Care Home: Athelstan House

What the care home does well Staff have a good awareness of some individuals` needs and they treated people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. Lavender unit is comfortable, tastefully decorated and furnished to a very good standard. It provides a safe, peaceful and well-maintained environment. The unit has good resources and facilities including up to date aids and adaptations. This helps enable people with disabilities to maximise their independence. The unit is well organised and managed by an effective, stable management team is working hard to promote the views and interests of all people who use the service. In order to identify strengths and weaknesses the unit has good systems in place to audit the services they deliver. Any provisions required to improve the services are actioned immediately and we saw clear audit trails of how these are met and constantly reviewed. What the care home could do better: The unit must actively promote individual`s` to exercise choice and control over the lives they choose to live by providing person centered planning. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Athelstan House Priory Way Burton Hill Malmesbury Wiltshire SN16 0EQ one star adequate service 25/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Wendy Kirby Date: 2 1 0 3 2 0 0 9 Information about the care home Name of care home: Address: Athelstan House Priory Way Burton Hill Malmesbury Wiltshire SN16 0EQ 01666848000 01666829562 manager.athelstan@osjctwilts.co.uk www.oxfordshire.gov.uk 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) : The Orders Of St John Care Trust care home 80 Number of places (if applicable): Under 65 Over 65 0 0 80 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 10 5 0 The maximum number of service users who can be accommodated is 80. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum of 10 places Mental Disorder (Code MD) - maximum of 5 places Old age, not falling within any other category (Code OP) - maximum of 80 places Date of last inspection 2 5 1 1 2 0 0 8 Care Homes for Older People Page 2 of 10 Brief description of the care home Athelstan House is a purpose built eighty bed care home which provides a range of care and nursing services. It is situated in close proximity to the amenities of the local town, is on a bus route, and is managed by The Orders of St John Care Trust. The home offers six nursing care places for Primary Care Trust referrals, twenty reenablement places for service users requiring help after discharge from hospital, four respite places, and long term nursing and residential care, including care for people with mild to moderate dementia. Accommodation is provided in single rooms with ensuite bathrooms and is situated on two floors. Assisted bathing facilities in communal bathrooms, spacious lounges and dining areas are provided throughout the home. All areas are accessible and a shaft lift is provided. There are large and attractive gardens surrounding the home. Information about the home is available in the Service User Guide which is issued to prospective residents. A copy of this first CSCI report will be made available in the home for anyone to read. The charges for Athelstan House are comprehensive and are based on the type of care and accommodation being provided. The overall fee range is between five hundred pounds and one thousand pounds, with individualised fee information available from the home. Hairdressing, Chiropody, Newspapers and Toiletries are charged at individual extra costs. Care Homes for Older People Page 3 of 10 What we found: We conducted an unannounced Random inspection on a Saturday morning, which lasted approximately four hours. Prior to the inspection we looked at various pieces of information to gather evidence in preparation for our visit. This included the previous inspection report and the homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The reason for this inspection was to: Look at the staffing levels between 8am and 2pm on Lavender unit. To see if there were sufficient staff deployed to meet the dependency levels of the people living in the home. To see if peoples wishes were respected and that they received care and meals in a timely manner. The following information outlines what we found and the subsequent outcome of the visit. There was an agency RGN on duty and four carers on the rota, one staff member had overslept so one came from another unit in the home in the interim. There were fourteen people living on Lavender at the time of our visit. We were told that two people were poorly and nine required two carers for all personal care and transfers. The RGN had worked previous shifts in the home and was knowledgeable about peoples needs, she told us that she enjoyed working ON Lavender and that she felt people were looked after well. The atmosphere was calm and peaceful and all carers on duty seemed happy and cheerful, they all came individually to say good morning and introduced themselves to us. At 10.15am only 4 people were left to get washed and dressed and they had had their breakfast. We spoke to two ladies in the dining room who were enjoying a peaceful breakfast, but felt that 10.40am was a bit late to start breakfast in light of morning coffee and then lunch at 12.30pm. One lady said, I would prefer to get up between 8 9am but it really depends where you are in the line as to when they get you up. We looked at the care files, which did not indicate what time people preferred to get up. The care plans were not person centered particularly around daily routines and they did not tell us how people living in the home would like to live their lives. We spoke with staff who were able to tell us what some people preferred in the home. They told us that some liked to have breakfast in bed on a weekend and that some preferred to be up washed and dressed before having breakfast. However none of this was evidenced in the care files and staff admitted that they didnt know personal Care Homes for Older People Page 4 of 10 preferences, likes and dislikes for all the people in their care. At 11am the newly appointed Head Nurse for the home and the unit head for Lavender both arrived at the home to assist us during our inspection. We discussed what we had found and they told us that they were in the process of introducing a new care file system in the home because they were not happy with the existing format. They told us that they had also looked at the care documentation and had identified weaknesses including the lack of person centered planning. All staff have will receive training on planning person centered care and how to develop the new system with the people living in the home . The Head Nurse and Unit Heads will be auditing the care files and talking to people living in the home. Written feedback will be given to staff following the audits and any other action required including any additional training. We spoke with all staff on duty about concerns that had been raised regarding previous staff shortages. Staff agreed that approximately five weeks ago staffing levels had been poor, for several different reasons. The home had an outbreak of sickness, including Flu and many staff had been off sick. In addition to this many staff had outstanding annual leave to take before the end of March. Staff told us that the home will always endeavor to get agency when people are absent, however at short notice they cant always get cover. When they have managed to supply the home with agency, travel time to the home can sometimes mean that the agency might not arrive until two hours into the shift which can compromise delivering care in a timely manner in order to fulfill peoples wishes. All staff agreed that things had improved and that four carers were always on duty, both the Head Nurse and Unit Leader told us that staffing levels do increase should dependency levels change. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 10 The unit must actively promote individuals to exercise choice and control over the lives they choose to live by providing person centered planning. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered manager 31/01/2009 must ensure that all aspects of residents care plans are written in full on the basis of all of their needs. This is to show in detail how the residents needs are to be met in relation to the management of wound dressings and any communication needs, in order that there is clear direction for staff when delivering care. 2 9 13 When any medication is 31/12/2008 administered to people who live in the home it must always be clearly and accurately recorded. (This particularly relates to records for prescribed treatments applied to the skin). This is to help to make sure people receive their prescribed medication correctly and to help reduce risks of mistakes. 3 9 13 Make arrangements for all 25/12/2008 medicines for six people living in the home identified at the inspection to be available and administered in accordance with the doctors Page 7 of 10 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action directions. Obtain advice from the doctor about managing the doses of medicines already missed on 24th November 2008. This is to reduce the risks to the health and wellbeing of these people that may be caused because you have not administered the medicines in the way the doctors have prescribed. 4 9 13 Take action to make sure 31/12/2008 that there are effective arrangements in place to monitor stock levels and to reorder medication and prescribed items in sufficient time. This is to protect people from risks of not having their prescribed treatments available when needed. 5 14 12 The registered manager 31/01/2009 must review the working arrangements on Heather and Foxglove units to ensure that there are sufficient resources to help residents rise in the mornings at a time that is acceptable to them. This is so that residents can exercise choice in all aspects of their daily lives, including when they can get up in the mornings, rather than when the work dictates they can. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The Registered person shall 06/07/2009 enable people to make decisions with respect to the care they want to receive and their heath and welfare, by providing person centered planning. This will actively promote individuals to exercise choice and control over the lives they choose to live. 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 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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