Care Home: Aaron Grange Care Home

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What the care home does well What has improved since the last inspection? All staff recruited are now receiving pre employment checks so that they can be seen to be `fit` to work with vulnerable people. This helps ensure that people living in the home are protected. Activities have continued to be developed so that people in the home can have a better quality of life. The complaints process is more consistent so that any issues are dealt with in a timely fashion and feedback is given so that people feel there concerns are listened to. An example of this is the attention paid to previous complaints around missing clothing which has now been resolved. The home has continued to develop some good practice in terms of improving the dementia care unit with signs and orientation aids so that people can find it easier to access areas including the garden. What the care home could do better: Evaluations of the care plan should be documented more fully and include an assessment of the progress set against the goals of the care plan. This will make reviews of the care plan easier to follow. We would recommend that evaluations are [periodically] carried out with residents and / or relatives as this further ensure that people are included in the care planning process.Aaron Grange Care HomeDS0000069135.V377279.R01.S.doc Version 5.2 Care needs that are no longer an issue can be discontinued as this will ensure the care plan is kept up to date and relevant. Both staff interviewed and residents and relatives spoken to on the day felt that staffing was adequate in terms of numbers and staff on both units. We did received some comments that sometimes it is difficult to find staff when visiting the home and areas are left without staff for periods. This could mean that staff may find it difficult to meet some care needs at certain times and maintain consistency. The local social service safeguarding team also have current investigations still pending and one of the themes that has arisen is lack of staff on occasions to mobilise people effectively. In terms of quality outcomes for residents around time for socialisation and observing residents at particular times then staffing may need to be reviewed if the home wishes to achieve further improved outcomes in these areas. We were advised that the staff responsible, and trained, to deliver staff training in the home has recently left. The remaining member of staff responsible has not had the required moving and handling instructor [3 day] training. This is therefore recommended so that staff can continue to receive training in the home. We are concerned that some residents currently have experienced falls and injuries which the safeguarding team are investigating. As part of the homes duty they must report untoward occurrences involving people in the home to us [Care Quality Commission] so that we can be made aware and kept up to date with important information about care. We have not received any notifications about these events and the manager was unsure as to the need to report them. This means that we have not been kept up to date and have had difficulties in effectively liaising with social service over these matters although it is recognised that the home have worked with safeguarding to manage these issues.. Key inspection report CARE HOMES FOR OLDER PEOPLE Aaron Grange Care Home Blacklow Brow Huyton with Roby Liverpool L36 5XG Lead Inspector Mike Perry Key Unannounced Inspection 25th August 2009 09:00 DS0000069135.V377279.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aaron Grange Care Home Address Blacklow Brow Huyton with Roby Liverpool L36 5XG 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) 0151 489 1127 0151 482 0778 aaron.grange@new-meronden.co.uk Aaroncare Limited Miss Cathy Ellen Jones Care Home 54 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (24) of places Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, 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: 24) Dementia over 65 years of age - Code DE (E) (maximum number of places: 30) The maximum number of service users who can be accommodated is: 54 Date of last inspection 27th August 2008 Brief Description of the Service: Aaron Grange is a 54-bedded care home that offers residential and EMI (Elderly Mentally Infirm) residential care. There are two units, Emily Unit which houses up to 30 EMI beds and Beecham Unit, which houses up to 24 residential beds. The home does not offer nursing care. The home is located in the Huyton area of Liverpool and is close to local amenities. It is a large listed building located on three floors and is accessible via an upper and lower car park and appropriate lifts. 19 of the bedrooms are en-suite, however there are ample numbers of bathrooms and toilets located around the home. The Registered Providers are Aaroncare Ltd. The responsible person is Mrs C Jarvis. The registered manager is Kathy Jones. The current rates for care in the home are £373.94 - £489.00 weekly. Aaron Grange Care Home DS0000069135.V377279.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 2 star. This means the people who use this service experience good quality outcomes. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The inspection took place over a period of one day [7 hours]. The inspector met with residents and spoke with a number of residents, relatives and visitors. There were additional conversations with health and social care professionals. These concerned the investigation of recent incidents from the safeguarding team. The inspector also spoke with members of care staff on a one to one basis and the registered manager, deputy manager and also Responsible Person who was present for the inspection. We toured of the premises was carried out and this covered most of the day areas in the home and some of the bedrooms. We observed the care. Records were examined and these included three of the resident’s care plans, staff files, and staff training records and health and safety records. Prior to the inspection the manager and Responsible Person completed an Annual Quality Assurance Assessment [AQAA] for the home, which is a comprehensive document outlining information about the service and any developments over the past year. This was returned in good time. We sent surveys before the inspection for people in the home to complete so that further comments could be collected. A separate pharmacy inspection was also completed on 4th October and the findings are reported under the ‘Health and Personal Care’ section of the report. What the service does well: The home has written information and residents and relatives spoken to say that they had received enough information prior to and during admission and this had assisted them in both choosing and settling into the home. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 6 All residents are assessed prior to admission to the home and appropriate social care and health care assessments had been completed. This helps ensure that the home can meet the needs of the people admitted. We found good attention paid to the general health and wellbeing of people in the home. Those spoken with where generally complimentary and some comments were: ‘It’s a wonderful place. The staff are smashing. [My relative] is always clean and well looked after. They keep me informed about how she is. I’ve not seen the care plan’. A resident said: ‘I get well looked after. Staff are very good - always chatty. Overall I would say the home is very good’. Residents can choose their own GP (General Practitioner) and are visited by a range of health professionals such as district nurses, social workers, opticians and dentists and this is recorded in the care notes. This shows that health care is well monitored and people in the home are supported to access community support. We spoke with a visiting nurse who was passed with the way staff generally monitor people’s fluid intake and support continence in the home. Residents and relatives spoken with at the inspection said that they were treated with respect and that privacy was maintained when needed. The level of interaction varied with different residents but the staff interventions were positive and were seen to enhance resident’s dignity and feeling of well-being. Residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. The home appears bright and welcoming. People commented on the support staff were able to provide. One commented: ‘It’s very nice here. They look after me well. I’m eating well – meals are good. I’ve put on a lot of weight since I’ve been here. I feel much better. I don’t join in the activities – I like to read. Staff talk to me. It’s very nice’. Residents generally enjoy the food and comments were positive. Throughout the day drinks were made available and there are also extra jugs of juice provided and some residents were seen to be helping themselves so that this area of care is well supported. The management team have made progress since the last inspection and were able to demonstrate continuing progress of care standards in the home. There are quality audits which can provide constructive feedback to the management so that continuous improvements can be made. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 7 Health and Safety is managed and the home is maintained safely through regular risk assessment. This ensures that people are living in a safe environment. Managers displayed an open attitude to the inspection and were positive regarding any discussions at the time. What has improved since the last inspection? What they could do better: Evaluations of the care plan should be documented more fully and include an assessment of the progress set against the goals of the care plan. This will make reviews of the care plan easier to follow. We would recommend that evaluations are [periodically] carried out with residents and / or relatives as this further ensure that people are included in the care planning process. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 8 Care needs that are no longer an issue can be discontinued as this will ensure the care plan is kept up to date and relevant. Both staff interviewed and residents and relatives spoken to on the day felt that staffing was adequate in terms of numbers and staff on both units. We did received some comments that sometimes it is difficult to find staff when visiting the home and areas are left without staff for periods. This could mean that staff may find it difficult to meet some care needs at certain times and maintain consistency. The local social service safeguarding team also have current investigations still pending and one of the themes that has arisen is lack of staff on occasions to mobilise people effectively. In terms of quality outcomes for residents around time for socialisation and observing residents at particular times then staffing may need to be reviewed if the home wishes to achieve further improved outcomes in these areas. We were advised that the staff responsible, and trained, to deliver staff training in the home has recently left. The remaining member of staff responsible has not had the required moving and handling instructor [3 day] training. This is therefore recommended so that staff can continue to receive training in the home. We are concerned that some residents currently have experienced falls and injuries which the safeguarding team are investigating. As part of the homes duty they must report untoward occurrences involving people in the home to us [Care Quality Commission] so that we can be made aware and kept up to date with important information about care. We have not received any notifications about these events and the manager was unsure as to the need to report them. This means that we have not been kept up to date and have had difficulties in effectively liaising with social service over these matters although it is recognised that the home have worked with safeguarding to manage these issues.. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Aaron Grange Care Home DS0000069135.V377279.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 Aaron Grange Care Home DS0000069135.V377279.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process is thorough and helps ensure that the home is able to identify and therefore meet resident’s needs. EVIDENCE: The home has written information [Service User Guide] and this is available for residents and relatives and is available in each of the bedrooms. Residents and relatives spoken to say that they had received enough information prior to and during admission and this had assisted them in both choosing and settling into the home. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 11 All residents are assessed prior to admission to the home. Three care files were reviewed and appropriate social care and, if required, health care assessments had been completed. The home has developed an assessment form which includes risk assessments. Relatives spoken to were very positive in support of the staff’s general approach to care and felt that staff had a clear understanding of residents needs. They felt involved in the care to the extent that they had been consulted at the initial assessment stage. Aaron Grange Care Home DS0000069135.V377279.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People health care is monitored effectively so that their rights in this area are upheld. EVIDENCE: We looked at care plans on the dementia unit [2] and also on the residential unit [1]. The home is trying to involve both residents and relatives in the planning of the care and some resident/relatives had signed plans to say they agree with how their care is going to be given. Relatives spoken with said that Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 13 they feel involved the care and that staff are always keen to discuss the care and report any changes. One commented: ‘It’s a wonderful place. The staff are smashing. [My relative] is always clean and well looked after. They keep me informed about how she is. I’ve not seen the care plan’. A resident said: ‘I get well looked after. Staff are very good - always chatty. Overall I would say the home is very good’. Plans are being reviewed by staff on a monthly basis, or sooner if needed. This evaluation process was discussed. Care plan evaluations should contain more than a general statement of ‘continue care’ and should be a discussion and statement of progress made set against the aims / goals of the care plan. This should show evidence of discussion with key workers and periodically relatives and residents. This was discussed on the last inspection and still needs some improvements particularly with respect to relatives and/or residents getting involved. None of the people spoken with were aware of their care plan. We found some care needs that had been met and were no longer an issue but continued to be reviewed. We would recommend that these are discontinued so that the care plan reflects up to date and current needs. The care plans seen were written in simple terms and where easy to follow. There was a lack of confusing [and disabling] medical terminology and residents needs were explained in terms that affected their daily life. For example one person had issues around restrictions being placed on them and the need to maintain locked doors which was explained. This displays a more person centred approach to care and shows residents as individuals. Residents have a range of risk assessments within their care plans covering, falls, nutrition, moving and handling, dependency and pressure sores. These look into the resident’s risk of harming themselves or others. These were completed to a good standard and then are included in the care plan. One resident has a pressure sore monitored through the care plan with regular input from the district nurse team. Residents can choose their own GP (General Practitioner) and are visited by a range of health professionals such as district nurses, social workers, opticians and dentists and this is recorded in the care notes. This shows that health care is well monitored and people in the home are supported to access community support. We spoke with a visiting nurse who was pleased with the way staff generally monitor people’s fluid intake and support continence in the home. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 14 Residents and relatives spoken to at the inspection said that they were treated with respect and that privacy was maintained when needed. We sat for a period on the dementia care unit and observed the care. The level of interaction varied with different residents but the staff interventions were positive and were seen to enhance resident’s dignity and feeling of well-being. Residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. We looked at how peoples medicines were handled and found that the management team was had taken action to improve the handling of medicines at the home. The manager carries out regular audits (checks) to help ensure medicines are safely managed and that should any weaknesses arise they are promptly addressed. The manager had identified that the medicines ordering could be better and was working with the doctors Practice Manager to bring about improvement in this area. The medicines policies are kept under review and provide written guidance to staff in the handling of medicines at the home. Staff handling medicines have completed certificated medicines training and are also assessed ‘in house’ to help ensure the homes procedures are followed. Part of the morning medicines round was observed. Care was taken to complete the medicines records immediately after administration to help ensure they are accurately maintained, reducing the risk of mistakes. Records showing the administration of medication were generally clearly completed and up-to-date, helping to support the safe administration of medicines. It was of concern that we saw two examples where handwritten medicines records impossibly showed that medicines had been administered before they had actually been received into the home. Senior staff spoken with explained that they had seen these errors and had spoken to staff and explained how entries should be made to reduce the risk of this re-occurring. Records of communication with healthcare professionals such as G.Ps were generally clearly made, so changes to peoples medicines could be tracked. Where medicines were prescribed when required there was often written information for staff about when that person may need the medication, but this was not completed for everyone. We also found that some of this information needed to be up-dated to show changes to peoples’ medicines. Staff spoken with were knowledgeable about the use of these medicines and daily entries on the whole (but not always) reflected the use of these medicines when needed. The written when required information should be completed and kept up-todate to help ensure consistency in the use of these medicines. We found that medicines including controlled drugs were stored securely. This helps to ensure that they are not misused or mishandled. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and families are encouraged to be socially active. EVIDENCE: The day areas in the home are bright and relaxed and residents are able to socialise. Residents spoken to were open and talked freely about daily life in the home and were generally pleased. General comments where that the atmosphere in the home is welcoming and staff are friendly. We observed residents in the day room on the dementia care unit and there was a good level of staff interaction and engagement with residents. Staff interviewed were clear that this area was always staffed and it was observed that staff regularly interacted and supported residents. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 16 The home employs an activities coordinator for 24 hours weekly. The pre inspection information [AQAA] tells us that this person is being supported by completing some extra training to equip her for the role. The activities person works a total of 24 hours weekly and it was discussed with the manager that with over 50 residents in the home it would be difficult to spend enough time to involve everybody and that an increase in activity hours would benefit the home in terms of consistency and quality outcomes for residents in this area. The activities listed on the rota posted outside the dementia unit consists of ball and chair activities and bingo. We saw staff engaging residents during the morning in a session of physical activity. Staff also reported regular attendance by an entertainer and also trips out of the home occasionally. One person commented: ‘It’s very nice here. They look after me well. I’m eating well – meals are good. I’ve put on a lot of weight since I’ve been here. I feel much better. I don’t join in the activities – I like to read. Staff talk to me. It’s very nice’. Residents also spoke about the routine of the day and one stated that there is no set time for getting up and that staff would work around individuals needs. Relatives who said that they were free to visit at any time supported this. Relatives reported that the manager continues to hold meetings to collect ideas and exchange information about the home. Some understanding of the social needs of residents with dementia was evident from the personalisation of bedrooms and the fact that some residents have been encouraged to bring in items of furniture so that surroundings are more familiar. There is now more orientation aids and signage for toilets etc and this work continues. The home has a rolling menu that changes week to week. Menus are displayed around the home and residents can have a choice of meals. The menus on the dementia care unit are displayed so that people can easily reference this. The home provides the choice of a cooked breakfast, which is appreciated by some residents. Residents generally enjoy the food and comments were positive. Throughout the day drinks were made available and there are also extra jugs of juice provided and some residents were seen to be helping themselves. We spoke with a visiting professional who commented on the homes attention to encouraging people’s fluid intake. Aaron Grange Care Home DS0000069135.V377279.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to ensure that concerns are acted on and people are listened to. This ensures that people in the home are protected. EVIDENCE: The home has a complaints procedure and this is displayed and is also in the homes information pack which is in each room. This ensures that the people in the home have access to the complaints process. Those we spoke with said that they felt they new who to complain to and that they would be listened to. We looked at the way the home manage complaints. Since the last inspection the home have revised there policy so that any ‘concerns’ are formally logged and dealt with. This includes any minor concern which may be dealt with very quickly as well as more serious complaints. We revised such a complaint and this had been dealt with appropriately. We discussed the previous inspection findings around the high incidents of complaints about the laundry and missing clothing. This has now been resolved with a reduction in the number of complaints. This shows that the home listen and respond to issues of concern. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 18 We discussed the way the home deals with any allegations of abuse or concerns around the safeguarding of people in the home and whether correct processes are followed to protect people. During the visit we discussed a referral the home had made in July 2009 to the safeguarding team regarding allegations by a resident in the home about the way a staff member had spoken to her. This had been referred appropriately and the home worked well with the safeguarding team from social services. We were also notified of this incident. Currently the safeguarding team are involved in investigating concerns around three residents in the home. The first involves a resident who has had unexplained injuries. Visiting professionals were concerned that the person was not being moved by a staff member appropriately. They also gave advice about removing bedrails as this may have been the cause of the injuries but this was not actioned immediately and resulted in further injuries being sustained. There are concerns around a resident who has had a number of falls resulting in attendance at casualty. There is a current concern that there may not be sufficient staff to ensure that this resident is assisted to walk. The other issue involves a resident who has received wounds which are again unexplained and may involved incorrect handling by staff. All of these were currently ongoing and the home is involved with the safeguarding team in reviewing them. The homes management act positively in that hey attend meetings with social services and act on any recommendations made. We have discussed these with safeguarding and the overriding concern is one of staff maintaining correct moving and handling methods so that people are supported appropriately. We have made some recommendations around this. The company are currently involved in reviewing practice in the home. We are concerned that none of the above incidents have been reported through to us [CQC] as part of the requirement for the home to ensure that we are informed about untoward occurrences with respect to any resident which may also result in a referral to the safeguarding team. It is important that all such occurrences are reported through the Care Quality Commission so that we can ensure we have up to date information about the home and that we can [if needed] liaise with other statutory bodies such as social services about the care in the home. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 19 Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be developed with the needs of the residents in mind so that they are provided with a safe and comfortable environment to live. EVIDENCE: Both units visited were clean, bright and well maintained. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. Both units are on a number of levels but there is easy access for wheelchairs and residents with mobility difficulties. There were reported, and also observed, to be good provision of disability aids and nursing Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 21 equipment such as bath hoists, walk in showers, raised toilets and handrails in corridors. The home has two large car parks and the home can be accessed from either. A lift is available to take residents between floors. Grounds are well maintained and pleasant to look at from the home. There were no areas in the home which had offensive odours at the time of the visit. Residents and relatives said the home was always clean. The external grounds are maintained well and can be accessed by residents. One of the day areas for the emilia unit has been moved t the ground floor so that there is now easier access to the garden for some people with demetia. Only a sample of bedrooms was looked at during this inspection; however those seen were clean and personalised with resident’s belongings. The home has an in house laundry and the previous inspection findings around dissatisfaction with clothes being lost have now been resolved. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and trained appropriately but staff numbers cannot always ensure consistent care. EVIDENCE: The dementia care unit had 29 residents on at the time of the inspection and was staffed with 4 carers in the morning and afternoon. On the general elderly unit there were 19 residents with 3 care staff. The over all staffing ratio is therefore 1 staff to 7 residents on the dementia care unit and [currently] 1:6 on the general care unit. The manager is additional to these figures although there has been a change from the previous inspection in that the deputy is now counted in the numbers for the dementia care unit which represents a reduction in the overall staff numbers [previously supernumery]. In addition to the basic care staff numbers Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 23 there are also ancillary staff such as laundry and kitchen staff as well as domestic cover. There is an activities organiser for 24 hours a week. Both staff interviewed and residents and relatives spoken to on the day felt that staffing was adequate in terms of numbers and staff on both units. The general dependency is monitored and some residents currently do have higher dependency needs and need more physical care. We received some comments from professionals that sometimes it is difficult to find staff when visiting the home and areas are left without staff for periods. Currently the safeguarding team from social services are involved in investigating some care issues in the home and there are concerns around the ability of staff to mobilise residents as well as maintain observations. We observed for example that one of the dementia care lounges was left without staff for a short period and staff had to be alerted by a resident to the fact that another resident was undressing and exposing herself. The importance of staff presence is to protect people’s dignity in such eventualities. We also spoke to person who was going for a hospital appointment and a staff member was to accompany her but there was no extra staff for this purpose which meant that for a period of time the general care unit had 2 staff only. This could mean that staff may find it difficult to meet some care needs at certain times and maintain consistency. In terms of quality outcomes for residents around time for socialisation and observing residents at particular times then staffing may need to be reviewed if the home wishes to achieve further improved outcomes in these areas. Staff files were seen and we found improvements from the last inspection in that all recruitment checks have been made and the files were easy to read and get the required information. This ensures that staff working in the home are fit and suitable and residents are protected. Training files were seen for staff and staff spoken to were pleased with the ongoing training in the home. Managers explained that most staff have NVQ training or are on an NVQ course. Training needs are continually assed through supervision and there is a training plan of training events for the immediate future. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management systems in place so that the home can continue to improve standards for people living there but the manager must be aware of all statutory reporting procedures so that the home can meet their regulatory requirements. EVIDENCE: Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 25 The Registered Manager is Kathy Jones. Kathy has had experience working in the home at deputy level and has completed a management qualification at NVQ level 4. She has been newly registered in the last year. She was able to show continued update of her knowledge. For example an awareness around the new ‘deprivation of liberty’ safeguards that have been introduced. The management team have made progress since the last inspection and have met some of the requirements and recommendations previously made and were able to demonstrate a continuing progress and raising of the care standards in the home. There are various internal audits that the company have introduced and some of these were seen. For example there are audits conducted around accidents in the home and general health and safety issues. Also there are quality audits around activities and regular medication audits. Overall the auditing system should provide constructive feedback to the management so that continuous improvements can be made. This was seen for example with the attention paid to management of laundry since the last visit and the resultant reduction in complaints. Health and Safety is managed and the home is maintained safely through regular risk assessment. The AQAA submitted by the home and those safety certificates and records seen were all up to date and monitored. We discussed moving and handling training for staff [given current concerns by social services – see ‘complaints and protection’]. We were advised that the staff responsible, and trained, to deliver staff training in the home has recently left. The remaining member of staff responsible has not had the required moving and handling instructor [3 day] training. This is therefore recommended so that staff can continue to receive training in the home. Accident reporting was discussed and accident records were reviewed and the monitoring was appropriate in that people who had had falls were recorded and the daily notes following the fall referenced appropriate observations showing that staff were aware how to monitor such incidents. We are concerned that some residents currently have experienced falls and injuries which the safeguarding team are investigating. As part of the homes duty they must report untoward occurrences involving people in the home to us [Care Quality Commission] so that we can be made aware and kept up to date with important information about care. Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37 Regulation 37 Requirement The manager home must inform the Care Quality Commission of any adverse incident involving people living in the home via the notification process. This is so that we can be made aware and kept up to date with important information about care and the home is meeting its statutory responsibilities. Timescale for action 01/10/09 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 OP7 Good Practice Recommendations Evaluations of the care plan should be documented more fully and include an assessment of the progress set against the goals of the care plan. We would recommend that evaluations are [periodically] carried out with residents and / or relatives as this further Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 28 ensure that people are included in the care planning process. Care needs that are no longer an issue can be discontinued as this will ensure the care plan is kept up to date and relevant. 2 OP9 Care needs to be taken to ensure that written individual guidance about the use of ‘when required’ medicines is kept up-to-date and that the use of these medicines is always supported by monitoring in peoples daily records. In terms of quality outcomes for residents around time for socialisation and observing residents at particular times then staffing may need to be reviewed if the home wishes to achieve further improved outcomes in these areas. As discussed the current staff responsible for moving and handling in the home should be referred for further manual handling instructor training so that they have the necessary skills to continue training for staff in the home. 3 OP27 4 OP38 Aaron Grange Care Home DS0000069135.V377279.R01.S.doc Version 5.2 Page 29 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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