Care Home: Aspen House

What the care home does well The atmosphere in the home was comfortable, homely and relaxed and staff were seen to be kind and caring towards people living in the home. Residents spoken with agreed that staff are very good and so were the meals. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has an accessible patio area to the side of the property and limited parking on the site. There is an open-house policy, which welcomes visitors at all reasonable times and complaints are handled well ensuring that residents feel listen to and their views acted upon. There are good care planning systems in place and staff training programmes to ensure they have the skills t meet assessed needs. A range of quality monitoring systems are used to ensure any shortfalls are identified and acted upon. What has improved since the last inspection? No requirements were made at the last key inspection. What the care home could do better: Shortfalls were identified in respect of the use of correction fluid on various documents such as staff rotas, care plans and recruitment documents. All care plans need to be complete, include a photograph of the resident and that they reflect current care needs. Improvements need to be made to the recording of medication and advice needs to be sought in respect of locking fire exit doors and use of safety gates on stairs. All staff must provide a written reference from their last employer and evidence that they can work in the UK. It is recommended that the Manager obtains training in the Mental Capacity Act and the Deprivation of Liberty Safeguards. Following the site visit the Registered Manager confirmed that action has been taken to meet all of the requirements and the one good practice recommendation. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aspen House 17 Wilbury Avenue Hove East Sussex BN3 6HS     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gwyneth Bryant     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Aspen House 17 Wilbury Avenue Hove East Sussex BN3 6HS 01273772255 01273772255 d.roussell@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Denise Marie Bernadette Roussel care home 15 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 15 The maximum number of service users to be accommodated is fifteen (15) The maximum number of service users who can be accommodated is: 15 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: Dementia - DE Date of last inspection Brief description of the care home Aspen House is registered to provide care and accommodation for up to fifteen older people who are in the various stages of dementia. The property consists of a large detached house with an additional two-storey purpose built extension. Residents bedrooms are located over two floors and there are nine single rooms and three shared rooms. Six of the bedrooms provide en suite facilities. A stair lift is available. Communal facilities include a lounge, a small quiet room, dining room, large entrance hall and a patio garden. The home is located in a quiet residential area of Hove, which is reasonably close to local transport and other amenities. The current scale of fees is from £445 to £500. Chiropody and hairdressing are extra charges. Care Homes for Older People Page 4 of 26 Brief description of the care home Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection and took place in five and a half hours. The purpose of the inspection was to check compliance with key standards and other standards. There were fourteen people in residence on the day. Four residents were spoken with in addition to discussions with the Registered Manager, the deputy manager and the cook. The last key inspection was carried out on 29 June 2007 and an Annual Service Review carried out on 16 June 2008. A number of documents and records were viewed; including personnel files, medication charts and care plans and a tour of the premises was also carried out. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how Care Homes for Older People Page 6 of 26 well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. What the care home does well: What has improved since the last inspection? What they could do better: 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission processes ensure that people are clear about the services provided and that the home can meet their assessed needs. Evidence: Three pre-admission records were viewed and were found to include all the information required by the standard. Two residents have been admitted on an emergency basis and although a pre admission assessment was not carried out, sufficient information was available to ensure the home could meet their needs. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All care plans need to be complete, consistent and accurately reflect current care needs and improvements need to be made to the recording of medication. Evidence: Five care plans were viewed in conjunction with other documents such as medication administration charts, daily notes and discussion with the Manager and her deputy. Care plans were variable with some giving comprehensive details of the resident and their needs while others less detailed. One person admitted as an emergency did not have a completed plan and this needs to be addressed to ensure staff have clear directions as to how to meet this persons needs. There were some shortfalls found in care plans as not all needs had been fully assessed, nor were there always directions to staff in meeting care needs. Reviews tended to be just a date and a signature which does not inform the reader whether or not all parts of the plan had been reviewed especially as other documents indicated that needs had changed. For example, the goal for one resident was to increase their intake of protein and increase their weight. Other records showed this had been Care Homes for Older People Page 11 of 26 Evidence: achieved but the care plan had not been updated and a new goal created. Not all parts of the care plans and risk assessments had been signed and dated therefore it was not possible to evidence when the person was assessed nor by whom. Some care plans included a summary of care needs in relation to how the individual likes to spend their day. These were very good and provided a good insight to preferred daily routines, therefore this needs to be extended for all residents to provide a point of reference for staff. Risk assessments had been carried out for those at risk of falls but while some were just a scoring system with little or no direction to staff in reducing the risk, others included good commentary on this aspect. A number of records in respect of food intake, activities and weight were held in other places. It is good practice to ensure all records relating to residents are in the care plan, thus ensuring that staff know where to look for all information and to facilitate the review process. Daily notes were variable with some giving an overview of how people spent their day but in the main were limited and often including information recorded elsewhere such as comments stating medication given. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, however terms such as had a good day or in a good mood is not helpful or adequate. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. During the site visit staff added to the are plans which indicates they are used as a working document rather than a paper record therefore good practice is achieved in this respect. Most care plans included information on meeting healthcare needs such as dentists, opticians and chiropody. Correction fluid had been used on some parts of the plans and this must cease. Overall, care plans need to be consistent, complete and accurately reflect current care needs to provide clear direction to staff in meeting those needs. Despite the shortfalls in records, the core staff team are competent and are clearly aware of how to meet the needs of the residents. This was evidenced by observing staff interacting with residents and discussion with the deputy manager and residents comments. Medication administration records were viewed and generally were satisfactory but there was evidence of some signatures being overwritten or scribbled out. In addition, there were some gaps so it was not clear if the medication had been given or not required. This suggests that, in some instances, medication is signed for prior to administration and this needs to be addressed as it must be clear whether or not medication has been given and by whom. Although all staff who administer medication have received appropriate training the shortfalls in the recording suggests that all staff who administer medication have their competency assessed by a suitably qualified person to ensure good practice is followed. Care Homes for Older People Page 12 of 26 Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals. Evidence: Activities sessions are provided during the morning and afternoons and the activity programme showed that these were varied. The home maintains an activity log to record which activity residents participated in. It would be good practice to include this information in care plans to evidence that activities are based on individual preferences or past leisure activities. Some residents still go out into the community alone and others go with their family or are escorted to the shops by staff. Throughout the site visit staff were seen to treat residents with care and respect and it was clear that comfortable working relationships had been developed. Two residents have been provided with keys to their rooms and one resident has chosen to hold their own money and lockable facilities have been provided. The menus for the week was viewed and it indicated that meals are varied and well balanced with alternative meals offered at each mealtime. Discussion with the cook found that he keeps records of residents likes and dislikes and was aware of how to meet the dietary needs of those who have diabetes. There is a food log which is used Care Homes for Older People Page 14 of 26 Evidence: to record all meals taken by individual residents and from this it was evident that they have a range of options at mealtimes. For those residents who need to increase weight it is good practice to ensure food records are more detailed to include exactly how much was eaten to enable staff to make adjustments accordingly. There is an open house visiting policy with visitors welcome at all reasonable times and residents spoken with indicated that they enjoyed their food. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: The AQAA indicated that there are policies and procedures for both complaints and Safeguarding Adults and that residents are provided with a copy of the complaints procedure. All complaints are logged and include actions taken and outcomes and are collated as part of the quality monitoring process. The Commission have not received any complaints in the last twelve months and the two complaints received in the home were investigated satisfactorily and recorded in the complaints log. All Safeguarding Adults information is in place according to the AQAA and the Manager confirmed that the issue of safeguarding adults is included in the induction process to raise awareness for new staff until accredited training can be arranged. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of decor within the home is good, providing people living in the home a safe, homely and comfortable environment. Evidence: A tour of the premises was carried out an a random selection of rooms inspected. The environment is good with most parts of the home well maintained and in good decorative order. The home continues to provide a safe, pleasant and comfortable place in which to live. Individual bedrooms were mostly well maintained and pleasingly decorated and it was evident that people are able to bring in their own possessions in order to personalise their bedrooms. There is an on-going maintenance and refurbishment programme in place to ensure that repairs and upgrading of rooms is carried out. There were some minor repairs needed such as replacing sealant around baths, wash handbasins and toilets as a matter of infection control. The home provides a designated smoking room for those residents who smoke and the Manager is in the process of gaining planning permission for a smoking room situated outside the building. There is a patio area to the side of the property which is accessible to residents and provides a place to sit when the weather permits. Staff were seen to be wearing gloves and aprons when necessary and there were ample gloves and aprons available in relevant parts of the home. The laundry facilities Care Homes for Older People Page 17 of 26 Evidence: are satisfactory and washing machines are able to wash clothes at temperatures that control the risk of infection. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff with the skills and competency to meet the needs of people living in the home but improvements need to be made to recruitment practices. Evidence: The Manager confirmed that there are three carers for each daytime shift and two carers for the night shift with one being waking and the other sleeping. One the day there were three carers on duty in addition to the Manager, a cleaner and the cook. Care staff were working unhurriedly which indicates there are sufficient staff to meet residents needs. Recruitment records for the last three people to be employed were viewed and these showed that some of the required information had been provided including Criminal Record Bureau and Protection of Vulnerable Adults checks, however they had not provided a written reference from their last employer. Each were in the UK on a work permit but there was no evidence to show that they were allowed to work in this particular care home as the work permit specified another care home. Two people had written references from colleagues or friends and this is not acceptable. Although these shortfalls could put residents at risk the Manager confirmed that these staff do not work alone, thus the risk to residents is minimised. There is a staff induction training programme in place that meets the Skills for Care requirements and ensure staff are familiar with working practices at the home. Care Homes for Older People Page 19 of 26 Evidence: Information in the AQAA showed that of the 10 care staff, seven have already achieved National Vocational Qualification at level 2 in care therefore the home exceeds this standard. The deputy manager had completed National Vocational training in care at level 4 giving her the knowledge to effectively manage the home. All staff receive mandatory training in fire safety and manual handling in addition to other training such as dementia care. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with good leadership and direction and systems are in place to ensure most aspects of service users health, welfare and safety are protected and promoted. Evidence: Although some requirements have been made as a result of the visit, each aspect was discussed with the Manager and she was aware of the importance of ensuring shortfalls are addressed and how to rectify them. The Registered Manager has the required skills and qualifications to manage the home and demonstrated a good understanding of individual residents care needs. Information in care plans indicated that one resident will make attempts to leave the building and as the front door is kept locked it is recommended that the Manager obtains training in the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure she is aware of what needs to be done should this particular resident insist on going out. There are various quality monitoring systems in place including staff meetings, staff Care Homes for Older People Page 21 of 26 Evidence: supervision and surveys, in addition to input from an outside consultant who has oversight of all aspects of the service at least twice a year. Results from surveys are collated and action taken where shortfalls are identified. Throughout the site visit both staff and residents came to the office to talk to the manager which demonstrates she is open and approachable. The home does not manage monies on behalf of residents but does hold small amounts of money for them. Clear records are maintained of all transactions, are signed for and receipts provided. Accident records were viewed and found to be maintained in line with good practice and the Manager said they are collated as part of the quality monitoring process to ensure future accidents are avoided where possible. Information in the AQAA demonstrated that all policies and procedures are updated annually and all safety checks are carried out on gas and electrical appliances and systems. There is an on-going programme of maintenance, upgrading and renovation of all parts of the home, including individual rooms as they become vacant. All staff receive regular fire safety training and a fire risk assessment has been carried out, however it did not include information on the use of a safety gate at the top of the stairs and the practice of locking a fire exit. Advice needs to be sought from the local fire service to ensure these practices do not put staff and residents at risk in the event of fire. Regular fire drills are carried and fire alarm systems regularly tested ensuring neither staff nor people living in the home are at risk in the event of fire. Self-closing devices, triggered by the fire alarm are fitted to all internal doors that require them. It was of concern that correction fluid had been used on a number of documents in the home and this practice must cease to ensure all records are clear. Care Homes for Older People Page 22 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 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, Care Homes 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 7 15 That all care plans are complete, accurately reflect current care needs and all records signed and dated. To ensure staff are directed in providing consistent and good quality care. 15/07/2009 2 9 13 That all staff who administer 15/06/2009 medication have their competency assessed by a suitably qualified person. To ensure they are aware of good practice. 3 37 17 That the use of correction fluid on documents ceases. To ensure all records are clear and accurate. 15/06/2009 4 38 13 That advice is sought from the fire service in respect of locking fire exits and using safety gates on stairways. To ensure service users and staff are not at risk in the event of fire. 15/06/2009 Care Homes for Older People Page 24 of 26 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 31 That the Manager obtains training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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