Care Home: Almadene Care Home

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What the care home does well In May 2008 the home successfully applied to the Commission to increase the number of people with a diagnosis of dementia that it can accommodate. The registered manager and her staff are working hard to further develop the service to meet resident`s needs and preferences, which they and relatives appreciate. Care plans and other important records regarding residents are detailed and up to date. Feedback from healthcare professionals was positive, one healthcare professional told us: Good care home, pleasant staff and clients always look well. The home is comfortable and well maintained, one resident told us: My room is really cosy and I could bring my own things in with me when I came. There is a low turn over of staff, which helps provide consistency of care. What has improved since the last inspection? At the last key inspection four requirements were made and we were pleased to see that these had all been complied with. The required improvements made were in the following areas: ensuring that the information about the home was updated, to help people decide if it would meet their needs and preferences; keeping a more detailed record of the food each person eats, to further assist monitor and promote people`s well being; to deal with an unpleasant smell in one of the residents rooms, to make their environment more pleasant and to ensure that records of hot water temperature checks were up to date, to further maximise health and safety. A good practice recommendation was also made to help improve end of life care where needed and this had been acted upon. What the care home could do better: At this inspection two requirements are made in the following areas: to ensure that staff recruitment checks are always properly carried out to maximise protection for residents; and, to improve the recording of money held for one resident so that their financial interests are properly safeguarded. Three good practice recommendations are also made to further improve the quality of service the home provides. Two of these relate to the physical environment to further assist residents with a diagnosis of dementia and the third is related to further assisting the registered manager monitor staff training. CARE HOMES FOR OLDER PEOPLE Almadene Care Home 19-21 The Avenue Highams Park London E4 9LB Lead Inspector Peter Illes Unannounced Inspection 22nd September 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 Almadene Care Home DS0000067385.V372052.R02.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. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Almadene Care Home Address 19-21 The Avenue Highams Park London E4 9LB 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) 020 8527 6643 020 8527 6643 almadenecarehome@talktalk.net/ksvnnthn@aol. com Goodcare Limited Ms Carol Anne Bryan Care Home 16 Category(ies) of Dementia (12), Learning disability (1), Old age, registration, with number not falling within any other category (15) of places Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 15) Dementia - Code DE (maximum number of places: 12) 2. Learning Disability - Code LD (maximum number of places: 1) The maximum number of service users who can be accommodated is: 16 29th December 2006 Date of last inspection Brief Description of the Service: Almadene Care Home is a privately owned care home registered to provide care, support and accommodation for 16 older people, some of whom may also have a diagnosis of dementia. The home will offer respite care subject ot availability. It is situated in a residential area in Highams Park. The home is close to shops, transport and other local amenities. The home has a well-maintained garden with established shrubs and flowers. The garden can be accessed either by steps or a ramp. The home has 12 single and 2 double bedrooms. Three of the single bedrooms would be difficult to access for people with mobility problems. There is a lift providing access to the first floor accommodation. The latest CSCI report and service user guide are available to all stakeholders from the home and copies are given to residents and relatives. The current weekly fee for the home, depending on the person’s assessed need, is from £535 for a single room and from £480 for a place in a double room. Almadene Care Home DS0000067385.V372052.R02.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 took approximately seven hours with the registered manager being available to assist throughout. There were sixteen people accommodated at the time of the inspection and no vacancies. The inspection was undertaken by the lead inspector who was assisted by an expert by experience, employed by Help the Aged (referred to as Ex. by Ex. in this report). An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Ex by Ex’s views are referred to and reflected through the report. However, terms such as “we”, “our” and “us” are also used where appropriate to indicate that inspection activity is undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with the majority of people living in the home, a number of them independently; independent discussion with relatives, friends and a GP who visited on the day; detailed discussion with the registered manager; a brief discussion with the registered provider who visited on the day and independent discussion with a number of staff, including an outside provider who ran a gentle exercise session on the day. Information was also obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection; independent feedback from a Contracts manager from L.B. of Waltham Forest; feedback questionnaires from seven residents, three healthcare professionals; two staff; a hairdresser and a Eucharistic Minister. Further information was gathered from a tour of the premises and documentation kept at the home. What the service does well: In May 2008 the home successfully applied to the Commission to increase the number of people with a diagnosis of dementia that it can accommodate. The registered manager and her staff are working hard to further develop the service to meet resident’s needs and preferences, which they and relatives appreciate. Care plans and other important records regarding residents are detailed and up to date. Feedback from healthcare professionals was positive, one healthcare professional told us: Good care home, pleasant staff and clients always look well. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 6 The home is comfortable and well maintained, one resident told us: My room is really cosy and I could bring my own things in with me when I came. There is a low turn over of staff, which helps provide consistency of care. 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. Almadene Care Home DS0000067385.V372052.R02.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 Almadene Care Home DS0000067385.V372052.R02.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&3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has up to date information about the services it provides so that people can know what to expect from the home. The needs of people seeking to live at the home are properly assessed to help staff in meeting these needs. EVIDENCE: At the last inspection a requirement had been made that the home’s statement of purpose and service user guide must be reviewed/updated to reflect the information displayed on the home’s certificate of registration. This requirement had been complied with. Earlier in 2008 the home successfully applied for a variation to its conditions of registration to allow more people with a diagnosis of dementia to be accommodated. The home’s latest annual quality assurance assessment (AQAA) stated: We have updated our service user guide which contains a brief summary of our home in the first page, a Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 9 map to find us along with bus and train routes, range of needs of service users, philosophy of care, residents rights, Staff details, admission procedure, facilities, info on meals , entertainment and activities, a brief note extending support for relatives, financial matters and complaints procedure. This guide is complemented by colour photographs of staff and various activities at the home. A copy of the updated service user guide was seen that evidenced this. One visitor spoken to independently confirmed that they had been given a copy of the service user’s guide. A copy of the home’s current certificate of registration was also seen displayed in the hall. The annual quality assurance assessment (AQAA) stated: We conduct a thorough needs assessment which covers the following. Personal hygiene needs, manual handling assessment, mobility, communication, medical history , medication, mental health and cognition, dietary needs and weight, dental and footcare, sleep pattern, personal safety, and risk management profile of person including personal, social,vocational, home life and leisure. As much information is gathered on the categories listed above so as to ensure we only take in service users whose care needs we can meet. We ensure that relatives and friends closest to the service users have a good understanding on how we operate and what services we offer. We invite potential residents to visit for a day to experience Almadene home life. The files of two residents that had recently been admitted to the home were inspected. These showed a range of satisfactory assessment information that had been undertaken before the person was admitted. The files also had a section called Life History, that gave background information on the persons past interests and life style to further assist staff in meeting people’s needs and preferences. The assessment information also recorded the person’s religious needs. The ethnic origin of all the current residents at the home was white British at the time. The registered manager stated that the home has had residents from a range of ethnic backgrounds and endeavours to meet people’s differing cultural needs and preferences. The Commission has recently published equality, diversity and human rights prompts on the CSCI Professional website; a copy of the prompts were left with the registered manager for information. The home does not provide intermediate care. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from having their needs and preferences properly recorded on their care plans, which include guidance to staff on how to meet these. People are well supported regarding their health care needs with access to a range of healthcare professionals. Satisfactory medication policies and procedures are in place to assist protect people living in the home. People are treated with respect and dignity, including with regard to end of life care, which they and their relatives appreciate. EVIDENCE: The files of five people were inspected and each contained a detailed care plan. The care plans included information on people’s current needs and preferences with guidance for staff on how to meet these. The care plans contained sections including: physical well-being; communication; mobility; personal Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 11 safety; religious observance; medical history and diet/ food. There was also a separate night care plan that was seen on the files inspected. Up to date risk assessments, including moving and handling risk assessments, were also seen. The home operates a key worker system and one key worker spoken to independently was able to describe the needs and preferences for the people they were key worker for. Evidence was seen on the files inspected that key workers review and evaluate the person’s care plan on a monthly basis or more frequently if required. The files also contained a separate monitoring sheet completed by the registered manager to ensure care plans were being reviewed regularly. There was evidence that residents, and were appropriate relatives or others, were involved in the care planning process. All the residents are registered with a GP. One GP was spoken to independently when they visited during the inspection. The GP stated that the home calls the surgery appropriately and was complimentary about the registered manager and of the senior staff who were in charge when the registered manager was not on duty. Feedback questionnaires were received from two district nurses who visit the home. Comments from one included: Good care home, pleasant staff and clients always look well; and comments from the other included: (residents) are kept in a nice routine, i.e. not left in bed; food is always good; entertainment is provided. If a patient needs nursing they (the staff) are very caring. A feedback questionnaire was also received from a dentist that visits the home. Comments included: We are called in to see clients if needed; and Bring patients to appointment and completed paperwork needed. Evidence was seen on the files inspected that residents access a wide range of healthcare professionals as required. Each file inspected had a form which contains information such as name, date of birth, next of kin, medication, brief medical history, allergies, doctors details. We were informed that the form is sent with a resident should they need an emergency visit to hospital. The home had a medication procedure attached to the medication trolley. If a person has an allergy to medications e.g. to penicillin, this is highlighted on their file and on the medication administration record (MAR) chart. There is a photograph of each resident with their MAR chart to minimise the risk of a mistake when administering medication. The medication and MAR chart for two residents were inspected and indicated that medication was being safely administered. Evidence was seen that all staff that administer medication have been trained to do so by the dispensing pharmacist. No one was being prescribed controlled drugs at the time of this inspection. Medication was being securely stored. Residents and visitors spoken to independently gave a range of positive feedback about the care provided at the home. One resident told us that staff provided personal care to them in a sensitive way. Residents were well presented throughout the inspection and evidence was seen that two residents Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 12 prefer to wash their own underwear and clothes and that staff discretely monitor that this is being done properly. Each care plan contained a section where resident’s wishes in respect of ageing, dying and action to be taken following service user’s death were recorded. At the last inspection a good practice recommendation was made that an End of Life Care Programme be introduced in the home for those residents who may become terminally ill. This had been acted upon and training for staff in this area introduced. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a range of leisure and recreational activities that they enjoy. Relatives and other visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of healthy and nutritious meals that they enjoy. EVIDENCE: The Ex by Ex noted: I was told by every resident I spoke to that the carers in the home were very good and this was reinforced by two visitors, with especial praise for the registered manager. During the morning, staff were heavily engaged in activities with the residents and I was impressed by their cheerfulness and pleasant interactions with residents. I felt that the staff in the morning genuinely liked the residents and enjoyed working with them. I think this is so important. Carers who actually Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 14 like the residents and show it make a big difference to the atmosphere in a home. In the afternoon, I felt the atmosphere in the home went a little flat. The person rostered to lead singing with the residents was on leave and nothing seemed to be going on in the home. Carers seemed more concerned with other tasks than in interacting with the residents, I felt, although much later, one member of staff did bravely step in and some singing took place. A visitor told me that it was usual for the afternoons to be quieter because the home anticipated that relatives and visitors would come in then. The home had a list of daily activities displayed in the dining room. The list for the week of this inspection included activities that were run by staff and activities that were facilitated by others from outside of the home. On the morning of this inspection a music and movement class was observed being held by an external provider; a quiz was scheduled to be held on the Wednesday morning, run by a volunteer and the London Children’s Ballet was scheduled to perform at the home on the coming Sunday morning. A range of other activities, to be facilitated by staff, were scheduled for the rest of the week. We were told that the London Children’s Ballet performs at the home periodically and were shown photographs of the previous visits earlier in 2008. Records are kept and were sampled of each activity held, including which residents participated and which chose not to. Feedback from residents and relatives was that overall they enjoyed the activities although one person told us that they did not like communal activities very much and chose to spend time in their room instead. The Ex by Ex also fed back to the registered manager regarding her observations relating to other individual residents. This was particularly in relation to those who do not participate in group activities because of their particular needs or wishes, some of who may benefit from more specific activities for people with dementia. The ethnic origin of all the residents at the time of this inspection was white British. The registered manager informed us that the home has had residents from other backgrounds and cultures in the past and works hard to meet all residents’ needs and preferences in relation to their culture and religion. We were told that representatives from a local Church of England church and local Catholic Church visited the home on a regular basis including, to give communion. A Eucharistic Minister sent us a feedback questionnaire and their comments included: I visit on a weekly basis; I take communion to residents. I find all the staff very understanding and they accommodate me. I get a very warm caring feeling when I visit Almadene. The home’s annual quality assurance assessment (AQAA) stated: Family and friends of the residents are welcome at all reasonable hours and we ensure we ascertain any issues regarding their relatives from them. As we are a small home we are able to offer a more personalised service to the residents and the relatives. We spoke to several relatives and visitors to the home who all Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 15 indicated that they were made welcome. One told us I am invariably offered a cup of tea, I can also see (my relative) in their room if that’s what we prefer. The home’s visitor’s book evidenced that the home had a range of visitors most days. Residents spoken to said they could get up and go to bed when they wanted to. Those residents that are able are encouraged to control their own money or are supported to do this by relatives or independent third parties; records sampled evidenced this. One resident told us that they bought in their own bedding and other personal possessions and were keen to show us their room, which they were obviously pleased with. We were invited to have lunch with the residents, which was well presented and which residents appeared to enjoy. The home has three part time cooks and the cook on duty on the day was spoken to independently. We were told that the menu was drawn up on a weekly basis and residents were consulted about this. The menu showed a choice for each meal although on the day of this inspection all the residents had the same lunch, lamb casserole with fresh vegetables. When asked before the meal some residents did not know or could not remember what they had ordered. The Ex by Ex noted: Lunch on the day of the visit was of good quality and tasty. The dining area is attractive and the residents seemed relaxed. Some residents who were more confused were seated in the living area to eat and fed on small tables drawn up to their armchairs. These residents mainly fed themselves and had been given dishes with raised edges to help them cope with the task. I was pleased to notice that carers were on hand to assist these confused residents at this meal if needed. There were no menus on the tables to remind residents what was for lunch or supper. Providing them would be a small touch that might help make the home feel more informative. A good practice recommendation is made in the Environment section of this report regarding clearer information for residents. The kitchen records showed a list of residents who needed a special diet and also any allergies or restrictions, for example if certain foods were not permitted because of an individual’s medication. Food was seen to be properly stored and a range of satisfactory health and safety records relating to the kitchen was seen. At the last key inspection a requirement was made that a record of the food provided for the residents is maintained and it is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. Records seen showed evidenced that this requirement was being complied with. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has satisfactory procedures for dealing with concerns and complaints and people living at the home felt confident that any issues raised would be properly dealt with by the home. Residents are also protected by the home’s safeguarding adults policy and procedures that the registered manager and staff are familiar with. EVIDENCE: The home’s annual quality assurance assessment (AQAA) stated: We take complaints seriously and adhere to complaints procedure. We act on the complaints within the stipulated time period. On admission of a resident the next of kin is sent details of the proprietor’s telephone, fax and email for future reference. The manager and proprietor’s home phone numbers and mobile phone numbers visibly hang in the dining area for any one to contact them if need arises. The home’s complaints procedure was seen displayed in the home and in the service user guide. There had been no complaints recorded at the home since the last key inspection and none had been received by the Commission in that time. People spoken to indicated that if they raised any issues with the staff these were dealt with promptly and to their satisfaction. They also stated that they felt confident that if they had a more serious Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 17 concern that the registered manager and staff would deal with this appropriately. The home had a satisfactory safeguarding adults policy and a copy of the L.B. of Waltham Forest’s safeguarding adults policy, the local authority whose are the home is located in. The home had appropriately referred a safeguarding issue to L.B. of Waltham Forest, in accordance with the above policies, following an incident with a resident and a third party (i.e. a person not employed by the home). This allegation had been substantiated and an agreed protection plan put in place by the home to further safeguard the resident in question. The investigation established that there was no concern about the conduct of the home. The home had also reported the allegation to the Commission at the time, as is required in the Care Homes Regulations 2001. No other safeguarding issues had been recorded by the home or reported to the Commission since the last key inspection. Records seen and staff spoken to independently evidenced that staff had received training in safeguarding adults and were aware of the actions they needed to take should an allegation or disclosure of abuse be made to them. One resident commented in their feedback questionnaire: I feel safe, very important. The home had an appropriate whistle blowing policy. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is well decorated, well furnished, well maintained and that meets their needs. However, they may benefit further from improved signs to help them find their way about and clearer information about day to day events in the home. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. EVIDENCE: The home has 12 single and 2 double bedrooms. Three of the single bedrooms would be difficult to access for people with mobility problems. There is a lift providing access to the first floor accommodation. The home is close to shops, Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 19 transport and other local amenities. The home has a well-maintained garden with established shrubs and flowers. The garden can be accessed either by steps or a ramp. We undertook a tour of the building and noted that it was generally well furnished, decorated and maintained. The Ex by Ex noted that arms on a few armchairs in the lounge had become worn and this was bought to the attention of the registered manager. The registered manager had indicated in the annual quality assurance assessment (AQAA) that these chairs are due to be replaced. The home consists of two adjoining houses that have been converted into a care home. Because of this it is not particularly easy to find one’s way around some of the corridors. The Ex by Ex noted: There were at least two doors internally which bore no indication on them of what lay on the other side and at first glance would seem to be dead-ends. I did not think that the doors to WCs and bathrooms were particularly well distinguished from other doors, and could have been more prominently marked and coloured to help people with confusion or dementia. Some signage is available to assist people with dementia such as signs on bathroom doors and on some bedroom doors. However, given the lay out of the building a good practice recommendation is made that further signage is put in place and consideration given to different colours in different areas, to assist people with dementia to locate the different areas in the home. In addition, the lounge had a notice board that had the date written on it but this was written in red ink and the writing was difficult to read. The registered manager stated that their had been a more prominent notice board in the lounge but that had been moved when a new large flat screen television had been installed there. A good practice recommendation is made that a notice board is installed in either the lounge or the dining room that is large enough to hold pertinent information to assist people with dementia, including the day, date, choices for the next meal, planned activities for the day and any other pertinent information to assist residents to know what is planned in the immediate future. Table menus may also be of benefit to residents. Residents are offered a key to their rooms and the majority of bedrooms were locked during the tour of the building. However, a number of residents agreed to show us their rooms and all indicated that they were pleased with them. One resident told us: My room is really cosy and I could bring my own things in with me when I came. The rooms seen were well decorated, light and airy and had been personalised by the person to their tastes and preferences. At the last inspection a requirement had been made that an offensive odour in one of the resident’s bedrooms is eliminated. The registered manager stated that the flooring in that person’s room had subsequently been changed to better meet that particular person’s needs and had resolved the difficulty. No offensive smells were identified during this inspection. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 20 The home was clean and tidy throughout the inspection and had appropriate laundry facilities that were seen, including that a new washing machine had been installed earlier in 2008. The home had an appropriate policy and procedure regarding chemicals or substances hazardous to health (COSHH), and staff were aware of this, see also the Management and Administration section of this report about how such policies are reinforced. The registered manager stated that the home was planning to introduce a more personalised system of laundry for towels and bed linen over the next twelve months. It was noted that that two residents prefer to wash their own underwear and clothes and were supported in this by staff. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff that are trained and have a range of competencies support people living at the home. The home’s recruitment procedure needs to be fully implemented at all times to maximise safety to people living at the home. EVIDENCE: At the time of this inspection the home was employing a registered manager, two senior carers, eleven permanent care staff and four bank care staff. Two care staff work the morning shift, two care staff the afternoon shift with a third care staff working 4.30pm to 8 pm and two waking care staff work at night. The registered manager confirmed her hours are in addition to this. The registered manager also confirmed that she usually worked during office hours although also worked some other times to help her be aware of what happened in the home on different shifts. The home also employs three cooks/ domestic staff and a maintenance person. We were informed that the home does not employ agency staff to ensure the continuity of care to the residents and that staff turnover was low. Throughout the visit, we received positive comments from residents and others about the Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 22 registered manager and staff working in the home. However, feedback from one resident in a feedback questionnaire was generally positive but included: Sometimes short of staff. This was discussed with the registered manager. However, given the current needs of residents the staffing ratio was judged as adequate at the time of this inspection. A copy of the rota was seen and accurately recorded the staff on duty during the day. All the staff but one have achieved qualifications that will assist them to further enhance the lives of residents and to further their own career development. Ten of the eleven permanent care staff and three of the four bank care staff have achieved the national vocational qualification (NVQ) level 2 in care. We were informed that only two bank care staff have been employed at the home since the last key inspection and their files were inspected. Both staff files contained completed application forms, copies of two staff references and proof of identity. One of the files also contained an enhanced criminal records bureau (CRB) check and protection of vulnerable adults (POVA) clearances. However, a CRB and POVA checks could not be located for the other member of staff. A requirement is made that no staff are employed at the home until the provider organisation has received a new and satisfactory criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, or, in exceptional circumstances, a POVA First check while waiting for the full CRB. In the latter circumstances the staff member must be supervised at all times until the full CRB is obtained. This is in order to maximise protection residents. (The registered manager contacted us shortly after the inspection activity finished to inform us that a new application for an enhanced CRB and POVA clearance for the identified member of staff had been completed and sent off. The registered manager also confirmed that the staff member was being supervised until the clearance was received). Records seen of training undertaken by staff in the past twelve months included Mental Capacity Act training, first aid, food hygiene, dementia care, moving and handling and safeguarding adults. However, it was difficult to obtain a clear overview of all the training that each individual staff member had undertaken and when refresher training was due as there was no single document to show this. A good practice recommendation is made that the home develops a training matrix that shows the training that each staff member has undertaken and when refresher training is due. Staff spoken to independently confirmed that they received regular training. As stated above, evidence was seen that staff had undertaken training on supporting the needs of people with dementia. However the Ex by Ex felt that, during afternoon tea on the day, the supervision and support she observed being offered to some residents with dementia should have been more sensitive and effective. This was fed back to the registered manager. Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from it being managed by a qualified and experienced registered manager. People accommodated and other stakeholders are consulted to monitor and improve the quality of the service the home provides. People’s financial interests are safeguarded although more robust record keeping is needed for one person to maximise their financial protection. Staff receive regular supervision to assist them meet the needs of people accommodated and to assist in their own development. The home has a range of effective health and safety procedures in place to protect people living there, and others that work or visit the home. EVIDENCE: Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 24 The registered manager is qualified and experienced to undertake her duties. She presents as being knowledgeable about the needs of the residents and was observed relating to them well during the inspection. Feedback from staff spoken to independently was positive and we were told that staff morale was good. An example of good management practice that was noted is how staff are being encouraged to keep up to date with policies and procedures. The annual quality assurance assessment (AQAA) states: A policy of the month is chosen from our policies and procedures folder and put up on the notice board. Staff (are required) to read and sign this document if fully understood. This ensures that staff are constantly refreshed with regards to some key policies of the home. This sheet was seen displayed in the home during this inspection with the policy of the month being about chemicals or substances hazardous to health (COSHH). Staff had signed the sheet and staff spoken to independently confirmed that the system worked for them. The Ex by Ex stated: There is much that is good about this home. However, this is a home, which has recently gained registration for a higher proportion of residents with dementia (It can take up to 12 in a home catering for 16). I think it needs to concentrate more actively on making the home better tailored for this client group. The orientation is not great in the home, the signage could be improved, the level of attention to confused clients needs monitoring and the activities provision, whilst reasonable for the less confused clients should also contain more activities for people with dementia. The home monitors the ongoing quality of the service offered to residents. An effective key worker system is in operation with key workers involved in regular reviews of care plans. The home holds regular residents meetings and records of meetings these meetings were sampled. The home arranges meetings for relatives and records of these were sampled. However, the last planned meeting on 6th June 2008 had to be cancelled as no relatives attended. The home also sends out satisfaction surveys to residents, relatives, health professionals and social care professionals, which are then reviewed and acted upon. Independent feedback was sought from a Contracts manager at L.B. of Waltham Forest; that local authority had placed a number of residents at the home. Feedback indicated that both the registered manager and the registered provider acted in a professional manner and that the authority had no concerns about the quality of management and care that the home currently provides. The registered provider is appointee for one resident although the documentation relating to this was not inspected on this occasion. The registered provider told us that this person’s funding local authority declined to accept this responsibility and there was nobody else to be appointee. We were told that the home was only holding money for one other resident and that money and related record was inspected. The money, £60, was kept securely Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 25 but the record seen relating to it only stated £50 and the recording was not robust enough to show a clear audit trail. A requirement is made that all money held for residents must be supported by an accurate, clear and robust audit trail to ensure that the resident’s financial interests are being properly safeguarded. Evidence was seen from staff files inspected and from staff spoken to independently that staff receive formal recorded supervision and staff confirmed that they felt that this was useful. At the last inspection a requirement was made that hot water temperatures tests are carried out and recorded. Satisfactory records of these were seen at this inspection. In addition a range of other satisfactory health and safety documentation was seen. This included: a gas safety certificate, electrical installation certificate and portable appliance test. The home’s fire log was inspected and showed that the fire fighting equipment had been serviced, regular safety checks on fire equipment were being carried out, that regular fire drills were being undertaken every three months and the home had a current fire plan and fire risk assessment. Almadene Care Home DS0000067385.V372052.R02.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Almadene Care Home DS0000067385.V372052.R02.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 OP29 Regulation 19 Requirement The registered persons must ensure that robust recruitment checks are undertaken before a member of staff starts work in the home. This includes that no staff are employed at the home until the provider organisation has received a new and satisfactory criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, or, in exceptional circumstances, a POVA First check while waiting for the full CRB. In the latter circumstances the staff member must be supervised at all times until the full CRB is obtained. This is in order to maximise protection residents. The registered persons must ensure that that all money held for residents must be supported by an accurate, clear and robust audit trail to ensure that the resident’s financial interests are being properly safeguarded. Timescale for action 20/10/08 2. OP35 17(2), Sch. 4 20/10/08 Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 28 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 OP22 Good Practice Recommendations The home should put further signage in place and consideration be given to different colours in different areas, to assist people with dementia to locate the different areas in the home. The home should have notice board is installed in either the lounge or the dining room that is large enough to hold pertinent information to assist people with dementia, including the day, date, choices for the next meal, planned activities for the day and any other pertinent information to assist residents to know what is planned in the immediate future. Table menus may also be of benefit to residents. The home should develop a staff training matrix that shows the training that each staff member has undertaken and when refresher training is due, to assist in planning for future training. 2. OP22 3. OP30 Almadene Care Home DS0000067385.V372052.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Almadene Care Home DS0000067385.V372052.R02.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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