Care Home: Alma Rest Home

What the care home does well Alma Rest Home provides comfortable and homely accommodation for up to 22 older people with dementia care needs. There is a good care planning and risk management process in place that is computer based providing clear record keeping. The home provides a good range of activities in house and service users have regular opportunities to access the local community with support. The home offers a healthy and balanced diet with a range of choices to suit individual preferences. There is a relatively stable staff team who are provided with all required training and are supported in their duties. Staff were positive about their working experiences in the home. What has improved since the last inspection? The registered provider has commenced a programme of refurbishment and redecoration throughout the home. This has provided an improved environment for residents. The requirement and recommendations made at the previous inspection have all been addressed. This includes the development of a computer based system for managing care plans, risk assessments and other key information relating to service user`s needs. What the care home could do better: 1 requirement and 2 recommendations have been made as a result of this inspection process. The home needs to ensure that storage for controlled drugs meets statutory requirements. The employment application form would benefit from review to ensure that a full employment history is gained for all new staff. The cook should undertake to complete an intermediate food hygiene certificate. It is also advised that the home ensures the pre-admission assessment form is completed in more detail in some cases, particularly where a prospective service user does not have a care manager and related information. CARE HOMES FOR OLDER PEOPLE Alma Rest Home Alma Residential Home 19-23 Alma Road Sheerness Kent ME12 2NZ Lead Inspector Joseph Harris Unannounced Inspection 24th November 2008 09:30 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 Alma Rest Home DS0000023899.V373351.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. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alma Rest Home Address Alma Residential Home 19-23 Alma Road Sheerness Kent ME12 2NZ 01795 665051 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) almaresthome@aol.com Mr Patrick Nicholas Pinagapany Mr Patrick Nicholas Pinagapany Care Home 22 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) 2. Dementia (DE)(E) The maximum number of service users to be accommodated is 22. Date of last inspection 27th November 2006 Brief Description of the Service: The Home provides residential care for older people who have dementia care needs. All service users have their own rooms, many of which are en-suite. The Home is on several floors and there is a lift access to all levels. The Home has a large lounge area in which there is plenty of space to wander if that is what the service users want to do. The dining areas are also part of this space. There is also a conservatory and small courtyard garden where service users can relax or entertain family and friends. The Home is situated near the sea front in Sheerness, and is close to shops and many other amenities. Sheerness has a railway station and the Home is near a bus route. The fees are £466 per week. Alma Rest Home DS0000023899.V373351.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. This key unannounced inspection process culminated in a site visit to the home on 24th November 2008. The site visit commenced at approximately 9.30am and concluded at 3.30pm, lasting for around 6 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the deputy manager, staff members and service users. The manager was not present at the time of the inspection. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: What has improved since the last inspection? The registered provider has commenced a programme of refurbishment and redecoration throughout the home. This has provided an improved environment for residents. The requirement and recommendations made at the previous inspection have all been addressed. This includes the development of a computer based system for managing care plans, risk assessments and other key information relating to service users needs. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 6 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. Alma Rest Home DS0000023899.V373351.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 Alma Rest Home DS0000023899.V373351.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): 3 and 6. Quality in this outcome area is good. The needs of prospective service users are assessed prior to admission. The home does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service user files were examined containing pre-admission assessment information. Referrals are received through care management and private sources. Where possible the home receives care management care plans and risk assessments and other background information including copies of any joint assessments. The service has developed its own assessment format covering all key areas of need which is completed in all cases. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 9 The deputy manager stated that on receipt of a referral discussions are held with the referrer to establish the suitability of the referral. Senior staff then aim to visit the prospective resident in their current accommodation identifying key areas of need, preferences and other aspects of support. The individual is then invited to spend time in the home range from introductory visits to overnight stays if desired. There has been a recent referral that following a trial visit was considered not to be appropriate for the home demonstrating that the assessment process is effective. The deputy manager was advised that the homes assessment should be completed in good detail especially when the referral is through private sources and minimal background information is available. The home does not offer respite or intermediate care services. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. The health and personal care needs of service users are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two individual service user files were examined containing care plan information and risk assessments. These were completed in good detail showing clear assessment of needs and actions to enable staff to meet those needs. The care plans are linked to assessment information and are kept under regular review. Plans showed evidence of being updated to reflect the changing needs of service users. It was noted that in some circumstances guidance was somewhat vague. This was discussed with the deputy manager who agreed to ensure that specific instructions are included. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 11 Risk assessments were in place covering a range of topics and developed individually. Risk management processes were not unduly restrictive and promoted the independence of service users appropriately. The care planning system in use is computerised and ensures that prompts are included for the review of documentation. The system also reduces the time staff spend on documentation allowing more time for working with residents. The next of kin for each resident is invited to read through the care plans and risk assessments signing to state that they agree with the plans. There is an effective keyworker system in place with identified staff responsible for developing and updating individual care plans. Healthcare issues are monitored and referred appropriately. Good records are maintained of service users health appointments and consultations with professionals including the outcomes of these visits. The home was advised that records showing a breakdown of visits for monitoring purposes could be developed. It was reported that the home receives good support from healthcare professionals including the Older People Mental Health Team, GPs and District Nurses. All service users are registered with a local GP and complimentary healthcare including chiropodist and dentist appointments are offered. Medication processes and records were examined and are well managed and kept up to date. There are clear policies and procedures in place and all administration records were complete and up to date. The home currently has use for one controlled drug and it was noted that the storage for this medication needs to be maintained within current guidance for such medication. Refer to requirement 1. Controlled drug records were, however, well maintained. Staff receive medication training before taking on responsibility for administration. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 12 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. Service users have a lifestyle that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are offered a stimulating and interesting range of activities in the home. Outside entertainers visit periodically to provide musical entertainment. Other organised activities take place such as baking, arts and crafts, exercise groups and games. These activities are tailored to the needs of service users, some of whom have relatively short attention spans. Staff offer residents regular opportunities to go out into the local community routinely accompanying staff on errands and shopping trips in the town. Some service users choose not to go out so regularly, but the opportunities are, nevertheless, regularly offered. Staff provide some personal grooming assistance such as painting nails and attending to hair and make-up. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 13 Some residents are escorted to the local church on a regular basis and a local vicar also attends the home to conduct communion services for those who have greater difficulty in attending church. Service users are encouraged and supported to help around the home if they wish to do so taking on cleaning duties or helping with the laying of tables, etc. Visitors are welcomed into the home and there is evidence that families are encouraged to take an active role in the day-to-day lives of service users. There is adequate space within the home to enable people to greet visitors in private should they wish to do so. A lunchtime service was observed showing that residents are offered choice with their meals and that mealtimes are a relaxed and sociable time of the day. Staff were efficient in serving residents and had time to assist people where required in an unhurried and relaxed manner. The home has a full-time cook who has a good awareness of the needs of service users with regard to diet and consults with people upon choice of menus. The kitchen is wellequipped and a range of good quality and fresh foods were in stick. Menu records are kept up to date. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 14 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. EVIDENCE: The service has a clear complaints process, which is summarised in the service user guide and displayed in the home. The complaints process meets stated requirements. The deputy manager stated that the aim of the home is to deal with any concerns informally in the first instance, but there is recourse to a formal process if required. Complaints are recorded and actions arising noted appropriately. There have been no complaints since the last inspection. Staff receive instruction in Adult Protection and abuse awareness issues. Policies and procedures are in place relating to these topics and staff are aware of these and the systems for recording and reporting suspected abuse. No adult protection alerts have been raised in connection with the service since the last inspection. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 15 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 and 26. Quality in this outcome area is good. The premises are suitable for the individual and collective needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken as part of the inspection process. The house is situated in a residential road close to the town of Sheerness. There is street parking available at the front of the building and a train station and bus routed nearby. The home has an enclosed courtyard with a covered smoking area to the rear of the building. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 16 There is a good range of communal space throughout the building offering comfortable and homely accommodation that is well decorated and furnished. A number of bedrooms were seen all of which are suitable for the service users needs. Suitable toilets and bathroom facilities are available throughout the home. There is a well equipped kitchen and a separate laundry area. A kitchenette is also available adjacent to the lounge area for drinks, snacks and breakfast preparation. The home was clean and hygienic throughout and hazardous substances are securely stored. Procedures are in place to minimise the spread of infection. A programme of redecoration and refurbishment is in progress throughout the building improving communal areas in particular. Improved facilities such as a new large screen television have also been purchased. Overhead hoists have been installed in key areas of the home to assist people with reduced mobility. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 17 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. There are sufficient, well trained staff on duty at all times. The recruitment practices of the home ensure the protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home operates with 4 staff on duty at key times of the day and the number of staff is flexible at all other times to ensure that the needs of the service users can be met. The manager and deputy manager also work office hours throughout the week. In addition to this the home employs a cook and two domestics. Staff were observed to be attentive to service users, unhurried and relaxed in their work. Over 50 of the staff team have achieved an NVQ level 2 or above and a number of staff are currently working towards this qualification. In discussion, staff were knowledgeable about their roles and the needs of the service users. The staff training matrix was examined and demonstrates that staff receive a good package of training including an in-house induction process for new staff. All mandatory training topics are covered and training needs are up to date. Other courses specific to the service are also provided including dementia care Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 18 and adult protection. It is recommended that the cook completes an intermediate food hygiene course. Refer to recommendation1. Staff recruitment files were examined for two staff members. All required information was in place including evidence of CRB and POVA checks, two written references and proof of identity. It is advised that the home reviews the employment application form to ensure that a full employment history is gathered and reason for leaving past employment. Refer to recommendation 2. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. The home is well run and in the best interest of the service users. The health and safety of service users is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for over 8 years and is also the registered provider of the service. He is supported by a deputy manager who was present at the time of the inspection. The deputy manager demonstrated a very good awareness of the running of the home and was positive about the management Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 20 of the service overall. Staff stated that the home is an enjoyable place to work and that the manager is open and approachable. The manager has achieved the required qualifications for running the home. Suitable quality assurances processes are in place to ensure the satisfaction of service users, their relatives and the development of the service. Annual surveys are sent out and the results of these are collated into a report with an action plan. A number of audits are carried out around key aspects of the running of the home. There is evidence of the on going improvement and development of the service. This includes issues around the environment, training and care planning processes. The home does not take on a financial appointee role for any service users and this is managed by people independent of the service. There is facility for the safekeeping of personal monies. Records are maintained in relation to this providing evidence of all incoming and outgoing transactions. A range of health and safety documentation was examined all of which was maintained and up to date. Service safety certificates including those for gas appliances, electrical wiring and hoist equipment were in date and in good working order. The deputy manager reported that the home meets the requirements of the environmental health and fire safety departments. Environmental risk assessments have been completed and reviewed. Fire safety records are kept up to date and accident records completed. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement The storage for Controlled Drugs must be maintained in adherence to the Royal Pharmaceutical Society of Great Britain guidance. Timescale for action 31/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP30 OP29 Good Practice Recommendations The cook should complete an intermediate food hygiene qualification. To update employment application forms ensuring a full employment history is documented and gaps explored. Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Alma Rest Home DS0000023899.V373351.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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