Care Home: Astell

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What the care home does well Astell is a well managed home, provides a safely maintained and clean environment for people to live in, and offers a very welcoming atmosphere for visitors. People are admitted to the home on the basis of an assessment of their individual needs, although this continues to be developed. Upon admission each person has their own personal documented plan of care to address their individual needs. Many residents and their families spoke very positively about the care and attention they received from the staff. People said that the staff were kind, caring and wonderful` and always willing. Several said that they `really liked them and got on well with them`. Another said that they were `always polite and nice`. Appropriate support equipment was in use in conjunction with individual risk assessments, there was evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of people receiving good care and support. Peoples` privacy and levels of independence are respected and maintained as much as possible. Some of the residents` relatives indicated that they too felt well supported and reassured by the home. People are reassured that the home takes any complaints and concerns seriously and does all it can to help them. There are policies and procedures in place for the protection of the vulnerable people, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies for those people wanting such a service. There are some good quality monitoring approaches adopted here, with residents and their families encouraged to have a say in how their home is run. Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place. The competence and skill of the staff group is developed through a structured training programme, and through ongoing training in topics relevant to the needs of the people living at the home. There is also a focus on the National Vocation Training programme for care staff. What has improved since the last inspection? Each of the statutory requirements for improvement issued at the last key inspection had been met. Some redecoration and refurbishment is ongoing within the home, in order to maintain the environment in good order for the people living here.Careplanning systems are much more consistent throughout the home and careplans now underpin the care practice within the home with minor amendments still required. CARE HOMES FOR OLDER PEOPLE Astell Overton Park Road Cheltenham Glos GL50 3BT Lead Inspector Mrs Helen James Key Unannounced Inspection 09:15a 28th January 2008 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 Astell DS0000016372.V347920.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. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astell Address Overton Park Road Cheltenham Glos GL50 3BT 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) 01242 529012 01242 584520 Cheltenham Old People`s Housing Society Limited (The Lilian Faithfull Homes) Mrs Barbara Ann Wilson Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th November 2006 Brief Description of the Service: Astell is a large attractive Victorian property, which has been adapted to provide comfortable accommodation for 36 elderly residents who require personal care. It is situated in a residential area, close to the centre of Cheltenham and to local amenities. The Home is owned and managed by a charitable organisation and is one of the Lillian Faithfull Homes. The fees for personal care range from £340 to £440 per week dependent on individuals assessed need, with a one off Capitation Charge of £5000 to secure tenancy. The fee is determined by whether the needs for care are high, medium or low and whether the accommodation has en-suite facilities. The fees do not include the cost of items such as newspapers, toiletries, magazines, chiropody and sundry items and there may be charges for some outings/trips. People are accommodated on three floors of the Home, accessed by a shaft lift. The majority of the bedrooms have en suite facilities. A variety of aids and adaptations have been provided throughout the property to assist people who are less able. Communal areas consist of a large comfortable lounge, which may be divided by screens to provide two separate rooms, when desired. There is also a pleasant dining room and small library, which may be booked for private use. The Home is maintained and decorated to a good standard. The Home has the benefit of enclosed well-maintained gardens. These are easily accessible and may be enjoyed by the people in pleasant weather. Astell DS0000016372.V347920.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. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This Key Unannounced inspection took place over one day in January 2008 and was completed by two inspectors. Twenty- two Key Standards for Older People were assessed on this occasion. Time during the inspection was spent speaking with the Registered Manager the Deputy, staff and people living at the home. Checks were made against the statutory requirements issued at the last key inspection, in order to assess the home’s compliance. A number of people living at the home were spoken to directly, in order to gauge their views and experiences of the service and the care provided at Astell. Some of the staff were interviewed. Comment cards were sent to the service for distribution prior to the inspection and seven relatives/representatives of people living at the home, two GP, who visits the home returned these, as did eight people who live at the home and six staff. Some of their comments feature in this report. Time was spent time cross-referencing information about the care and welfare gained from talking to and observing people with individual care records. A range of other records were examined to include accidents, staff files and training, quality assurance documentation and health and safety systems. The opportunities for residents to exercise choice and to maintain social contacts were also considered. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. The pre-inspection Annual Quality Assurance Assessment (AQAA) record was provided to the Commission from the Provider prior to the inspection. The quality and choice of meals was raised as an issue by the AQAA and this was in the process of being addressed. What the service does well: Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 6 Astell is a well managed home, provides a safely maintained and clean environment for people to live in, and offers a very welcoming atmosphere for visitors. People are admitted to the home on the basis of an assessment of their individual needs, although this continues to be developed. Upon admission each person has their own personal documented plan of care to address their individual needs. Many residents and their families spoke very positively about the care and attention they received from the staff. People said that the staff were kind, caring and wonderful’ and always willing. Several said that they ‘really liked them and got on well with them’. Another said that they were ‘always polite and nice’. Appropriate support equipment was in use in conjunction with individual risk assessments, there was evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of people receiving good care and support. Peoples’ privacy and levels of independence are respected and maintained as much as possible. Some of the residents’ relatives indicated that they too felt well supported and reassured by the home. People are reassured that the home takes any complaints and concerns seriously and does all it can to help them. There are policies and procedures in place for the protection of the vulnerable people, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies for those people wanting such a service. There are some good quality monitoring approaches adopted here, with residents and their families encouraged to have a say in how their home is run. Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place. The competence and skill of the staff group is developed through a structured training programme, and through ongoing training in topics relevant to the needs of the people living at the home. There is also a focus on the National Vocation Training programme for care staff. What has improved since the last inspection? Each of the statutory requirements for improvement issued at the last key inspection had been met. Some redecoration and refurbishment is ongoing within the home, in order to maintain the environment in good order for the people living here. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 7 Careplanning systems are much more consistent throughout the home and careplans now underpin the care practice within the home with minor amendments still required. 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. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 8 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 Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for prospective people and their representatives to make an informed choice before moving into the home. The home ensures that people are admitted to the home on the basis of a full assessment of their needs, ensuring that they can receive the care they require. EVIDENCE: The Home sends a comprehensive package of information to prospective people and ensures that all prospective people are seen and assessed prior to admission. The home offers visits to the home at times to suit individuals and ensures that the Manager or deputy are available to answer any questions. There is a pre-admission assessment that is documented to ensure that the needs of each person can be fully met. This is reassessed on admission. There have several new admissions to the home since the last inspection. Talking to two new people, they were well informed about the home prior to Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 10 admission and were assessed prior to coming in; ‘they knew what to expect when they came’. Individual care information was available in the home and was reviewed and updated regularly. Care records seen included an assessment of the persons’ needs prior to admission and on admission. The assessment was based on general information and on the activities of daily living in order to ascertain that needs could be met by the home. People may also receive an assessment from the community nursing service if they have a health care need. A plan for care is drawn up with each person and his or her representative based on the assessed need. People have contracts (not seen on this occasion) but it tends to be relatives / representatives or Social Services who deal with this and not necessarily the person who is to live at the home. This is due to the fact that some are unable to deal with this themselves or do not want to. The contract must contain all the required details and must be compliant with the Office of Fair Trading Standards. The fees for personal care range from £375 to £ 450 dependent on individual assessed need and the fee is determined by whether the needs for care are high, medium or low and type of accommodation. People spoken with confirmed that they were ‘happy at the home and they liked the carers and received the help and care they needed’. Respite care is provided but not intermediate care. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are treated with respect and dignity and are facilitated and supported by staff to live as fulfilling and independent lives as possible within their own limitations. Care records underpinned this but require some refinements but appear to involve the person/ their representatives and allow care staff to understand the person centred care individuals require. EVIDENCE: Care files were examined in detail and for specific detail of care. All had a full and informative assessments completed, based on the activities of daily living, which is reviewed regularly. The home has improved by ensuring that people and their family are involved in the care planning process and this was evidenced through signatory evidence, although not for all the aim is to have them all completed. Speaking and observing the people whose files were examined confirmed that the needs identified reflected their current care needs. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 12 All had care plans for the problems identified and this was reviewed on a monthly basis with the person and signed by them in some cases. Daily records were not completed for all people living at the home, it appeared that when there were problems or any day-to-day incident/event an entry was made, but several records examined had not had entries for a week or more. It is essential for the audit trail of care and incidents that an entry is made daily. The following care record refinements are required: • A daily entry must be made in the daily notes for everybody. • Where a person has a diabetic need a record of how frequently the BM test is being done must be care planned as well as who is doing it. The result must be recorded in the evaluation. • Where injections are being given for specific reasons this must be care planned and the frequency and who is doing this. The evaluation must record when it was last given. • All care documentation must be completed fully with nothing left blank. • Where a person is intermittently aggressive the care plan must state in detail how the care staff are to manage the person. Risk assessments were completed for ‘moving and handling’ and these were reviewed monthly. Where someone has been assessed as at risk of pressure damage, health professionals have been contacted and appropriate equipment provided and preventative measures implemented. Records of doctors and other multi -disciplinary health care visits are kept, these and conversations with people at the home confirmed visits from chiropodist, optician, dentist, Psychiatric nurse etc as required. Accidents and incidents were recorded and indicated that they were followed up and appropriate action was taken. But it was noted that all accident reports were still in the accident book these must be filed elsewhere in an audit file or on the personal file relating to the individual to comply with Data protection. Staff spoken with confirmed that they were fully informed about the needs of the people living at the home and how to meet their needs. People spoken with confirmed that they were very happy with the care received. Medication was examined at this inspection, a monitored dose system is in place and the responsibility for medication is delegated to the Deputy Manager. There are good records of medication in and out of the home and Medication charts are completed diligently with the correct information. But the following issues in a sample of 8 Medication charts were identified during the inspection:• Some of the written prescriptions from the dispensing Pharmacy were written in a confusing manner. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 13 On charts where medication had been handwritten there were no amounts documented or the item was not signed or initialled by the transcriber or witness. • There were gaps in the medication administration charts where medication should have been given raising queries as to whether it had been given or the person had refused. The supplying pharmacy has changed recently and the Manager is addressing some of the written instruction issues with the pharmacist. The Manager is to ensure the weekly medication audit is reinstated as practice is beginning to get inconsistent. Staff who dispense medication have been trained and need to be reminded of their responsibility. Doctors also review people’s medication when necessary and with some prompting at a minimum yearly. Some of the staff spoken with confirmed that they had attended medication training to an accredited level with a local college. At least five people are assessed as able and competent to manage their own medication or certain medication that they are prescribed. This is formally documented via a risk assessment. People appeared comfortable and appropriately cared for, with all speaking positively regarding the way in which they were looked after here. Many spoke of caring staff and good standards of care and attention, as did some visitors to the home. One resident said that ‘you couldn’t fault it here; it was just the best’. Others said, “The carers are excellent“ “I’m very happy here”, “Staff are very professional”, “wonderful carers, have become good friends”, “they come when I ring the bell”, “staff are well trained”. • Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have the opportunity to remain socially active, exercise choice, and have a nutritious diet that offers choice and variety. EVIDENCE: The AQAA states that a carer has been identified as activities organiser and has undertaken a one-day course specifically in this. She is supported by the Manager in organising trips and outings. It also stated that the provision of activities has increased, with community links within the local community enhanced for people, although transport has proven a challenge when trying to organise outings for them. A varied programme of social activities was available, with something held each day; people living at the home had been consulted about their ideas and suggestions for social activity and events. The programme is designed to meet a variety of abilities, tastes and interests, and included music and art therapy, entertainments and exercises, quizzes and games, and bus trips around local area and to local facilities. The diary seen makes comments about the quality of the activities. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 15 Staff endeavour to spend social time with people on a one- to- one basis who choose not to or are unable to join in socially when they have the time. There is a multi-denominational religious service held in the home each month, and people are given the opportunity to go out to the local church if they wish. Visitors were witnessed coming in and out of the home, and there were no restrictions placed upon them when spending time with their relatives. People were seen spending time in various locations around the home, in accordance with their wishes. Some were rather more reliant on the staff to assist them in this regard, but staff were mindful of this, and were heard offering choice to people, and being sensitive to their wishes. A number of people confirmed that they were freely able to choose what they did, with one saying that ‘there are no laws here’. Visitors to the home confirmed on surveys that people are supported to live their lives how they choose, with levels of independence respected. Many of the residents’ bedrooms contained personal belongings, and as a consequence appeared individual and homely. Eight people living at the home returned completed survey forms to us, and these showed that they were very satisfied with care and medical support they received; however all commented on the variable standard of food at the home. One said food could be better “it’s a bit hit and miss, one person said, “I dread going for lunch or dinner, I feel I have to eat something just to stay alive!” “I use those supplement drinks to help”, “vegetables are not fresh”, “catering manager is not helpful”, “The head cook can’t cook”, “cakes and pudding are normally hard or heavy”, “I buy my own soup so I can have it on days when the food looks worst”. At the time of publication of this report the Catering provision has been out to tender and a new contractor has been engaged by the company. The Chief Executive reports that the new contractors are providing a good level of catering to the people living at the home. All were positive about the Manager/staff and home one say she was so glad that she ‘came for respite glad I stayed’ and many saying ‘very good care’. One person said that sometimes the staff sometime forgot to come back and help her with writing. One person was negative about everything but it was difficult for us to follow this up as the survey was sent back anonymously. All said there were suitable social activities for them if they wanted to join in and that on the whole they were satisfied with them. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 16 One relative said that activities were poor and also said that staff were too busy to sit and chat and they do not have time to do the little jobs around the home eg: dead flowers left etc. Another said, ‘the care home okay, but they could answer the door quicker’. Seven visitors and relatives returned completed surveys to us, and five of these confirmed their satisfaction with the quality of the care given to their relative, with comments such as caring and dedicated staff, a caring and friendly home, ‘treat father with respect for what independence he has’ and‘ ‘impressed with home and staff and a very professional approach’. Two commented that ‘new staff lack skills and training’ and ‘everything done to the best of the staff ability. We looked at all the information and our judgement is that the home is still providing a good service and that they know what further improvements they need to make. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have confidence in the staff to help, and resolve their concerns, and are reassured regarding the policies protecting their rights and the prevention of abuse. EVIDENCE: The AQAA states that the Manager has an open door policy for people living at the home, relatives and staff and this was confirmed in discussions and via surveys received. The home had a clearly written and accessible procedure for addressing any concerns and complaints; a copy is issued to all residents and their families on enquiry or residency. No complaints have been received since the last inspection concerns are dealt with as and when they arise. There is a complaint record book to record any such events. The majority of people and their relatives confirmed that they knew how to raise complaints/ concerns if they had any, and that they had ‘faith in the Manager and staff to deal with any issues of concern’. Some said that if they had raised any they had been addressed to their satisfaction. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 18 The AQAA states that the Manager has attended POVA and other related training in the last year. The home had documented policies and procedures to address forms of abuse and whistle blowing, which were readily available for staff to read. The home also had useful guidance on Residents’ Rights, Risks and Restraint, as published by CSCI, the Department of Health guidance ‘No Secrets’, and the local council’s Safeguarding Adults Multi-Agency policies and procedures. Training in the newly introduced Mental Capacity Act would be invaluable to all staff and a copy of the easy-read version of this document for staff to have access too. Training is given about safeguarding vulnerable adults and prevention of abuse during induction and updates at regular intervals following this. All staff had received a training session in safeguarding vulnerable adults last year from records seen and from comments from staff it appeared that staff had an understanding of abuse issues, and what to do if they had any concerns. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in this home are provided with comfortable and generally pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: The AQAA states that the home has a supportive maintenance team daily who deal with all issues as and when they arise. This is auditable through the maintenance records. The home is refurbished on an ongoing basis with key areas of repair and redecoration programmed in. The roof has been lagged, handrails and paths replaced and aids and adaptations purchased. A new mini bus has been purchased with better suspension and a tail-lift to assist in facilitating greater access to trips for all people living at the home. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 20 There are plans to repaint all communal areas and re-carpet areas of the home, resurface the car park making it flatter and update the front of the building. In the longer term it is planned to improve bedrooms by making ensuite facilities larger. All areas of the home looked bright, clean and were well maintained. There were no odours detected. Everyone who responded to surveys were satisfied with the standards of cleanliness in the home. Clinical waste was correctly managed and there were good supplies of liquid soaps, paper towels, gloves and aprons for staff to use as part of the prevention of cross infection. The laundry systems were now improved to ensure good infection control practice from each floor to entry to the laundry system in the laundry room. The items were now appropriately received, segregated and washed in accordance with infection control measures. The home has a written policy on infection control and also uses the Department of Health Infection Control guidelines for Care Homes. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a currently stable and competent workforce, and can be assured by the home’s recruitment procedures, which are robust. EVIDENCE: The AQAA states that there had been a change to the care staff and promotion of carers to senior care roles via in-house training and supervision to enable the Manager to delegate specific responsibilities to them. Use of agency staff has reduced more recently due to recruitment of new staff allowing for greater continuity for people living at the home. During this visit it was reported that there is still use of agency on night shifts due to difficulties in recruiting but it tends to be the same agency carers who are used. The rotas demonstrate that there will generally be the Manager or Deputy or both with six to seven carers on duty each day, with two at night; these were consistent with staff on duty on the day of inspection. An ancillary team of cleaning, catering, maintenance, administration and laundry staff supports the care team, and the manager works in a supernumerary capacity; the deputy manager also has regular supernumerary days. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 22 The home is making progress with the National Vocational Qualification (NVQ) training programme for care staff. There are five care staff qualified to at least level 2 at this time, with another four still working towards it. Personnel files relating to staff were not examined as these are held centrally and there were no issues with recruitment processes at any of the company’s inspections. Records relating to induction and training were examined as these are held on site. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. The home has a designated training coordinator, who maintains records of training and development needed or completed for all staff. These records are available to the Manager via computer link to the central administration office. Records seen demonstrated the range of training undertaken, with different courses and learning available according to the person’s role in the home. There is a review of the training provision within the company at the present time and the Manager will keep CSCI informed of how training is to be provided in the future. All mandatory training is up-to-date. Training records demonstrated that new staff receive a structured induction training that is in line with the national common induction standards for care workers, and that they worked under supervision for this period; supervision records were seen in staff files. One new member of staff said that she had received relevant training to her role, a good induction, and was kept up to date with new ways of working. Two other members of staff spoken with confirmed that they received regular training updates and were able to alert the Manager when they felt they required training in areas of procedure or practice. Visitors confirmed on surveys that they considered staff to be appropriately skilled and experienced for their roles. Except for one who felt it ‘took a long time to train staff’. Astell DS0000016372.V347920.R01.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, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from respectful management, which strives to monitor quality and standards. EVIDENCE: The manager of Astell has managed the home for two years and has experience in providing care to older people in a variety of settings. She is registered with CSCI for her role, and has achieved the Registered Manager’s Award. The home’s first AQAA was completed to an adequate standard. Appraisal for all staff is undertaken yearly. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 24 Staff supervision records were seen and were good for the induction period but the ongoing supervision of staff appears to be adhoc and staff confirmed this. The Manager reports that she does supervision but it isn’t always with the staff being aware. It was discussed with the Manager that this needs reviewing, as all supervision should be documented to demonstrate compliance of six times a year and ensure an audit trail for disciplinary issues. Staff must also see what is written about them and sign it to say they have read it. Staff must receive ongoing supervision six times a year. The Manager must also ensure that she receives regular supervision. Staff meetings every three months or more frequently if needed. There are regular auditing arrangements as part of the quality control systems, and the Company has recently been re-accredited for the Investors in People Quality Award. The Chief Executive and Trustees carry out regular monitoring visits, producing written reports as required these need to be available to share with the CSCI and users of the service. The outcomes of CSCI reports are shared with the staff team. People/ Relatives and outside agencies who use the service were invited to participate in an annual survey, during which they could give their views and opinions of the service they had received. Action plans need to be drawn up relating to the outcome of this exercise with actions that are to be taken to address any particular areas. These need to be available to share with the CSCI. People living at the home are able to attend ‘House Meetings’, and recorded minutes of one of these demonstrated that people are consulted about their views, and could have a say in how their home is run. The home offered a safe system for looking after residents’ money and valuables if they wish, but they are generally encouraged to send valuables home with relatives. The home had written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training is provided for staff. Records showed that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. Fire drills for staff had been carried out regularly. Fire safety training for staff is comprehensive with practical instruction delivered, and instruction in evacuation procedures. There is a daily Fire Risk Assessment of the home undertaken by a Senior member of staff. Fire safety risk assessments for individuals are recorded in Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 25 the home’s Fire Risk assessment folder or in resident’s care files, although they were not examined on this visit. Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply have been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment had been undertaken in a timely fashion, and the associated records were kept in these areas. There was first aid equipment provided, and first aid training has been provided to the care staff and the manager in order to provide adequate first aid cover for the home. Accident records were maintained, with incidents monitored and audited, and examples of these were seen during the case tracking exercise with individual records. However, it was noted that all the accident records were still in the accident book this is not compliant with Data Protection and needs to be addressed. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 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 2 X 3 Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1 & 2) Requirement A copy of the reviewed and updated Statement of Purpose and a Service User’s Guide to be sent to the Commission. Timescale for action 30/06/08 2. OP7 15(1) 30/07/08 The registered person shall ensure that the following care record refinements are made: • A daily entry must be made in the daily notes for everybody. • Where a person has a diabetic need a record of how frequently the BM test is done must be care planned as well as who is doing it. The result must be recorded in the evaluation. • Where Injections are being given for specific reasons this must be care planned and the frequency and who is doing this. The evaluation must record when it was last given. • All care documentation must be completed fully with nothing left blank. • Where a person is DS0000016372.V347920.R01.S.doc Version 5.2 Page 28 Astell intermittently aggressive the care plan must state in detail how the care staff are to manage the person/situation. 3. OP9 13(2) The registered person must 30/06/08 make arrangements for the safe administration of medicines in the home: • Written prescriptions from the dispensing Pharmacy must be written clearly. • Where medication has been handwritten amounts must be documented and signed or initialled by the transcriber or witness. • All gaps in the medication administration charts must be accounted for by writing the appropriate code for non-administration. Provide Mental Capacity Act Training for all staff. The Registered person must produce an annual quality assurance report to evidence the review of the quality systems in the home. This must include internal and stakeholders’ views and future developments in the home. Supervision arrangements for all staff must be put into practice so that they receive supervision six times a year. Accident reports in the accident book must be filed appropriately to comply with Data protection. 30/07/08 30/12/08 4. 5. OP18 OP33 13(6) 24 (2) 7. OP36 18(2) 30/07/08 8. OP38 17(1a) 30/06/08 Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 29 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. 3. Refer to Standard OP18 OP33 OP33 Good Practice Recommendations Provide an easy-read copy of the Mental Capacity Act for staff to access. The Chief Executive and Trustees monitoring visits and reports need to be available to the CSCI and users of the service in the home. A quality assurance policy and procedure should be devised to detail how the systems are used within the home and how this affects the development of the service. Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Astell DS0000016372.V347920.R01.S.doc Version 5.2 Page 31 - 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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