September 2005 3. 6 15 4. 5. 6 7 15 13 30 September 2005 30 September 2005 31 December 2005 30 September 2005 Page 24 6. 11 16 7. 17 16 Aspley Neuro Disability Unit Version 1.30 prepare and serve meals 8. 17 18 The Registered Person must ensure staff are provided with the relevant training to fulfil their role and function in the home The Registered Person must ensure residents choosing to self-medicate is assessed and recorded The Registered Person must ensure all complaints are recorded including details of the investigation and outcomes / action taken The Registered Person must ensure there are sufficient bathing facilities to meet the needs of the residents The Registered Person must ensure all staff working at the home have a POVA first check carried out followed by an Enhanced Disclosure with the Criminal Records Bureau The Registered Person must ensure all Registered Nurses are currently registered with the Nursing and Midwifery Council 30 September 2005 30 September 2005 30 September 2005 31 December 2005 Immediate 9. 20 12 10. 22 22 11. 27 23 12. 34 19 13. 34 19 Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 2 17 27 30 Good Practice Recommendations To consider implementing different documentation to address short-term care To ensure temperature recordings are maintained for all fridges used to store residents food To consider altering an existing bathing facility to a walk in shower Machines in the laundry room that create excessive noise needs to be addressed to ensure there is no disturbance to residents when used at night C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 25 Aspley Neuro Disability Unit 5. 6. 30 33 To provide all bins with fitted lids Ensure the managers hours of work are completed for each day Aspley Neuro Disability Unit C53 C03 S59536 Aspley Neuro V223974 230505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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