CARE HOMES FOR OLDER PEOPLE
St Aidan Lodge St Aidan Lodge Front Street Framwellgate Moor Durham DH1 5EJ Lead Inspector
Bridgit Stockton Key Unannounced Inspection 12th September 2007 09:30 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 St Aidan Lodge DS0000007502.V349075.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. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Aidan Lodge Address St Aidan Lodge Front Street Framwellgate Moor Durham DH1 5EJ 0191 3709691 0191 3865806 staidanlodge@eurocallbroadband.uk.net 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) Ideal Care (North) Limited Ms Carol Ann Shannon Care Home 62 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (30) of places St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 30 Older Persons and 32 Older Persons with Dementia Date of last inspection 20th September 2006 Brief Description of the Service: St Aidan Lodge is a purpose built care home situated in the centre of Framwellgate Moor, on the outskirts of Durham City. It caters for 62 residential service users on two floors, with the kitchen, laundry and additional facilities located in a basement area. St Aidan Lodge is registered to provide personal care for 30 older people situated on the ground floor, and 32 older people with dementia situated on the first floor. The home is spacious, with a variety of communal space, including lounge and dining areas, a smoking room and spacious garden area. All bedrooms are large single rooms with en-suite toilet and washing facilities. Rooms are well equipped and furnished and there are a number of suitably equipped and adapted bath and shower rooms. The range of fees charged at the home are £364.50 to £417.00 per week. Toiletries, newspapers and hairdressing are not included in this fee. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this inspection was to assess the quality of the care and support received by the people who live at St. Aidan’s care home The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. I looked in detail at the care and records of four people, examined other records and looked around the home. I spent eight hours at the home over two days. I gave out questionnaires to people who live at the home, their relatives and healthcare professionals. I received nine completed questionnaires from the people who live at St Aidan’s, six from their relatives and one from a healthcare professional. Feedback from these surveys is included in this report. The manager also completed the home’s pre-inspection questionnaire. These questionnaires provide valuable information to help me form a judgement about the quality of service offered at St Aidans. What the service does well:
The people I spoke to said they are happy with the care and support they receive. One person wrote in her questionnaire ‘I am very happy living here, it’s nice.’ Another said that the staff are ‘lovely and very hard working’. Relatives of the people who live at St Aidan’s commented that the ‘Staff are wonderful’. A visiting healthcare professional wrote that the staff ‘Look after patients registered with our practice well. We are kept informed of any new problems.’ The pre-admission assessments are thorough and the majority of people commented on their questionnaires that they had sufficient information about the home before choosing to live there. One person wrote ‘when I came for a visit, I was made very welcome, I wanted to stay here from the start’ The people who live at the home and their relatives confirmed that they know how to raise a concern or make a complaint, if they needed to. One person said ‘I would tell the staff or the manager if I have a problem’. The staff are aware of their responsibilities if they believe that neglect or poor care practice is taking place and were confidant that if they raised any issues the manager would take the ‘proper action’ to investigate. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 6 There are thorough recruitment and selection procedures in place, to make sure that staff are suitable and safe to work with the people who live at the home. People looked well cared for, and there was a nice open friendly relationship between staff and people living at St Aidans. People said they really enjoyed the activities that take place. One person said ‘I like games especially cards. It good to do things now when you have time. I didn’t have much chance to do things before, that is until I came here’. People said they enjoyed the food they were given and said that there was a good choice. One person said ‘I am always ready for my meals, they are always nice, I get better fed here than I did at home’. What has improved since the last inspection? What they could do better:
The medication recording and administration systems need to be improved, to make them accurate and to assist with the auditing of stock. Staff need further training to make sure they follow the homes policies and procedures, to make sure they know how to deal with people’s medication properly and safely. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 7 The manager needs to look at everyone’s care plan to make sure that they give clear guidance and directions to care staff about meeting people’s needs. Information about people must be accurate and up to date so people get the right care and support they need. Some of the staff need to have more regular fire precaution and prevention training, although everyone had received annual training, the fire and rescue service ask that staff who work in care home are trained more regularly. 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. St Aidan Lodge DS0000007502.V349075.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 St Aidan Lodge DS0000007502.V349075.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): 2,3 & 6 Quality in this outcome area is good People’s needs are properly assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans I looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the person’s needs. A senior member of staff visits the person at home or in hospital to discuss their care needs. Social Services assessments are also used to determine this as well; these were also available to look at. People are welcome to visit the home before reaching a decision.
St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 10 I also looked at contracts people have with the home. These were detailed and included a breakdown of the fees and who was responsible for paying for the care provided. The home does not provide intermediate care. St Aidan Lodge DS0000007502.V349075.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): 7, 8, 9 & 10 Quality in this outcome area is poor. Care plans do not provide staff with enough detail to meet peoples identified health and personal care needs. This, coupled with poor practice in the storage and administration of medication puts some people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at four care plans in detail, to make sure that people’s health and personal care needs are being met in the way the person prefers and to help them maintain their health and well-being. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 12 Since the last inspection all the care plans have been rewritten and staff have been updated and trained in how to complete them. However the four care plans looked at, were not written in enough detail to ensure that people’s needs could be met. In one care plan the person required a diabetic diet. In the nutritional section of the plan and on the ‘kitchen notification’ form it did not mention this. Another plan stated that a person was catheterised; reading the daily record sheet it became apparent the catheter had been removed, yet the plan had not been altered or updated following this. Both of these omissions in recording could potentially seriously affect a person’s health and well being. During my visit I looked at how peoples medication was looked after by the staff at the home. Some staff were not following the medication policy and procedures of the home. Tablets were difficult to audit because there was not a record of what medication the home had received or what the existing stock balance was. Some staff had not signed the medication administration record to denote that medication had been administered. In some cases the medication administration record had been signed as given but the tablets remained in the monitored dose system. Some tablets had not been stored securely in the medication trolley; blister packs of antibiotics were loose on top of the trolley. The manager was asked to lock any loose packs of tablets in the medicine trolley. Also, when people were admitted to the home staff will use tablets that people bring with them. Sometimes these tablets have been dispensed into other containers from the original packets and are not labelled properly. People are at risk from this practice. To reduce the risk of harm to people, I asked the manager to obtain further training for all staff who administer medication. She needs to make sure that staff are properly trained and are safe to handle people’s medication. It was also decided to ask for some help and advice from the primary care trust pharmacist who will visit the home. During my visit I noticed that staff treat people with respect and maintain people’s dignity. One person said ‘the staff do their best. I could not manage without them, that’s for sure’. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 13 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, & 15 Quality in this outcome area is good. The recreational and social needs of people are well catered for which enables them to make daily choices and promotes independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During my visit the atmosphere in the home was friendly and welcoming, with visitors coming and going throughout the day. Some people were enjoying chatting with each other; some were listing to music or else joining in with a quiz. The activities coordinator divides her time between the two units. Activities for the people in the dementia unit were appropriate and promoted life long skills, such as baking and reminiscence. Downstairs, quizzes, board games and coffee mornings are some of the activities on offer. The activities coordinator keeps a dairy of all the activities on offer and who has joined in with them.
St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 14 The home has a mini bus for trips out, and people said they really enjoyed this when the weather was fine. During the second day of inspection, a church service was being held and people could attend if they wanted to. I spoke to a relative who said ‘mum really enjoys living here we are always made welcome’. Everyone said the food was good, and a choice of meals was offered. The menus were well thought out. I took the opportunity to watch breakfast being served. Some people were having bacon and egg; others were having toast and cereal. The cook was helping serve and I spoke with her about the menu and choice of food. She was knowledgeable about peoples diet requirements and knew what people liked to eat and what portion sizes they preferred. If anyone needed extra supplements during the day, milkshakes and fruit smoothies were some of the things offered. One person said ‘I eat very well, we get a nice choice, I have no complaints about the food’. People could either have their meals in the communal dining area or else in the privacy of their bedrooms. The majority of people chose the communal facilities. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is good. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told me they would speak to the manager or any of the staff if they had any concerns or complaints. Staff told me that training has taken place in the protection of vulnerable adults in abuse. I looked at four personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures.
St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 16 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 & 26. Quality in this outcome area is good. People live in a safe, comfortable, well maintained and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the bedrooms that I saw reflect the person’s individual preferences and taste. There is a programme of re-decoration for the bedrooms, as well as for the rest of the home. Several bedrooms and the main reception area have recently been re-decorated and look fresh and attractive. The bedroom doors all have locks, and there is a lockable storage space in the rooms. This means that people can keep their belongings private and secure. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 17 The home is fresh, clean, comfortable and well looked after. Everyone who commented agreed that the home is always, or usually, well kept. One person wrote in the questionnaire ‘very fresh and clean. No bad smells when you come through the door’ St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 18 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 & 30. Quality in this outcome area is good. People can be confident that staff are trained and on duty in sufficient numbers to meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new member of staff starts work until a POVA register check had been completed. Then, if the CRB check had not been received, they would work only under the supervision of an experienced staff member. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 19 The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 20 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, 33, 35 & 38. Quality in this outcome area is adequate . Whilst the home is reasonably managed there are some health and welfare issues that need review so people are looked after safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the qualifications and the skills to manage the home. During the inspection the manager was shocked and disappointed that staff weren’t carrying out some things that she had requested them to do. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 21 For example updating care plans and following policy and procedure when dealing with people’s medication. I advised her that she should develop her own quality checks and systems for making sure that staff are following instructions and procedure so that she can be confident that people who are being looked after are getting the right care and support safely. Residents and relatives meetings are held, the minutes are available in the home. The home sends out questionnaires to relatives, in order to gain information about how people view the service and what improvements they would like to see. I looked at the records held at the home regarding people’s personal allowance. All transactions are recorded correctly and receipts are kept. One person’s money was counted and matched the total on the record. The homes health and safety file was examined; all equipment in the home is regularly checked and certificates were up to date. Some of the staff need to have more regular fire precaution and prevention training, although everyone had received annual training, the fire and rescue service ask that staff who work in care home are trained more regularly. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 & 17 Schedule 3 Requirement Timescale for action 12/09/07 2. OP7 15 3 OP38 23 For the health and protection of everyone at the home, • All medication must be administered and recorded accurately. • All staff who deal with peoples medication, have refresher training in the homes policies and procedures that surround medication systems and To avoid risk of harm, care plans 31/12/07 must describe accurately the care and assistance that people require to live safely Care staff must received fire 31/10/07 training at regular intervals as directed by the fire and rescue service. This is to make sure that people are safe. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 24 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 OP38 Good Practice Recommendations The manager should explore ways of making sure that staff carryout her instructions properly and devise some audit system for checking this. St Aidan Lodge DS0000007502.V349075.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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