Inspection on 07/02/08 for The Alders

This inspection was carried out on 7th February 2008.

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 11/10/07

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 7th February 2008 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.V358965.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.V358965.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 vacant Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include:*Up to 32 service users in the category of OP (Old age not falling within any other category). 11th October 2007 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 position of the home’s manager is currently vacant. 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 the general manager of the home. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is adequate. This means that the people who use this service experienced adequate quality outcomes This is the second site visit and was unannounced so the residents, general manager and staff were not aware of the visit. It was undertaken by two regulation inspectors and a specialist pharmacist inspector. 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. As well as the site visit, judgements have been made about the service based on information supplied by the registered provider/manager. The site visit took place over one day and included - spending time observing staff on duty, taking time to sit and speak with residents, speaking with staff and speaking with the general manager. As well as this, a number of records and documents were examined. A short meeting took place to provide feedback to the registered provider and general manager. The home’s general manager was available during the inspection to answer questions and provide additional information. 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 site visit was enjoyable with everyone welcoming, friendly and cooperative during the visit. What the service does well: The home is situated in a quiet residential area, close to local shops and amenities. The home is mostly over one floor which means all areas of the home are accessible to the residents. There are a small number of rooms on The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 6 an upper floor in the older part of the home, and a stair lift is provided for residents to use. The home has a ongoing redecoration and refurbishment programme in place which means the home is well maintained and a pleasant and homely place to live in. The general manager stated that it is important that people who live at this home view it as “their own home”. At the previous inspection a number of positive comments were received including : “the managers are caring to both residents staff and I feel I could go to them anytime if I have a problem and get their full support”, “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” and “we speak to X regularly and feel that he is well cared for and feels secure at the Alders. The staff are very friendly and always obliging”. At this inspection, residents still felt that the care staff were doing a good job under difficult circumstances. The people who use this service are able to look after and take their own medicines if they wish and this helps them remain independent. What has improved since the last inspection? 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 person centred information needs to be provided to ensure staff are fully informed over individual needs and the home needs to make sure they are checked regularly to make sure the care plan remains up to date. There may be times when an individual resident is not able to do something because they may be at risk. For any resident at the home where a risk has been identified, there should be a separate assessment done and included in the care plan so that all staff have clear guidance. Risk assessments should also be reviewed on a regularly basis. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 7 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 always record individual input. Concerns were raised over staffing levels in the home which, at times, did not appear to be sufficient to meet the needs of the residents. Individual comments raised at a previous inspection also felt staffing levels were of concern. The registered provider acknowledged that some residents do need a lot more support. It was advised that the staffing levels should be reviewed to meet individual needs rather than being at a minimum level. There was inequality of activities in the home – some residents are supported to follow community activities, but there are 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. Information from the home confirmed there is a commitment to training. A number of people who had achieved National Vocational Qualifications have left and this has reduced the level of staff with this qualification within the home. However, the training programme for the home is being developed and the management need to ensure all staff receive basic training so that they are protected and also provide care as outlined in good practice guidelines. Some records of medicines given to residents were inaccurate and this can lead to mistakes that could affect their health. Some medicines were not given as the doctor intended and occasionally medicines ran out so residents did not get the treatment they needed. Arrangements for giving medication at night were not satisfactory but the service had planned to train night staff so they could give medication promptly when needed. Risk assessments should be done for all people who look after and take their own medicines to make sure this is done safely. 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.V358965.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The admissions documentation is not being completed which means that full information about individual needs and wishes is not being found out and areas of choice and risk are not being addressed. EVIDENCE: Whilst not assessed, the general manager was advised to review the Statement of Purpose and Service User guide with the new contact information for us and to make it more user friendly for people to read. Different format may also be useful. Files for two reasonably recent new admissions to the home were examined and evidenced that whilst information is being provided by the commissioning social worker, the home is not ascertaining full information about routines, The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 10 choices, individual needs and wishes. The files seen did not have any information regarding social history and there was no evidence that areas of risk had been addressed. The home does not offer intermediate care. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People who use this service experience adequate outcomes in this area. 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. Medication is not well managed and puts people at risk. EVIDENCE: Four care plans were examined – one specifically following concerns over number of accidents recorded in the accident book. Our findings are as follows : Care files are organised into separate sections, covering mobility/transfers, social, personal care/bathing, health, diet, blood, skin and pressure care and discharge arrangements For one resident there was no actual care plan and nothing to instruct staff as to the residents needs. Care notes are not done on a daily notes which means The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 12 there is no consistent record of follow up of issues or care given. This resident had a number of falls but no risk assessment had been completed. However, from talking with staff, steps had been taken to address the falls but nothing is recorded in the care plan. There is evidence of healthcare input, and visiting healthcare professionals were spoken with who confirmed they had no concerns about the care given and staff responded promptly to any healthcare issues raised. Personal care records were completed haphazardly and did not provide a complete picture of the care given by staff. Where a resident may need some additional support, there is nothing in the care plans which would guide staff or provide a consistent approach. Weight monitoring does not always take place and there is a lack of prompt action when nutritional concerns are raised. Concern was raised with the general manager over the lack of risk assessments. One resident was seen to have experienced several falls but no risk assessment had been completed. The home keeps a communication book to direct staff to view people’s files when significant events have occurred. However, on several occasions, entries such as ‘all residents fine’ – ‘all care given’ were viewed on dates where people had had falls and clearly staff would not then be aware of such a significant event. The communication book smells heavily of cigarette smoke which would indicate that it is kept in a communal area and may be open to be read by anyone. Care staff were spoken with and demonstrated that they have a kindly and caring approach to the work that they do. They were generally aware of the needs of the residents spoken about but this information is not gained from the care plans but passed on verbally. This is of concern as it means care staff have to rely on their memory as there are no effective care plans in place to provide guidance. An effective and comprehensive care plan is vital when there are people who need additional support or a consistent approach. The service kept records of medicines given to the people who live there but a number of these were inaccurate. This increases the risk of mistakes such as residents needlessly missing their medicine, being given the wrong dose or the wrong medicine. The records did not always say if there were good reasons for omitting medicines. Most records were pre-printed by the pharmacy however on occasions staff hand-wrote these and errors were made, for example, in one case the resident’s surname was wrong. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 13 Medicines occasionally ran out so residents did not have the treatment they needed. For example, one resident who suffered mini-strokes did not have their treatment for nearly three weeks. Some dosage changes were seen but it was not clear who had authorised them. In one case staff said that the district nurse instructed the dose change but there were no records to support this. Some medicines were not given as prescribed and this could affect health. For example, some people who were prescribed antibiotics did not get them at 3pm on a number of occasions. Residents were able to look after and take their own medicines when they wanted and were able to and this helped them remain independent. One resident, who took a medicine that needed to be given at very specific times of the day to keep them well, was happy to be able to do this for themselves so it could be taken promptly. The care plans of two residents were checked but one did not have an assessment of the risks involved that is needed to protect them from harm. Night staff were not able to give medicines because they were not trained. However, training in safe handling of medicines had been arranged later in the month. We were told that if medicines were needed at night then trained staff would be called in to give it. This would, however, delay treatment and cause unnecessary suffering if medicine, such as painkillers, were needed. The records for handling of medicines liable to misuse (called Controlled Drugs) were poor. Not all medicines were recorded and this could lead to them going astray. These records were corrected during the inspection. Staff had started a system of checks for medicines to make sure that they were handled properly and they aimed to repeat this monthly. These ongoing checks should help to identify problems promptly so they can be addressed to keep the people who use the service safe. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People who use this service experience adequate outcomes in this area. 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 which means the residents are given good nutritional food. EVIDENCE: Care plans examined and residents spoken with confirmed that there is little provided in the way of activities. Care plans did not evidence much information regarding individual routines, wishes, preferences, activities, etc. None of the care plans examined had completed social bibliographies. Daily records also provide little evidence that the residents are provided with social stimulation or opportunities to take part in activities. From discussions with residents it would appear that most are able to follow their own lifestyle and make their own choices but this is dependent on the residents own ability to do so. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 15 At the previous inspection in October 2007, no concerns were raised by residents and relatives over visiting to the home and during this inspection site visit visitors to the home were seen coming in and out of the home. One resident was waiting to go to out when we first arrived. Following concerns raised regarding food provided, particularly a lack of fresh vegetables and fruit, the menu for the home was examined, the chef on duty spoken with and food stocks seen. The menus evidence that a range of good nutritional food is provided. Residents spoken with all confirmed that they are very happy with the food provided, they can choose what they wish and the home will provide something different if that is what they want, and sometimes have “too much food” to eat and have fresh vegetables and fresh fruit on offer every day. We heard a member of staff discussing the meals available for the day and asking the residents which they would prefer. Another resident was heard to ask for a piece of fruit which was provided. The home have just introduced a sweet trolley and this is going down very well with the residents with several positive comments being made. Staff spoken with also confirmed that there is a “good selection of food” available, Residents “always get fresh vegetables” and a number make different choices at each meal. Also, there are lots of drinks and snacks available. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s policies and procedures enable residents and their relatives to voice their concerns, although there is little evidence that people are being listened to and appropriate action taken. The lack of consistency and minimum staffing levels means that residents are not always safeguarded. EVIDENCE: When asked for the complaints book we were told the home did not have one as the staff spoken with were not aware of any complaints being made. Advice was given over this. However, we are aware of at least three complaints from relatives and one from a resident. Whilst residents were able to confirm that they knew how to make a complaint, there is no evidence that any complaints have been recorded and, at the last inspection, residents spoken with indicated they felt any complaints are not taken seriously or addressed promptly. This means the home needs to review the current system so that adheres to the Care Homes Regulations, its own procedures and provides evidence that complaints and concerns are taken seriously and addressed. A number of complaints/concerns have been sent to us which have been addressed in this report. These included attitude of the management, staffing, The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 17 medication, food and use of electric by residents. Further advice and guidance has already been provided. The complaints procedure is included in information provided to residents but advice was given to make this available in different formats (i.e. large print). Staff spoken with were aware of the home’s safeguarding policies and whistle blowing and were clear about the procedure to be followed if they had any concerns Care plans examined note that there are a lack of risk assessments or the home taking appropriate action following falls which means that residents are not protected. 3 people were taken to Accident and Emergency department on one day in December. The home’s accident book and staffing levels were examined. No accidents were recorded and the general manager confirmed that these residents were taken as a matter of precaution. However, staffing levels on that day were at a minimum, with agency staff being used. This will be discussed further in the staffing section of this report. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 18 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 People who use this service experience good outcomes in this area. 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 service users which is generally well maintained. EVIDENCE: The environment was assessed during the inspection in October 2007, with no major issues being raised. At this second key inspection, whilst not all areas of the home were seen communal areas and some rooms were seen. The following issues were discussed with the general manager : A concern was raised with us about a resident being denied a heater as their room was cold. The resident concerned was spoken with and confirmed that the registered provider had taken appropriate action when it was known that The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 19 the room was not as warm as they preferred. This had not been recorded anywhere. Some rooms still do not have locks on them. Some rooms do not have a lockable facility in place for the resident to use. Information from the home confirms that there are now door guards in place to ensure fire doors close should the alarm be activated. The general manager confirmed that the home had a fire risk assessment in place and a lot of work had been carried out recently to improve fire safety in the home. Risk assessment for the smoking room had been completed and was available for all staff members to see. During a tour of the home, it was noticed that music was being played throughout the home. This was discussed with the general manager who was advised to speak with residents to make sure it is what they want in their home. Staff confirmed that they had recently received training in infection control. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 20 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels are not adequate to meet the needs of residents. The recruitment of staff has not been done thoroughly which means the home cannot be evidence that only people who are safe to work with vulnerable people are employed. Staff have not been receiving training for their day-to-day work which means that the care provided may not meet current good practices. EVIDENCE: The staffing levels in the home remain of concern. Staffing levels were spot checked on a number of dates and found to have either less than or minimum levels of staff on duty and, in addition, a high number of agency staff have been used. Often there is only two carers plus manager on duty. Some staff spoken to said that staffing levels had been problematic at times but that this was going to improve when new staff started. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 21 During feedback the registered provider indicated that some residents had a high level of support needs this put demands on the staff in the home. Advice was given that this would be a good opportunity to review the staffing levels so that needs rather than the minimum levels could be met. One resident said that they didn’t think there were enough “girls on duty sometimes”. Other residents spoken with confirmed that there had been lots of changes in the staff team and preferred to have the staff they knew. Comment was made that there were too many agency staff and a high staff turnover - “there have been different ones on”. However, residents were positive about the care staff on duty and felt staff were doing a good job. Discussions with the general manager confirmed that there have been staffing problems, especially as the registered manager and deputy manager walked out over the Christmas period. However, herself and the registered provider had been working hands on and whilst a high number of agency staff are being used, these tend to be agency workers who are familiar with the home and the residents. At the previous inspection in October 2007, the general manager confirmed that, at that time, 50 of care staff were trained to NVQ Level II and above. A number of these staff have now left which means that currently 4 care staff (36 ) are trained to NVQ Level II or above. This is something the general manager is aware of and training is being planned. 3 new staff files were examined and whilst generally organised did not evidence that a thorough check is being made on staff recruited to work at the home. For example, incomplete employment history, lack of interview records for two of the staff, only one reference on file for another and gaps in employment were not discussed. This was discussed with the general manager who confirmed that since she had taken over management of the home she was ensuring all the required checks were being made on any prospective staff. The updated staff training matrix was provided and this evidenced that training in a number of areas has been accessed by staff. However, a number of gaps, particularly for mandatory training, was in evidence. The general manager confirmed that training is now being planned for the future and will ensure all staff are trained appropriate to the care work as soon as training courses become available. Training for all staff in moving and handling is essential as the previous inspection reports that visiting professionals had raised concerns over moving and handling in the home. The general manager confirmed that training in the safe administration of medicines has been organised for February 2008 for all staff responsible for this area and staff had just done training in the care of people with Parkinson’s disease the previous week. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 22 Discussions with staff confirmed that the home are now using a standard induction pack which is in line with skills for care standards. However, when viewing rota for week commencing 11th Feb we noticed one new staff member working her shift on the 11th Feb she appeared to be on rota and there was no indication that she would be receiving induction or orientation. One file evidenced that induction had been provided but the employee had not signed the form to indicate that this had been provided or understood. Discussion with a fairly new member of staff confirmed that the induction programme was ongoing but some basic information (i.e. fire safety) had not yet been done. There was no evidence, from the files examined, that care staff had been given formal supervision. One staff file stated that close monitoring and supervision to be given but there was no evidence of this. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 23 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 and 38 Standard 35 was not assessed on this occasion but was assessed and met at the first key inspection in October 2007 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Management tasks and responsibilities are not being completed which means the management cannot ensure the health and safety of the residents and staff. EVIDENCE: As the registered manager walked out over the Christmas period, the home is currently without a registered manager but the registered provider and general manager are taking steps to address this. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 24 Several staff spoken with felt that the atmosphere at the home and staff morale had improved greatly in recent weeks and were pleased with the management support provided by the registered provider and general manager. However, one resident said that it was “early days” given the changes to the management team. The previous key inspection record notes that information from 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. The home holds the ISO 9001 quality assurance award. At this site visit, records of residents meetings, staff meetings and management meetings were requested and it was found that no meetings had been held in recent months. In addition, residents do not always feel that action is taken quickly if any concerns are raised and no complaints or concerns are recorded. Advice was given that the home needs to reinstate these meetings and also use the existing quality systems to ensure residents feel involved in their home, feel listened to and, importantly, the home can evidence that their concerns are acted upon. No financial records were examined during this site visit as these were examined during previous inspection in October 2007 and no issues were raised. The accident book was examined and, from viewing care notes, it was found that at least two accidents for one resident had not been recorded. In addition, there was a discrepancy in recording of an accident – the general manager is to investigate this and provide feedback to us. At the previous inspection a number of requirements were made and, from examination of records, etc at this inspection, it was confirmed that the majority of these have now been met, although some remain outstanding and have been included in this report. Since the last inspection, we have received a small number of concerns that were looked into at this site visit and none were found to be substantiated. The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x x x x 2 The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 26 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 be reviewed at least monthly or earlier if needs change. Care plans must also include any restrictions on residents and include evidence of involvement of the resident. [Previous timescales of 30/09/06; 30/011/07 and 04/12/07 not met] 2. OP18 13(4)(c) Risk assessments must be carried out as required and included in care plans so that risk can be identified and measure put in place to reduce the possibilities of these happening. There must be clear and accurate records of current medication and the time and DS0000059652.V358965.R01.S.doc Timescale for action 31/03/08 31/03/08 3. OP9 17(1)(a) 01/04/08 The Alders Version 5.2 Page 27 4. OP9 13(2) 5. 6. OP9 OP9 13(2) 15 7. OP27 18(1)(a) date of administration to help ensure medicines are administered correctly. This was to have been met by 04/12/07 To ensure residents health and well-being medication must be administered as prescribed and special instructions e.g. ‘before food’ must be followed This was to have been met by 04/12/07 Systems for ordering medication must be reviewed to ensure that medicines never run out. Risk assessments should be done and followed up for all people who look after and take their own medication to make sure this is done safely Staffing levels must be reviewed to ensure that the needs of the residents can be met [Previous timescale of 24/08/07, 30/11/07 and 04/12/07 not met] 01/04/08 01/04/08 01/04/08 29/02/08 8. 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. 31/03/08 9. OP8 13 (1)(b) [Previous timescale of 30/09/06, 30/11/07 and 04/12/07 not met] Records of healthcare input must 31/03/08 be maintained for all residents [Previous timescale of 20/11/07 and 04/12/07 not met] 10. OP12 16(2)(n) The home must, consult residents about a programme of activities and, having regard to needs of residents, develop activities DS0000059652.V358965.R01.S.doc 31/03/08 The Alders Version 5.2 Page 28 [Previous timescale of 30/11/07 not met) 11. OP30 18(2)(c) (i) 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. (Previous timescale of 31/12/07 not met) Any complaints raised should be recorded in a complaints book so that the home can demonstrate the actions it has taken to address these 30/04/08 12. OP16 22(3 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP22 OP37 Good Practice Recommendations Consideration should be given to the purchasing of ski chairs to enable residents to mobilise better Care records should be completed daily so that the home can evidence the care provided, especially where specialist care or input is needed. 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 ‘complaints’ book should be put in place so that residents are confident their day to day issues are noted and are addressed promptly. OP7 4. OP33 The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 29 5. OP15 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 and a full employment history should be obtained 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 nutrition 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) 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. The homes Statement of Purpose and Service User Guide should be updated with the commissions new contact information. Thought should be put into making the Service User Guide more user friendly and in different formats It is recommended that medicines administration records, written by staff, are checked for accuracy by a second member of staff. It is recommended that arrangements for administration of medication at night are reviewed to ensure this can be done promptly when necessary until night staff are trained and assessed as competent in the task. Formal supervision should be provided to all staff as outlined in the National Minimum Standards. The general manager should investigate the discrepancy in the accident report as discussed and provide guidance to staff, as required. We should be informed of the outcome of this investigation. 6. 7. OP29 OP28 8. OP3 9. OP1 10. 11. OP9 OP9 12. 13. OP30 OP37 The Alders DS0000059652.V358965.R01.S.doc Version 5.2 Page 30 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.V358965.R01.S.doc Version 5.2 Page 31 - 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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