Inspection on 16/01/08 for St Albans House

This inspection was carried out on 16th January 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

St Albans House 12/09/06

St Albans House 20/02/06

St Albans House 05/01/05

St Albans House 15/07/04

St Albans House 31/03/04

St Albans House 07/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE St Albans House 59-61 St Albans Avenue Queens Park Bournemouth Dorset BH8 9EG Lead Inspector Jo Palmer Key Unannounced Inspection 16th January 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 St Albans House DS0000003982.V357343.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 Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Albans House Address 59-61 St Albans Avenue Queens Park Bournemouth Dorset BH8 9EG 01202 397817 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) Mr Timothy Martin Culley Mrs Sally Eileen Culley Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: St Albans House is located in a quiet residential area of Bournemouth between Queens Park and Charminster. Most local amenities are available in Charminster, approximately ¼ mile level walk from the home. The home is registered for 28 residents in the category of older people (OP) and is run by the owner/managers Mr and Mrs Culley. The care home comprises two houses linked together at ground and first floor levels. Accommodation is provided on the ground and first floor as follows: Ground floor 9 bedrooms, 6 with full ensuite, 3 with toilet and wash hand basins. First floor 13 bedrooms, all with private wash and toilet facilities. Residents have access to a variety of communal areas. The home has a large lounge area linking to a dining room. Along the length of the home to the rear of the property is a large conservatory overlooking the garden. The large grounds are well maintained and contain an oriental sunken garden area in addition to the large lawn area. Seating is provided outside in the summer months. Upstairs the two properties are linked via a covered sun terrace providing further communal seating. All communal areas are tastefully decorated and plants and flowers add to the domestic character of these rooms. All food is cooked on the premises and the menus offer a range of choices. St Albans offers a wide variety of activities on a regular basis including physical exercise, musical evenings, card and board games, reminiscence therapy and regular interdenominational church services. Current fees are £450 to £575. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx St Albans House DS0000003982.V357343.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place on 16th January 2008 between 10.30 and 15.00 as part of the routine inspection schedule for the home. The last inspection was in September 2006. Mr and Mrs Culley, owners/managers of St Albans House were present to assist with the inspection process The main purpose of this key inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting the requirement and recommendations made at the previous inspection. The inspector spoke with six residents, briefly with two staff members, a relative and a visiting hairdresser. The Commission for Social Care Inspection sends questionnaires to service users, their relatives, staff and visiting professionals in order to obtain feedback about the services provided and an Annual Quality Assurance Assessment (AQAA) is also sent for completion by the manager/responsible person. The completed AQAA and returned surveys* were used to inform parts of this inspection. Examination of relevant records and a tour of the premises completed the inspection. *Surveys were returned from: 9 residents 11 relatives, friends or carers 2 Care Managers 5 visiting health professionals What the service does well: Medication systems are supported by good practice and procedure which staff follow, records are fully completed and signed appropriately. Residents spoken with confirmed they supported with fairness, dignity and respect and visitors are welcome in the home. Residents are able to make choices about the meals they prefer and like, the menu is varied and meals are well balanced. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 6 The home’s environment provides for the individual requirements of people living there, it is homely, clean, safe and comfortable, is well maintained and residents rooms reflect their individuality. Mr and Mrs Culley have sound knowledge of residents needs in the home from a personal level and have been managing St Albans House since 1980. This inspection however has lead to some areas being highlighted that need improvement. The Annual Quality Assurance Assessment (AQAA) gives clear, relevant information although is not wholly supported by evidence indicating how and when improvements will be made over the next 12 months. Health and safety policies and procedures are in place for the protection of residents. What has improved since the last inspection? What they could do better: Two requirements are repeated from the previous inspection and this visit has resulted in a further nine. Mr & Mrs Culley must give serious consideration to how these will be addressed. Of the eleven requirements, five are relating to a poor standard of care documentation. Pre-admission assessments, on-going assessments, care plans and daily recording systems require reviewing to ensure the best outcomes for residents and that all personal and health and welfare needs are met. Residents must be assured that there records are kept confidentially and that they have access to them as they wish. Whilst medication systems are in order, it is required that all medicines are stored securely, the practice of leaving some medicines on top of the cabinet, not locked away, must cease. Whilst residents spoken to perceive that their needs are met, several commented on the lack of stimulation in the home although one actively stated that at her time of life, she did not want to be involved in active recreational pursuits. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 7 To ensure residents are in safe hands, the staffing circumstances need reviewing. All staff must be safely recruited and where the home is not responsible for this (whilst using agency staff) it is the responsibility of the owners to ensure the agency have recruited safely and trained appropriately. 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 Albans House DS0000003982.V357343.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 Albans House DS0000003982.V357343.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): 3 (standard 6 is not applicable) Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The admissions procedure is not robust and does not ensure that a persons needs are fully assessed before entering the home in order that they can be assured it is the right place to move to where their needs can be met. EVIDENCE: Mrs Culley explained the admissions process; a person would enquire about a placement at the home and a visit would be arranged. Either during this visit or at a visit to the person at home, Mrs Culley would carry out an assessment of their needs, a decision would be made whether the person wanted to move into St Albans and a date would be arranged; the person would then move to the home for a trial period. Mrs Culley confirmed that the person would be provided with a copy of the home’s handbook and a letter agreeing to the trial period based on the assessment of need. A copy of the Terms and Conditions of residency (Contract) would be issued detailing the fees and services. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 10 Examination of residents’ care records did not fully support this process; an assessment form is available but in each instance of those examined (three files) the form provides a simple checklist. Under headings of personal care, health, mobility for example, the assessor had ticked one section indicating the level of dependence but no further information was provided. For instance, on one form, under the heading relating to elimination, the section ‘wears pads day/night’ had been ticked. There was no further information regarding this person’s needs in relation to elimination. On one file, the entry in the records for the resident on admission to the home was that s/he was ‘underweight’; there was no pre-admission assessment in relation to this and no weight measurement. Although a dietician had visited this person 2 months later, there was no care plan in place relating to nutrition; there is room for improvement in this area. Mrs Culley confirmed that a letter was sent following the pre-admission assessment confirming that, based on the information obtained from assessment, St Albans House was a suitable place for the person’s needs to be met; blank copies of the letter were seen at inspection. St Albans House DS0000003982.V357343.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current systems for care planning do not provide care staff with detail of each resident’s assessed health and personal care needs and how these are to be met and do not support resident’s right to privacy. Medication systems are generally well managed in the interests of residents although storage needs reviewing. Residents spoken with confirmed they are treated with respect and their dignity is upheld by staff practices. EVIDENCE: Resident care records are unwieldy. A Kardex system holds each resident’s care records although these were out of date, care plans and risk assessments are held in a separate file and a daily report book is used by staff to record significant events of each shift. The Kardex holds information for residents St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 12 such as their name, address, GP, next of kin, and health diagnoses. Subsequent pages are a transcript of records from the daily report book; the Kardex sheets are copied from the daily report book at intermittent intervals although it was noted that some had not been updated for several months, one record had not been written since October 2007. Care staff use a daily report book at the end of their shift and enter details of the care provided for some residents, for instance, whether the resident has had a bath and other issues relating to personal care or whether the resident is unwell and seen a doctor. The daily report book is not a confidential record and does not support the resident’s rights to privacy or comply with data protection legislation. If a resident asked to see their records or if the records were required as evidence of a person’s care, the reader would have access to privileged information about other residents in the home. In one instance, information was recorded concerning the resident’s admission details including diagnosis, reasons for needing to enter a care home and personal family and social history. Care plans are written under headings relating to the person’s needs for their living environment, health, daily living, and relationships; these provide basic details of how perceived needs are to be met but as outlined in the previous section, as needs are not fully assessed, it is difficult to determine how they have been identified. There are no systems in place for on-going assessment of need once a resident is living at the home. Of the care plans examined, the residents concerned had no complex needs and were recorded as maintaining a high level of independence in their daily living being in need of only minimal assistance from staff, although a tour of the home to meet with residents identified that several required help with using the toilet and with bathing. Residents spoken with confirmed that they felt their needs were met and that staff were kind and respectful. One care file held information relating to the resident’s self management of diabetes. Mrs Culley confirmed that this resident arranged her own appointments, prescriptions, blood sugar levels and insulin administration. A format is used where in these cases, the resident will sign a declaration stating they understand the consequences of managing their own medication, the form also has a section for the GP to give approval indicating that the resident is capable of continuing to manage their medication. In this instance, approval had not been given by the GP and there was no indication of the reasons for this or of further assessment. Mrs Culley also stated that this resident was aware of her own needs and if she were to feel she were to have a hypoglycaemic attack she would ring staff for assistance. Mrs Culley said that a sugary drink would be given although instruction for this was not documented. Risk assessments are held in the care-planning file and relate to any perceived risks presented to the resident, for instance, the risks of falling. Action needed to be taken by staff to reduce these risks was clear. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 13 Medication systems were examined; a locked cabinet is kept in a dining area of the home and additional storage is available for stocks. The contents of the cabinet were noted to be in order with records supporting an audit of medicines held. A monitored dosage system is used for most medications although where medicines are not suited to this type of packaging, they are issued in boxed or bottled containers. Records seen demonstrated the effective receipt, administration and disposal of medicines. Some medicines were stored on top of the trolley, not locked away; Mrs Culley stated that this had been agreed with the pharmacist. The inspector consulted the pharmacist at the Commission for Social Care Inspection regarding this and it is considered necessary to keep all medicines in a locked, secure facility. St Albans House DS0000003982.V357343.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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The absence of effective assessments and care recording systems leaves staff without formalised action plans to follow in order that each service user’s assessed needs in relation to social, cultural, religious and recreational activities are met; this also limits evidence that residents are able to exercise choice and control over their lives. Residents however perceive generally that the services meet their needs. Family and friends are able to visit at any time. Meals in the home are well accepted by residents who confirmed their dietary needs are met. EVIDENCE: St Albans House provides some organised entertainment such as singers and musicians and residents confirmed that someone comes with a giant scrabble game, which they can play with other residents. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 15 Residents’ needs are not fully assessed (see previous sections of report) and care is not planned around individual social needs. Residents spoken with generally confirmed that they felt there was sufficient to keep them occupied although several commented, when asked, that there was not much to do and they spent their day ‘sitting’ in the lounge, they did not perceive this as a problem however. One lady commented on how she enjoyed reading and confirmed that a visiting library comes monthly from which she gets three books; newspapers and magazines are also available. Returned surveys generally commented positively although three returns indicated that more activities or trips out would be nice. On the day of inspection, two residents were able to go out with relatives, one relative spoken with, with the resident, confirmed that the home was very flexible and they were able to arrange their own affairs, come and go as they please and were able to get up, go to bed and generally organise their own daily routine in the home. A visiting hairdresser was spoken with briefly who confirmed that regular visits to St Albans House had provided the opinion that it was a very well run service where residents’ care needs were paramount. Meals are provided from a central kitchen; the kitchen, food supplies and records of food provided were not examined. Care plans associated with nutritional assessments were not available for staff reference in order that individual nutritional requirements could be met. Residents spoken with confirmed that the provision of meals was good and that there was always a choice, this was confirmed when a member of staff was observed giving residents their options for the evening meal; three choices of a light meal were given or an alternative of a selection of sandwiches. St Albans House DS0000003982.V357343.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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to protect the residents living at the home although to ensure that any incidents will be managed appropriately staff training in adult protection needs to be in place. EVIDENCE: A complaints procedure is available to residents and visitors to the home. This details the action necessary should any complaints be received; Mrs Culley confirmed that no complaints have been received. Respondents to surveys all stated that they had no complaints but would be happy to raise any concerns. An adult protection policy is in place with procedures detailed for contacting the appropriate authorities should any concerns or allegations be made. Of the ten care staff employed, four have received training in issues relating to abuse and adult protection. It is a statutory obligation for all staff to attend this training. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 17 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, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, comfortable, safe and well-maintained environment, which meets their individual needs. EVIDENCE: Residents spoken with confirmed that they are comfortable in their rooms and are able to bring personal effects to make their space more homely; the lounge, dining room and other seating areas in the home have a homely ‘domestic’ feel to them. Bathrooms, showers and toilets are sited around the home and many rooms have en-suite facilities, these provide suitable amenities, are clean and well maintained. Call points are sited appropriately around the home and residents spoken with confirmed these are answered promptly by staff. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 18 A requirement of the last inspection has been addressed in relation to equipment needed for lifting residents although in emergency only. A Mangar® Emergency Lifting Cushion (ELC) has been purchased which provides assistance for staff in moving a resident from the floor should they fall. A pillow lift has also been purchased which assists a resident to move to a sitting position in bed. Both pieces of equipment can be slipped under the resident and then inflated to the necessary height. The ELC does not allow for transfer of a resident from bed to chair or wheelchair to toilet although Mrs Culley confirmed that should any resident require this type of care, they would not be accommodated at St Albans House. Radiators and hot surfaces in the home have been guarded to reduce any risk posed of accidental scalding. Residents confirmed that the laundry system is effective with clothes etc being taken for laundering and returned the following day, pressed and in good condition. Infection control procedures are observed with provision of proper hand washing facilities. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels may not meet the needs of the people using the service as needs have not been thoroughly assessed and care delivery is not planned, there is a reliance on agency staff which could lead to inconsistencies in care delivery. Procedures are in place for the safe recruitment of staff, no new staff have been appointed. Agency staff are used although these safe procedures have not been employed in assessing suitability of agency appointed staff which could leave residents vulnerable. Mandatory training requirements are not met meaning staff are not equipped with the necessary skills to meet the health and safety needs of residents. EVIDENCE: Overall resident dependencies have not been measured and individual assessments and care plans for residents do not give a clear indication of actual need, the numbers of staff on duty is therefore subjective. Rotas seen confirmed that there are four care staff on duty each morning, three each afternoon and one at night with a second sleeping in/on call. Additionally, the rota shows that Mrs Culley is available throughout the day for care work, St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 20 administration and management, there is a domestic housekeeper in the home each weekday morning, a cook and a kitchen assistant. Mr Culley is not on the home’s rota although confirmed that he is always available for support, maintenance, shopping and odd jobs. Residents spoken with, and returned surveys indicated that there are sufficient numbers of staff available although the absence of comprehensive assessments makes this difficult to measure. Due to a series of unfortunate circumstances, the home is experiencing high levels of sickness and absence and is therefore using some agency staff; Mrs Culley stated that often they get the same agency carer who is getting to know the residents, the home and the routines, although more frequently (as was the case during the week of inspection) a different agency carer arrived daily who didn’t know the home or the residents. There has been limited staff training recently although Mrs Culley stated that due to staff circumstances, several courses that had been booked had been cancelled. Whilst it is acknowledged that this is unfortunate, it remains that many of the staff at the home have not received training, or training up dates on mandatory training courses. There are thirteen care staff employed, two domestics, three cooks and three kitchen assistants; the following courses have been attended: Health and Safety: - 2 carers in 2007, 1 in 2006, 1 in 2004 and 3 in 2003. 3 staff have not received this training. First Aid: - 4 carers in 2006, 1 in 2004 and 1 in 2003. 4 staff have not received this training. Moving and Handling: - 1 carer in 2006, 6 in 2004 and 1 in 2003. 2 staff have not received this training. Infection control: - 3 carers in 2006. 7 staff have not received this training. Adult protection: - 2 carers in 2007, 1 in 2006. 7 staff have not received this training. Food hygiene: - 2 carers in 2006, 2 in 2003. 4 staff have not received this training, records were unavailable for 2 carers. Medicines management: - 1 carer in 2007, 2 in 2006 and 2 in 2005. records were unavailable for other staff. Additionally, some staff have received training in the following areas of care: Diabetes (4 staff), Dementia and challenging behaviour (3 staff), Falls awareness (3 staff) and Dysphagia (1 staff) One member of staff has attained NVQ level 3. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 21 No new staff have been appointed since the last inspection, it is not therefore possible to measure the home’s commitment to delivering effective induction programmes based on NTO specification. At the time of inspection, St Albans House was using agency staff occasionally to cover shifts in the home. It is the role of the agency to ensure all staff employed are suitable. It is however, the role of the home to ensure that the agency has carried out the appropriate checks and that the staff member has received the appropriate training. None of the staff provided by the agency for the week of inspection had supporting records to indicate that they had received appropriate clearance in terms of references, CRB and POVA checks or of the level of training they had received. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 22 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, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The owners/managers take responsibility for the day to day management of the service and are aware of the basic processes set out in the National Minimum Standards and of the need to keep up to date with practice and to develop the service; a difficult set of circumstances and unfortunate situation with the previously consistent staff group has led to this becoming strained. All sections of the Annual Quality Assurance Assessment (AQAA) were completed and the information gives a reasonable picture of the current situation within the service, although there are areas where more supporting evidence would have been useful to demonstrate what the service has done in the last year and how it is planning to improve. People are supported to manage their own money where possible; their financial interests are protected by the home’s policy. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 23 Health and safety policies and procedures are in place for the protection of residents. EVIDENCE: Mrs Culley is a qualified nurse and has been managing St Albans House since she and Mr Culley bought it in 1980. Prior to this inspection the home was sent an annual quality assurance assessment (AQAA), which they were requested to submit to the Commission for Social Care Inspection to identify what the home feels they do well and set out their plans for improvement over the next twelve months. The AQAA was completed and returned to inform this inspection and to demonstrate the home’s aims although some areas were limited in respect of the areas in which the service needs to improve. Mrs Culley has purchased a Quality Assurance Audit package and whilst questionnaires have been sent to residents and returned, no further work on the quality assurance programme has been undertaken. In order to protect residents, it is the policy of the home not to have any involvement with their personal finances. Therefore, any resident unable or not wishing to handle their own affairs has a relative or other representative to deal with their finances etc. Any purchases that a resident may require including hairdressing and chiropody appointments are paid for by the home and then invoiced to the fee payer (Power of Attorney) as appropriate. Residents could have access to their care files and Mrs Culley stated that she believes they are not interested in accessing their records. (See standards 7 and 8) The Fire Risk Assessment held on file was dated October 2006, Dorset Fire and Rescue Service last visited the home in May 2007 and approved this risk assessment. Any accident in the home is appropriately reported using the correct reporting format. Mrs Culley is aware of the need to report any accidents or events in the home which fall under Regulation 37 particularly in respect of RIDDOR (Reporting Injuries, Diseases and Dangerous Occurrences Regulations) although no such accidents have occurred in the home recently. A review of accident reports in the home demonstrates that no major injuries have occurred and there are no patterns or trends in accident occurrence involving residents, staff members, time of day or particular aspects of the environment. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 24 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 1 3 X X X X X x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 1 3 St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 25 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 12 Requirement Timescale for action 31/03/08 2 OP8 13 3 OP8 13 Care plans must be written based on information provided from assessment, prior to admission and thereafter with effective systems in place to review assessed needs and detail how these needs are to be met by staff in the home. Risk assessments in relation to 31/03/08 self management of medication by residents must be robust and where a GP has not approved this but the resident wishes to continue, further assessment must be undertaken to rationalize the decision to continue. Where a resident has a condition 31/03/08 that may require urgent attention (hypoglycaemia in relation to diabetes) action for emergency aid must be detailed explicitly in their care plan. St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 26 4 OP7 OP8 14 & 15 5 6 7 8 OP37 17 13 18 18 OP9 OP18 OP27 9 OP28 18 10 OP29 19 In order to carry out effective assessments on which to base a plan of care, records relating to care delivered by staff must be up to date and include not only significant events but give a good account of the resident’s life in the home. Records must be held confidentially and support the residents rights to privacy. All medicines must be held securely in the home for the protection of residents All staff must be trained in issues relating to recognising and reporting any incidents of abuse. Staffing numbers available to provide care must be based on the assessed needs of residents and around planned delivery of care. Staff must be trained to meet the care needs and health and safety needs of residents living at the home, mandatory training requirements must be met. The registered person must operate a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. Evidence of a new employees identification must be held on file, 2 written references and a Criminal Records Bureau/POVA check must be obtained prior to an employee commencing duties or being confirmed in post. This requirement is carried over as although no new staff have been employed, the use of agency staff in the home necessitates the same level of clearance to ensure their suitability. 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 27 11 OP30 12 & 18 It is a requirement that all staff must receive induction training to NTO specification within the required timescales. This requirement is carried over from the previous 2 inspections as although no new staff have been appointed the home must ensure that agency staff used have the appropriate level of training 31/03/08 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. Refer to Standard OP12 OP28 Good Practice Recommendations It is recommended that residents social and recreational needs are assessed and activities arranged that meet individual need. A plan must be developed and implemented to ensure that 50 of care staff are trained to a minimum of NVQ level 2 in care It is recommended that Mrs Culley consider undertaking NVQ level 4 and the Registered Managers award in order that she can keep abreast of current good management practice. Further work must be undertaken with regard to quality assurance systems in the home, by means of surveys, analysis and annual development plans, in order to demonstrate that the home is meeting its aims and objectives and statement of purpose OP31 4. OP33 St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Region Colston 33 33 Colston Avenue Bristol BS1 4UA 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 St Albans House DS0000003982.V357343.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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