Inspection on 27/04/05 for The Alders

This inspection was carried out on 27th April 2005.

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

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

Other inspections for this house

The Alders 20/11/08

The Alders 07/02/08

The Alders 11/10/07

The Alders 23/08/06

The Alders 21/02/06

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 Joy Howson-Booth Unannounced 27 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 CS0000059652.V221555.R01.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Alders Address 1 Arnside Crescent Morecambe Lancashire LA4 5PP 01772 825825 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Calderdean Limited Mrs Elaine Fallowfield CRH Care Home 29 Category(ies) of OP 29 registration, with number of places The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home shall at all times employs a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Date of last inspection 11 January 2005 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 diningn room and these are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. Residents 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 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. 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 the new manager is currently undergoing registration with the Commission for Social Care Inspection. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of the current year and the home was not aware the inspection was to take place. The inspection lasted for 8 hours and the home was visited twice. The inspection included reading of care plans and other documents to do with care provided and recruitment of staff. 12 residents were talked with, along with two visitors to the home, and the owner and newly appointed manager of the home. Comment cards were also left and four were returned. As well as this, staff on duty were observed and were also talked with. What the service does well: The Alders provides a comfortable and homely place for people to live and the people who live their say they feel well looked after and their needs are met. One resident said “you would have to go a very long way to be treated better than the staff treat me here “. A visitor to the home said “my relative is very happy at The Alders and has no complaints about the level of care”. Other comment cards received agreed with this. Residents are able to maintain their own independence and familiar contacts, with one resident going out to the local pub, another out with family members. The rooms residents use are well decorated and the furniture looks homely and comfortable. At present, rooms are decorated on a yearly basis or when they become empty. All rooms are decorated in a neutral colour scheme but residents are able to add to this with their own personalised furniture and furnishings, bedding and treasured possessions. If a resident wished to have a particular colour scheme, this would be organised through the manager. The owners of the home visit the home every day and speak with the manager. The owners also talk with the residents to make sure they are all being looked after well. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: From this inspection, it was noted that: More information needs to be obtained before residents go into the home and the written information over their care needs (care plan) needs to have more information about individual residents needs so that staff can be clear about what these are and what care they need to give to meet these. People who go into The Alders should have their own copy of the service user guide. This is a booklet which gives information over how the home runs on a day to day basis, about the staff, what care they can expect, who the resident needs to talk to if they are unhappy with something and the last inspection report from the Commission for Social Care Inspection. This can then be read and used to provide information in the future. When a resident expresses some concern or makes a complaint this should be written in the complaints book and used to make the service better in the future. Also, more residents and staff meetings need to be held. Although the residents were not asked about the meals during this inspection, comment was made by two residents that they would prefer “better bread” and a comment card said that the “food varies from good to poor depending on staff”. The new manager said she was planning to discuss meals with the residents in the next few days. When taking on staff the home needs to make sure that all the checks are done so that residents are confident the staff are able to look after them. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 7 The manager of the home needs to make sure that when a risk has been recognized this is looked into, and staff are given instructions to make sure they look after both the resident and themselves. 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 CS0000059652.V221555.R01.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 and 6 Full information is not provided or sought by the home to ensure people are able to make informed choices or to enable the home to make an informed judgement as to whether or not the individuals needs can be met. EVIDENCE: A Statement of Purpose and Service User Guide was seen and found to be comprehensive, although information of the relevant experience and qualifications of the newly appointed manager and recent staff appointments needs to be included. The pre-admission assessment information was not completed for one newly admitted resident and, for three others, did not have all the relevant information completed in terms of routines, dietary preferences, medication, hearing and dental care, history of falls, social history, social interests and hobbies, religion, personal safety and risk, carer and family involvement, community and social contacts and financial arrangements. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 10 A sample of contracts were examined and found to provide the required information, although the contracts need to include the room which will be occupied. Prospective residents are able to visit the home and undertake a four-week trial period. Discussions with residents confirmed that they were not aware of the home’s information documents (Statement of Purpose and Service User Guide). The Alders does not provide an intermediate care facility. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Written records made to support people living at this home are not adequate. This means that staff are reliant on their own knowledge and memory to meet individual care needs and conditions. As a result, residents may not be given the actual care that they require to meet their individual needs. EVIDENCE: Five care plans for residents at The Alders were examined and, for the most recently admitted resident, no plan of care was in evidence. Not all care plans included the pre-admission information. None of the care plans examined included information on social histories or interests of the resident, nor did they contain information in the form of a pen picture which would provide staff with information over daily routines, preferences, lifestyles, social contacts, last wishes. Some care plans provided information to staff, but this was not always clear and some used vague terms like “needs assistance”. There was no evidence that the residents had been involved in completing their care plan. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 12 One resident was assessed as needing bed rails but there was no risk assessment or consent form on their care file. Risk assessments were seen for moving and handling but did not contain clear instructions for staff and one falls risk assessment had not been reviewed since February 2005. Care records were fragmented and as most actual care plans were put into one plastic wallet this did not enable staff to access these in an effective way. Whilst reviews were noted as taking place, the lack of “no change” in care that was recorded may mean that a thorough review is not actually taking place. There was clear evidence that healthcare needs are being met with regular entries by GP’s, District Nurses, Continence Adviser, Specialist Diabetic Nurse. Additional healthcare needs (eyesight, hearing, foot, oral care) are not being recorded as being addressed. One resident who has been assessed as having depression has nothing on their care plan which would alert staff or provide information as to how this resident is to be supported. Specialist care is required by residents in the form of catheter care and stoma care. There is no record that staff who undertake this care have received any training or competency assessment which puts the resident at risk. Weight records are being maintained for the majority of residents, although the lack of appropriate scales for those residents who cannot weight bear is of concern as staff are using their own visual checks “doesn’t appear to have lost weight” and this may put these residents at risk. One resident had no weight records maintained. The owner advised that, given this information, appropriate scales would be purchased to enable all residents to be weighed. A specialist Pharmacist Inspector visited The Alders and undertook a full audit of the medication system. Generally, the medication system was working well, although some requirements and recommendations were made in a separate report which has already been forwarded to the owner. 12 residents were spoken with and all commented that the staff treat them with dignity and respect. Many positive comments were made about the care staff – one resident said that “you would have to go a very long way to be treated better than the staff treat me here”. Two comment cards were received – both indicating that they liked living at the home, feel well cared for and their privacy is respected. Two comment cards were received from relatives of residents which confirmed they are able to see their relatives in private. One comment card stated “my relative is very happy at The Alders and has no complaints about the level of care”. Observations made during this inspection also supported the comments made by residents that they are treated with dignity and respect. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 13 The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed during this inspection. EVIDENCE: The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints procedure in place although there is no evidence of any complaints being recorded or acted upon. EVIDENCE: The written complaints procedure was seen in the service user information and is also on display in the home. Two complaints have been received by the Commission for Social Care Inspection in the last twelve months. One complaint was substantiated in part and the other was not substantiated. One relative comment card received stated they were not aware of the home’s complaints procedure, although another relative stated they were. Comment cards received from residents stated they knew who to talk to if they were unhappy with their care. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The standard of the environment within this home is very good providing residents with an attractive and homely place to live. The owner is very proactive in ensuring the home’s environment is well maintained which means the residents have a safe environment in which to live. EVIDENCE: The lighting, heating and décor within the home is to a high standard. There are a range of lounges, an outdoor seating area which is pleasant and well maintained. The home was toured during this inspection and all residents rooms were pleasantly decorated and made homely by residents who have brought in their own treasured personal items. The owner was advised that some beds seemed “soft” and may need replacing. The owner confirmed the new manager would undertake an audit of the beds to ensure they were replaced as needed. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 17 All the residents rooms have ensuite facilities, have a lockable facility and their own emergency call system in place. All toilet and bathing facilities were clean and tidy. One bathroom (Number 21) requires a new bath and the owner confirmed this is on order. The home has a range of equipment and facilities, including handrails around all corridors which aid residents to maintain their independence. The dining room furniture was discussed with the owner who has recently purchased new chairs but is considering new tables in the future. Advice was provided that chairs with “ski” runners rather than legs may be better to assist residents to mobilise and the owner is to look into this. Water temperatures were tested and found to be 52 degrees celcius. The owner has confirmed that this has been reduced to the required 43 degrees and has requested a plumber to review the system to ensure the safe water temperature remains constant. Daily visits by the owner ensure that the home is well maintained and that issues are dealt with immediately. Maintenance certificates were seen for equipment in the home, including records for staff fire safety training and fire drills. Since the last inspection, the owner has installed fire closures for all doors. The owner was advised that the laundry door was wedged open and must be kept shut as recommended by the fire safety officer. The home was clean and tidy and generally odour free, although room 9 had a strong odour of urine. In addition, the carpet in room 7 had some stains. The owner confirmed that these carpets would be replaced. A number of residents were spoken with and all felt they were very happy with their individual rooms. The use of the smaller lounge in the extension of the home appears to be a well-used and provides a quiet environment which is utilised by a number of the ladies in the home. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Since the last inspection, the standard of vetting and recruitment has improved, although the recruitment system is not being consistently followed which potentially puts residents at risk. EVIDENCE: Four staff files were examined and found to generally contain the required information, although two files did not contain references from the last employers, one file contained only one reference, and one reference was from a friend and colleague. The manager stated that a verbal reference had been obtained but this had not been recorded. The two newly appointed staff had not completed a health declaration and there was no proof of identity on their files. There was some evidence that staff had undertaken the home’s own induction procedure but the latest two members of staff had only undertaken the fire safety training. The staff rota was seen and found that there are sufficient staff on duty, including a member of the management team during the waking day, at all times. Concern was expressed that the two newly appointed members of staff were on duty together despite advice to the contrary from the Commission. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Limited consultation processes do not fully demonstrate the home is run in the best interest of the residents. Health and Safety matters on care issues are not always maintained posing potential risks to staff and resident safety. The environment however is maintained to a good safe standard. EVIDENCE: The owners undertaken daily visits to the home and address any issues that arise ongoing basis. Maintenance is carried out on an ongoing basis and this inspection evidenced maintenance and service certificates. Confirmation was received that staff meetings and residents meetings take place, although comment was made that these need to happen on a more frequent basis. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 20 The home has a formal external quality assurance system in place (ISO 2000), but this system needs to be utilised fully to be effective. No other surveys take place, which are recommended and should include relatives, visitors to the home and external professionals. Advice was given that a business plan for the home would benefit the manager to forward planning and prioritise training requirements for staff. The owner confirmed that work required following a recent fire safety officer’s visit has been completed. The owner is required to confirm this in writing to the Commission. Risk assessments are not always completed or provide clear instructions to staff or reviewed. Staff files examined did not provide evidence that staff had undertaken mandatory training in moving and handling, food hygiene, first aid, infection control. The manager needs to ensure that this training meets the TOPSS (Training Opportunities in Personal Social Services) induction standards. Whilst fire safety training had been provided, the management need to ensure full understanding – for example, the laundry door being wedged open despite this being identified as a fire door which must be kept shut. Specialist training and competency assessments (for example stoma and catheter care) had not been recorded as being provided to staff who provide this care. The accident book was seen and accurately maintained. The management were advised that this should be used as means of monitoring so that appropriate action can be taken if an accident pattern or trend is seen. The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 x 3 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 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x 2 The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 1 3 Regulation 5(2) 14 Requirement A copy of the service user guide must be provided to all service users in the home Service users who are admitted to the home must be assessed by a suitable qualified or trained person to ensure the home is able to meet identified needs. A procedure must also be put in place for any emergency admissions to the home Service user care plans must detail how the needs of the service user are to be met and contain full information over all aspects of the service users health and welfare. Service user care plans must also evidence involvement of the service user. The requirements and recommendations made by the Pharmacist Inspector must be addressed within the timescale agreed The stained carpet and the carpet with the odour of urine must be replaced. In additon, the damaged bath must be replaced The water temperature must be maintained at 43 degrees celcius CS0000059652.V221555.R01.doc Timescale for action 30 June 2005 27 April 2005 3. 7 15 31 May 2005 4. 9 13 14 June 2005 5. 24 23 31 May 2005 6. 25 13 27 April 2005 Page 23 The Alders Version 1.30 7. 29 19 8. 38 23 9. 38 13 10. 38 18 The home must maintain a thorough recruitment procedure which ensure the safety of service users Confirmation must be sent to the Commission that the requirements and recommendations made in the Fire Officers recent report have been fully addressed. In addition, staff must be fully aware of fire safety, for example, by not wedging open fire doors Risk Assessments for both service users care and for working practices in the home must be clear and reviewed every 6 weeks or sooner, if required Staff must receive mandatory training to the National Training Organisation standard at the start of their employment. Specialist training must also be provided and the staff members competency assessed for specialist care needs. 27 April 2005 31 May 2005 30 June 2005 30 June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 2 7 8 16 24 22 Good Practice Recommendations The Contract should provide the room number to be occupied Care plans should be reorganised to make them accessible and user friendly for staff Appropriate scales should be obtained to enable all service users to have their weight monitored All complaints should be recorded, along with the action taken by the staff at the home to address the issues raised Service users should be consulted to ensure the mattresses on their beds are to their preferred firmness Consideration should be given to the purchasing of ski CS0000059652.V221555.R01.doc Version 1.30 Page 24 The Alders 7. 8. 9. 10. 7 8 17 33 chairs to enable service users to mobilise better Care plans should also include a social history and interests, last wishes and financial arrangements Consent forms should be obtained for the use of bed rails or other restrictive equipment. The use of these should be reviewed every 6 weeks. Daily records should record the time the entry is being made and not day and night The current quality assurance system should be expanded to include service user, relatives, visitors and external professional feedback The Alders CS0000059652.V221555.R01.doc Version 1.30 Page 25 Commission for Social Care Inspection 2nd Floor Unit 1, Tustin Court Portway 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 CS0000059652.V221555.R01.doc Version 1.30 Page 26 - 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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