Inspection on 23/08/06 for The Alders

This inspection was carried out on 23rd August 2006.

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 11/10/07

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 11:00 23 August 2006 rd 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.V286294.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.V286294.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) 01772 825825 Calderdean Ltd Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home shall at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission 21st February 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 three lounges and a through dining room and these are used for a variety of purposes and provide service users with a choice of where to sit and who to sit with. Service user’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 which is used by service users in the warmer months. Service users are encouraged to retain links with the families and friends and contacts in the local community. The Alders is a no smoking home. The home is owned by Calderdean Limited, the Directors (Mr & Mrs Croft) visiting the home on a daily basis. At present, the home does not have a registered manager, although a new manager is currently undergoing registration with the Commission for Social Care Inspection. The current range of fees are from £324.50 to £366.00 per week for residential accommodation. Respite fees are £378.14 per week. Further details over fees can be obtained from the general manager or manager of the home. The Alders DS0000059652.V286294.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 inspection that was unannounced so the general manager, manager, staff and service users 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 site visit took place over one day, although a further short visit was made to the home to provide feedback to the general manager. The site visit included taking time to sit and speak with service users, observing staff on duty performing the day to day routines, speaking with staff, examining documents held in the home and speaking with the general manager and manager. The inspector looked around the home, including communal rooms, bathrooms and toilets. Some service users were spoken with in their own rooms which provided an opportunity to see individual environments and how these have been personalised with treasured personal items. The tour also provided an opportunity to find out about any improvements made and to see if the home was comfortable, clean and safe for people to live in. Comment cards were also sent to service users at the home and comment cards were also left with the manager for service users, relatives and other visitors to complete. Only a small number were returned but these spoke of satisfaction with the care provided by the home. Comment cards were also received from a GP surgery and a healthcare professional. Additional information was also supplied from a pre-inspection questionnaire completed by the manager. The site visit was positive with everyone welcoming, friendly and co-operative during the visit. The Alders has been assessed as a good home, although a number of standards have shown shortfalls during this inspection. The general manager has provided assurance that these will be addressed as it is the aim of the home to improve from being a good service to one which provides an excellent service to the service users accommodated. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A new General Manager has been appointed to provide monitoring and support to the management team and staff at the home. It is the General Manager’s intention to undertake all the monitoring and quality assurance of the home, which will strengthen the good practices currently in place. The manager of the home has achieved the Registered Managers Award and is hoping to be registered with the Commission in the near future. There is a new management team in place, consisting of the manager, assistant manager and deputy manager. Roles and responsibilities are being developed for these three people. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 7 From talking with service users, the meals provided have much improved with a range of choices at breakfast and choices at other meals throughout the day. Care plans have much improved, although some work is still required to ensure these reflect the range of needs and wishes of each individual service user and also details the care provided by the staff at the home. The recruitment of staff has much improved with all the required checks being carried out on staff prior to them commencing work. This means that the service users are safeguarded from people who may not be fit to work with vulnerable adults. Information supplied by the home also confirms that staff are recruited in a fair and equal way, with equal consideration being given to all prospective employees. Induction and other training is also provided to staff. What they could do better: All service users must be provided with a copy of the Service User Guide. The pre-admission assessments must provide more detail and provide information over the individual social history, needs, wishes, hopes, interests and routines and address any specific issues of race, gender, disability, sexuality, age, religion or belief. An inventory of property must be recorded for service users who bring in items to the home on admission. Service user care plans do not currently reflect the diversity or individuality of each service user, particularly in relation to their interests, skills, abilities, wishes, hopes, etc. The care plans also need to reflect any specific equality and diversity issues applicable to the individual service user and how the staff at the home are to meet these needs. Activities have become somewhat limited and there is little opportunity for service users to get out unless they are independent to do so. All medications kept or administered by the home must be done so as required by the Regulations. Staffing levels for both care staff and domestic staff must be reviewed to make sure there are sufficient care staff on duty to meet the individual needs of service users and also to ensure the cleanliness of the home. The front door must be kept secure to ensure the safety of the service users and the home itself. Fire doors must not be wedged open. Repairs and replacements outlined in this report must be addressed. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 8 Staff must be provided with the opportunity to review their care practices and talk to the manager about any identified training needs. The General Manager was asked to confirm that the home’s gas safety certificate and hard wiring certificate are up to date. The Commission needs to be told about any serious injury which may occur to any service user and advice has been given to the General Manager regarding this. The General Manager is also required to provide the Commission with a monthly report on the home, assessing various areas. A number of recommendations have also been made. 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 Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 9 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.V286294.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on the home is not being provided to the service users which means people accommodated or any prospective service users are not fully informed. Insufficient information is being obtained over needs which means an informed decision cannot be made over whether these can be met. EVIDENCE: Through discussion with the Manager and General Manager, it was confirmed that the Service User Guide has still not been provided to all service users in the home, although a copy of the Service User Guide is available to existing and prospective service users. This is something that needs to be addressed to comply with the Care Homes Regulations. Discussion with service users confirmed that they had not received or were not aware of the Service User Guide. A service user comment card indicated that they had received enough information about the home to enable them to make a judgement about whether The Alders was a place they would like to live at. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 11 The General Manager also confirmed that the terms and conditions/contract for the home still requires updating to inform service users that “financial contributions to trips out are requested”. Three assessments for newer service users were examined and found to be incomplete and the information obtained somewhat basic. The assessments did not contain information that recognises the individual’s diversity or individuality. For example, one section for routines was completed “sleeps well”. There was no information on preferred times of retiring or rising or the preferred routines of the individuals concerned. Discussion with both the manager and General Manager recognised that the assessments carried out previously were somewhat sparse and a new assessment format has been introduced. The General Manager is aware of the need to obtain much more information and confirmed this is something that will be addressed for future prospective service users. The admissions procedure was also discussed with the General Manager for the home as the records reflect that a lot of information is given to the service user on the day of admission. Admission/property lists were not always completed as required by the Care Homes Regulations and National Minimum Standards. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans provide good information over the needs of the service users and how these are to be met by staff at the home. EVIDENCE: A new care plan format has been introduced which provides much more comprehensive information over the needs of the individual service users in the home. The General Manager stated that the staff are now learning to use these documents. Discussions with staff also confirmed that they have access to and use the care plans as working documents. During this site visit, six care plans were examined and the following found : Generally, the information was much more comprehensive and clearly staff are involved in writing and contributing to these working documents. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 13 There was evidence of care plan reviews but these need to be done on a monthly basis, or sooner if needs change. Information is recorded but no evidence of follow up. The daily diary book also makes reference – “see care plan” but the appropriate section is not always identified so it is very difficult to find out what this was referring to. The system for recording in the care plans is unclear as some days record information, for example, over what the service user has had to eat and some days nothing is recorded. Given that this information is not recorded on a daily basis is it is not possible to form a picture of the care provided to the service users by staff at home. Risk assessments were not always undertaken when a risk is identified. Discussions with service users were all very positive about the care provided by the staff at the home. Service users commented that “staff are excellent” and “we’re very well looked after”. One visiting relative was also spoken with who confirmed that they are “very satisfied” with the care provided. A comment card received from a service user indicated they “always receive the care and support they need”. A comment card was received from a GP surgery which also states that they are satisfied with the care provided at the home. Residents are able to keep their own GP’s if this is possible. A comment card was received from a healthcare professional who again confirmed that the staff show a good understanding of care needs. With regard to healthcare, whilst there is clear evidence of a range of healthcare professionals being appropriately involved in the care of the service users at the home, again there was a lack of follow up information/actions by the home. Daily monitoring of fluid input and output was requested by a District Nurse. Evidence of this was seen, although the records were not consistently maintained. No weight records were in evidence and confirmation is still required that suitable weighing scales have been purchased. The use of cot sides and lap belts was also discussed with the General Manager and advice given that a risk assessment, disclaimer and agreement with the GP, as well as monthly review needs to take place before any decision to use cot sides or lap belts is taken as these are seen as forms of restraint. Medication stocks and records were examined and anomalies, including anomalies with the controlled drugs, were found, as follows : The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 14 Medication received into the home for one service user on respite had not been recorded in so that it was not possible to undertake an audit trail. Medication timings was discussed as the Medication Administration Records sheets (MARs) times do not correspond with the timings of medication administration in the home. The General Manager was advised to speak with the Pharmacist to ensure any changes of medication timings are agreed. This should then be recorded on the individual care plans. Although medication is supplied on a monthly basis, staff are using existing individual service users’ stocks which means that it is not possible to undertake an audit trail. The controlled drugs book was examined and anomalies found. A separate letter has been sent regarding this. The General Manager confirmed that medication training is to be organised for everyone who administers medication. Further advice was also given that anyone who administers medication should be competent, experienced and trained to do so. Staff spoken with also confirmed they are aware how to ensure privacy and dignity for the service users. Some service users have their own telephone in their rooms, although there is a cordless phone if the wish to have privacy. No issues were raised by service users over clothing in the home, although one issue had been raised with the General Manager who is to speak with the staff concerned. Privacy and dignity are covered in the home’s induction. There are no shared rooms in the home. Service users spoken with confirmed that they are treated with dignity and respect by the staff at the home. Observations during this site visit also confirmed that staff are respectful and are caring and attentive to the service users. A comment card received by both a GP and a healthcare professional confirmed that they are always able to see their patients in private. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The home enables the service users to follow an adequate standard of lifestyle, with individual routines being respected and family/friend contacts being maintained EVIDENCE: Service users spoken with, and observed, were seen to be free to follow their own daily routines and lifestyles. Service users are free to use their own rooms where they can enjoy TV, music or other quiet pastimes. Those that are able can go out do and others organise their own day to day routines. One lounge is a quieter place where service users can sit and chat and the other larger lounge is enjoyed by another group of service users. There is also a courtyard area where service users can sit and enjoy the sunshine. During the site visit communal banter and good interactions were noted, both between service users and between service users and staff. Service users confirmed that they are free to receive visitors to the home and can see them in private. A visitor also confirmed that they are able to visit at The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 16 any time, and are always made welcome. Where they are able, service users can access local shops and amenities. However, the care plans have little information that distinguishes one service user’s social needs and interests from another, nor do they recognise individual service users’ diversity, their interests, wishes or choices. Some have bibliographies which outline social histories and interests, others not. Generally care plans state “encourage to take part in social activities” but without knowing what people are interested in this is a blanket statement that means little and cannot be measured. Service users spoken with generally felt that there was a lack of activities, although some commented this maybe due to a shortage of staff. The service users confirmed that they used to enjoy playing various games (dominoes, skittles, karaoke, etc.) but these are no longer organised. One service user said that “we used to do quite a lot but we don’t do much now”. Service users also said that there was no opportunity to go out on outings as there are “no drivers”. Where interests and activities are known about, the home supports these. However, this is something that needs to be contained clearly within the care plans. For example, one care plan states “to encourage to attend x” but without any further information on when, where, why, etc., it would be difficult for staff to talk to the service user about this interest, offer a timely reminder on the day and make sure, by providing practical support if needed, that they attend. There is no record or feedback which would enable the activity to be planned further or information as to whether it remains something enjoyed by the service user concerned. The above was discussed with the General Manager who confirmed that the activities organiser has been on long-term sick leave but is expected to return shortly. However, the comments about activities, etc., are noted and will be addressed. Service users are encouraged to maintain their own financial independence as long as possible. The lack of a Service User Guide means that information over external contacts, for example, advocates is not readily available. Service users are able to bring in their own personal possessions, and many rooms have items which are clearly treasured and personal to their owners. However, the lack of inventories of furniture, etc., brought into the home was raised with the General Manager as this does not comply with the Care Homes Regulations. The General Manager is aware of the requirements over Data Protection and record keeping. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 17 Service users spoken with all felt the meals had much improved over recent months. There is a new four weekly menu in place, with a separate breakfast menu outlining a range of alternatives. Care plans evidenced that service users are offered choices, and this was also confirmed as a member of staff was seen asking service users what they would like for tea on the afternoon of the site visit. One service user who particularly wanted brown bread confirmed this was now being provided. Discussions with staff confirmed that meals served to the service users had improved. Observations and comments were passed on to the General Manager, as follows : The crockery on the tables is mismatched. This does not provide a positive image either for the service users or the home. Some service users said that sometimes the crockery and cutlery on the tables are not clean. Service users also commented that they are often given the “wrong” spoons to eat food, for example, a soup spoon for dessert or a dessert spoon to eat boiled eggs. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 18 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality it this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users know how to voice their feelings and who to go to if they are unhappy. Service users are generally safeguarded by staff at the home EVIDENCE: The complaints procedure is included in the home’s brochure (which service users are given) and in the Service User guide, although, as previously mentioned, service users do not have their own copy of the latter document. Service users spoken with confirmed they knew who to talk with if they were unhappy with aspects of their care. Since the last inspection, one complaint has been received by the Commission which was passed to the provider to investigate. The provider provided the Commission with a report on the investigation and findings. This was seen to be recorded in the home’s complaints record book. Safeguarding adults and whistle blowing are covered in the home’s induction process and discussions with staff previously confirmed that if any concerns were raised they would go to the manager or provider. Now the home has a General Manager in post, staff also have access to an additional person if they have concerns or need any advice. The General Manager is looking at providing staff with update training and staff have also covered adult abuse awareness in the National Vocational Qualification training. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 19 The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 provides a comfortable and homely environment for the service users which is generally well maintained. EVIDENCE: A tour of the home took place and service users spoken with during this. Generally the home appeared clean and tidy although the following were noted: Some rooms have stained carpets. This was discussed with the General Manager who confirmed that there is an ongoing programme with these stained carpets about to be replaced and this was confirmed by service users. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 21 The tiles in one ensuite shower room were cracked. Advice was given to the General Manager that these need to be replaced and other ensuites checked. The shower room and toilet at one end of the building is now looking tired and the toilet seat is not fixed on properly. The General Manager confirmed this room was to be upgraded in the near future. Some rooms do not have locks on them. Advice was given that the service users 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. Water temperatures were tested and found to be satisfactory. A log for water temperatures was seen – last tested in July 2006. Attention to detail is needed. Crockery and cutlery have already been mentioned. There was no valence sheet on one bed and another bed had the valance sheet fitted incorrectly. Some chairs in the dining room need cleaning as they are stained. Some service users mentioned that they felt the cleanliness of the home was sometimes not as good as it used to be. Service users said that when there were sufficient domestic staff on duty the cleanliness of the home was very good as there was time to do things thoroughly. However, more recently, there have not been enough domestic staff on duty which means only the basic areas are attended to. All parts of the home are accessible to service users, with a stairlift 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. Some fire doors were wedged open – a separate letter has been sent regarding this. During the feedback visit, the General Manager was made aware that the main door was not locked so access was gained easily and as there was no staff in the vicinity this compromised the safety of both the service users and the home. 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. Comment was made by one service user that staff do not appear to wash their hands when going into the kitchen. It was confirmed that there are separate The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 22 hand washing facilities in the kitchen which are not immediately visible which staff do use. However, the General Manager is to make sure staff are aware of infection control requirements. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. 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 is generally at an adequate level, with support and training provided to improve knowledge and skills. A thorough recruitment procedure is being followed which safeguards the service users. EVIDENCE: The staffing rotas were examined and discussed with the manager and General Manager. There have been no reductions in staffing levels, although it is noted that there have been some difficulties with maintaining staffing levels due to holidays, sickness, etc., and, as needed, agency staff have been brought in. Staff spoken with also felt that there were times when there was not enough staff on duty to enable them to meet the service users needs. Service users spoken with raised concerns about the level of staff both during the day and at night and that the night staff seemed to be young. Staffing in the home was discussed with the General Manager who confirmed that there had been no reduction in staffing levels but recognised that there had been difficulties with the daytime levels of staff and as for the night care team, they are experienced in care work and no one employed is under the age of 23. Advice was given to the General Manager to ensure that there are sufficient staff on duty both during the day and at night to meet the needs of the service users accommodated. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 24 There are three members of the management team for the home, which are overseen by the General Manager. These members of management are currently working on devising their own individual roles and responsibilities within the home which will make accountability and responsibilities much clearer. There is a separate management rota and a member of the management team on duty throughout the day. Information supplied by the manager confirmed that of the 13 care staff employed in the home 6 have obtained National Vocational Qualification (NVQ) Level II or above. Training is ongoing in the home. Staff files were seen that evidenced training certificates. The fire record book evidenced staff have been provided with update training. Recruitment in the home has much improved with all the required checks and documentation being obtained prior to any new member of staff commencing work. Advice was given that a consistent application form needs to be used as three different ones had been used over the last twelve months. In addition, a full employment history must be obtained. Training is ongoing in the home. Staff files were seen that evidenced training certificates. Information supplied by the home confirmed that training in the last twelve months has included – first aid, fire awareness, risk assessment, key worker role and responsibilities, induction training, medication, training and management training. Staff spoken with confirmed that training is ongoing and a member of staff indicated their enjoyment of the NVQ training they are undertaking and how this is benefiting the service users at the home. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has bee made using available evidence including a visit to this service. Although some management tasks require attention, generally the management of the home is good which means service users live in a safe, well managed home. EVIDENCE: The manager of the home is still undergoing registration with the Commission, although confirmation has been received that she has achieved the Registered Managers Award. Discussion with the service users and staff confirmed that they are confident in the manager of the home and find her approachable. The creation of a new post of general manager for the home is positive and means that the manager has a point of contact and also can be provided with advice and guidance. The general manager will also undertake quality assurance systems within the home and also undertake the monthly provider visits as required by the Care Homes Regulations. The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 26 The home continues to have the ISO quality assurance system in place, although no further work has been done on including outside professionals, relatives, etc., in surveys. The new General Manager has visited each service user to inform them of her role and to provide them with another point of contact if they have any concerns. It is unclear if service users meetings are being held as no records were available, although staff confirmed staff meetings do take place. Records of charges and payments were seen - these are now individually kept by the General Manager who is working on including a full breakdown of charges due and payments made. A selection of service users’ personal monies held by the home and associated records were examined and found to be accurately kept. No formal supervision records could be seen on file. Staff spoken with were unable to confirm that they are provided with ‘supervision’ or given the opportunity to sit down with the manager to talk about their care practices, training needs, etc. A selection of maintenance records were seen and the following noted : The home’s public liability insurance certificate was on display and up to date. Portable appliance testing records were seen – conducted in January 2006. The hard wiring certificate for the home was not found and the General Manager is to send confirmation of this. The fire maintenance certificate was seen completed in January 2006 and fire drills take place. The emergency call system was checked in April 2006. Confirmation is required from the General Manager that the gas appliance certificate has been issued as this was not clear from the documentation held on file. Risk assessments had been carried out for the building in January 2006. Staff confirmed that any maintenance issues are written in a maintenance book which is signed off when completed. Staff also confirmed that any issues raised are attended to promptly. The accident book was seen and the following noted : It was clear that once an accident occurs appropriate and prompt medical attention is sought. On reading the accident book it was seen that the home had not always reported these accidents to the Commission. The Commission has a role in commenting and reporting on how people are kept safe and the homes failure The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 27 to comply with this Regulation impacts on this and ultimately the well being of the service users. Five service users had suffered accidents that were not properly recorded or reported since the last inspection. In addition, the accident forms were not always completed in full. Further advice was given that any serious injury must be reported to the Commission and good practice would advise that anyone taken to the A & E department should be reported to the Commission, even if no serious injury is found. Advice was also given about wording in one accident report which appeared to indicate that the member of staff on duty had taken a decision that cot sides should be used. Advice has already been provided to the home over this issue. The General Manager confirmed that mandatory training is covered within the home’s induction programme which has been verified as equal to National Vocational Qualification Level I The Alders DS0000059652.V286294.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 2 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 X 3 1 X 2 The Alders DS0000059652.V286294.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 OP1 Regulation 5(2) Requirement A copy of the service user guide must be provided to all service users in the home (previous timescale of 30.6.05 and 2.2.06 not met) Pre-admission assessments on prospective service users must be more detailed and evidence that The prospective service user’s needs, wishes, interests, routines, etc., are obtained and the information that is obtained is detailed enough to base a decision over admission to the home. The admission procedure must include an inventory of furniture and items brought into the home. Service users care plans must detail any actions to be taken by staff to meet identified needs. Care plans must also evidence that risk assessments are carried out, particularly in relation to the use of cot sides or lap belts. Care records must include weight monitoring. Service user DS0000059652.V286294.R01.S.doc Timescale for action 30/09/06 2. OP3 14 31/08/06 3. OP7 15 30/09/06 The Alders Version 5.2 Page 30 4. OP12 12 care plans must also evidence involvement of the service user Service users routines, preferred activities, social history and preferences should be recorded in their care plan so that activities can be tailored to meet needs All medications, including controlled drugs, must be administered as prescribed and according to the administration of drugs in residential care homes. Records must be accurately maintained and enable an audit trail to be carried out The domestic staffing levels must be reviewed to ensure there are sufficient domestic staff on duty to ensure the premises are clean at all times. Areas of cleanliness outlined in this report must be addressed The home must ensure the safety of the service users and the security of the home. The repairs and replacements outlined in this report must be addressed promptly. Locks on service users individual rooms must be provided unless their care plan indicates otherwise Fire doors must not be wedged open Staffing levels must be reviewed to ensure that the needs of the service users can be met Formal supervision must be provided to staff at least six times a year and recorded Confirmation must be received that the hard wiring electrical certificate and the gas appliances certificate has been obtained The Commission must be notified of any death, serious injury or DS0000059652.V286294.R01.S.doc 30/09/06 5. OP9 13 23/08/06 6. OP26 23 30/09/06 7. 8. OP38 OP19 13 23 23/08/06 30/09/06 9. 10. 11. 12. OP38 OP27 OP36 23 18 18 13 23/08/06 24/08/06 30/09/06 30/09/06 OP38 13. OP38 37 23/08/06 Page 31 The Alders Version 5.2 14. OP33 26 serious illness or any event as outlined in Regulation 37 of the Care Homes Regulations A monthly report must be provided to the Commission as outlined in Regulation 26 of the Care Homes Regulations 30/09/06 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 OP8 Good Practice Recommendations Confirmation should be sent to the Commission that appropriate scales have been obtained to enable all service users to have their weight monitored Consideration should be given to the purchasing of ski chairs to enable service users to mobilise better Care plans should also include last wishes and financial arrangements The current quality assurance system should be expanded to include service users, relatives, visitors and external professional feedback New crockery should be purchased for service users to use One employment application form should be used. A full employment history should be obtained. Medication should only be administered by appropriately trained staff The manager should ensure that staff follow good practice guidance with regard to infection control Care and domestic staff should continue to access the National Vocational qualification training to improve their knowledge and skills 2. 3. 4. 5. 6. 7. 8. 9. OP22 OP7 OP33 OP15 OP29 OP9 OP26 OP28 The Alders DS0000059652.V286294.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Alders DS0000059652.V286294.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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