Inspection on 11/10/07 for The Alders

This inspection was carried out on 11th October 2007.

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

The Alders 20/11/08

The Alders 07/02/08

The Alders 23/08/06

The Alders 21/02/06

The Alders 27/04/05

The Alders 11/01/05

The Alders 20/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Alders 1 Arnside Crescent Morecambe Lancashire LA4 5PP Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 11th October 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 The Alders DS0000059652.V347253.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. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Alders Address 1 Arnside Crescent Morecambe Lancashire LA4 5PP 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) 01524 832198 F/P 01524 832198 Calderdean Ltd Mrs Jacqueline Harrison Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 residents to include:*Up to 32 residents in the category of OP (Old age not falling within any other category). 23rd August 2006 Date of last inspection Brief Description of the Service: The Alders is situated in a residential area of Morecambe, close to shops and local amenities. There are two separate dining rooms and three lounges that are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. Resident’s rooms are all single and have ensuite facilities. There are two stair lifts in the home. In the centre of the home is an attractive courtyard that is used by residents in the warmer months. Residents are encouraged to retain links with the families and friends and contacts in the local community. The Alders is a no smoking home, although there are currently 3 residents who smoke. The home is owned by Calderdean Limited, the Directors (Mr Jonathan Croft & Mrs Margaret Croft), Mrs Croft visiting the home on a daily basis. Since the last inspection, the company have appointed a General Manager (Mrs Margaret Smith) who overseas all the services within the company. The home’s manager (Mrs Jacqueline Harrison) is registered with the Commission for Social Care Inspection. The current range of fees are from £342.50 to £386.00 per week for residential accommodation, respite fees vary. Further details over fees can be obtained from either the general manager or registered manager of the home. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit and was unannounced so the general manager and registered manager, staff and residents were not aware of the visit. The site visit forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. The inspector for the service carried out the site visit with the help of an “expert by experience” - Mrs Noreen Haselden. The expert by experience is a person appointed by Help the Aged, under the direction of the Commission for Social Care inspection, and had a role to take part in the site visit to The Alders to provide an additional view of what it is like to live there. The information provided by the expert by experience was used in the feedback to the general and registered managers and is also contained in this report. As well as the site visit, judgements have been made about the service based on information supplied by the registered provider/manager. Comment cards were made available to residents, their relatives, GP surgeries, healthcare professionals and staff who work at the home. A good level of responses were received from all the above. Comments and issues made were discussed with the general and registered managers, although care was taken to protect peoples’ identity. The site visit took place over one day and included - spending time observing staff on duty performing the day-to-day care tasks, taking time to sit and speak with residents, speaking with staff and speaking with the registered provider/manager. As well as this, a number of records and documents were examined. The inspector and expert by experience also enjoyed a meal sat with the residents, which provided a first hand sample of the mealtimes in the home. The home’s registered manager was available during the inspection to answer questions and provide additional information. The expert by experience had a tour of the home and, as well as this, the inspector looked around communal rooms, a small number of personal rooms to see first hand if the home was a comfortable, clean and safe for people to live in. Every year the registered person is asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. This information, in part, has been used to focus our inspection activity and is included in this report. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 6 The site visit was enjoyable with everyone welcoming, friendly and cooperative during the visit. What the service does well: What has improved since the last inspection? At the last inspection in 2006, several requirements were made for the home to address. A number of these have been completed, including : • • • • Residents have been provided with a copy of the home’s Service User Guide Improvements to the pre-admission assessment procedure Medication administration and recording Domestic staffing levels DS0000059652.V347253.R01.S.doc Version 5.2 Page 7 The Alders • • • • • Security of the home A number of repairs Door guards fitted to fire doors so that these are not now wedged open Notification to the Commission of serious incidents and injuries Monthly visits and reports by the general manager The home is also continuing with the National Vocational Qualification training with over 50 of staff now trained to NVQ Level II. This means staff are now provided with training over current good care practices and supporting people with dignity and respect. What they could do better: All registered care homes are expected to keep a written record for every resident, which describes their needs and how the care that is given meets these needs. These records are called care plans. A number of these were sampled and showed that much more information needs to be provided to ensure staff are fully informed over individual needs. There may be times when an individual resident is not able to do something because they may be at risk. This is called a ‘restriction’. For any resident at the home where there are any restrictions, the care plan should clearly state what the restriction is, give clear guidance to staff and review on a regular basis. The home needs to make sure that where there is a restriction, they ensure residents’ rights are upheld and the requirements of the new Mental Capacity Act legislation. These care plans also need to inform staff about any areas of risk so that both the resident and staff are protected. All care plans need to be reviewed at least once a month or if the individual residents’ needs change. Registered care homes are also required by law to make sure individual residents’ healthcare needs are met. Residents at The Alders said that their healthcare needs are met but, the home’s records do not record individual input. Healthcare professionals also indicated that whilst staff do try to make sure healthcare advice is followed, their advice is not always followed consistently. Feedback during the inspection raised concerns over staffing levels which, at times, did not appear to be sufficient to meet the needs of the residents. Individual comments raised this as a concern too. Comments included : “I feel I can’t spend time with various residents who need one to one care” and “just the fact having days with not many staff is extremely tiring and puts pressure on caring for residents. I feel I can’t spend time with various residents who need one to one care.” This was supported by comments from residents which included “I have heard staff say to other people that they will have to The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 8 wait” and “staff are so very busy now – it used to be nice to have someone to talk to me but the staff don’t have the time for that now”. There was inequality of activities in the home – some residents are supported to follow community activities, but there is very limited activities for other people in the home. The care plans do not provide information over individual residents’ social interests so that staff know how they should provide support. The home needs to look at the administration of medication during the nighttime as the current system is not safe practice. Information from the home confirmed there is a commitment to training and this is evidenced by the number of people who have completed National Vocational Qualification training. However, the training records have not been completed and do not include current staff which means it is not possible to verify which staff have completed basic and other training. Whilst the home has regular fire drills, there is a need to ensure that night staff are also involved so that they are competent to know what to do should a fire occur during the night time. As well as the above requirements, a number of recommendations have been made which include : • • • • • • • • To continue to improve the pre-admission assessment to ensure the home gathers full information about any prospective resident Care plans to include last wishes and for the home to take account of the new Mental Capacity Act To expand the current quality assurance system and to reinstate residents meetings. To improve the meals serve records to provide more detail To replace the mis-matched crockery and cutlery used by residents To ensure a reference is obtained from any prospective employee’s last employer To consider purchasing different chairs for the dining room (i.e. ‘ski’ chairs) so that the residents can mobilise easier To include specific training for both care and auxiliary staff The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 9 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. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 10 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 The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home’s system to assess people who may like to live at the home has improved, which means that only people whose needs can be met will be accommodated. EVIDENCE: All residents have now been provided with a copy of the Service User Guide. Two assessments for newly admitted residents were examined and found to provide more information. Importantly, it was seen that staff were able to support the new resident to feel at home, giving them time to settle and giving reassurance and help, as needed. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 12 Information from the home confirmed that a visit is always done, either to see the prospective resident in their own home or whilst in hospital. During that visit, information (in the form of the home’s brochure) is given and the service user guide is provided. Residents felt they had enough information about the home to make a decision about whether they wanted to live there or not. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Insufficient information is provided to inform staff and to demonstrate individual health and personal care needs are being met, although residents feel well cared for. EVIDENCE: Four care files were examined and the following found to contain basic information that did not provide sufficient information over specific individual health and personal care needs. Care records were not completed daily and many days’ gaps were in evidence. This does not provide a clear picture of care provided and to that staff are being proactive in providing care and addressing health and personal care issues as they arise. The care plans need to also identify and address all areas The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 14 of risk. This should also include any areas where residents have restrictions and should also take account of the new Mental Capacity Act guidance for care providers. Personal daily care charts are not being completed. For the four residents care plans examined, there was limited evidence of healthcare input, generally only recording visits by GP’s and District Nurse. Whilst residents have confirmed that they feel their healthcare needs are being met, the records are not being adequately maintained. Residents confirmed that their personal care needs are usually met, although some concerns were raised over staffing levels, particularly in the morning, which clearly influence the staff ability to meet needs – this is addressed in the staffing section. Relatives also expressed confidence in the care provided by the staff at the home. A visiting relative was also spoken with who was very happy with the home and the care provided. Individual comments included “this care home was arranged by X’‘s care people, and seems satisfactory” and “I find that this home has a genuine concern for all its residents, the staff doing their utmost for everyone, with a friendliness which reaches out not only to those for whom they care but also to those visiting them.” Concerns were also raised over communication within the home. One comment received said “we are only told half a story and often new residents are not mentioned.” Given that new and agency staff would refer to the care plan, it is essential this is addressed so that full information is available at the time of handovers and in the care plans so that all staff have sufficient information to ensure health and personal care needs are met. Residents spoken with, and those who completed comment cards, all said that they felt their medical and healthcare needs are met Healthcare professionals confirmed that staff will seek their advice and when this is given care staff generally follow their instructions. However some concern was raised that this is not always done consistently. Healthcare professionals also raised the need for staff to be more proactive in care, for example, for staff to have training in aspects such as mouth care for poorly residents, regular position changes to prevent sores, etc. A visiting healthcare professional was spoken with who spoke highly of the care provided by the staff at the home and confirmed that the staff team deal with “some difficult people very well”, treating them with respect, making them feel at home and providing reassurance and support. An administration of medication round was observed and this was done individually and carefully by the member of staff concerned. Medication stocks and records were examined and generally found to be accurate, although advice was provided over controlled drugs kept in the home. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 15 The registered manager was also advised that, for any medications administered PRN (as needed), with a variable dose (for example paracetemols), the Medication Administration Records sheets should indicate the number of tablets actually taken. The home also needs to implement a homely medicines record sheet for residents. There is not currently an formal controlled drugs book in place, the home currently using loose leaf records. Advice given that this is not appropriate and a proper Controlled Drugs register book should be put in place. The inspection found that the office keep a small supply of pain killers in place so that night staff can administer these as needed to individual residents. This is not good practice and there should be someone trained to give medicines on duty 24 hours a day. This practice is dangerous and could lead to mistakes. This was discussed with the general and registered managers who were advised that any member of staff left in charge should be competent to deal with all tasks, including medication administration. The registered manager was also made aware that for any resident who chooses to self-medicate, either all or part of their medications, there should be a risk assessment carried out. Information provided by the home confirmed that they have done their own competency training for any member of staff who administer medications. Some staff have undertaken a formal “safe handling of medications” training course at the local College and this should be provided to all staff who hold this responsibility. Healthcare professionals confirmed that residents are generally treated with respect and their privacy maintained. The registered manager is to reinstate residents being seen in their own rooms when healthcare professionals visit as this ensure privacy and dignity is maintained. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are limited activities available for residents to enjoy, although individual wishes and choices are respected. Meals are generally to a good standard. EVIDENCE: Whilst individual 1 to 1 support is provided to some residents to enable them to attend community activities, activities in the home have dwindled. It was noted that the last activity notice was dated April 2007. Residents indicated that currently, there are very few activities provided in the home. One resident said they had heard that a trip to Blackpool Lights had been mentioned but, to date, nothing else had been mentioned. Staff also indicated that, because of the staffing levels, they had not had time to organise activities. This is clearly an area that needs to be addressed. Residents and relatives raised no concerns over visiting to the home and during the inspection site visit a number of family members were seen coming in and out of the home, either to spend time or to take their relatives out for the morning/afternoon. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 17 Residents who completed comment cards, and those spoken with, were generally happy with the food, although comments included “food choice is very limited. Some meals are too much and not always to my liking” and “it would be nice to have more variety of meals”. Records of menus and meals served were seen. Advice was given that these are not detailed enough to provide information over the full meal provided to enable a judgement to be made over the nutritional content. The expert by experience and the inspector took a meal with the residents at lunchtime in order to assess the quality and quantity of food provided and the environment. Dining tables were appropriately laid out, a teapot of tea and a jug of milk and sugar basin available on each table for residents to help themselves. Residents were offered a starter of either oxtail soup or fruit juice. For main course, there was a choice of egg and bacon pie or stewed steak, peas, carrots and mashed potatoes with gravy. Pudding consisted of fruit pie and custard. One of the residents said that the food was very good but she felt that she was given too much to eat at times. The member of staff serving meals was pleasant and nothing was too much trouble. They also seemed to know the likes and dislikes of the different residents and no-one was rushed or hurried to finish their meal. Additional teapots of tea were provided to residents who asked. Advice and comments were provided to the general and registered managers and included : residents should be offered a choice of soup as a few people said they did not like oxtail soup and “would have to have fruit juice”. The expert by experience felt that a roll and butter could have been offered with the soup too. The main course was to a good standard. It was hot and the portion size was good. A service user said that the meat was “tough” and the gravy appeared glutinous. Whilst residents had pre-chosen their puddings, no alternative was offered to those people who declined the pie and custard. Napkins were brought out (consisting of kitchen roll) towards the end of the meal. Physically, the dining rooms are well presented and laid out in a communal way. The tablecloths were clean and the flowers in vases added to the homely feel. However, the crockery was mis-matched, as was the cutlery. The expert by experience felt that some of the cutlery she saw was “not very clean”. The above observations and comments were discussed with the general and registered managers who are include meals and menus on the residents’ meetings agenda and also monitor the meat and meals generally. Napkins are The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 18 to be provided and the managers are going to address the mismatched crockery and cutlery. Discussions with the cook on duty confirmed that stocks and supplies for food are to a good standard and are provided in good quantities. It was also confirmed that local suppliers are used (for meat and fish), although most food is purchased from a central point. The cook said that on admission either herself or staff talk with the new resident about their likes and dislikes, preferences for food and dietary needs. Where possible, individual requests for specific meals will be provided. One example is a resident who likes liver and onions and Yorkshire puddings – these are now regularly on the menu. The home also make their own cakes and scones which, the cooks said, are enjoyed by the residents. The kitchen is well equipped and if any item is needed it is purchased promptly by the registered manager. The cook has done “Intermediate Food hygiene” training which included training in food hygiene, infection control and pest control. It was confirmed that whilst she has experience in catering for older people, she would welcome training in nutrition. This is something that the home can organise. Staff were seen asking residents what they would like to eat for their tea. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home’s policies and procedures enable residents to voice their feelings, although there are times when residents do not feel listened to. When a full staffing level is maintained, residents are safeguarded in the home. EVIDENCE: The home has a formal complaints procedure which is on display and also provided to residents in the Service User Guide. No complaints have been received by the commission regarding this home. The home confirmed they have not received any complaints in the last 12 months, although the commission were notified of one incident when the relatives of a missing item felt the home could have been more helpful. Residents and their relatives all confirmed that they are aware of who to complain to if they have any concerns. One resident spoken with said they would “see the boss”, although a couple of residents felt that there have been occasions when it has taken too long for an issue to be sorted out. The home needs to develop a system whereby day to day concerns/issues raised by residents can be recorded, along with actions taken or feedback given, to evidence that residents concerns are being dealt with. This is something for the home to address. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 20 One relative raised concerns over the laundry system in the home. This was discussed with the general and registered managers who are to look into this and develop a system to address the concerns raised. Safeguarding adults and whistle blowing are covered in the home’s induction process and safeguarding adults is also covered in the National Vocational Qualification training. Discussions with staff during this site visit confirmed that if any concerns were raised they would go to the registered manager or general manager or social services/commission. At the last inspection, the general manager was looking at providing staff with update training on safeguarding adults. Whilst this has not yet been provided, the general manager confirmed that plans are in place to provide this training. At times, the home’s staffing levels have fallen below a safe level which gives concerns over the home’s ability to safeguard residents as there does not appear to be sufficient staff on duty to fully supervise and support. Concern was also raised over residents having to go through the laundry (which can be slippery and a hazard) to get to the smoking point. The registered manager was advised to ensure that this is appropriately risk assessed for any residents who choose to smoke. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home continues to provide a comfortable and homely environment for the residents which is generally well maintained. EVIDENCE: Not all areas of the home were seen, but communal areas and some private rooms were seen. Generally the home appeared clean and tidy although a couple of rooms had a slight odour. The communal areas have new carpets in place. There is an ongoing redecoration programme in place, carried out by the home’s handyman. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 22 The previous inspection noted that the shower room and toilet at one end of the building was now looking tired. This has been redecorated. The expert by experience toured the home and found that each service user had their own room with private facilities. Some rooms still do not have locks on them. Advice was given that the residents need to be asked and, if they do not wish a lock on their room, this be recorded on their care plan. Once rooms without locks become empty then a lock should then be put in place and a risk assessment carried out on any new occupant. Some rooms still do not have a lockable facility in place for the resident to use. Attention to detail is needed. Crockery and cutlery have already been mentioned. The pillowcases on some beds had not been put on properly. The home employs two cleaners working on different shifts to ensure the home is kept clean. Residents confirmed that they feel their home is clean and fresh, although sometimes there is a lack of attention to detail (cobwebs in corners, for example). Residents confirmed they are happy with their individual rooms, furniture and furnishings. A number of rooms have been personalised with treasured items to make homely and familiar. Residents are been able to bring in their own items of furniture. All parts of the home are accessible to residents, with a stair lift in place for the second floor. Handrails are also provided throughout the home. A range of other aids and adaptations are provided to ensure residents can maintain their independence. During the site visit, the call system for the home continued to be used by residents. The expert by experienced observed that the call bells seemed to ring for a while before they were answered. It is suggested that this system could be upgraded so that staff do not have to leave the area they are working in to go to either the office or the kitchen to see which call bell is ringing, and then go to the resident concerned. This is time consuming and also adds to the delay in answering call bells. Information from the home confirms that there are now door guards in place to ensure fire doors close automatically should the alarm be activated. Security of the home was also raised in the last inspection report. The general manager confirmed that all staff are provided with training in the home’s security and safety during their induction. Observations during the site visit confirmed that the home is kept secure. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 23 There is a separate laundry and protective clothing is supplied for staff to ensure infection control is maintained in the home. It has previously been assessed that the home meets with the requirements of this standard. Information from the home confirmed that infection control training had been provided to staff. This was supported through discussions with staff who all confirmed that they have received this training. The home has soap dispensers in place in toilets but these need to be filled up and disposable towels provided so that infection control is supported by good hand washing systems. One relative has asked could a hand towel be made available in residents’ ensuite rooms. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. There are times when staffing levels are not sufficient to meet the needs of residents. Appropriate checks are made to ensure only people who are safe to work with vulnerable people are employed. The home’s training records do not evidence that staff are being provided with training to ensure the protection of residents and themselves. EVIDENCE: Feedback received from both residents and staff indicate there are times when staffing levels are not adequate to meet the needs of the residents. Information supplied by the home states that a high number of residents require assistance with their personal care. However, on examining the staffing rota for the previous 8 week period, it was seen that a high number of working days had less than what would be considered appropriate to ensure the needs and wellbeing of residents. This was also evidenced through discussions at the time of the site visit and survey forms from residents. Comments included – “I have heard staff say to other people that they will have to wait” and another comment “staff are so very busy now – it used to be nice to have someone to talk to me but the staff don’t have the time for that now”. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 25 Staff files examined for staff recruited since the last site visit, confirmed that generally appropriate checks are made before starting employment. The registered manager was advised of the need to ensure references are obtained from any prospective employees’ most recent employer. Staff confirmed that appropriate checks had been carried out before they commenced work. One member of staff spoken with also confirmed that they felt their recruitment had been thorough. Information from the home confirms that all the people who have worked in the home in the past 12 months have had satisfactory pre-employment checks. The staff training matrix has not been updated to evidence what training has been provided to staff and does not currently include all the members of staff employed. As a result, it was not possible to evidence what training had been undertaken, particularly by newer staff, in relation to mandatory training (e.g. moving and handling). This was of further concern given that an accident form was seen where a member of staff had injured her back when moving a resident. Healthcare professionals also commented that they had witnessed care staff moving residents incorrectly. This was discussed with the general and registered managers who confirmed that all staff are to attend a moving and handling training course in November 2007. However, staff have confirmed that they feel they have been given training relevant to their role and training that has helped them understand and meet individual needs. Staff also confirmed that they have just undertaken training in infection control. Information from the home does not indicate what training has been provided in the previous 12 months (other than National Vocational Qualification Training) nor does it provide information about future training plans, although the information does confirm that it has a “commitment to training which includes new risk assessments”. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management team lack consistency in fulfilling their responsibilities, which means management tasks are not being fully completed. EVIDENCE: The registered manager confirmed that she now has the registered managers award. The registered manager remains in overall control of the home, although support is provided by the general manager and the registered provider is also on hand on a regular basis and provides input. The inspection found that some key tasks are not being fully addressed. Because the management team are having to work hands on due to low staffing levels, this may have contributed to the situation. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 27 Not all of the previous requirements have been addressed in full. Information provided by the home confirms that there are external and internal quality assurance systems in place, although the involvement of the residents appears limited. There are no residents meetings held, although the registered manager does speak with residents on a daily basis. It is also to noted that some residents do not always feel listened to. The home holds the ISO 9001 quality assurance award. Staff spoken with confirmed that staff meetings are held, usually every couple of months, and the management team are on hand, if needed. Whilst daily handovers are given, comments indicate this is not always done thoroughly. Personal money records and cash held for residents was examined. These were accurately maintained. Records of charges and payments were seen and these appear to be accurately maintained and providing a breakdown of fees payable by the various parties. The commission require the home to have a monthly visit by the general manager who is to produce a report. Copies of these reports were seen during the site visit. As mentioned earlier, the training records do not evidence that staff appointed since the last site inspection have had all the required mandatory training. Information provided by the home confirms that all the required maintenance and safety checks are being carried out on equipment within the home. The Gas Safety Certificate and PATT electrical testing certificate was seen during the site visit but the registered manager was unable to find the hard wiring certificate for the home. This is to be forwarded to the commission. The AQAA also confirms that the home has all the required policies and procedures in place, although further work should be carried out regarding the induction of new staff and refresher training for existing staff to ensure they are fully competent in these. Staff spoken with confirmed they could access the home’s policies and procedures. The accident book was examined and found to be accurately maintained. Advice was given to the registered manager that monitoring of this document should take place as it can highlight patterns, areas of risk, training needs. In addition, the accident book and incident forms indicate that the commission have not been notified of some incidents. It was confirmed that there is a fire safety policy and fire risk assessment in place. Fire drills take place on a weekly basis. The registered manager needs to ensure night staff are fully conversant in the home’s fire procedure. The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 28 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 3 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 1 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 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) and 15(2) Requirement Residents care plans must detail the care needs of each resident and any actions to be taken by staff to meet identified needs. Care plans must also include any restrictions on residents. Risk assessments must be carried out as required, including medication, restrictions and any other issues highlighted in individual care plans. Care records must include weight monitoring. Service user care plans must also evidence involvement of the service user. Care plans must be reviewed at least monthly or earlier if needs change. (Previous timescale of 30/09/06 not met) Records of healthcare input must be maintained for all residents Staffing levels must be reviewed to ensure that the needs of the residents can be met (previous timescale of 24/08/07 not met) The home must ensure that medications are able to be given during the night-time, if needed. DS0000059652.V347253.R01.S.doc Timescale for action 30/11/07 2. 3. OP8 OP27 13 (1)(b) 18(1)(a) 31/10/07 17/10/07 4. OP9 13(2) 17/10/07 The Alders Version 5.2 Page 30 The storage of all medications must be safe and secure. Night staff who administer medications are assessed as competent until formal training can be provided. A formal controlled drugs register must be put in place 5. OP12 16(2)(m) and 16(2)(n) Residents routines, preferred activities, social history and preferences should be recorded in their care plan so that activities can be tailored to meet needs (Previous timescale of 30/09/06 not met) The home must, consult residents about a programme of activities and, having regard to needs of residents, develop activities Confirmation must be received that the hard wiring electrical certificate has been obtained (previous timescale of 30/09/06 not met) Staff must be provided with training to ensure the safety of residents and their own safety and any training that is appropriate to the work they are to perform Training records must be updated to evidence the training provided to staff and that their competency has been assessed The registered manager must ensure that night staff left in charge or the home are competent in the home’s fire drill procedure 30/11/07 6. OP12 16(2)(n) 30/11/07 7. OP38 23(2)(b) 30/11/07 8. OP30 18(2)(c)(i ) 31/12/07 8. OP30 18(2)(c)(i ) 23(4)(e) 31/10/07 9. OP38 31/10/07 The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 31 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 OP3 OP7 OP33 Good Practice Recommendations The home should continue to develop its pre-admission assessment procedure to ensure it is person centred and provides full information about the prospective resident Care plans should also include last wishes and financial arrangements, taking into account the guidance following implementation of the new Mental Capacity Act The current quality assurance system should be expanded to include residents, relatives, visitors and external professional feedback. Residents meetings should be reinstated. A ‘concerns’ book should be put in place so that residents are confident their day to day issues are noted and are addressed promptly. Meals served records should provide more information to enable a judgement to be made over the nutrition provided The mis-matched crockery and cutlery should be replaced for residents to use. Proper napkins should also be provided References should include the last employer Consideration should be given to the purchasing of ski chairs to enable residents to mobilise better Care and domestic staff should continue to access the National Vocational qualification training to improve their knowledge and skills. Specific training should be provided – for example, update training in safeguarding adults to care staff and training in nutritional for older people should be accessed by the cooks. Staff to develop specialist knowledge so that they can be a point of reference for other care staff (i.e. diabetes, Parkinson’s disease) 4. 5. 6. 7. 8. OP15 OP15 OP29 OP22 OP28 The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Alders DS0000059652.V347253.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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