Care Home: Aisling Lodge

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What the care home does well Staff are caring and attentive to people. They were observed to be respectful and careful when talking and when assisting people. Individual health needs continue to be promoted by seeking the support of community nurses and GPs, when they are needed. The home was clean and tidy and the accommodation was comfortable. The home is reasonably spacious for the number of places and the type of care it provides to the people currently living there. What has improved since the last inspection? The home has met the one requirement made at the last inspection. Care plans were improved in format and content since the last inspection. They contained satisfactory details and adequate detail of the care needs and care tasks needed. The auditing of care is carried out weekly and is an effective element of care planning that produces good outcomes for people living at the home. Improvements to the environment have taken place; much of the ground floor area has been redecorated and new carpets have been laid to hallways and the dining area. A new shower and a new chairlift have been installed and a new ramp for wheelchair access has been built. What the care home could do better: Six requirements and eight recommendation have been made in this report. Greater attention to dignity, choice and quality of food at meal times should be promoted. There should be enough staff to assist people with their food when they have been served with their meal, so they are not left waiting to be helped. Meals and mealtimes could be more person-centred by offering a choice of menu and making menus available to people at meal times and by providing suitable additives, or sauces, or salad dressings for people to help themselves to. These food dressings should be put on the table for people to choose as they wish and that they are visually reminded of this etiquette in a manner that preserves their dignity. People should be offered a choice of drink in containers that maintain a person`s dignity by making sure that they are offered an appropriate utensil that is not worn and scratched and is properly dried. The maintenance of the home could be improved by ensuring that there is a planned schedule to address topics identified for improvement. A number of topics are referred to in this report in the `Environment` outcome group of National Minimum Standards and the recommendations made in this report should be considered. Recruitment records for new staff should be completed in a way that the references obtained are more informative of the referee who has supplied them, so there is no doubt who has supplied a reference. The actual start date that a person commences employment should be clearly recorded in their recruitment record.Induction training should be structured and based on the Skills for Care Council Standards for Induction with evidence of the progression through induction. Regulation 26 reports must be carried out in accordance with The Care Homes Regulations 2001. Management systems to monitor the administration of medication should be effective. CARE HOMES FOR OLDER PEOPLE Aisling Lodge Church Street St Neots Cambridgeshire PE19 2BU Lead Inspector Don Traylen Unannounced Inspection 23rd July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aisling Lodge Address Church Street St Neots Cambridgeshire PE19 2BU 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) 01480 476789 01480 214410 mogs_56@hotmail.com Orchid Care Homes Ltd Miss Laura Penelope Binge Care Home 22 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (19) of places Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. OP (19) for the duration of condition number 2. DE(E) for 3 named females for the duration of their residency only. DE(E) 3 places for unnamed individuals for over 65 years of age with dementia. When 3 unnamed individuals over 65 years of age with dementia are in the home then the number of other service users may not exceed 19. 25/07/2007 Date of last inspection Brief Description of the Service: Aisling Lodge is a privately owned registered care home that provides accommodation and care for up to twenty-two people over 65 years of age. The home is situated close to the centre of the busy market town of St. Neots, opposite the church, with shops and local facilities only a few minutes walk from the home. Originally a Victorian rectory, the old part of the house retains many original features. It has been extended to provide accommodation in single and double rooms. The home has an enclosed, walled garden. As at July 2007 the fees ranged between £351 and £500 per week. Additional costs include those for private chiropody, hairdressing and some toiletries. A copy of the inspection report is available at the home on request and via the CSCI website. Aisling Lodge DS0000064767.V370272.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 home completed and an Annual Quality Assurance Assessments (AQAA) prior to this inspection. Three survey forms were retuned to the Commission of the 20 sent to the home. An ‘expert by experience’ participated in part of this inspection and consulted at least eight people for their views and observed their experiences and interactions with care staff and with other people living at the home. Assessments and care plans were read and a tour of the home was carried out. The recruitment records for two care staff were assessed and their induction training arrangements and ongoing training arrangements were requested. One visitor to the home was asked for her views of the home. What the service does well: Staff are caring and attentive to people. They were observed to be respectful and careful when talking and when assisting people. Individual health needs continue to be promoted by seeking the support of community nurses and GPs, when they are needed. The home was clean and tidy and the accommodation was comfortable. The home is reasonably spacious for the number of places and the type of care it provides to the people currently living there. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Six requirements and eight recommendation have been made in this report. Greater attention to dignity, choice and quality of food at meal times should be promoted. There should be enough staff to assist people with their food when they have been served with their meal, so they are not left waiting to be helped. Meals and mealtimes could be more person-centred by offering a choice of menu and making menus available to people at meal times and by providing suitable additives, or sauces, or salad dressings for people to help themselves to. These food dressings should be put on the table for people to choose as they wish and that they are visually reminded of this etiquette in a manner that preserves their dignity. People should be offered a choice of drink in containers that maintain a person’s dignity by making sure that they are offered an appropriate utensil that is not worn and scratched and is properly dried. The maintenance of the home could be improved by ensuring that there is a planned schedule to address topics identified for improvement. A number of topics are referred to in this report in the ‘Environment’ outcome group of National Minimum Standards and the recommendations made in this report should be considered. Recruitment records for new staff should be completed in a way that the references obtained are more informative of the referee who has supplied them, so there is no doubt who has supplied a reference. The actual start date that a person commences employment should be clearly recorded in their recruitment record. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 7 Induction training should be structured and based on the Skills for Care Council Standards for Induction with evidence of the progression through induction. Regulation 26 reports must be carried out in accordance with The Care Homes Regulations 2001. Management systems to monitor the administration of medication should be effective. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6, Quality in this outcome area is adequate. People are reasonably assured the home has adequate information about their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cambridgeshire Primary Care Trust (PCT) had comprehensively assessed one person and a copy of this assessment was read. The PCT assessment for one other person showed that it was not current for her admission to the home and appeared not to include all her needs. The assessment carried out by the home was undated, was not structured and was not written in an organised format and did not express all needs. A recommendation for improvements in the home’s ability to assess was made in the last inspection report for the 25/07/2007. Intermediate care is not provided and therefore standard 6 was not assessed. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is good. People are assured their care is planned and recorded and of being referred to Health Services when necessary and are treated with respect, although the management of their medication is not fully assured. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three people were read. They contained good personal descriptions of the care to be given and advice regarding medication. A daily routine was a useful and practical guide to care that was written into the plans. Photos and next of kin detail and a mental health and cognition assessment were included in one persons plan. A plan to protect the person was written. Sight, hearing and oral care were planned. Personal care, continence and mobility and spiritual and social care needs were recorded. This person’s needs regarding her behaviour had been responded to through the monitoring that was recorded. The person’s daughter had been involved in her care plan Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 11 and was aware of her needs and care. Some of the notes were hand written, whilst other were Word documents. This person’s care plan showed that the District Nurse and a Social Worker had been contacted after an incident of concern was recorded. A review had taken place on 16/04/2008 and monthly summary reports had been maintained up to June 2008. The auditing of care plans is effective and produces good outcomes. The administration and management of medication was assessed. There were missing entries in the Medication Administration Record (MAR) chart for one person. There was no recorded explanation for the missing entries. The person administering medication the following day did not notice, or report these missing entries. A count of the medication indicated these had not been administered. When this was discovered during the inspection, the home followed their policy and reported it to the GP for advice and also reported it as a potential adult abuse incident. There is a concern that the home has not monitored their medication records despite the home’s AQAA stating on page 31, “that effective quality assurance & monitoring system are in place.” People said that they were treated with respect and that staff were considerate and attentive. Staff were observed engaging with people when they were assisting them during the lunchtime meal. The expert by experience reported on people’s views about their care and respect. Apart from one case there was universal praise for the way that staff treated and reacted: • Person 1 said: “Excellent, very caring, they put something of their self into it. Most knock before entering and the exceptions were valid”. A lady with bed sores, who says that she sees the District Nurse about once a week and that they explain the situation to her. Person 2 said: Staff? “Alright … looked after at night, pull the cord they come.” Person 3: Staff? “ Lovely, can’t do enough for you.” Person 4: “ Home is very good. I feel quite satisfied. Staff treat me very well, help us as much as they can. They are busy…not much time to talk to us.” Person 5: “ More than satisfied, food is beautiful and the girls are good to me.” Person 6: A visitor whose father had been in the home 2 weeks said “ Seems fine. Staff are very efficient, the way booked in, took control of the tablets, seem to know what they are doing. Keeping an eye on him with the food ”. Person 7 said: “even agency staff are good ” and that as a diabetic the staff had been very aware of her condition, having twice anticipated problems for her and that “they take me to appointments “. • • • • • • The exception was observed when after lunch one person was very anxious to go to the toilet and was told politely to wait as it was occupied, who then being anxious that she would “ wet herself “ asked and was told a little later that Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 12 there was another toilet along the corridor near the dining room and finally after further waiting (and the intervention of the expert by experience), she gained access to the toilet. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. People are assured of a quiet lifestyle at the home where their opportunity to exert influence and choice is not fully developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of people living at the home gave the impression that they would like more activities. It was remarked upon that the grass in the large garden was too long and unsafe to walk on. The large and attractive garden was in need of maintenance and looked overgrown and unkempt. It was reported by one person that the grass was “never short” and the gardens was not used much. This person was clearly interested in the garden and talked about not being able to enjoy this area as much as he wanted to. He was observed to go outside and around the side entry to the garden, but was asked to return by a care assistant. At 12 noon a gardener/maintenance worker started to cut the grass. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 14 In the two main lounges, one with a TV turned on and one without, there was a lack of staff and la lack of interaction with people. There was little and mostly no interaction between the residents. There was a printed list of some form of activity on most days. A member of staff said that for “activities depend on how busy we are ”. People made comments about activities that include the following: 1. Activities? “ Not a lot, happy watching television, can do what you want”. 2. Activities? “ Prefer to be on my own “; this wish was respected. 3. Activities? “Not really, I like watching TV”. 4. “No organised events” but said there were card games “no music and no excursions”. The expert by experience concluded that the people spoken to didn’t feel that there was much by way of activity. For people’s views and ideas to influence life in the home there was said to be an informal system encouraged between staff and residents. As a people said “ Formal system no, board for suggestions…tend to tell the staff”; other residents sitting nearby agreed. The issue arising is the benefit of some form of agreed and appropriate formal system alongside the informal system. Overall, the food was regarded as at least satisfactory, or good. The choice at breakfast was welcomed but clearly a choice at lunchtime would also be welcomed. People’s comments made to the expert by experience included: 1. Lunchtime choice? “no” like one? “yes … food varies”. 2. Food “adequate”. Had no choice at lunchtime but welcomed choice at breakfast like bread and jam. 3. “ Food is lovely … eating a lot better” [lost a lot of weight recently in hospital]. 4. Food “ Alright, nice dinner and supper ”; she asked for and received ice cream today. 5. 5. “ Food is very good, I quite enjoy it “ Choice for lunch? “no general run of food … not like just leave”. 6. “ Food is beautiful”. 7. The visitor said “Food is good, mum ate here”. The lunch observed was quiche, new potatoes, salad and cheesecake and this was written on the menu board but no alternative choice was offered. The daily menu board is in the corridor but not in the dining room. Orange juice was served already poured in well-used plastic vessels. The meals were served already plated. There was no dressing offered for the salad or potatoes. Eleven people were seated in the dining room. Whilst none of the residents were in obvious need of some help, there was not many staff in attendance. Four people seated in the lounge were given assistance and attention and help to eat. One person, who was being assisted to eat, was served her meal in bowl and could not clearly see her food (this was because it could not be seen Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 15 when observing this interaction), whilst the three other people were given plates. At one point there was only one care assistant left to help four people to eat who had each been served their meal. Whilst two of the people could manage some of their food independently, although quite slowly, it was clear they each needed some encouragement and practical assistance. During this time the TV was left switched on, although nobody was watching it or had been watching it for the fifteen minutes prior to lunchtime when they were observed. One person ate her lunch in her room. She had eaten some of the main course and said that she would have welcomed help with eating. She seemed to struggle to move from sitting on the bed to lying down. One care assistant was writing a report, or notes during lunchtime, when people needed assistance with their food. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Complaints and concerns are taken seriously and responded to appropriately, despite the home’s adult abuse policy being unclear about the way people will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a suitable written complaints policy. When people were asked the question of what the complaints procedure was, the replies were: “ not know really but ask to see Laura (Manager)… yes feel complaint would be acted on “ and from another resident, “not know really haven’t had a complaint”. In summary there is not a clearly signposted complaints procedure as far as the people spoken to were concerned, but a feeling that if the need arose they would be able to complain effectively. Apart from one person of the several people spoken none had any complaints. The ‘expert by experience’ referred this one complaint to the manager during the inspection who said she was aware of the concern and would speak to the person again and respond to her complaint. One person was asked if he felt safe and what he would do if he ever felt he had been harmed and replied he would speak to his daughter. His daughter who was present said she would report to the Social Worker, should she ever consider her father to be harmed. She was not aware of the measure the home takes to protect vulnerable people. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 17 The adult abuse policy was dated 02/07/2007 and did not reflect whatever the philosophy of the home is towards abuse and what actions they will carry out to protect people in line with Cambridgeshire County Council Guidelines. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,25,26, Quality in this outcome area is adequate. People are assured of a comfortable and clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Walls and had been repainted to the ground floor area. New carpets have been laid in the dining rooms and hallways. A new shower and a new chairlift have been installed and a new ramp for wheelchair access has been built. The wooden frames to the windows and doors need repairing and repainting. Paintwork was worn and revealed rotten wood in places. Door fittings were out of alignment and consequently some doors did not close properly. Some of the internal doors frames and skirting were scuffed and unprotected from further damage. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 19 The observations of the environment made by the expert by experience were, “there was the general impression of some modest recent internal improvements like new hall carpets, but of a building that would benefit from improvements to the internal fabric. For example, some fire doors didn’t shut properly, a toilet [bathroom 4] lacked a toilet seat, the pull cord wasn’t easily operable and there were potential infection hazards; an alternative bathroom nearby was less than ideal. There were 2 equipment hazards outside a bedroom door. Apart from numbers on the bedroom doors there was no personalisation of the bedrooms; a few bedrooms seen had been personalised and were reasonably decorated. Some other areas would benefit from decoration. A potentially attractive garden was not, according to some residents, being used much mainly because of the tall grass. Whilst acknowledging the manager’s intention to engage a handyman, there was not the impression of a home alert to the need to constantly monitor and review these issues.” The kitchen is frequently used as a throughway and was recommended in the last report to cease being used in this way. This use increases the risk of cross contamination and general interruption to the cook. An Environmental Health Officer inspected the kitchens on 06/06/2008 and made requirements relating to the cleanliness of the kitchen. A cleaning roster has been made in response to these environmental requirements and improvements to the cleanliness had been made. A very worn and stained metal teapot that the manager said was used was in the kitchen alongside a burnt plastic bowl that contained eggs. The fridge temperatures had been recorded at 5 & 6 degrees C, which is above the recommended temperature for food safety. The two doors at either end of the kitchen are both internal doors and are not fire resistant. The door from the kitchen leading to the office area did not close. A fire extinguisher near to room the kitchen by a toilet was loose and hanging from its wall fixing. The plastic drinking vessels stored on the dining room sideboard that were in readiness to use at lunchtime had not been dried properly and were worn and scratched. The laundry room is small and was very warm and not adequately ventilated and had not been maintained in terms of its general decorative condition and the lack of any sluice for soiled items and had older equipment, although this was said to be working well and observed to be fully operative. One toilet by the stairs on the upper floor had a portable male urinal pot and a plastic jug. A bathroom numbered ‘3’, was used as a storage area but a person living in room number 14 nearby went to use the toilet in this bathroom Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 20 just after it was seen. Bathroom number ‘4’ did not have a toilet seat or any soap and had a continence pad on the top of the cistern and although it was dry it was not a clean pad. Staff questionnaires showed that staff are aware that improvements to the home’s internal environment and equipment are needed. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is adequate. People are not assured that staff are recruited through a rigorous and thorough process designed to protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were four care staff working the morning shift and three care staff working the afternoon shift. There are two care assistants working at night. Staff rosters showed this is the usual arrangement. The manager said that agency care staff are being utilised until the home manages to recruit enough permanent care staff. The recruitment details of two recently care staff were read. Two references were obtained for each person although the document used to request the references did not contain the address of the referee and it did not indicate the capacity or relationship of the referee. There were letters of offers of employment and one of these indicated that employment was offered to one person on 22/05/08, which was before a POVA First check was received on the 28/05/2008. However, the date employment commenced was not recorded in either person’s file. Part of the one requirement made in the last report asked Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 22 for the home to record the start date when a new member of staff commenced work. The induction training arrangements for these two staff were assessed and were ambiguous in content although the Skills for Care standards were included. One person had just commenced her induction after an offer of employment was made on 22/05/08. The other person’s induction was brief and his induction in the Skill for Care Council’s standards was not completed approximately six months after being offered employment. This person stated he had received some training. He said he was not aware of the training that was arranged for him and did not know about NVQ in care awards, although he said he had heard of them. The manager explained that she had prepared a full induction training for four care staff and explained that this was the first structured induction undertaken for these staff and was based on the Skills for Care Induction Standards. Comments made by staff in the homes questionnaire indicated they wanted more training provided, including NVQ level 3 awards in care. The training analyses matrix was not developed and information about all training undertaken by staff was not available. Training arrangements for adult protection showed that six staff had in-depth training in adult protection from Cambridgeshire County Council and the manager had been trained in management responsibilities in adult protection. All staff had been booked for Mental Capacity Act training for various dates in the future. Cambridgeshire PCT had provided medication training for nominated staff responsible for administering medication. The manager has arranged to undertake medication competency training with Cambridgeshire PCT. Moving and Handling training and Dementia care training had also been provided by the PCT. Diabetes training has been provided by District Nurses for some staff. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,37,38, Quality in this outcome area is good. People are assured the manager considers their best interests a priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said the home is intending to employ a team leader in the future to assist her to achieve management improvements. The manager does not have the facility to access by email the POVA First team to check on the applications of new staff. It is recommended that the home have email and Internet as a necessary means to communicate so the home Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 24 can access POVA First checks and can also access essential websites relating to the care industry. Regulation 37 reports have been sent to the Commission when this has been necessary. There were no regulation 26 reports available at the home to inspect when the manager was asked for these. The fire alarm test certificate was dated 08/01/08 and 10/06/08 for the six monthly visits to assess the alarm. A gas certificate was dated 08/07/08. The emergency light was tested weekly the fire extinguishers were serviced and fire drill was last carried out on 23/06/08. Quality assurance process included ‘staff questionnaires ‘resident questionnaires’ and ‘professional questionnaires’. These had been analysed but did not indicate what the home have done, or are considering in response. The folder that contained the homes policies was not indexed and these were not stored alphabetically. It was unclear and difficult to find any particular policy. The manager described her office to be in need of organised and it was in the process of being re-organised. Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 X X X 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X 3 2 Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 26 No 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 OP9 Regulation 13(2) Requirement The home must ensure that they have a safe system for administering and recording medication, so that if any medication has not been administered the response by the home must safeguard the person and expert advice from a GP or other suitably qualified health professional is sought immediately, so that people are not placed at risk of missing their medication or of being overdosed. The home must make a referral to the Fire Safety Officer to assess the suitability of the two doors leading from the kitchen so that people are safe from the risk of fire. Any fire extinguisher that is attached to a wall must be secure, so that people are free from this hazard. All bathrooms and toilets that are used must be well maintained, fit for purpose and free from hazards. Regulation 26 reports must be DS0000064767.V370272.R01.S.doc Timescale for action 01/08/08 2 OP19 23(4)( 01/09/08 3 OP19 13(4)(a) 01/10/08 4 OP21 13 (4)(a) 01/10/09 5 OP33 26 01/09/08 Page 27 Aisling Lodge Version 5.2 6 OP38 13(3) carried out in accordance with The Care Homes Regulations 2001. The potential spread, or cause of infection by the poorly maintained drinking vessels must be prevented so that people are not placed at unnecessary risk. 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP3 OP10 OP18 OP19 Good Practice Recommendations The home should make arrangements to ensure they can competently assess people’s needs. The plastic drinking vessels should be replaced by suitable alternatives that are appropriate and retains people’s dignity. The home should review their adult abuse policy The home should produce a plan to indicate their intentions for the environmental improvements and general maintenance that has been highlighted in this report. Bathroom or toilets not in use should be kept locked and the bathroom signs removed. The details recorded on the document used to request references should include clear information about the referee’s address, their authority and relationship to the applicant. The home should improve their records of the recruitment details by recording the date when a person actually commences employment Induction training should be based on the Skills for Care Standards and staff competencies should be measured and recorded as having been assessed throughout their induction training. 5 6 OP21 OP29 7 8 OP29 OP30 Aisling Lodge DS0000064767.V370272.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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