Inspection on 08/10/08 for The Alton Centre

This inspection was carried out on 8th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Alton Centre 04/11/08

The Alton Centre 08/10/07

The Alton Centre 20/06/07

The Alton Centre 07/06/06

The Alton Centre 12/12/05

The Alton Centre 05/05/05

The Alton Centre 16/11/04

The Alton Centre 14/07/04

The Alton Centre 25/05/04

The Alton Centre 13/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: The Alton Centre Irchester Road Knuston Spinney Wellingborough Northants NN29 7EY Adequate 10/10/2007 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Louise Bushell Date: 0 8 1 0 2 0 0 8 Information about the care home Name of care home: Address: The Alton Centre Irchester Road Knuston Spinney Wellingborough Northants NN29 7EY 01933413646 01933413664 altoncentre@activecarepartnerships.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Active Care Partnerships Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability 40 Over 65 0 Conditions of registration: The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability - Code PD The maximum number of service users who can be accommodated is: 40 That Active Care Partnership employs Ms Cunningham forthwith as the manager of the home, with that appointment to last with the requirement that Active Care Partnership be required to submit an application for registration for Ms Cunningham forthwith, with the position thereafter to be discussed with CSCI. There will be two registered general nurses on duty at all times for six months There will be five care staff on the day shift and four on the night shift for six months. That the resident number will not increase beyond 19 for six months, but any increase or any variation will be discussed with CSCI. Care Homes for Adults (18-65 years) Page 2 of 14 That Mr White will attend the home two days per week for six months. But Lisa Lovett would attend the home two days per week for six months. That the division catering manager will attend the home every fortnight for six months: and The group quality assurance Manager will attend the home once a months for six months. Date of last inspection Brief description of the care home The home currently provides care for 19 physically disabled adults between the ages of 18 and 65 years. The home is situated in a small village, close to two local towns and their amenities. Transport is provided in the form of two mini-buses. Accommodation for the client group with Physical Disabilities is mainly provided over three floors and is in single rooms with ensuite facilities. Six residents have their own selfcontained bungalows in the grounds but attend the main house for meals and activities. Adaptations such as ceiling hoists and mobility aids are provided according to assessed needs. This part of the home is known as The Alton Centre. Residents with Learning Difficulties are accommodated in a separate unit with separate staff and management. They also have single rooms and en-suite facilities. The unit is known as Thorpe Life Skills Centre. Statements of Purpose and Service Users Guide for each of the two areas are available from the Proposed Managers at the home. Inspection reports are available from the home or from the Commission for Social Care Inspection website. Information is available in the main entrance hallway in The Alton Centre. The Commission for Social Care Inspection applied for an urgent cancellation through the Magistrates Court on the 7th August 2008 which was granted. We applied for an urgent closure because of the risk to the health and wellbeing of the people who use the service. The Care Standards Tribunal overturned this decision and imposed the condtions of registration as described under the condtions of the registration categories. 2 4 0 9 2 0 0 8 Care Homes for Adults (18-65 years) Page 3 of 14 What we found: An unannounced random inspection was conducted on Wednesday 8th October 2008 by Stephanie Vaughan and Louise Bushell. The purpose of this random inspection was to review compliance with the imposed conditions of registration specified by the Care Standards Tribunal on the 5th September 2008. In addition to this, a specific review of all requirements that have exceeded the time scales set. The outcomes are as follows for the visit on 8th October 2008: Mrs Deirdre Cunningham (proposed Registered Manager) was the person in charge at the time of this inspection. Mr Micheal Keighley - Operations Director was on site, including Lyndsay Carpenter the new Operations Manager, during the visit to the service. Mrs Deirdre Cunningham advised that there have been no new admissions to the service. Records were received and occupancy levels were checked. The level of occupancy is in compliance with imposed conditions of registration. Mrs Deirdre Cunningham confirmed verbally that she was in the process of applying for her Criminal Records Bureau check (CRB). A CRB application number was provided. Mrs Cunningham advised that she would be attending one of the Commissions offices to submit her CRB application on Tuesday 14th October 2008. This is in compliance with the imposed conditions of registration. There were two Registered Nurses on duty during this inspection and five carers. The Rota was reviewed and discussions with a number of people who use the service occurred. Confirmation was received verbally from the people who use the service that the staffing levels had been sustained at a level sufficient to meet their needs. The rota evidently showed that the staffing levels were being maintained as stipulated through the imposed conditions of registration. There were four carers and two Registered Nurses on duty at night and five carers and two Registered Nurses on duty during the day. Mrs Deirdre Cunningham advised that the staffing levels are being maintained as directed and the use of the Care Bureau Agency continues to ensure consistency of levels. One of the nurses on duty from the agency verbally confirmed that she has been working at the unit for over two weeks now and is familiar with all individual needs. The service has produced a training plan which determines that there have been a variety of courses available for staff to attend. The current focus of staff training includes fire safety, health and safety, safeguarding of vulnerable adults and person centred planning. Information was submitted by the provider on the 2nd October 2008 regarding a variance to the imposed conditions of registration. This determined that Lisa Lovett, Training Manager would attend the service for one day during the week commencing the 29th September 2008 and then three days for the week commencing the 6th of October 2008 as directed by Active Care Partnership. We received notification on the 29th of September 2008 that Ms Carol Galloway Operational and Project Manager would be attending the service for two days a week Care Homes for Adults (18-65 years) Page 4 of 14 commencing the 29th of September 2008, whilst Mr S Whyte is on annual leave. The provider stated that Ms Galloway has considerable operational management experience. The organisations Catering Manager - John Simpson attended the service on the 30th September 2008 and continues to implement the catering action plan. Mr Johns Simpsons visit to the service is in compliance with the imposed conditions of registration. Mr Micheal Keighley and Mrs Deirdre Cunningham verbally confirmed that the organisations Quality Manager was due to attend the service on the 9th October 2008. The service continues to make improvements to the environment, there is now a scheduled programme for improvements throughout the building, for example redecorations, refurbishment and repair. A limited tour of the premises was conducted. All areas were seen to be clean and hygienic and free from offensive odour. We have received information that a further Registered Nurse has been suspended pending investigation into concerns about her knowledge and practice. In addition this we have also received two Notifications, one of which has implications for safe guarding and the appropriate referrals have been made. We are now awaiting the outcome. Appropriate Regulation 37 Notifications are being submitted in a timely manner. The service continues to provide weekly progress reports to the Commission regarding actions and improvements that have been made. To date these have been received as required. Outstanding requirements: 1 - Standard 17, Requirement 12 (4) (b). The Registered Person must ensure that the choice of food is provided for the identified service user that takes in to account his dietary needs arising from his religion. We case tracked the identified person relevant to this requirement and found evidence to demonstrate that compliance has been achieved. The evidence includes food records showing that cultural needs are being met. Confirmation was also obtained from the individual and staff. This requirement has now been met. 2 - Standard 19, Requirement 12 (1). The Registered Person must ensure that all care staff implement the care plan in place for the management of the identified service users diabetes. This is to ensure the consistent monitoring and the management of the service users diabetes. We case tracked the identified person relevant to this requirement. The individual plan of care has been revised in liaison with the Diabetic Specialist Nurse and now contains detailed instruction to staff about the management of this persons diabetes. Staff have received individual quick reference guides which clearly sets out the diabetic management protocol for this person. Staff have signed to confirm that they Care Homes for Adults (18-65 years) Page 5 of 14 understand the protocol and how to implement this. Case tracking identified that the care was being given as specified. This requirement has now been met. 3 - Standard 19, Requirement 12 (1). The Registered Person must ensure that the optimum range of blood sugar levels for the identified service user is recorded, together with the action that the nurses should take if the level falls outside this range. This is to ensure consistent monitoring and management of the service users diabetes. This was an immediate requirement dated 06/08/08. We case tracked the identified person relevant to this requirement, there is now evidence that blood sugar levels are conducted and recorded as specified in the individual plan of care. There is direction on the actions to follow if the blood sugar falls outside of the optimum range. Records now show that the nursing staff are now implementing appropriate action in response to the blood sugar level. This requirement has now been met. 4 - Standard 19, Requirement 12 (1). The Registered Person must ensure that the time when the identified service user eats her meal is recorded. This is to ensure consistent monitoring and management of the service users diabetes. Immediate requirement made on the 06/08/08. We case tracked the identified person relevant to this requirement, there is now evidence that accurate food records are being maintained. However these do not specifically specify the times that meals are served, there are records to indicate the times when blood sugars have have been taken. The care plan shows that the blood sugars are to be taken fifteen minutes after food is consumed, thus indicating the times that meals are consumed. This requirement has now been met. 5 - Standard 19, Requirement 12 (1). The Registered Person must ensure that the time that the identified persons blood sugar levels are taken is recorded accurately. This is to ensure consistent monitoring and management of the service users diabetes. Immediate requirement 06/08/08. We case tracked the identified person relevant to this requirement, there is now evidence that blood sugar levels are conducted and that the times are recorded as specified in the individual plan of care. This requirement has now been met. 6 - Standard 19, Requirement 12. Wound care must be carried out as detailed in a relevant and up to date care plan that actually reflects the need. Entries of monitoring and assessment must be accurate and deterioration and development of any wound must be acted upon. This was an immediate requirement dated 06/08/08. Individual plans of care continue to improve and now show that people have risk assessments in place for the management of pressure. Specific care plans have been Care Homes for Adults (18-65 years) Page 6 of 14 developed for the management of wound care and include photographic evidence to ensure that the service is able to monitor the deterioration, improvement and development of any wound. The service is obtaining guidance from the Tissue Viability Nurse on a regular basis. Records also indicate that appropriate dressings are applied in line with current best practice. Staff training in the management of wound care has been under taken and further training is planned. This requirement has now been met. 7 - Standard 19, Requirement 12 (1). The Registered person must ensure that the identified service user is assisted to eat her meal promptly when her insulin has been administered. This is to ensure consistent management of the service user diabetes. Immediate requirement 06/08/08. We case tracked the identified person relevant to this requirement, there is now evidence that this person has had their diabetic management reviewed by the Diabetic Specialist Nurse. The new care plans identify that the person now has their meals before the blood sugar is estimated and the insulin required is calculated according to this result. Staff confirmed that full support is provided during meal times. Records indicate that insulin is given as prescribed. This requirement has now been met. 8 - Standard 19, Requirement 12 (1). The Registered Person must ensure that the times when the identified service users receives her insulin are recorded accurate on the Medication Administration Records this is to ensure consistent monitoring and management of the service users diabetes. We case tracked the identified person relevant to this requirement, there is now evidence that the times the person receives their insulin is recorded on the Medication Administration Record and also on the blood sugar record. This requirement is now met. 9 - Standard 19, Requirement 12 (1). The Registered Person must ensure that the times when the identified service users receives her insulin at the times prescribed by her medical practitioner. This is to ensure consistent monitoring and management of the service users diabetes. We case tracked the identified person relevant to this requirement, there is now evidence that the times the person receives their insulin is recorded on the Medication Administration Record which is as prescribed by the persons medical practitioner. This requirement is now met. 10 - Standard 19, Requirement 12 (1). The Registered Person must ensure that the information contained in the identified service users care plan regarding the management of her diabetes is communicated clearly to all nursing staff responsible for her daily care. This is to ensure consistent monitoring and management of her diabetes. Care Homes for Adults (18-65 years) Page 7 of 14 We case tracked the identified person relevant to this requirement, there is now evidence that staff have received individual quick reference guides which clearly sets out the diabetic management protocol for this person. Staff have signed to confirm that they understand the protocol and how to implement this. Case tracking identified that the care was being given as specified. Staff spoken to were able to confirm their knowledge of the content and the implementation of the plan of care. This requirement has now been met. 11 - Standard 19, Requirement 12 & 13. Action must be taken to secure medical attention when a person requires this. Two people were case tracked and records showed that appropriate referrals are now being made to Health Care Specialists in a timely manner. This requirement has now been met. 12 - Standard 19, Requirement 12 (1). The Registered Person must ensure that what the identified service user has eaten is accurately recorded. This is to enable his diet to be monitored, to ensure that he eats sufficient food of good nutritional quality to maintain his wellbeing. Immediate requirement made on the 06/08/08. Food records viewed showed accurate records of the foods consumed were being maintained. However individual plans of care showed that low sugar and low fat diets had been recommended by the dietician. It clear that the individuals have exercised personal choice and preferences. There were no risk assessments in place to show how the people were to be supported in making positive choices within recommended guidelines. This requirement has now been met. A further requirement has been made 13 - Standard 19, Requirement 12 (1). The Registered Person must ensure that what the identified service user is given support to eat his meals as identified in his care plan. This is to ensure that he eats sufficient food of good nutritional quality to maintain his health and wellbeing. Immediate requirement made on the 06/08/08. Through observation and discussion with staff, it was established that the specified person is now receiving full one to one support during all meal times, this is to ensure that appropriate levels of support is being provided. This requirement has now been met. 14 - Standard 20, Requirement 13 (2) & 18 (1) (a). An effective system for ordering medication must be in place to ensure that there are sufficient quantities of medication so that people receive their medication and prevents the risk of deterioration in their health. Systems must be sufficient to identify when errors in recording have been made and action taken on this. Audits must be undertaken to identify the inaccuracies identified at this inspection where medication stock did not reconcile with records. Care Homes for Adults (18-65 years) Page 8 of 14 There is evidence that the service is now in the process of changing to the use of a Monitored Dose System (MDS). This means that stock control systems are in place and it is possible to cross reference the remaining stock with the items dispensed. There was sufficient supplies of medication available in the service. The management of the service have initiated a daily audit of medication systems to ensure that any errors are identified in order for the appropriate action to be taken. Medication records were in good order. This requirement has now been met. 15 - Standard 37, Requirement 9 & 12 (1). Management of the home must be effective and sufficient to ensure people receive the care and support required to stop serious risk to their health. Following this requirement there have been changes to the management of the service. There is now a full time, proposed Registered Manager in post who is currently seeking registration with the Commission for Social Care Inspection. The proposed person is also a qualified Registered Nurse with previous experience at the Alton Centre. The proposed person is supported by the Responsible Individual, a Clinical Specialist and an Operations Manager. This requirement has now been met. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 9 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 2 14 & 15 Care must be taken to 19/10/2008 ensure that all service users welfare needs are transferred to the care plan from admission and assessment documentation to ensure that their needs are met. (Previous Requirement) Care plans must be regularly 19/10/2008 reviewed, and guidance within them implemented to ensure the health and welfare of people living in the home. Risk assessments must be undertaken by staff who are fully trained and competent to complete this task. (Previous Requirement) 19/10/2008 2 6 12(1) 3 6 13 & 18 4 19 12 & 13 When people have a catheter 19/10/2008 the care provided must be based on current good practice and clinical guidance, so that people are not at risk of discomfort caused by pulling when catheter bags full of urine are left hanging at the side of a bed on to the floor. Care must be taken to ensure that all service users 19/10/2008 5 19 14 & 15 Care Homes for Adults (18-65 years) Page 10 of 14 welfare needs are transferred to the care plan from admission and assessment documentation to ensure that their needs are met. (Previous Requirement) 6 20 13 Care should be taken to ensure directions on service users medicines are unambiguous to ensure the safety of the system(Previous Requirement) To properly protect service users properly, staff must have a full understanding of and follow safeguarding procedures promptly. (Previous Requirement) To properly protect service users properly, staff must have a full understanding of and follow safeguarding procedures promptly. (Previous Requirement) Risk assessments must be undertaken by staff who are fully trained and competent to complete this task. (Previous Requirement) 19/10/2008 7 23 13 19/10/2008 8 35 13 19/10/2008 9 35 13 & 18 19/10/2008 10 36 18 (1 3) All staff must receive 19/10/2008 supervision to assess their level of competence; at least six times a year, to ensure that the people who use the service are in safe hands at all times. Training, support and monitoring of staff must be enough to ensure sufficient 19/10/2008 11 37 12(1) & 18(1)(a) Care Homes for Adults (18-65 years) Page 11 of 14 levels of competency is held by them to meet the assessed needs of people living in the home, monitoring must be able to identify serious shortfalls in competency, then action must be taken to safeguard the people living at the home. Care Homes for Adults (18-65 years) Page 12 of 14 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Risk assessments must be conducted in situations where peoples rights to choose conflict with current best practice. To ensure peoples rights are balanced with the potential risks and action is taken to manage these risks. 04/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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