Care Home: Ayresome Court

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What the care home does well Ayrerome Court provides people with a very homely, clean and a well maintained environment. Both the communal spaces and bedrooms are tastefully decorated with good quality furnishings.People living at Ayresome Court say they are cared for well by a very good staff team. There are opportunities for activities and there is an person appointed to arrange social and recreational events. People enjoy the meals provided and there is a choice as well as alternatives. What the care home could do better: There is the need to ensure that all staff have formal supervision at regular intervals as well as an annual appraisal. Care is needed to ensure that appropriate references are in place and prior to commencing of employment the ISA First must have been received by the service and there needs to be evidence of the supervision arrangement in place prior to return of the CRB. The two shower rooms needs to be cleaned and refurbished. There should be an action plan in place following internal inspections. The skill mix of the staff needs to be reviewed to ensure that there is sufficient skill mix of staff to meet the different needs of people living at the home. Random inspection report Care homes for older people Name: Address: Ayresome Court Green Lane Yarm Stockton-on-Tees TS15 9EH two star good service 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Jacqueline Herring Date: 1 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Ayresome Court Green Lane Yarm Stockton-on-Tees TS15 9EH 016427888280 016427888287 ayresomecourt@bondcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Angela Margaret Fellows Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross BC OpCo Ltd care home 43 Number of places (if applicable): Under 65 Over 65 43 0 old age, not falling within any other category physical disability Conditions of registration: 0 5 The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 43 Physical Disability, Code PD, maximum number of places 5 Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Ayresome Court is registered to provide personal and nursing care to forty-three older people. The home is situated on the outskirts of Yarm and is close to shops and a pub. Ayresome Court is a purpose built facility. There are two lounges, a dining room and a hairdressing room. All bedrooms are single in nature and all have ensuite facilities, which comprise of a toilet and hand washbasin. All bedrooms meet with size requirements of National Minimum Standards. Gardens and grounds to the front and rear of the property are accessible to people that use the service and well maintained. Care Homes for Older People Page 3 of 12 What we found: This inspection was a random unannounced inspection. It took place on 14 June 2010 and was completed in one day by two compliance inspectors. The purpose of the inspection was to look at a range of matters that effect the care, welfare and wellbeing of people living at Ayresome Court. During the visit we looked at a number of care records of people living at Ayresome Court, medication administration records, menus and information about activities. We also looked at staff recruitment records, staff training records and staff supervision records. We also looked at some maintenance and servicing information along with quality assurance information. We had a look around the home, spoke with people living there and relatives who were visiting, we also spoke to staff and the manager. The care files of three people living at Ayresome Court were looked at, there was evidence of assessment information being received from previous care establishment ie North Tees General Hospital and also that reviews of the care placement were taking place. Of the records looked at, one for someone who had recently been admitted, one for a person with personal care needs and one for a person with complex health and medical needs. Assessments of need were in place. Peoples physical and social assessment contained additional comments about the individual and their needs. A range of supporting risk assessments were in place, including among others nutritional assessments, risk of falls, pressure ulcer assessment and continence, these were being reviewed on a monthly basis. Care is needed for the use of bedrail as they are in use for two of the people whose records were looked at however only one had a risk assessment in place. Care plans had been developed for areas of identified need and the interventions were well described and gave staff the information they needed to care and support people. It was also identified the different roles and responsibilities of staff in some of the care delivery. All care plans are being evaluated on a monthly basis, care is however needed with the evaluations to ensure they are value based and reflect the effectiveness of the care being provided. Other supporting documentation was in place for example turns chart, nutrition charts and wound care records. In two of the care plans looked at, aspects of the interventions were no longer relevant and needed to be discontinued. There was evidence of other health care professionals being contacted when a need arose. There was input from GP, DNs, Chiropodist, Dentist, Speech and Language Therapy and Dietitians. The care records in place at Ayresome Court also have a social profile form. In one of the three care records looked at, this had not been completed and in all three, the life history Care Homes for Older People Page 4 of 12 of these people also had not been completed. There is an activities person, who records the activities that people are involved in, this is a coded system and does not include any meaningful comments about participation and enjoyment. One person said they enjoyed the coffee mornings. During the afternoon of the inspection there was a singer, people were enjoying this and were accompanying with musical instruments. The standard Southern Cross menus are in place, with alternatives meals being available. The complaints records were looked at, there have been no recorded complaints within the last twelve months. People spoken to confirmed they knew who to contact in the event they had concerns or wanted to make a complaint. The training matrix showed that staff had received training in regard to Protection of Vulnerable Adults and staff spoken to also confirmed this to be so. There is however the need to ensure that this topic is covered through the induction programme for new staff. Ayresome Court provides a clean, well maintained and homely environment for people. It is tastefully decorated, with good quality furniture and fittings. The shower room on the ground floor needs some attention, gloss paint is peeling and the fixture for the shower head is broken. The upstairs shower had mildew to the cladding. The rear garden is also in need of attention, however funds have been raised and an improvement project is underway. The recruitment and training files of four staff were looked at. Two were for newly employed staff and the other two were established staff, whose records we looked at specifically for training and supervision purposes. The files of the two new staff members contained completed application forms, references and Criminal Record Bureau checks. In one of the files looked at, this staff member had previously worked at Ayresome Court, however no up to date references were available on their file and there was no POVA First check, which there should have been as they commenced employment prior to the return of the CRB. The manager did say that this would have been obtained as staff would not commence employment without it. She was also sure that references had been obtained. This persons induction could not be evidenced. In the second file looked at, one of the references read as if the referee had worked with them in the field of care, however this was from a friend and this person had never undertaken care work before. This persons induction had all been completed in one day, which is of concern as there is a lot of topics to cover through the induction programme and particularly as this person had been involved in care work before this appointment. Training records were looked at in respect of the four staff. The individual training records are not up to date, however the manager has a separate matrix, which she continually updates. There is evidence to show that training has taken place but the actual system for recording this needs to be strengthened. Recent training has included; infection Care Homes for Older People Page 5 of 12 control, bed rail assessments, fire, moving and handling and mental capacity act. The manager said that they would update all of the training records and ensure there was a clear system in place. Areas of training that needed some further development is in relation to palliative care, for which plans are underway for the Gold Standard Framework. This is needed as Ayresome Court provides nursing care for people who require palliative care and end of life care. First aid training is also needed. People who live at the home spoke positively about the staff team. One person said, staff are very nice, they are always cheerful, do anything for you, they are all lovely. People also thought there was sufficient staff on duty and that the staff kept popping in to make sure that everything was ok. There is some concern about the skill mix within Ayresome Court as there is usually only one qualified nurse on duty and the current category of mix of people living there is twenty-three people receiving nursing and fourteen people receiving personal care. The qualified nurse is responsible for administering all of the medication, attending to peoples nursing needs such as specialist feeds and wound care for people receiving nursing care as well as attending to GPs and other matters that arise during the shift. At the moment although there are Senior Care Assistants in post they have not extended their role to include care duties that would support the qualified nurse such as administration of medication. The manager has the required knowledge, skill and experience, they are a qualified nurse and are registered with CQC. We looked at the staff supervision and appraisal system. The supervision matrix was not up to date and only showed supervisions for May and July 2009, and this was only for a proportion of the staff. The two new staff member whose files were looked at had not received supervisions since commencement of employment. Another member of staff whose file was looked, there was no evidence to show they had received supervision since 19/6/08. Another member of staff had supervision on 6/5/09 and 22/7/09 but none since. Other supervisions records looked at showed that four staff received supervision on 11/6/10. These were not individual supervisions, they were all the same. We were informed by the manager that she was in the process of bringing both the staff supervisions and appraisals up to date. Regulation 26 visits and Key Outcome Inspection Tool inspection reports were looked at. Whilst regulation 26 visits are taking place on a monthly basis there is no action plan developed as a result. The report states no action plan to review. There should be an action plan as following the Key Outcome Inspection of 26/11/09 the service was internally downgraded from green to amber. What the care home does well: Ayrerome Court provides people with a very homely, clean and a well maintained environment. Both the communal spaces and bedrooms are tastefully decorated with good quality furnishings. Care Homes for Older People Page 6 of 12 People living at Ayresome Court say they are cared for well by a very good staff team. There are opportunities for activities and there is an person appointed to arrange social and recreational events. People enjoy the meals provided and there is a choice as well as alternatives. 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 2. Care Homes for Older People Page 7 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 12 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 21 23 The two shower rooms must be thoroughly cleaned and redecorated. This will ensure that people who use the showers are provided with a clean, well maintained environment. 30/07/2010 2 27 19 The manager must obtain up 30/07/2010 to date references when new staff are appointed, whether they have worked at the home previously or not. This will ensure that thorough recruitment practices are in place that protect people who use the service. 3 36 18 All staff must receive formal 27/08/2010 supervision at least six times per year. This will ensure that staff are provided with the support they need to fulfill their job role. 4 38 18 All staff must receive 27/08/2010 Page 9 of 12 Care Homes for Older People 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 training that is appropriate to the work they are to perform. There must be sufficient staff employed at the home that are trained in first aid. This will ensure that peoples needs are being met by staff who have the appropriate knowledge, skill and experience. 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 8 In the event that bed rails need to be used to ensure peoples safety there should be a multi disciplinary risk assessment in place for all such people. The activities records for individuals should be developed further to include among other areas, enjoyment or not of the activities and level of participation. Peoples social assessments and life history information should be completed as this will provide information that needs to be taken into account when arranging activities. 2 12 3 4 18 27 All new staff should receive protection of vulnerable adults training. The skill mix of the staff team should be reviewed to ensure that it is appropriate to fully meet the differing needs of people living at Ayresome Court. The planned palliative care/end of life training should take place and an appropriate number of staff should complete this training. The information from internal audits, regulation 26 visits and other audits should be cross referenced and should Page 10 of 12 5 30 6 33 Care Homes for Older People 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 result in action plans that details actions to be taken for improvements and timescales for compliance. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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