Care Home: Allington House

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What the care home does well Provides people with an extremely pleasant and homely environment in which to live. People are confident that their needs can be met by the staff and they described the staff team as being helpful, pleasant and friendly. The staff also spoke of the team work and support for each other within Allington House. People are provided with good opportunities for social and recreational activities both within the home and outside of it. Both people living at the home and staff were enthusiastic about the work of the activities co-ordinator. What the care home could do better: There are a number of areas in need of improvement and further development. The pre admission assessments need to be completed more thoroughly as this determines if the needs of people can be met at Allington House. The care records on the nursing unit are generally well written, however there are areas of assessed need for which care plans had not been developed and there is the need to develop more person-centred plans, work has commenced on this. More work is needed in regard to the care records on the EMI unit, as the assessments contained very limited information. There were no assessments or care plans relating to dementia or the needs associated with people`s dementia. There were a range of careneeds identified through the records for which there should be care plans in place, such as, agitation, restiveness to care interventions and periods of aggression. The way in which incidents and recorded and then managed need to be looked at. Incidents have occurred within the EMI unit however incident records are not always completed and it is unclear what action is taken as a result of these incidents. Although challenging behaviour charts are completed, these do not seem to be used for anything and no risk assessments or care plans are developed as a result. A number of staff need to receive Protection of Vulnerable Adults training. Whilst the environment is extremely pleasant, the people who live in the EMI unit do not have a bathing facility, they can only have a shower, unless they go onto another unit which is not acceptable. There is a range of training that is needed, both mandatory and client specific. There is the need to update staff with among others, fire training, moving and handling and a number of staff need to be trained in First Aid so that there is always a first aider on duty. None of the staff have received any dementia care or challenging behaviour training. There is no plan in place for qualified staff to update their clinical skills and knowledge and to remain competent with a number of these skill. Staff supervision also needs to take place at least six times per year and needs to be a personal formal supervision system. Again, the new manager has already commenced with this. Random inspection report Care homes for older people Name: Address: Allington House Marsh House Avenue Billingham Cleveland TS23 2HB two star good service 17/12/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jacqueline Herring Date: 2 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Allington House Marsh House Avenue Billingham Cleveland TS23 2HB 01642565839 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross OPCO Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 46 Number of places (if applicable): Under 65 Over 65 0 46 dementia old age, not falling within any other category Conditions of registration: 24 0 The maximum number of service users who can be accommodated is: 46 The registered person may povide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home fall within the following categories: Old Age, not falling within any other categories, Code OP- maximum number of places 46 Dementia, Code DE, maximum number of places 24 Date of last inspection 1 7 1 2 2 0 0 8 Care Homes for Older People Page 2 of 14 Brief description of the care home Allington House is a purpose built, two storey care home situated on the outskirts of Billingham. It provides nursing care for older people and personal care for older people with dementia in two clearly defined units. The home is well located for ease of access to the local town centre and in very close proximity to a local pub. All of the rooms are single rooms with ensuite facilities and a good amount of communal space. Garden areas are available and in the process of being developed further for the safe use of all. Care Homes for Older People Page 3 of 14 What we found: This inspection was a random unannounced inspection. It took place on 24 June 2010 and was completed in one day by one compliance inspector. The purpose of the inspection was to look at a range of matters that effect the care, welfare and wellbeing of people living at Allington House. During the visit we looked at a number of care records of four people living at Allington House; their associated medication administration records and information about activities. We also looked at staff recruitment records, staff training records and staff supervision records. We also looked at some maintenance and servicing information. We had a look around the home, spoke with people living there, we also spoke to staff and the newly appointed manager and her deputy. The care files of four people were looked at during this inspection, two from the nursing unit and two from the EMI unit; one of each for a recently admitted person. Whilst pre assessment records were in place these records had not been fully completed and the scores for each of the individual assessment areas had not been added up. One person who has dementia had not had the dementia assessment part of this record completed. It was however good to see that some additional information about the individuals had been added to the notes sections. Information from peoples care managers was also in place. The care files for two people receiving nursing care were looked at. The physical and social assessments had been fully completed with additional comments to support the assessment. There were also a range of other assessments in place, including pressure ulcer assessment, nutritional risk assessment and dependency assessment and areas of need and risk were identified. Corresponding care plans were in place for most of those areas identified. There was not a plan of care in one of the file for pressure ulcer/skin integrity despite this persons assessment identified the person as high risk and the body map showing some reddened area since admission. This was the same for another person who had a history of depression and also seizures. The interventions within the care plans were on the whole well described and gave staff the information they needed to meet peoples needs. They could be enhance further with the inclusion of more person centered information. Both the manager and the deputy confirmed that work was underway with this and that all care files would be reviewed and updated. Care is also needed with the use of bedrails as the assessment that was in place was not a specific bed rail assessment and there was concern as to whether this person should have one in place as the care plan stated, trying to climb out of bed. Daily records were well written and very informative. The care files of two people living in the EMI unit were looked at. There is the need to Care Homes for Older People Page 4 of 14 develop the assessments and care plans further. The physical and social assessment in one of the files did not give adequate information as to this persons needs, it was merely a number of areas being circled with no additional information as to what this meant and how it effected them as an individual such as, safe environment, wander. Within the eating and drinking section, there were no likes, dislikes or preferences recorded. In both peoples care files, they had care plans for the same areas of need, including safe environment, personal cleansing and working and playing. The actual care need or problem was not specific enough and do not tell you what the actual problem or need is, for example, in a care plan for eliminating, it just states, Eliminating. This is then not made specific in the care interventions. Again need to be developed into more person centred plans of care. Neither of these people had care plans in place for their dementia or problems associated with dementia despite this being the primary reason for them living at Allington House. Moreover, when looking at information with the care plans and daily records, there are clearly areas of need that should be specifically care planned for. Examples of this included a person who becomes agitated or has been quite of lot of agitation, restiveness when bathing and dressing. Concern was also expressed about the wording within one of the care plans, A lot of persuasion to wash or change clothes, family aware of this, understands if need to persuade by any means. It is not clear what is meant by this and clearly does not give the staff the direction on how to meet this area of need. There is also the need to ensure that information is cross referenced, as one person had been prescribed supplements for weight loss, however the nutritional assessment and care plan did not reflect this. In all of the care files looked at there was evidence of other health care professionals being involved in peoples care, including the GP, District Nurses, Dietitian, Chiropodist and involvement of the memory clinic. The Medication Administration Records were looked at for all four people. In the main they were fine, with no gaps in administration. There is the need to ensure that all handwritten entries are double signed. Accident records are in place and the current analysis is the fairly recent one brought into all of the Southern Cross homes. As with other services recently visited, this analysis does not provide all of the management information needed such as time of the day or specific unit. There is also the need to separate accidents from incidents, so that there is picture of the incidents that are occurring within the service. Not all incidents are being recorded on incident forms. Staff are using challenging behaviour charts to record incidents but they said that they do not always complete an incident form, that they would only do this if it was a serious incident. Concern was expressed that there have been incidents occurring for which regulation 37 should have been sent to CQC and that consideration should have been given to making safeguarding referrals, for example, X hit, kicked and slapped by X, When incidents are recorded on the incident records the follow up action is not always clear. For example, Hit on the back of the head by another resident while leaving the dining room, there was no investigation and no follow up. Care Homes for Older People Page 5 of 14 Discussion took place with the manager about the medication training as one member of staff who has been administering medication said they had completed a one day Boots course followed by an in house competency assessment. It was agreed that the manager would review the training for care staff to ensure that the training they have received qualified them to safely handle and administer medication. People spoke positively about the social and recreation opportunities available to them. This ranged from Bingo, Dominoes, Cake Making, Church Services, Outings, one to one activities, recent visit from the Discovery Zoo, showing reptiles. There were photographs of people involved in the Discovery Zoo visit and they really looked like this was an enjoyable event. On the day of the inspection, the activities co-ordinator was taking a small group of people to a Military march in Stockton High Street, followed by tea at the the Town Hall. The activities co-ordinator keep records of the activities people are involved in and it looked as if many of the residents are involved in a number of activities. The actual recording of these tends to be a code and does not include more detailed information about participation, enjoyment etc. One person said, The activities co-ordinator is wonderful, there is loads going on, singers, go out into the garden, dominoes and a Chinese Night. Menus are on display in the main reception of the home. The complaints log was looked at. Complaints were being recorded on the formal complaints record. There was evidence to show that complaints were being investigated and resolved. Correspondence is in place detailing outcome to the complainants. The training matrix showed that less than 50 of staff had completed Protection of Vulnerable Adults training and some of this had been completed quite some time ago, the most recent being June 2009. Allington House provides a very pleasant, well decorated and homely environment for people. It is spacious with different lounge and dining areas available and there is a pleasant garden with garden furniture, lawned areas, flower beds and shrubs. It was identified that within the EMI unit, people do not have the facility to have a bath. A number of the bedrooms do have ensuite showers available and there is one shower room on the unit but not bathroom. This does not enable people to have a choice or that there preferences for bath or shower is considered. Care is also needed with the regard to the cleaning trolley as this had been left unsupervised in the EMI unit and was fully of cleaning products which could be a potential risk to people living within this unit. The recruitment and training files were looked at for four staff, two who were relatively new staff and two who had worked at the home for some time. The new staff files were looked at for recruitment and induction purposes, while the other two files were looked at for training and supervision purposes. In the files of the new staff there were completed application forms and employment history. Where there was a period of unemployment, this had been explored and there was a record made. Criminal records bureau checks and ISA First were also in place. One Care Homes for Older People Page 6 of 14 of the staff commenced employment on a ISA First, however there was no documentation in place to detail the supervision arrangements that were in place prior to the return of the CRB, which was a period of one month. In both of the files for the new staff there was no evidence to show they had completed an induction. A member of staff confirmed that they had been given the induction programme and they still had it, but they were not completed. One of the staff commenced employment in October 2009 and the other in December 2009. In respect of training, both the new staff had very little training since commencement of employment, one had received moving and handling and oral health, while the other had received fire and food hygiene. This person appraisal did identified a number of training needs. In regard to the other two staff, there was evidence of some up to date training that included Mental Capacity Act and Deprivation of Liberties, fire training and food hygiene, even so this was not up to date for everyone. The actual training matrix showed that there was the need to increase training for all staff in terms of both mandatory training, such as fire, moving and handling and health and safety as well as more client specific. The Key Outcome Inspection Tool, Southern Crosss own internal inspection also identified this, it was stated, Training statistics have fallen in the home and plans to re dress this need to be implemented. The training matrix showed that three staff had been trained in First Aid, however this training for one person was in 2003, for another 2005 and for the last 2007. It is of concern that the service has a dementia care unit and is providing care for up to twelve people with dementia, however, none of the staff have had any training in regard to dementia care, challenging behaviour or person centred care. Discussion also took place with a qualified nurse regarding their ongoing clinical updating and the system that was in place to ensure that they are up to date with best current practice and that they remain competent. They said that currently nothing was provided for this, although they have requested updating in palliative care, cannulation, venapuncture and catherterisation. Staffing levels were discussed and we were informed that there had been problems with staffing. One member of staff said they had been short staffed on a regular basis, due to sickness and holidays. They did confirm as did the manager that recruitment has taken place and they had appointed both qualified nurses and care staff, who were due to commence in the near future. They also said that due to the dependency needs of the people on the ground floor nursing unit they really did need a further care assistant, however, this is not in the budget. A person living in the ground floor unit home said, There are not enough staff, they are rushing around and they are tired out. Staff were confident that people are being cared for properly and that there was a good staff team working at Allington House. Comments made by people living at the home included, Staff are so helpful, they are a jolly lot, helpful and pleasant. A new manager has recently been appointed who confirmed that they are in the process of registering with CQC. She has been a registered manager in the past and has care Care Homes for Older People Page 7 of 14 home experience. On the day of the inspection she was very clear about the work that needed to achieved at Allington House and said that she had a list of priorities that included the updating of care plans, staff training and supervison. Both the manager and deputy manager were very receptive to the feedback given. Weekly fire checks are taking place and there have been five fire drills since January. Water temperatures are being tested weekly and this were all in order. Regulation 26 visits are taking place and copies of the reports were available. The format of the reports have recently changed and they now include a review of the previous action plan. The action plan was available from the last visit and a recent internal inspection has been carried out. A further area that is in need of improvement is in relation to staff supervision as they have not been taking place at the frequency needed and the quality of them is not as it should be. Up until recently the supervison sessions were generally the same for staff and not an individual, personal supervison. Some of the topic covered at supervision was, Introduction of the new PR company. Others for qualified nurses included, Syringe Driver, Administering Fentanyl Patch. These are more related to policies and procedures rather than supervision unless a specific need had been identified. The manager had commenced supervison with a number of staff, these were specific to the individual staff member and included actions and learning for the next supervision session. What the care home does well: What they could do better: There are a number of areas in need of improvement and further development. The pre admission assessments need to be completed more thoroughly as this determines if the needs of people can be met at Allington House. The care records on the nursing unit are generally well written, however there are areas of assessed need for which care plans had not been developed and there is the need to develop more person-centred plans, work has commenced on this. More work is needed in regard to the care records on the EMI unit, as the assessments contained very limited information. There were no assessments or care plans relating to dementia or the needs associated with peoples dementia. There were a range of care Care Homes for Older People Page 8 of 14 needs identified through the records for which there should be care plans in place, such as, agitation, restiveness to care interventions and periods of aggression. The way in which incidents and recorded and then managed need to be looked at. Incidents have occurred within the EMI unit however incident records are not always completed and it is unclear what action is taken as a result of these incidents. Although challenging behaviour charts are completed, these do not seem to be used for anything and no risk assessments or care plans are developed as a result. A number of staff need to receive Protection of Vulnerable Adults training. Whilst the environment is extremely pleasant, the people who live in the EMI unit do not have a bathing facility, they can only have a shower, unless they go onto another unit which is not acceptable. There is a range of training that is needed, both mandatory and client specific. There is the need to update staff with among others, fire training, moving and handling and a number of staff need to be trained in First Aid so that there is always a first aider on duty. None of the staff have received any dementia care or challenging behaviour training. There is no plan in place for qualified staff to update their clinical skills and knowledge and to remain competent with a number of these skill. Staff supervision also needs to take place at least six times per year and needs to be a personal formal supervision system. Again, the new manager has already commenced with this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 14 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The pre admission assessment must be fully completed and must contain a good level of information. This will ensure that there is sufficient information to demonstrate that peoples needs can be met. 01/08/2010 2 8 12 In the event of 02/08/2010 incidents effective measures must be in place to review each incident after it has occurred and investigation or follow-up action must be taken where necessary. This will ensure proper provision or health and welfare of people. 3 18 13 All staff must receive Protection of Vulnerable Adults Training. This will ensure that the safety, wellbeing and welfare needs of people living at the home are 01/09/2010 Care Homes for Older People Page 11 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action protected. 4 19 23 People who live in the EMI unit must have both showering and bathing facilities available to them. This will ensure that people have a choice of facilities and have their preferences taken into account. 5 30 18 Staff must receive appropriate induction training on commencement of employment, which must be completed. This will ensure they have the appropriate training for the work they are to and ensure the health, safety and wellbeing of people living at the home. 6 36 18 All staff must receive formal 02/08/2010 supervision at least six times per year. This will ensure that staff are provided with the support they need to fulfill their job role. 7 38 18 All staff must receive 01/09/2010 training that is appropriate to the work they are to perform. There must be sufficient staff employed at the home that are trained in first aid. This will ensure that peoples needs are being met by staff Page 12 of 14 01/10/2010 01/09/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action who have the appropriate knowledge, skill and experience. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Staff should ensure that they cross reference information within the care records and ensure that the assessment and care plans are updated as a result. Care plans should be developed for all areas of assessed needs. The work that has commenced on developing the care records into more person specific plans should continue. 2 8 In the event that bed rails need to be used to ensure peoples safety there should be a multi disciplinary risk assessment in place for all such people. The activities records for individuals should be developed further to include among other areas, enjoyment or not of the activities and level of participation. Staffing levels should be reviewed to ensure there are sufficient staff to meet the varying needs of people living at Allington House. Staff should have the training to give them the knowledge, skill and information they need to safety meet the needs of people living at Allington House. This includes training specific to people nursing and care needs including dementia care. Qualified nurses should also have opportunities for updating their clinical skills to ensure they remain competent in delivering clinical care to people. 3 12 4 28 5 30 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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