Inspection on 29/05/07 for The Allenbrook Nursing Home

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Allenbrook Nursing Home 17/08/06

The Allenbrook Nursing Home 27/02/06

The Allenbrook Nursing Home 15/02/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Allenbrook Nursing Home Ltd 209 Spies Lane Halesowen West Midlands B62 9SJ Lead Inspector Cathy Moore Key Unannounced Inspection 29th May 2007 07.20 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 Allenbrook Nursing Home Ltd DS0000062764.V330663.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 Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Allenbrook Nursing Home Ltd Address 209 Spies Lane Halesowen West Midlands B62 9SJ 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) 0121 422 5844 0121 423 2837 The Allenbrook Nursing Home Ltd Ms Jane Ruth Franklin Care Home 36 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (36), of places Physical disability (6), Terminally ill (6) The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mrs Franklin - Manager to undertake and complete NVQ level 4 in management within twelve months of the above date.(11 April 2006) 17 August 2006 Date of last inspection Brief Description of the Service: Allenbrook Nursing Home is situated close to the Halesowen and Quinton border and is a few minutes walk from local shops, churches and amenities. The home is accessible by public transport and offers a small parking area at the front of the property for visitors. Service user accommodation is on two floors, which is serviced by a passenger lift. Bedrooms offer 4 shared, (all ensuite) and 28 single occupancy rooms, (27 of which are en-suite). There is a large lounge/dining room with a conservatory off one end of the lounge leading to a pleasant garden area with plenty of garden furniture including a gazebo to provide shade. Meal times are flexible and service users may choose to eat in their respective rooms or in the communal dining area. An open visiting policy is in operation and relatives and friends may call at any reasonable time. A range of activities are offered and a regular church service is held at the home. In addition to the GP other visiting healthcare professionals include, dentist, optician, chiropody and an occupational therapist. A hairdresser visits fortnightly and complimentary medicine may be arranged on request. Allenbrook Nursing Home aims to provide its service users with a secure, relaxed, and homely environment in which their care, well being, and comfort is of prime importance. The fees for the home are currently £ 550 - £600 per week. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector, on one day between 07.20 and 17.00 hours. Prior to the inspection questionnaires were sent to the manager, service users’ and relatives for completion to give us a view of the home. The inspection was carried out mostly in the lounge area where observations could be made on staff and service user involvements and general daily routines. The manager was involved with the inspection throughout the day. I spoke to four relatives, six service users and four staff to gain their views on the home. I looked at the breakfast and lunch meal times, medication systems, health and safety/ maintenance records and randomly looked at the premises which included living areas, six bedrooms, toilets and bathrooms, the garden and laundry. I looked at four service user files to assess admission, care and other processes. I looked at three staff files to assess supervision, training and recruitment processes. What the service does well: The atmosphere of the home is warm, welcoming and friendly. The home is maintained to a good standard, it is comfortable and homely. The service generally provides good staffing levels. Staff, are helpful, friendly and motivated. Staff have received the required mandatory training examples being; moving and handling and fire training. NVQ attainment for care staff is high. Medication systems are well managed to ensure safety. The meals provided are of a good standard, varied and nutritious. The home offers an open visiting policy. Visitors are made to feel welcome. I spoke to a number of service users’ who told me; “ I like it here”. “ I think it is very nice, the staff are lovely”. “ Very good”. Our questionnaire asked relatives to tell us what the home does well, the following comments were received. Staff are very kind. The nursing care has been as expected residents are generally well cared for and appropriate medical care is organised for the benefit of the resident. Patients and visitors are treated with respect. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 6 The facilities generally are good, the home is maintained well. The dining area and lounge are pleasant and the food is satisfactory. The atmosphere is generally friendly. Some religious services are provided which the residents enjoy and there is entertainment from time to time. The staff who look after my mother are caring and friendly. The home is clean and the clients look well cared for. I am made to feel welcome when I visit. They look after the people to the best of their ability. Look after his appearance. Food is very good. Very caring spend time with him. With the amount of residents the staff do very well but I do think that one more carer would make such a difference. The food service is very good. It is a very clean home. They do their best to look after their residents. I give them 9 ½ out of 10. What has improved since the last inspection? The manager has completed her Registered Managers Award and is awaiting her certificate. A new handyperson and a gardener have been employed who have made a positive impact on the home internally and the garden. New hoists have been purchased. Ten staff are doing a course in leadership and management. The Nurses have received medication training provided by their providing pharmacist. At least four bedrooms have been refurbished. A recording system for personal care and bedroom checks has been implemented. The home has been reassessed and has again achieved the gold healthy eating award. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 7 Twice a week two laundry staff are provided to ensure greater efficiency in this area. What they could do better: The home must carefully consider further admissions regarding service users who have dementia or confusion to assess their capability to meet needs and the impact on service users’ already accommodated. Activity provision generally is inadequate. Care plans must be expanded upon to ensure that they are person centred and contain all needs such as religious and dementia needs. Care plans must contain sufficient detail and instruction. Some aspects of health and safety examples being; suitable access restrictions to where hot water is above the recommended temperature. All current and valid service certificates being available for inspection. Our questionnaire asked relatives to tell us what the home could do better. The following comments were received; I’ve not noticed myself, but other family and friends have mentioned the smell of urine when they enter the home. There should be more provision of chiropody services. The patients with dementia can be disruptive and noisy at times and get on. nerves. I should like to see more mental stimulation for those clients who are able to participate in activities. They need to pay more attention to the physical mobility of their residents’. A few minutes of raising legs and arms or standing up and short walks on a regular basis. For residents hoping to move out of nursing care referral to rehabilitation would improve patients situations and be more stimulating than keeping people safely in their chairs. Improved staffing at night time. Difficult at times to obtain help to go to the toilet at night. The light was sometimes left on when. wanted to sleep. More physiotherapists going into the home and also need more stimulating. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 8 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 Allenbrook Nursing Home Ltd DS0000062764.V330663.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 Allenbrook Nursing Home Ltd DS0000062764.V330663.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4. Quality in this outcome area is adequate. The service consults the assessment information to see if they can meet the prospective service users’ needs. However, the service is at the present providing accommodation to a high number of service users’ who have dementia, confusion or cognitive impairment when only a small number of staff have received dementia training to allow them to assess service users well being or ill being. Further, adequate stimulation for these service users’ is not always provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at four service user files and saw that assessment of need documentation was on file for all, which means that staff do try to see prospective service users and assess their needs before they are offered a place in the home. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 11 Although I gained evidence from service users and relatives alike to confirm that a good proportion are satisfied with the home I was concerned about the number of service users accommodated who have a diagnosis of dementia or confusion and varying degrees of cognitive impairment as this does have an impact on service users who do not have these diagnoses for example; one person commented; “. is often sat for meals with people who have dementia, who are not able to hold a conversation or who are disruptive. Further, I noted that only a small number of staff have received training to give them the skill and knowledge to care for these people. I was further concerned about the lack of stimulation available for these service users’ as without, orientation can be diminished. I made observations in the lounge for most of the morning and noticed considerable amounts of time when service users’ had no contact or stimulation and were just asleep in their chairs. Other people agreed with my findings examples of feedback from people spoken to during the inspection and from completed questionnaires is as follows; “ I think that she could do with some more mental stimulation”. “ The number of people like this does cause a problem”. “ Need more stimulation”. I did not see any record on the new service users’ files acknowledging that the home could meet their needs as there should be, which would show how these diagnoses would be managed by the home. The question ‘ Do you feel that the care home or agency meets the needs of your friend /relative? was asked in a questionnaire sent to relatives. Nine responses were received, in answer to the question 2 said always, 6 usually and 1 sometimes. The Allenbrook Nursing Home Ltd DS0000062764.V330663.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care plans are available for each service user however, the home must make sure that all needs are recorded and included. People who live in this home have access to healthcare services. The home has an efficient medication policy supported by procedures and practice which staff understand and follow. Service users’ feel that they are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at four service user files and saw that a care plan was included for each. However care plans are of a ‘core’ care plan type and not particularly ‘ person cantered’, which means in general a list of pre typed instructions are available for each situation, rather than care plans being tailored to the individual. More attention must be paid to specific needs that were not included in sufficient detail or included at all. For example; care plans were not available regarding religious needs. Dementia care plans were basic; “. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 13 Has no aggression is very pleasant who is confused at times’ and ‘. is very confused and remains wandering due to disease. Need close observation. There was no personal instructions for staff on how to determine the ‘well being’ or ‘ Ill being’ of each, how to stimulate or increase orientation. The home is registered to provide nursing care, a registered nurse is on duty at all times to attend to the service users’ nursing needs. Generally, other healthcare services are accessed when needed. Comments were received about the lack of chiropody at one time. One relative said; “. had been at Allen brook for 10 months before chiropody and was in discomfort”. The manager confirmed that this had been a problem as far as NHS provision was concerned. She has now approached the NHS who have agreed to more regular chiropody input for the home. Other issues were also received and do need consideration by the home as follows; “ I was not informed when. had to see a consultant”. Dentures not removed at night on a number of occasions. Evidence was available on all service user files to confirm that risk assessment are being carried out to identify and reduce risk regarding for example; tissue viability and nutrition. Positive comments were received regarding health and personal care. One relative commented; “ My .. is well cared for physically”. Another, “ The home has provided very good nursing care”. “ I have been pleased with the progress my .. has made with walking”. A relative I spoke to said; “ Personal care ok, they keep us informed”. One relative did comment however, that more rehabilitation and encouragement to mobilise is needed. I looked at the homes medication system and found that the medications are well managed and safe which means that there is no risk to service users’. I saw that medications are stored correctly. That medications coming into and out of the home are accounted for and there were no staff signature gaps on medication records. I indirectly observed the nurse giving out the medications and observed good practice. I saw that she made sure she had drinks available before starting, locked the medication trolley when she left it. Stayed with the service users’ to ensure that they had actually taken their medication and explained to each what she was doing. Two issues do need further consideration. I saw an insulin injection being given at the breakfast table in front of other service users’ which may have an impact on that persons dignity. Whilst short life preparations are all date labelled, medication boxes are not which could prevent effective audit of totals. I saw that the preferred name of each service user had been determine and recorded and heard staff using service users’ preferred names which showed respect. Toilet and bathroom doors were shut when in use. I saw that interactions between staff and service users’ were positive. Staff were polite to service users’. A relative made the following comment; “ Patients and visitors are treated with respect”. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. There is little opportunity for service users’ to engage in meaningful and suitable activities, consequently their stimulation and recreational needs are not all being met. The home actively encourages service users’ to maintain contact with family and friends. Meals provided are varied, nourishing and of a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I spoke to a number of service users’ and generally determined that daily routines were to their satisfaction. One said; “ I get up and go to bed when I want”. Another said; “ I ask and they take me”. The lack of stimulation for service users’ with dementia and cognitive impairment has been highlighted in the first section of this report. I found from speaking to staff and service users’ that in general activity provision is lacking. One service user told me; “ Boring, nothing to do. All we do is sit on our backsides and have meals. Everyone is sleeping. Nothing to look forward to, same everyday”. Another service user when asked about activities responded; “ Not a lot”. And another said; “ Don’t do a lot. I’d like to be up and about a bit The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 15 more”. Other people I asked about activity provision said,; “ Sit down that’s all they do”. “ Not enough activities”. “ We need more activities, need more stimulation”. I spoke to the manager about the area of activities and she told me that they have advertised for an activities co-ordinator to improve activity provision. I told her that one service user had said; “ I love reading”, and suggested that the input from the mobile community library may be useful for this person and others. It is positive that people from different faiths visit the home. One relative said; “ Vicar comes and gives communion”. A staff member said; “ The vicar visits”. The home has an open visiting policy. All service users’ I spoke with confirmed that they have visitors on a regular basis as follows; “ I have got lots of cousins, one main one comes to see me”. “ Sister and family come”. “ My two sons visit weekly”. About visiting, visitors at the home during the inspection told me; “ We visit all the time. Made to feel welcome, tea is offered”. “ Made to feel welcome”. I saw information available in the home giving contacts for external advocacy services for service users’ to access if they wish to assist in gaining more control and support in their lives. I saw in each service users’ bedroom personal belongings which means that service users ‘ are allowed to bring into the home their personal effects to make their rooms more personalised and homely. One service user told me; “ I have brought in some bits such as my chair. It is a special chair which helps me”. The home must be congratulated on recently again, being awarded with the Gold standard healthy eating award. The tables in the dining room were nicely laid with tablecloths and floral decorations which makes this area feel very homely. I saw that menu boards were in use to inform service users’ meals on offer for that day. I observed both breakfast and the main meal times. I saw that staff were on hand to give assistance to those who needed help. I heard staff asking service users’ what they would like to eat which is all positive. Breakfast time service users could choose what they wanted to eat from a range of cereals, bread, toast and preserves. The meal time was unhurried and the atmosphere relaxed. Again lunch time staff were on hand to give help and the atmosphere was pleasant and relaxed. There was only one meal on display which consisted of braised steak, vegetables, creamed potatoes, rhubarb crumble or fresh fruit. However, I was told by one service user; “ If you don’t like what they offer you can choose something else”. Many positive comments were made by service users’ about the food which included; “ Its like a hotel service, very good. Food is always good”. “ Food good, they ask us what we want”. “ The food is wonderful”. “ Food is very good, variation. I enjoy each meal, we have some good meals”. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 16 However, one service user was not happy with the meal. I observed that she got very upset. She did not like the soft diet provided. She referred to the meal as “ Muck”. I spoke to the service user who told me; “ They think I choke, its because my teeth don’t fit”. A staff member told me “ She is prone to chocking”, but was not able to confirm that the service user had been seen by a speech therapist, dietician or indeed dentist to see if the problem was due to loose fitting dentures. The manager told me; “ I think we have a good system in place (regarding food intake monitoring) we observe what is eaten by each resident, if we are concerned we record in more detail and refer to the doctor and dietician. A completed food intake chart I saw for one service user confirmed that the home does record food intake in detail when the need arises. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The complaints procedure is supplied to service users’ and is displayed in the home which means service users and their families are aware how to make a complaint. The home has safeguarding processes in place. However, to date not all staff have received abuse awareness training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received about this home. The home has a complaints procedure which is on display and available in the service user guide. Feedback from a questionnaire sent to relatives told us that 7 of 9 always know how to make a complaint, 1 did not and 1 couldn’t remember. A Commission service user questionnaire showed that 3 of 3 service users’ know how to make a complaint. Service users’ and relatives spoken to about complaints said; “ I would go to the lady in charge, Jane”. “ If I had a complaint I would feel comfortable to approach staff. “I have no concerns”. There have not been any allegations or incidents of abuse. The home has procedures and processes in place to deal with concerns if any arose. To date not all staff have received abuse awareness training although this was a requirement made previously. The Allenbrook Nursing Home Ltd DS0000062764.V330663.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): 19,24,25,26. Quality in this outcome area is good. The home provides a well maintained, fairly safe environment that has a positive, friendly atmosphere. Consideration should be made however, to enhancing the environment to aid orientation. Infection control processes are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well maintained both internally and externally. Maintenance has been enhanced recently with the employment of a new handyperson and a gardener. The manager was very clear about work needs to be done in the home and has a planned programme in place. Since the last inspection work has been attended to which includes; the redecoration and re-carpeting of at least four bedrooms and work in the garden. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 19 The homes’ living space comprises of a large lounge area which is segregated by a dining space in the middle and a conservatory. One service user told me; “The living areas are quite nice- a lot of space”. Two service users told me how much they like to sit in the conservatory. As the home has a number of people with dementia or confusion consideration should be given to orientation such as; colour schemes and signage. Large face clocks in the lounge areas could aid orientation in terms of time. One relative made the following comment; “ The lounge dining room is large, everyone sat round the outside looking at each other and the television. It would be nice for more able people to be grouped together for conversation”. I spoke to a number of service users about their bedrooms. One said; “ Its better than the last home- I’ve got my own toilet”. Another said; “ I’ve got my own room its quite nice”. One service user said; “ My bedroom is only small but comfortable”. I was concerned to see that a number of hot water temperatures had been recorded as being as high as 59oc in rooms such as; sluice rooms and the visitors toilet as there was no restriction to access to these rooms a potential hazard is present which needs to be addressed. On entering the home there was a slight odour which lessened as the day went on. There was also an odour in one bedroom highlighted to the manager during the inspection. The manager told me we have tried everything- but are considering changing the flooring. The home was found to be clean, this confirmed by comments from relatives and service users’ as follows; “ “ Very nice and clean”. “ It is a very clean home”. The Allenbrook Nursing Home Ltd DS0000062764.V330663.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): 27,28,29,30. Quality in this outcome area is good. Staffing levels, staff attitude and motivation is very good, however as previously highlighted there are inadequate numbers of staff trained in dementia care. Recruitment processes are robust and induction programmes are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels are in general good staffing is provided as follows; AM 2-3 Registered nurses and 7 carers. PM I Registered nurse and 6-7 carers. Night 1 Registered nurse and three carers. In addition catering, laundry and cleaning staff are provided every day and the home has a maintenance person and gardener. Comments about staff were very positive, however some comment was made about occasional staffing levels as follows; “ Staff are very kind”. “ Generally the staff are caring, attentive and competent”. “ Generally the staff are very approachable”. “ The staff who look after my mother are caring and friendly”. “All very friendly”. “ Staff are good. Enough staff, always someone if you need them”. “ Matron and staff very good, very kind”.“ Staff do well, occasionally could do with one more”. “ Mostly kind sometimes rushed off their feet then we have to wait”. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 21 The home has a good attainment level for care staff achieving NVQ level 2 or above, which is good as it means service users’ are in safe hands. I looked at four staff files and saw that recruitment processes are good in that all of the required checks and documents are obtained before they are allowed to commence work. Induction processes are in place for new staff. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The manager has the required qualifications and experience. The manager has good people skills. Her practice, skill and knowledge are based on continuous development. The home has a good track history of meeting health and safety requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a first level Registered Nurse. She showed me a letter dated May 2007 confirming that she has completed her Registered Managers award and is now awaiting her certificate- well done. The manager shows good leadership skills and approachability. This proven by speaking to people during the inspection. One staff member told me “ Yes I feel comfortable to approach the manager”. A visitor confirmed that she would The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 23 feel “comfortable to approach the manager if she had a complaint” and a service user told me; “If I had a complaint I would go to the manager Jane”. From talking to the manager and spending time with her during the inspection it was clear that she wants to continue to develop the home and is not satisfied if things are not right. I was shown a completed quality assessment/ monitoring package. The manager confirmed to be that this is adequate and would fulfil her obligations in terms of the service self assessment and the completing of a future annual quality assurance assessment that will be required by the Commission. The manager was able to provide evidence of regular staff meetings but stated to date service user meetings are not held. I saw many records of staff meetings dated as examples; 11/4/07, and 10/4/07. I was very interested to look at the ‘ Allenbrook newsletter’ Summer 2007, which has been given to service users and relatives and been made available within the home. The owner visits and undertakes work tasks at the home very frequently which is positive as it shows that he keeps up to date with the functioning of the home and is available if people want to speak to him. He is not at present however, completing a monthly report of any audits he carries out at the home as he should to satisfy Regulation 26. The home does not often hold money in safe keeping for service users. This is mostly held by relatives. If service users receive a service from for instance a chiropodist then the home invoices the relative responsible for their money. A small number of valuables were kept in safe keeping with records made of what is held. I looked at staff files and saw that all had received recent one to one supervision which is good as this means that staff are supported and learning needs discussed. The manager confirmed that processes are in place to ensure regular supervision for all staff. From these staff files I noted that mandatory training is up to date which increases safety in the home. Even one new staff member for example had received all of the required training. All staff had received fire training in March 2007 and recent fire drills had been carried out. I did not look at the kitchen as Environmental Heath carried out an inspection within the last month. I have requested that a copy of this inspection report be forwarded to me when received by the home. I looked at health and safety records and service certificates. Fire extinguishers had been serviced in Jan 07, the lift serviced in April 07. The water system had been tested in November 2006. A number of records were not available in files. The manager was not able to locate them during the inspection but was convinced all work had been done. These certificates and documents have been listed in the requirements section of this report, copies to be sent to the Commission. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x 3 2 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 14(1) Requirement Timescale for action 29/06/07 2 OP4 14(1) 3 OP7 15(1)(b) The registered person must ensure that; No more than 6 service users are accommodated at any one time who have a diagnosis of dementia. Due consideration is taken before admitting any further service users who have confusion or other cogitative impairments in terms of meeting their needs and the needs of service users already accommodated. A written Regulation 14 acknowledgement is issued to each prospective service user confirming that the home can meet their full needs. The registered person must 01/09/07 ensure that all staff receive dementia training- preferably training that is accredited. This is to ensure that staff are able to meet the needs of people with dementia and keep them safe. The registered person must 29/08/07 ensure that the care plans are informative and detailed and that DS0000062764.V330663.R01.S.doc Version 5.2 The Allenbrook Nursing Home Ltd Page 26 4 OP9 13(2) 5 OP12 16(2)(m) (n) 6 OP18 13(6) they include all needs examples being; dementia care, orientation, religion, stimulation and activities. The registered persons must ensure that the opening date of all medication packets is recorded to allow efficient auditing. The registered persons must ensure that suitable activities, recreation and stimulation is provided to meet service users’ needs. The registered person must make arrangements to train staff in adult protection procedures. Timescale of 30/09/06 partly met. 6 staff have been trained to date. The registered persons must ensure that suitable and safe access restrictions are put into place in rooms where hot water is provided higher than 43oc such as; the sluice rooms and visitors toilet ( or any other areas identified through hot water temperature testing). This was discussed with the manager during the inspection. The registered persons must provide the following current service /appliance/safety certificates to the CSCI; Updated 5 year fixed electrical wiring test showing – satisfactory. Gas landlords safety certificate In-house monthly test records for the emergency lighting system. 29/06/07 29/06/07 01/10/07 7 OP25 13(4)( c) 29/06/07 8 OP38 13(4)( c) 29/06/07 The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 27 Engineers fire alarm and emergency lighting certificates. Certificate for PAT tests 4.1.07. 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 OP26 Good Practice Recommendations Hot water mixing valves should be subjected to anti-scald testing on an annual basis. The Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Allenbrook Nursing Home Ltd DS0000062764.V330663.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!