Care Home: Aitken House

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What the care home does well Residents are cared for in a homely environment within the Norfolk market town of North Walsham. Each of the residents` bedrooms contains their own personal possessions and is decorated according to their taste. The home has a small loyal staff team to care for the residents. This friendly staff team appear to know the residents` needs and help them to remain as independent as possible, offering support when required. Residents are encouraged to continue with their own hobbies and interests. Written guidelines are in place for prospective residents clearly explaining the admission procedure. The home does all it can to assess and continue meeting the needs of the residents. Good clear record keeping is in place.The Proprietors manage the home on a daily basis maintaining the ethos of the home, although currently the deputy manager has taken on more managerial duties to maintain the continuity of care for the residents. Staff arrange several organised activities each week with a variety of outings that the residents have chosen to do. The home is kept clean and tidy with several of the residents helping with the household chores. What has improved since the last inspection? Several areas of the home have been redecorated since the previous inspection. Residents have facilities to make their own hot and cold drinks and have access to a fridge within the dining room, so they can maintain their independence. What the care home could do better: Due to the proprietor recruiting new care staff the numbers obtaining the recommended NVQ qualification has reduced and this needs to be addressed. This also reduces the number of staff having attended the adult protection training, even though the staff are made aware of various forms of abuse during the induction programme it is recommended that they attend an updated course to ensure that residents are protected from any form of abuse. Although the care plans have information on residents` mental health support needs, when the care plans are reviewed more detail on how support is given emotionally for residents, should be considered. CARE HOME ADULTS 18-65 Aitken House 28 Yarmouth Road North Walsham Norfolk NR28 9AT Lead Inspector Hilda Stephenson Unannounced Inspection 30th June 2008 09:00 Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 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 Aitken House DS0000027309.V367425.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 Adults 18-65. 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. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aitken House Address 28 Yarmouth Road North Walsham Norfolk NR28 9AT 01692 404502 NO FAX # 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) Mr Khemraj Joory Mrs Toongbhadra Joory Mr Khemraj Joory Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 category: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 20 25.8.06 Date of last inspection Brief Description of the Service: Aitken House is a two storey building situated in the town of North Walsham that accommodates up to 20 adults with mental health problems. There are 14 single and 3-shared bedrooms situated on both the ground and first floors. The communal rooms consist of one quiet lounge, and one lounge with an attached smoking area, with two small dining rooms situated off the kitchen. The home has a large garden that is laid to lawn with a wild life pond. There is ample parking to the front of the building. The home is owned and managed by Mr & Mrs Joory. The current fees are between £325.00 and £358.00 per week. Aitken House DS0000027309.V367425.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. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from the providers, the service users as well as others who work at or visit the home. This report gives a brief overview of the service and the current quality judgements for each outcome group. The evidence gathered to publish this report was obtained by speaking to seven of the twelve residents, three staff and the proprietor during the day, and checking through care records, medication records, policies and procedures. The proprietor returned the annual quality assurance assessment, which provided written information about the home since the last inspection. Further evidence was gathered from comments received through the comment cards that were returned to the office from residents prior to the visit. During this site visit a tour of the building and grounds was undertaken and found the home to be clean, tidy and very well decorated throughout. The deputy manager has applied to become the registered manager and is currently undertaking more management duties with daily support from the proprietors. What the service does well: Residents are cared for in a homely environment within the Norfolk market town of North Walsham. Each of the residents’ bedrooms contains their own personal possessions and is decorated according to their taste. The home has a small loyal staff team to care for the residents. This friendly staff team appear to know the residents’ needs and help them to remain as independent as possible, offering support when required. Residents are encouraged to continue with their own hobbies and interests. Written guidelines are in place for prospective residents clearly explaining the admission procedure. The home does all it can to assess and continue meeting the needs of the residents. Good clear record keeping is in place. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 6 The Proprietors manage the home on a daily basis maintaining the ethos of the home, although currently the deputy manager has taken on more managerial duties to maintain the continuity of care for the residents. Staff arrange several organised activities each week with a variety of outings that the residents have chosen to do. The home is kept clean and tidy with several of the residents helping with the household chores. What has improved since the last inspection? What they could do better: 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. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good clear written information is available to prospective residents. New residents are assessed and invited to visit the home prior to moving in so staff know what support needs they require. EVIDENCE: One resident has been admitted to the home in recent months. The resident’s care records, admission details and moving in process was looked at during this visit. The resident was spoken to and stated ‘ I was helped to move in here by my Social Worker and the manager, I came to visit to meet the other residents first before making up my mind. I have a key worker who helps look after me’. The written guidelines given to prospective residents are clearly written with a copy of the last inspection report and results of the quality assurance survey included. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 9 Two residents were case tracked throughout this site visit checking records from the time of admission to the present day. Both residents and seven others were spoken to during the visit. The home has developed a clear assessment format. Records of visits and details from other disciplines were contained within each individual care plan. A copy of the contract with an annual letter informing residents of any change of fees was also stored within the individual records. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents make their own decisions on their day-to-day activities and care plans identify health, personal and mental health needs of the residents and with their input, and these are reviewed regularly to continue to meet their needs. Residents know that information about them is appropriately handled, which respects their confidentiality. EVIDENCE: Each resident has a basic written care plan. Two care plans were examined and found to contain details of the residents’ personal care, social, health and mental health needs. Residents are involved at the time the care plans are Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 11 written by their key worker and are invited to attend regular reviews, to discuss development and changes with their care. When talking with residents it was confirmed that they make their own decisions regarding their daily needs, with several going out during the day. The care plans contained individual risk taking with the relevant assessment details in place, which is good practice to ensure that both the resident and the staff are aware of their commitment to each other. Both residents confirmed that they related to their own key worker who fully supported them and assisted whenever they could. Within the care plans were records of support given by the visiting Community Psychiatric Nurses and GPs, although the majority of the time the residents visit the GP at the surgery. Informal residents’ meetings take place when they meet up for the arranged activities to discuss outings, social events, meals and activities. These are recorded in an informal manner and are available for residents to read. One comment received from a resident about how ‘I prefer the cook to make the quiches, rather than buy them in’ had been discussed and the cook now makes sure that all meals are home cooked. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a communal setting and meal times are included as part of their socialising. Private individual time is also recognised and social activities are arranged during the week which take into account the views of residents and help promote their interests. EVIDENCE: Several residents either go out to work, college, shopping or to visit friends. Their individual interests are included within the care plan and staff encourages residents to continue with their social interests and hobbies. Several of the residents go out shopping and assist those residents who are less able to go out, with their shopping needs. Some residents have part time jobs in the local town and one resident has attended college. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 13 A number of residents who were spoken to were happy that they could do what they liked, with staff organising an activity in the evening which they could take part in if they wished. Throughout the day, residents were observed having a sociable nutritious lunch; before and after lunch residents occupied themselves by reading, sitting in the garden, going out to the shops or listening to the radio. One resident required constant support by the staff and time was given willingly to repeat and reassure this resident. Past evidence from previous visits showed that the menu is arranged during residents’ meetings, with special parties and barbecues arranged at short notice. One resident had just enjoyed a surprise party arranged by relatives and staff and stated ‘I was overjoyed to have such a lovely day on my birthday’. The home provides a selection of wholesome meals, several residents enjoy helping the staff by setting the tables for meal times and preparing vegetables and making drinks for other residents. Facilities are provided for residents to make hot drinks and store food in a fridge provided within the dining room. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are well supported by staff and visiting professionals and medication is stored and administered safely which helps to protect residents. EVIDENCE: Appropriate safe medication administration procedures are in place. One of the residents who was case tracked self medicates, collecting medicines from the pharmacy and having secure storage within their own room. An appropriate risk assessment is in place. A random selection of medication administration records were checked and corresponded with medicines within the locked cupboard. Written procedures are in place and both the Proprietors are trained nurses who oversee and supervise when necessary. Currently the staff that administer medication are updating their knowledge by completing a distance learning medication course. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 15 The care plans contained records of visits from the Community Psychiatric Nurse who visits some of the residents to help monitor their mental health needs, with some attending appointments with a Consultant Psychiatrist. The key workers should consider adding more detail of the emotional support offered to residents when reviewing the care plans. Any medical needs are arranged through the local GP surgery with residents visiting the surgery themselves. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a complaints system in place with evidence of residents’ views being listened and acted upon. Good safe procedures are in place to help protect residents. EVIDENCE: The home has an active complaints procedure in place, encouraging residents and relatives to air their views. Informal discussions during activity sessions give residents an opportunity to discuss any issues in a group and regular meetings with key workers give residents an opportunity if they prefer a more private discussion. This was confirmed by several of the residents when speaking with them. During this site visit no complaints were received and one comment made on one of the comment cards received prior to this visit was discussed with the cook. CSCI have received two anonymous telephone calls regarding staffing levels since the last inspection; the proprietor with an unsubstantiated outcome investigated one of these complaints. The policy on the protection of adults was seen and signed by staff who had read it, evidence within staff files confirmed that staff have undertaken adult protection awareness training and this is also included in the induction Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 17 programme, although their have been some newly recruited staff during recent months and it is recommended that they attend a locally recognised adult protection training course. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean and tidy with comfortable private and communal space so that their comfort and privacy is promoted. EVIDENCE: A tour of the building was undertaken, which showed that all areas of the home were clean and tidy. The maintenance records were seen and this confirmed that three bedrooms, one toilet and bathroom had been redecorated since the previous inspection. The kitchen sink had been replaced and no recommendations were issued at the last environmental health officers visit. Residents confirmed that they are informed and asked their opinion regarding any changes to the environment or future decorating. Wheelchair users are accommodated on the ground floor with appropriate hoist and grab rail facilities within the bathrooms. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 19 Wheelchair users are accommodated on the ground floor with appropriate hoist and grab rail facilities within the bathrooms. The home has a large pleasant accessible private garden. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides knowledgeable, competent staff to meet the needs of the residents. EVIDENCE: Evidence of good practice was seen regarding recruitment and the proprietor follows a clear procedure when employing new staff. The staff files were seen of two of the latest care staff to be recruited, confirming that training and supervision takes place on a regular basis. Training such as manual handling, first aid, medication, fire training and mental health awareness has been undertaken during this past year. The proprietors encourage their staff to undertake the recommended NVQ training with slightly lower numbers having achieved this due to four recently recruited staff. The rota showed adequate levels of staff, with extra brought in when outings or escorts were arranged. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 21 Residents who were spoken to confirm that staff have time when they wish to talk in private, with one stating ‘my key worker is exceptional, she provides me with support and encouragement’. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Both proprietors manage the home with Mrs Joory taking overall managerial responsibility and the home has clear health and safety procedures in place promoting residents’ safety. EVIDENCE: Mrs Joory takes overall responsibility for the day-to-day management of the home. She is a trained mental health nurse, offering support to both residents and staff. The proprietors have placed more managerial responsibility on to the deputy manager who has now applied to become the registered manager. The home has good health and safety procedures in place to ensure the safety of residents and staff. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 23 A random selection of the maintenance records were checked and were noted to be up to date. Good accurate record keeping shows that residents are involved in their own care and have access to their documents. The registration certificate showed that the home accommodates adults with five of the residents who are over the age of 65 years. The home has a pleasant atmosphere; residents appeared relaxed and comfortable within their surroundings, with ongoing support given by the staff. The staff are well motivated and confirmed that they receive regular support from the proprietors. Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA19 YA23 Good Practice Recommendations Detailed emotional support should be documented when reviewing care plans. Newly recruited staff should attend a recommended adult protection training to ensure they have a good understanding of these procedures following on from the induction programme. The numbers of care staff achieving the recommended NVQ qualification in care should be increased to ensure that resident’s needs are met. 3 YA32 Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 26 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. Extracts may not be used or reproduced without the express permission of CSCI Aitken House DS0000027309.V367425.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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