Care Home: Aldringham Court

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What the care home does well What has improved since the last inspection? The home has addressed the requirements following the last inspection; they are using specialist-washing bags for items soiled by bodily fluids, to reduce the chance of infection spreading. They ensure staff do not start work at the home until required checks have been undertaken to confirm their identity, and that no concerns have been raised about their conduct and work practices. Systems are in place to ensure food and cleaning equipment is not stored together. What the care home could do better: To develop care plans further, to include more detailed information about the resident prior to moving into the home, to enable staff to support residents with their emotional well being. Where the home has moved from using their own care plans, to the ones brought in by the new owners, they have lost some of the previous information such as life histories, the home should look at how this can be incorporated. Staff should continue developing their range of social activities, to ensure all residents, depending on their individual preferences and interests, can take part, or have access to stimulating and fulfilling activities, when they wish. CARE HOMES FOR OLDER PEOPLE Aldringham Court Aldeburgh Road Aldringham Leiston Suffolk IP16 4QF Lead Inspector Jill Clarke Key Unannounced Inspection 31st October 2007 09:45 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 Aldringham Court DS0000067913.V354023.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. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldringham Court Address Aldeburgh Road Aldringham Leiston Suffolk IP16 4QF 01728 832191 01728 830138 aldringham@aol.com 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) Healthcare Homes Limited Miss Vivian Maya Edrosa Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: Aldringham Court Nursing Home is a unique ‘art nouveau’ building set in 3 acres of well-maintained gardens and woodland. A driveway leads from the main road to a car park at the front of the home for visitors. The home is located near Aldeburgh, 2 miles from the Suffolk Heritage Coast. The home accommodates a maximum of 34 older people. The home has 2 lounges, a reading room and a newly refurbished conservatory. There are single and double rooms (13 of the ground floor rooms have en-suite facilities). A nurse call system is connected throughout the building and a shaft lift ensures that all residents are able to access the first floor. There is wheelchair access to the home and gardens. The manager leads a team of care staff, some are registered nurses and others are carers. All are trained to meet the needs of the residents. Fees range from £550 to £725 depending on size of room, and if it is a shared or single. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 7½ hours, which focused on the core standards relating to older people. We also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) surveys were sent to the home in September. This gave an opportunity for people using, working in, and associated with the service, to give their views on how they thought it is run. At the time of writing this report 15 resident, 9 relative/visitor, 12 staff, and 5 healthcare professionals (GP, Community Nurses, Chiropodist, Aromatherapist and Reflexologist) had been returned. Comments from which have been included in this report. Prior to the inspection, the agency was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides the CSCI with information on how the home is meeting/exceeding the National Minimum Standards, and any planned work for the next 12 months. Comments from which have also been included in this report. The Registered Manager was available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. A tour of the building took in all the communal rooms, dining room and a sample of 2 bedrooms. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, Service Users Guide, Fire Risk Assessment and medication records. Time was also spent talking (2 in the privacy of their rooms), and sitting with residents, gaining general feedback and observing the day’s routines. People living at the home preferred to be described as residents, rather than service users, therefore this report reflects their wishes. What the service does well: All residents have a pre-assessment undertaken and they (or if they are unable to their advocate) are encouraged to visit the home, before they move in. This allows people to find out more about Aldringham Court, and decide if the home will be able to provide the level of care, and environment they are looking for. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 6 The staff work well as a team, and are committed and take a pride in ensuring they provide a quality service. Residents, relatives, and health professionals visiting the home, praised the level of care given, friendliness of the staff, and the homely environment. Their comments included: Residents - “they treat me very well – I respect that”, ‘very considerate’ ‘very good nurses’, ‘very nice home indeed’, with 1 resident saying that they gave the home a ‘score of 9 out of 10’. Relatives/visitors – ‘when we visit we are satisfied with the care my mother is getting’ and ‘I have always found staff very good, always ready to help’. Health professionals ‘staff are always polite and friendly’ , ‘professional, caring’ and ‘In my field I visit a number of care homes and feel Aldringham Court is one of the better homes’. 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. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 7 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 Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4 and 5 (The home does not currently have residents on intermediate care, therefore this standard was not assessed during this visit) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have their care and nursing needs assessed, be given information on the home, and be invited to look around, to support them in choosing if the home will meet their needs. EVIDENCE: The home has a combined ‘Residents Guide and Statement of Purpose’; last up dated in July 2007. The booklet makes no reference to being issued in different format to meet people’s sensory/communication needs. Time spent with a resident showed that they could just managed to read the font size. The Statement of Purpose, which informs people they ‘are obliged to have in place’ should include more local information. For example under the heading ‘Religion & Worship’, it states ‘we have clergymen of many denominations visiting the Home and we encourage you to exercise your spiritual needs’. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 9 However, there was no further information, on who visits and when, and any contact numbers. Under staffing, it stated that they have a minimum of 2 senior carers and 11 carers ‘on duty per shift’. This could rightly lead people to think that they will find this amount of carers on duty when they visit during the day. However, in reality the 11 carers mentioned are split across an early and late shift, (see Staffing section of this report). There was no postal address or telephone number for the home included. This was brought to the attention of the manager who showed us a new, 3-fold page leaflet, which they had produced for prospective residents. This was far more personalised and included photographs of the residents ‘Magazine Committee at work’ and different views of the home. Although it did not give sufficient localised information for residents once they moved in, it was more informative to support people in choosing if the home was right for them, and made a good supplement to the more ‘corporate’ booklet. Although the Residents Guide and Statement of Purpose could be more informative, residents surveyed said that they had been given enough information about the home. They said this helped them to decide if Aldringham Court was the right place for them. This reflected the relatives’ comments, who also felt that they had been given sufficient information, and described staff as ‘very helpful’. The manager “encourages” all prospective residents, or if unable to, their relatives/advocates to visit the home. They are then able to look at the environment, meet people living there, and ask staff any questions. The manager will visit prospective residents, taking with them a brochure, and carry out a pre-assessment. This supports the staff in identifying if they are able to give the acquired level of support, taking into account any specialist equipment, which would need to be in place (hoists, specialised beds/mattress). Residents are given a ‘Statement of Terms for Residents’ which sets out the weekly fees payable, what is included in the fees, and the terms and conditions of residency. The statement informed people that ‘Aldringham Court is registered with the CSCI, however then went on to say that it undertook to ‘maintain a standard of care as required by the Residential Care Homes Regulations 1984 and the Registration Authority.’ This information is out of date and needs to be amended to reflect the Care Standards Act 2000. Those residents surveyed, who were able to remember, confirmed that they had received a contract. Although 1 resident said that ‘no contract’ had been issued since the ‘new ownership in 2006’. The manager said a contract is only issued on admission, and there after, a letter is sent to confirm any increase in fees. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 10 Time spent with a new resident showed that they had settled in, and “got on well with the other residents”. They described the staff as “very good”, “had no complaints” and went onto say that the level of care given was “quite adequate”. Relatives/visitors surveyed were asked if they felt the home met the needs of their relative/friend, 7 replied ‘always’, and 2 ‘usually’. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 11 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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect your health and nursing care needs to be monitored, and access to medical support as required. EVIDENCE: Since the last inspection staff have been introducing a new care plan format, brought in by their new owners (Healthcare Homes). During this inspection 3 resident’s (1 new, 1 with high Nursing needs, 1 with mental health needs) care plans were looked at. After reading and gaining an insight into the differing levels of support the 3 residents required, time was spent with the residents, and where able, hearing their views on the level of service provided. We found care plans held a good level of information on the resident’s physical and nursing care. This included monitoring nutritional needs, skin viability (monitoring skin to ensure does not become red and break down), and where pressure sores have developed, action taken to heal the wound. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 12 Staff completes a monthly ‘Dependency Assessment’, which enables them to monitor any physical or mental health changes. What changes have been identified and action taken to support the resident, is then recorded in the ‘Care Assessment Problem/Need,’ area of the care plan. The Care Assessment includes ‘Expected Outcomes’, ‘Care Instruction’ which staff complete. From the sample of care plans read, staff were being given clear guidance on level of support to be given with individual residents physical health. However, there was not the same level of detailed information to support residents emotional and mental health needs. For example an identified ‘self care deficit’ referred to the person ‘feeling low’, but no further information on what support was to be given when the person felt this way. Where ‘confused at times’ had been written – there was no further information to identify any trigger points. Another care plan under the heading ‘Unpredictable behaviour’ had been written ‘can be physically aggressive’. This led to discussions with staff over the wording ‘aggression’ which dementia research has shown, is normally the resident demonstrating their ‘frustration’, at staff not understanding them. For staff to be able to do this ‘to see pass the illness to the person’, they should be aware of the person’s life. There was no information on ‘trigger points’ or ‘life histories’ held on files to support staff on this. Where the care plan template headings stated ‘residents interests and social activities’, there was very limited information given. Residents, who were able to complete the CSCI surveys, confirmed that they ‘always’ or ‘usually’ received the level of care and medical support they needed. Comments included ‘If we want any extra care or support we can always complain anonymously to the residents committee’, and ‘good standard of care’. This reflected feedback form relatives/friends who felt the home ‘always’ provided the level of care they expected. A General Practitioner, who visits the home regularly, praised the ‘extremely good care provided for a very dependent group of residents’, other positive comments from visiting health professionals (which evidences that staff are monitoring residents health needs) included ‘referrals are made to other health services to improve outcomes in individuals health status’. They confirmed that staff are always ensuring residents are treated with respect, and their privacy and dignity is being maintained. For example ‘residents privacy is ensured when they are receiving personal care’. This reflected observation during the inspection, and feedback from residents. Staff surveyed, when asked ‘what does the service do well’ 1 carer had written that staff ‘respect their (residents) privacy, dignity, choice’. The home has safe systems in place for recording, storing and dispensing of medication (held in safe keeping on behalf of the residents), by trained Nurses. The majority of the medication is supplied every 28 days from the local pharmacy in ‘blister packs’, where staff are able to see the prescribed tablets Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 13 and push out of the blister the required amount, at the prescribed times of the day. Medication that cannot be dispensed by the pharmacist into these containers, are sent in separate labelled boxes and bottles. Staff record that medication has been given (or as otherwise indicated using a code) on Medication Administration Records (MAR) charts, which are printed out for each resident by the dispensing chemist. MAR charts looked at, had been fully completed, which included the quality of medication received. A check of 2 residents medication not held in the blister packs (including controlled medication) was correct to the homes records. A notice on the information board advertised forthcoming medication training for nurses in November, to keep their knowledge updated. Towards the end of lunch, staff were observed giving out medication from a lockable trolley in the dining room. Medication was given to residents one at a time, after the amount to be given had been checked against the MAR chart. On approaching a resident the member of staff was heard to ask the resident if they “were ready for their medication”, to ensure that it did not interfere with the enjoyment of their meal. Staff have attended training in ‘end of life care’, and will be using the ‘Liverpool pathway’, care planning to support residents dying. The home provides a ‘Bereavement information pack’; to support family and friends at an emotional time, deal with formal arrangements. It provides information on registering a death, arranging the funeral, as well as a national list of contact addresses for different ‘Religions and Cultures’. This includes the Hindu centre, Synagogue, Jehovah’s Witness, and the District Manager of the Christian Science Committee. This is a useful book, produced by ‘Healthcare Homes’ for all their establishments. However, the copy seen still required local addresses and contact numbers to be added in the spaces provided. Staff also confirmed, with the families agreement, a representative form the home to attend the resident’s funeral, so they can “pay their respects”. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be offered a range of stimulating activities to join in with, and offered a choice of home cooked meals, within a relaxing environment. EVIDENCE: Residents surveyed were asked if they felt the home arranged activities that they were able to take part in, 7 replied ‘always’ (lots of things – like the outings best’), 3 ‘usually’ (‘ it would be nice to have more activities and these to be varied’), 4 ‘sometimes’, with 1 left blank. The Therapies and activities list for the 29th October to the 2nd November were displayed on the noticed board, which also held photographs to record past events such as the summer fete. An aromatherapist visit 3 times a week, and records showed that this enables all residents to be asked if they wish to have a massage (free of charge). There is also a visiting Reflexologist and Hairdresser. Activities for the week showed: Monday – 2.30 pm –Scrabble & Speciality afternoon tea. Tuesday – 2.00 pm Bingo, 4.00 pm Bowling Wednesday – 2.30 pm – 105th Birthday celebrations Thursday – 2.00 pm Poetry group, 4.00 pm ‘one to ones’ Friday – 2.30 ‘Extend’ – (armchair exercise) Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 15 The activities co-ordinator (who came over as being very committed and motivated) works part-time. A resident described them as being ‘very active – always does something’. Working 25 hours a week, limits how much 1 to 1 time can be spent with residents, however, they make best use of the time available to organise stimulating activities for a range of residents needs. This includes external outings once a month for 3 to 6 residents. Some residents also visit a local community centre, and take part in a quiz. Discussion with 1 resident identified that they did get bored at times, but felt what activities were arranged, were “very good”. During the inspection, there was 105th birthday celebrations going on throughout the day, which included a visit from a local primary school to sing happy birthday, and present cards they had made themselves. Residents are kept updated on what is happening at the home through the ‘Aldringham Court’s Newsletter’. The September /October issue updated people on residents and staffs birthdays, visiting ‘Music Man’ in September, and monthly ‘Holy Communion’. The ‘activities report’, shared with people experiences from an outing in August when they went to a local hotel for afternoon tea, and a talk and film show given on the ‘River Alde’. There was some ‘updates’ from a resident on how much had been raised at the summer fete, and the ‘diary of a retired canine police constable’ who has recently become a ‘pat’ dog at the home. Residents surveyed were asked if they felt staff listened and acted on what they said, all but 1 had replied ‘Yes’ (3 had added mostly or usually). The resident who had said no, had also added ‘sometimes’. Residents felt that the CSCI should have allowed them to answer using the response ranges, which we gave to other questions asked (always, usually, sometimes, never), instead of being asked Yes or No. The Residents Guide and Statement of Purpose informs residents that there are ‘a number of agencies that provide’ an advocacy service. However there was no contact numbers given, instead the resident is asked to ‘speak to the manager’. Time spent talking to a new resident, identified that they did not feel restricted by living in a care home, and although they said staff woke them up in the morning, they preferred this, as it gave a ‘structure’ to their day. Health professionals surveyed felt that residents were supported ‘to live the life they choose’, comments included ‘yes – as far as I am aware’, and ‘with the resources available, choices are offered and decisions respected’. Residents surveyed were asked if they liked the meals at the home, 1 replied ‘always’, 3 ‘usually’, 3 ‘sometimes’, and 1 had been left blank with the comments ‘they all taste the same to me’. Other comments included food being served up ‘which I must not eat’, which results in them leaving those items of food, which they felt was ‘wasteful’. Another resident said the meals were ‘very good’ and that staff ‘go to a lot of trouble for me’. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 16 At 11.15 a visit to the dining area identified that residents meals had already been cooked and plated, and were set out on the table ready to be put into the heater, ready for lunch at 12.30. The Cook explained this was normal procedure due to the different ways some of the meals need to be prepared, for example pureed meals. The catering staff raised no concerns, that this practice would affect the nutritional content of the meal. The Cook had just attended a training session on ‘Nutrition Matters’, which they had found interesting, and were looking at ways they could use the information gained. A resident was laying the tables ready for lunch. The home has developed a 9-week rotating menu, copies of which are given to residents in a booklet, and a copy of the ‘menu for the week’ is put on display. Although there is only 1 choice given for lunch and dessert, discussions with residents and staff confirmed that they can ask for an alternate if they wish. When staff were taking residents to the dining room, a member of staff informed the resident that they were having “Roast Lamb” for lunch, “and your favourite Bannoffee Pie’. The atmosphere in the dinning room was relaxed, with ‘classic FM’ playing discreetly in the background. Residents sat in small groups, or on their own, if they preferred. Staff were seen to sit and discreetly give assistance, and instigate conversations with residents. Staff were attentive, and offered other choices of desserts if the resident did not want what was on the menu. Towards the end of the meal, a member of staff, who was shortly returning to work, visited with their baby, which seemed to gain everyone’s interest, as residents eagerly awaited their introduction. The interest shown by the residents, and interaction with the member of staff, further enhanced the ‘homely’ atmosphere. As part of the birthday celebrations residents enjoyed a fruitcake, (which was delicious) which residents had helped make. Time spent with a resident confirmed that they are offered “plenty” of drinks, which are “regularly brought round”. Aldringham Court DS0000067913.V354023.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect their concerns to be listened too, and appropriate action taken by the staff to address them. EVIDENCE: The Residents Guide and Statement of Purpose does not give residents full information on their complaints policy. This includes timescales, or contact number/address of the CSCI, if they are unsatisfied on how their complaint has been dealt with and wish to seek further advice. Instead it directs residents to the ‘Complaints Procedure displayed in the reception area’, which did contain all the required up to date information. There was no information given as to whether the complaints policy is supplied in different formats to assist people who may not be able read it. Residents surveyed were aware of whom to speak to if they are unhappy with their care and said they would make a formal complaint through the manager, or via a relative. This reflected conversations during the inspection, where residents said they would tell staff if they have any concerns. As 1 resident had already stated (see Health and Personal care section of this report), people can also raise concerns anonymously through the residents committee. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 18 All but 1 of the relatives /visitors surveyed said they knew how to make a complaint. Where 1 person had said ‘No’, they had further commented ‘if necessary I would speak to someone - I’ve had no need to do so, so far’. Where relatives/visitors said they have raised concerns, they felt that the home had ‘always’ responded appropriately’. Comments included ‘I fully appreciate as we are all human - standards can slip at times, but if I at anytime have shown some concerns – the response has always been positive’. The AQAA showed that the home had only received 1 (anonymous) complaint during the last 12 months, which the home had addressed, taking into account the limited information given. Staff surveyed were all aware of what action to take if a resident of visitor raised any concerns about the home ‘procedure in day book’, ‘report to a higher authority’. A member of staff also commented that ‘minor or major complaints – the home treats it seriously’. Training records seen, and information supplied in the AQAA confirmed that staff receive training in safeguarding residents welfare. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 19 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, 22, 23 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect a clean, bright, homely environment, which is well maintained. EVIDENCE: A walk around the home confirmed a health professional’s view that the ‘physical environment is relaxing, bright and open’. Residents confirmed that the home is ‘always’, ‘usually’ kept clean and fresh, and that they had ‘nice cleaners who were very helpful’, which reflected our findings. Time spent talking to a member of the domestic staff, confirmed that they had received training in reducing the chance of any infections being passed around the home, which included using a “new disposable cloth and gloves” for each room when they are cleaning. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 20 During lunchtime a member of staff was seen carrying 2 meals trays, stacked on top of one another. When they entered a resident’s bedroom they put the trays down on the resident’s bed, taking the top tray off, and giving it to the resident. Then taking the second tray they carried it to another resident’s bedroom. This could be seen as a possible source of transferring infections. In the medication fridge, an open pot of yoghurt was being stored, for a resident who liked their medication taken with yoghurt. Staff were reminded that the foods should not be kept with medication (as they can become contaminated). Staff agreed to keep the yoghurt in the kitchen, and follow safe handling of food procedures, by ensuring that they recorded the date it was opened. To address a requirement made at the last inspection, the home now use dispersible bags (special bags which can go straight into the washing machine) for linen soiled by body fluids, as part of their infection control procedures. The décor and soft furnishings enhance the homely atmosphere. A relative surveyed, felt that the home ‘provides a caring, comfortable and efficiently run environment’. Time spent visiting and talking to residents in their bedrooms, showed that the rooms had been personalised, and met their needs. The large conservatory leads into the lounge, both areas was in constant use during the inspection. The AQAA confirmed that ‘the residents use the inside and outside of the building freely. The home has a warm, homely atmosphere and is well maintained’. Staff also stated that they ‘try to ensure where appropriate residents are seated in comfortable domestic chairs and not left seated in wheelchairs’. At the time of the inspection, the home was in the process of fitting automatic fire door closures, to enable doors to be held open – giving residents easy access to rooms. The homes fire risk assessment looked at, just covered the ‘automatic door closers’, and did not take in all possible hazards, such as inflammable liquids and the storage of oxygen that they hold on site. The manager said that the Fire Safety officer had seen their risk assessment last year during a visit last year, and “were happy with it”. At the time of writing CSCI was seeking further advice about the acceptability of this risk assessment. Records seen showed that required checks are regularly undertaken to ensure that the fire call system and emergency lights are maintained, and kept in good working order. Aldringham Court DS0000067913.V354023.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be looked after by trained staff, in sufficient numbers to meet their individual needs. EVIDENCE: Copies of staffing rotas seen, showed that the home try to maintain their staffing levels at 6 carers in the morning (7 am to 2 pm), 5 in the afternoon/evening (2 pm to 9 pm) and 2 at night (8 pm to 8 am). In addition there is a Nurse in Charge and the Manager. There is also an extra member of staff on duty, Monday to Friday from 7.30 to 2 pm to support residents requiring assistance with their food and refreshments. Kitchen rotas showed that there are catering staff available between 6.30 am to 7.30 pm. Residents surveyed were asked if they felt staff were available when they needed them, 4 replied ‘always’, 9 ‘usually’ (‘very busy in the evenings’) and 2 ‘sometimes’ (‘depends how many staff are on’ and ‘sometimes have to wait to go to the toilet’). This reflected the staff responses when asked if they thought there was enough staff on duty to meet individual peoples needs, 2 replied ‘always’, 7 ‘usually’ and 2 ‘sometimes’. Comments included ‘shifts are staffed at appropriate levels - although we could always put extra pairs of hands to good use’, and ‘very difficult when there are staff shortages’. Staff when asked what they felt the home did well, replied we ‘give good quality care’ and ‘optimum care rendered to the service user with dignity’. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 22 Staff asked if they felt the ‘induction’ training they received covered everything they needed to know to be able to carry out their role, all but 1 of the staff felt it ‘mostly’ or ‘fully’ met their needs, with 1 member of staff feeling it only ‘partly’ met them. However, no further information was given as to why they felt this way. Ancillary staff, also completes an induction booklet. Time spent with a member for the housekeeping staff, confirmed that they had undertaken induction training. They had also been asked if they would like to take an National Vocational Qualification (NVQ) in Housekeeping, which 2 other members of staff had achieved. The AQQA identified that ‘3 members of care staff have achieved NVQ level 2, with 6 further staff currently studying for their NVQ 2. There were also 3 members of staff who had achieved an NVQ 3 in care. Training records, and ‘flyers’ for forthcoming training showed that regular ‘induction weeks’ are held for new care staff, which covers ‘Principle of Care, Moving and Handling’, ‘Health & Safety’, ‘Food Hygiene’, ‘Communication and abuse’. The induction training is undertaken at the companies “regional office in Lowestoft”, and runs at set times during the year. If staff requires manual handling training before they attend their induction training, the home has their own Manual Handling Trainer who will undertake this. The manager has produced a training record log, which enables them to monitor the training staff has undertaken, and when refresher training is required. Staff confirmed they received training relevant to their role, and they were being kept updated on new ways of working. They also said the training they received supported them to meet individual residents cultural and diversity needs. This reflected feedback from health care professionals who felt staff ‘always’ or ‘usually’ have the right skills and experience to support, and respond to different residents needs. Comments included ‘there is no differentiation to the care given to any resident’ and staff ‘always recognise when individual needs differ from another’s and these are accounted for’. To ensure that the home is following safe recruitment procedures, 2 new staffs files were looked at. Good practice was seen with the use of ‘new starters employment check list’, to monitor that all the required paperwork, and identity checks had been undertaken/received. This included Criminal Bureau Records (CRB) checks, 2 written references, and paperwork to validate their name and address. The application form for 1 of the staff had not been fully completed. However, once we pointed this out, as the person was on duty, they managed to supply the missing information during the site visit. When discussed with the manager they showed a new Healthcare Homes application form, which they will now starting to use. The form asks staff to list their previous employment, giving ‘approx date, name of employer, job title, and duty’. However, we noted that the new form did not ask applicants to state why they had left their jobs. The home would require this information to Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 23 enable them to be able validate why they had left any previous employment, where they have worked with vulnerable adults or children. Aldringham Court DS0000067913.V354023.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect the home to be run by an experienced manager, who leads a staff team who are committed to working in the best interests of the people they care for. EVIDENCE: The Registered Manager, Miss Vivian Edrosa, is a Registered General Nurse, and has completed the Registered Managers Award. Time spent with the manager evidenced their commitment to providing a quality, individualised service, provided by a team of staff who “work well together”. This reflected relatives/visitors comment, when asked what they felt the home did well, they replied ‘give time and support to people as individuals’ and ‘although my friend is so incapacitated she is always treated with kindness, respect and as an individual’. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 25 All but 2 of the staff asked, said that they ‘regularly’ or ‘often’ met with the manager, for support and gain feedback on their work. Comments included we have ‘regular supervision meetings’, the manager ‘is always happy to talk to staff when on shift’ and ‘she is available if I need to speak to her’. Where 2 of the staff had said they ‘sometimes’ meet with the manager, they also commented that if they needed to ‘talk to the manager, I can leave a note and she will get back to me at some point’. Comments from staff surveyed, those spoken with, and through observations during the visit, identified that staff work well together. They had a good ‘team spirit’, which can only enhance what a relative describes as a ‘caring, comfortable and efficiently run environment’. Out of the 12 staff surveys received, 10 had commented under ‘what the home does well’, about the level of care they give. Comments included ‘as a nursing home we try to work well as a team. This enables us to give a good service’, and we put ‘the service users welfare first’. The AQAA confirms that they hold ‘regular’ meetings ‘so they can listen to the views of residents and relatives’, to ensure that the home is ‘run in the best interests of the residents’. The minutes of meetings are ‘displayed in the nurses station’. The home also has a suggestion box, which is regularly used. Discussions with 1 resident confirmed that they would be happy to take on the role of a ‘Link Resident’, and will be responsible for distributing and supporting other residents to complete future CSCI surveys. The positive comments from Health professionals completing the CSCI surveys, showed that they have a good working relationship with the home. They felt staff would always seek advice if required, listening and taking action on what is said, to promote residents welfare. There are systems in place to ensure staff receive training, to promote residents welfare (see Staffing section of this report) and using cleaning chemicals safely, and ensuring any equipment used throughout the home is regularly maintain. The home has systems in place to hold residents monies in safe- keeping if they wish. The ways in which the home can support residents to manage their monies and pensions are included in the Statement of Purpose and Residents Guide. Although no resident’s individual accounts were looked at during this visit, checks were undertaken during the last inspection, which were found to be correct. Aldringham Court DS0000067913.V354023.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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 3 X X 3 3 X X 2 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 3 3 X 3 3 x 3 Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 27 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. 1. Standard OP1 Regulation 4 (1)5 (1) Requirement The home must ensure that the Statement of Purpose and Service Users Guide gives people full information on action to take if they wish to make a complaint, and how the complaint will be dealt with. Timescale for action 31/12/07 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 OP1 Good Practice Recommendations To make the ‘Residents Guide and Statement of Purpose’ more user friendly and informative, staff should look at how they can involve residents in producing the document, for example asking the ‘magazine Committee’ to take the lead. The home should review the information in their care plans, to see if it supports them in knowing about the person, giving staff a greater understanding of how they may react in different circumstances, and wish to be cared for. DS0000067913.V354023.R01.S.doc Version 5.2 Page 28 2. OP7 Aldringham Court 3. OP26 The home should review the current practice of how many food trays staff take into bedrooms, and where they place them, to reduce any risk of transferring infections. Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Aldringham Court DS0000067913.V354023.R01.S.doc Version 5.2 Page 30 - 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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