Care Home: Aaron Crest Care Home

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What the care home does well Care plans were in place for all those whose care we `tracked` and records were well organised making information easy to find. Assessments had been conducted as needed, so that risk of harm was identified. Pressure care audits had been introduced, so that the provision of pressure care was being monitored. People spoken to told us that their hygiene needs were being met by the home and records seen supported this information. These residents also told us that they were happy living at Aaron Crest and that they were well looked after. Advice had been sought from the District Nursing service, so that people with pressure wounds were receiving appropriate treatment and were provided with the correct equipment in order to promote healing. Referrals had also been made to request input from other external professionals to ensure that people living at the home received the care and support required. Residents spoken to told us that a Doctor`s visit is requested if they are not feeling well. Fluid balance and dietary intake charts had been maintained for those with nutritional difficulties to ensure that they received an adequate, well balanced diet and to monitor their fluid intake. In general medications were being managed well and relevant staff had received appropriate training before they were able to administer medicines, to ensure that they were deemed competent to undertake this role. The policies and procedures of the home in relation to safeguarding vulnerable adults were relevant and contained all the information expected, so that staff were aware of their responsibilities to report any allegations of abuse. Records showed that staff had received appropriate training in the protection of people in their care and staff spoken to told us that they would know what to do should they be concerned about the safety of someone living at the home. Recruitment practices adopted by the home ensured that people employed were fit to work with this vulnerable client group. We found the home to be clean and tidy providing a pleasant environment for people to live in. It was well maintained and those living at the home looked comfortable in their surroundings. A staff rota was in place showing the number and skill mix of staff on duty at any one time and records showed that a wide range of training was provided for staff, so that they were kept up to date with current legislation and guidelines. What the care home could do better: The pressure risk assessment tool could have provided staff with clearer guidance about what they needed to do as a result of the possible risk identified. The plans of care could have provided a clearer picture of people`s assessed needs and how these needs were to be best met. This could have been achieved by less use of vague terminology and more specific guidance for staff in a person centered way. Although the District Nursing service were maintaining their own records in relation to the treatment of pressure sores, the care plan seen could have also incorporated this information, providing a holistic approach to this individual`s care. Documents could have been introduced to demonstrate that instructions in the care plan were being followed in day to day practice, such as, a record of how often one resident was being assisted to stand in order to relieve pressure and how long he had been supported in the standing position. Hand written entries on the Medication Administration Records could have been signed, witnessed and countersigned in order to prevent the possibility of any transcription errors and the receipt of medications could have consistently been recorded, so that a clear audit trail could have been followed. The management team could look at the arrangement of accommodation at the home to determine if alternative solutions are possible to allow stretcher transfers to hospital if necessary. Random inspection report Care homes for older people Name: Address: Aaron Crest Care Home Tanhouse Road Aaroncrest Skelmersdale WN8 6AZ three star excellent service 22/01/2009 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Vivienne Morris Date: 1 6 0 6 2 0 1 0 Information about the care home Name of care home: Address: Aaron Crest Care Home Tanhouse Road Aaroncrest Skelmersdale WN8 6AZ 01695558880 Telephone number: Fax number: Email address: Provider web address: aaron.crest@new-meronden.co.uk Name of registered provider(s): Name of registered manager (if applicable) Aaroncare Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 66 Number of places (if applicable): Under 65 Over 65 0 37 0 dementia old age, not falling within any other category physical disability Conditions of registration: 29 0 5 The maximum number of service users who can be accommodated is:66 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 categories: Old age, not falling within any other category - Code OP (maximum number of places 37), Dementia - Code DE (maximum number of places 29), Physical disability - Code PD (maximum number of places 5). Date of last inspection 2 2 0 1 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Aaroncrest is a purpose built care home, providing accomodation for up to 66 older people who require support with nursing or personal care, including those whose needs are associated with a dementia related illness. There are also a small number of places available for people with a physical disability. Accommodation is on two floors served by a passenger lift. Ramps to the front of the home allow access for wheelchair users and specialised aids and equipment are available to assist those with mobility problems. The majority of rooms are single, although one companion room is available for people who might wish to share. Some en-suite facilities are provided, and there are sufficient washing, bathing and toilet facilities located throughout the home. At the time of this inspection fees ranged from £389 to £567 per week with additional costs being incurred for private chiropody, hairdressing, newspapers, magazines and escort duties. Care Homes for Older People Page 3 of 11 What we found: We conducted a random inspection at Aaron Crest Nursing Home on 16th June 2010, which lasted five hours and was in response to information received from a variety of sources. During our visit we tracked the nutritional, pressure and personal care of a number of people living at the home. We examined their care records and looked at all relevant documentation. We spoke to residents, staff and visitors, who gave us some positive feedback about the service provided. A tour of the premises was conducted when all communal areas were seen and a random selection of private accommodation was viewed. At the time of our visit there were four people who had pressure wounds. We tracked the pressure care of one of these residents. The care files were well organised making information easy to find. An assessment had been conducted showing that this individual was at very high risk of pressure area damage. However, there was no guidance included on the risk assessment form telling staff of strategies needing to be implemented as a result of the assessment. Internal audits had been conducted so that the quality of pressure care provided was being monitored. We established that the District Nursing Service was involved in the care of this persons pressure wounds, to ensure appropriate treatment was administered. However, the plan of care could have provided staff with more detailed information in relation to pressure care. Some statements were vague and not specific enough, such as, use ointments as and when required and monitor skin integrity for any changes in skin colour. The plan of care failed to indicate that the resident had pressure wounds or how they were being treated, so that staff were fully aware of the care required. The care plan stated, Encourage to stand for short periods to alleviate pressure. However, there was no record to show that this instruction had been followed in day to day practice. We visited the resident in his bedroom and noted that appropriate pressure relieving equipment was provided, despite no record of this being included in the plan of care. We tracked the care of one individual requiring support with personal care. The plan of care was vague in places and not totally person centered. It stated, To be assisted with personal hygiene due to confusion. Maybe one or two carers. Enjoys baths and showers. However, some information provided was more person centered, such as, Able to assist with small hygiene needs like washing hands. The bathing record showed that a bath was offered on a regular basis to ensure hygiene needs were being sufficiently met. All service users spoken to told us that they are able to have a bath or shower when they want one. One of these people told us, I am being very well looked after. I have to appreciate that. A pharmacy inspection had been conducted by the Care Quality Commission on the 22nd April 2010, when two requirements had been made. At the time of this visit to the service we found that both requirements had been appropriately addressed to ensure that people were protected by the medication practices adopted by the home. However, we found that on this occasion not all hand written entries on the Medication Administration Care Homes for Older People Page 4 of 11 Records had been signed, witnessed and countersigned in order to prevent the possibility of any transcription errors and the receipt of medications had not always been recorded, so that a clear audit trail could be followed. All residents spoken to told us that staff requested a Doctors visit if they were unwell and that their call bells were answered promptly, which we observed at the time of our visit to the home. We tracked the nutritional care of one person with swallowing difficulties to ensure an adequate dietary and fluid intake was being provided. A fluid balance and diet chart were in place, so that nutritional intake was monitored. A risk assessment had been conducted and monthly weight records were seen. The plan of care for February 2010 stated, Resident weight loss due to swallowing difficulties and change in consistency of diet and on 6th February 2010 instructions were that weekly weights were necessary. However, this instruction had not been followed as monthly weights were still being recorded at the time of our visit to the service. Staff spoken to told us that weekly weights had just been commenced. Records showed that in February 2010 referral had also been made to the dietician and speech and language therapist, but there was no record of their visits taking place. We advised the manager to follow these referrals up, to ensure appropriate intervention is sought. Policies and procedures adopted by the home in relation to the protection of people living at Aaron Crest were relevant and provided staff with the correct course of action to take should they be concerned that someone in their care was being mistreated. Staff spoken to told us that they would know what to do if they felt that someone living at the home was being abused. We toured the premises at the time of our visit, when we viewed all communal areas and a random selection of private accommodation. We found the home to be clean, tidy and pleasant smelling throughout with waste bins being emptied, so that a comfortable and homely environment was provided for the people living at Aaron Crest. Those spoken to told us that the home was always fresh and clean and that their bedrooms are cleaned regularly. The duty rota was examined, which showed the number and skill mix of staff on duty at any one time. However, it is the responsibility of the registered person to ensure that the assessed needs of those living at the home are met by the number and skill mix of staff on duty. We were told that staffing levels had recently been increased on night duty and that an increase on day duty was planned in the near future. We saw that there were several care staff in the lounge during our visit to ensure people were being observed in order to minimise the risk of harm. One person living at the home said, They are short staffed and the carers work long hours. The files of three people working at the home were examined, which demonstrated that recruitment practices were satisfactory to ensure that staff employed at Aaron Crest were deemed fit to work with vulnerable adults. Records showed that staff were provided with a wide range of training, so that they were kept up to date with current practices and new ways of working. Staff spoken to told us Care Homes for Older People Page 5 of 11 that they received a lot of training to ensure they could do the job expected of them. Accident records were seen, which were retained in line with data protection regulations, so that personal information about people was sufficiently protected. We established that the passenger lift could not accommodate a stretcher for those needing to be transferred to hospital by this method from the first floor. We were told that consideration was being given to accommodating the nursing clients on the ground floor as they were more likely to require a stretcher transfer to hospital. What the care home does well: Care plans were in place for all those whose care we tracked and records were well organised making information easy to find. Assessments had been conducted as needed, so that risk of harm was identified. Pressure care audits had been introduced, so that the provision of pressure care was being monitored. People spoken to told us that their hygiene needs were being met by the home and records seen supported this information. These residents also told us that they were happy living at Aaron Crest and that they were well looked after. Advice had been sought from the District Nursing service, so that people with pressure wounds were receiving appropriate treatment and were provided with the correct equipment in order to promote healing. Referrals had also been made to request input from other external professionals to ensure that people living at the home received the care and support required. Residents spoken to told us that a Doctors visit is requested if they are not feeling well. Fluid balance and dietary intake charts had been maintained for those with nutritional difficulties to ensure that they received an adequate, well balanced diet and to monitor their fluid intake. In general medications were being managed well and relevant staff had received appropriate training before they were able to administer medicines, to ensure that they were deemed competent to undertake this role. The policies and procedures of the home in relation to safeguarding vulnerable adults were relevant and contained all the information expected, so that staff were aware of their responsibilities to report any allegations of abuse. Records showed that staff had received appropriate training in the protection of people in their care and staff spoken to told us that they would know what to do should they be concerned about the safety of someone living at the home. Recruitment practices adopted by the home ensured that people employed were fit to work with this vulnerable client group. We found the home to be clean and tidy providing a pleasant environment for people to live in. It was well maintained and those living at the home looked comfortable in their surroundings. A staff rota was in place showing the number and skill mix of staff on duty at any one time and records showed that a wide range of training was provided for staff, so that they were kept up to date with current legislation and guidelines. Care Homes for Older People Page 6 of 11 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 Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, 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 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 1 7 Instructions in the care plans should be followed in day to day practice, with records maintained, so that a clear audit trail can be followed and to ensure that people living at the home are receiving the care and support they need. Plans of care should include all assessed needs and should provide more detailed, person centered information and vague statements should be avoided, so that staff are provided with a clear picture of the care and support each individual requires. It is advisable that the referals made to the dietician and speech and language therapist in February 2010 are followed up and if visits have been made, then a record of these and the outcome be made in the individuals care file. It is recommended that guidance for staff be added to the pressure risk tool, so that they know what is needed as a result of the assessment. Care plans should incorporate all assessed needs, even when seperate records are maintained by the District Nurse. Not all hand written entries on the Medication Page 9 of 11 2 7 3 8 4 8 5 9 Care Homes for Older People 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 Administration Records had been signed, witnessed and countersigned in order to prevent the possibility of any transcription errors and the receipt of medications had not always been recorded, so that a clear audit trail could be followed. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 Older People 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: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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