Random inspection report - Care Quality Commission

Random inspection report
Care homes for older people
Name: Allington Court
Address: Lye Lane
Bricket Wood
St. Albans
Hertfordshire
AL2 3TN
The quality rating for this care home is: two star good service
The rating was made on: 01/10/2009
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: Date:
Patricia House 0 3 0 3 2 0 1 0

Information about the care home
Name of care home: Allington Court
Address: Lye Lane
Bricket Wood
St. Albans
Hertfordshire
AL2 3TN
Telephone number: 01923894542
Fax number: 01923894544
Email address: sylvestj@bupa.com
Provider web address: www.bupa.com
Name of registered provider(s): BUPA Care Homes (BNH) Ltd
Name of registered manager (if applicable)
Type of registration: care home
Number of places registered: 44
Conditions of registration:
Category(ies) : Number of places (if applicable):
Under 65 Over 65
dementia 10 44
Conditions of registration:
Date of last inspection 0 1 1 0 2 0 0 9
Brief description of the care home
Allington Court is registered to provide accommodation and nursing care to 44 older
people with dementia, 10 of whom may be below 65 years of age. It is owned and
operated by BUPA Care Homes Limited and is situated in extensive grounds, adjacent
to another BUPA care home, in a semi-rural location in the village of Bricket Wood,
within easy access of the M25 and M1 motorways.
There is ample parking space provided at the front of the building.
The home was purpose built for this service user group and is in the form of a hexagon
with two internal courtyards, which, together with the attractive and secure grounds
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Brief description of the care home
provide ample additional communal space where service users can walk and exercise,
or simply sit and enjoy the gardens and views.
All service users are accommodated in single rooms and there are four lounges, an
activity room and dining room.
There is an information folder/Service User's Guide in the reception area of the home,
which includes contact details of the Care Quality Commission, (CQC), and information
about charges for the home. The last CQC inspection report and the home's Statement
of Purpose are displayed in the home's reception area and copies are also available on
request.
Current weekly fees start at £995 and are calculated according to need. Additional
charges apply for hairdressing, personal toiletries and newspapers and for any
chiropody, dentistry and optician services where these are subject to charge.
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What we found:
This random inspection took place on 3rd March 2010 with Patricia House and Sheila
Knopp, Regulation Inspectors, in order to assess the progress made in implementing the
requirements made in the report of the last inspection visit. A new manager and deputy
manager have also been appointed since the last inspection.The inspection took place on
one day and the inspectors spoke with staff, visitors and residents, where they were able
to make a response.
One new domestic worker has been appointed since the last inspection visit but currently
the home has vacancies for five full-time equivalent registered nurses. The manager said
that despite this shortage, only appropriate candidates would be appointed and that, in
the meantime, only agency nurses who have worked at the home previously, would be
used. This is so that the residents receive care from staff who know them and know the
procedures in the home and can provide continuity of care.
What the care home does well:
The staff we spoke with praised the new manager and said they found her approachable
and thorough in dealing with any issues which arose. The staff said that standards were
continuing to improve at the home. We spoke with the manager and the new deputy and
found that they had already identified the issues of concern we noted during the visit and
had planned a variety of actions to respond to these issues. The two managers clearly
work as a team and have also restructured the whole staff team in order to ensure all
members of staff receive adequate support and supervision. The home now has senior
and junior nurses in place as well as senior care workers.
A new domestic worker had been appointed so that hygiene standards can be maintained
in the home and there are now three activity co-ordinators working in the home. We
spoke with one co-ordinator and saw the wide range of activities they have planned which
cover each day of the week. The home also has very large wipe clean boards which
clearly set out the activities offered for that week.
A wide range of equipment has been provided for the benefit of the residents so that
appropriate activities can take place and so that residents can receive appropriate
stimulation. Some changes have also been made to the environment and there are more
pictures on the walls of communal areas and memory boxes have been positioned outside
bedrooms to enable residents to find their own rooms and remain as independent as
possible. The television in one lounge has also been repositioned so that more residents
are able to see and hear the programmes they are interested in.
We checked the complaints records and saw that the only complaint recorded since the
last inspection had been appropriately and thoroughly dealt with.
What they could do better:
We checked the records of participation at activities for the previous week and saw that
there were regularly only five or six people taking part in the organised events. This
means that most of the residents remain in the communal lounges, or their bedrooms,
and as there are usually only two co-ordinators on duty at any one time, care staff should
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inevitably be involved with providing stimulation for the remaining residents. The activity
co-ordinator has discussed residents' preferences and choices with their relatives and has
produced individual files so that staff can be aware of the things people enjoy and might
want to take part in. There is a lot of equipment around for staff to use with residents but
we were told that, as yet, care staff are not using this equipment or engaging with
residents in a meaningful way. We saw care workers and some nurses walk through
lounges where residents were sitting and make no eye contact or acknowledge the people
there. Two visitors told us that their residents are sometimes left alone in lounges for
long periods and we saw residents left alone in lounges during the inspection.
The manager is aware of these issues and has planned a rolling training programme for
staff to address these working practices.
We tracked a selection of care plans and found that although most appropriate
information was recorded, the plans were quite confusing and information took some
time to find. However, we saw evidence that the manager has already started to edit the
planning and said she will be introducing a new format for care planning. Some reviews
of care needs however had not been kept up to date and the planning for people with
additional mental health and learning difficulty needs also required more detail to ensure
staff are aware of how to meet individual needs. Some records showing people's weight
loss did not show how this concern was being monitored in practice. At the previous
inspection the manager at that time had introduced care plan summaries or "information
sheets" detailing the daily needs of each resident. These sheets are positioned behind
bedroom doors so that all staff are aware of individual care needs. However one member
of staff said they were not aware of this information and we saw that one resident was
brought to the lounge by a care worker without their glasses and zimmer frame despite
this equipment being noted as essential on the information sheet.
The manager has introduced a new staffing structure in order to address the staff care
practice and two of the nurses and a senior care worker were attending a care planning
course on the afternoon of the inspection. The manager said that they would then begin
to cascade this training to staff through the home.
Two of the visitors we spoke with also commented that they often find their relatives still
in bed at 11am, despite being ready to get up. The visitors felt that staff were not
assisting these people to get up when the wanted, and as they were going to bed quite
early, they were going for long periods without food or drink. The manager said this
concern would be addressed. Current guidelines for elderly people are clear that people
should not go for longer than 12 hours without food and drink for the benefit of their
health.
Currently there are areas of the home is in need of some redecoration and refurbishment.
The chairs in communal lounges are generally very worn and some have torn covers.
These need replacing soon and the manager said this upgrade was due to happen soon.
The sink in the laundry is old and broken and has not yet been replaced but the manager
said this was due to happen the following week. The home has no treatment room and
the clinical room is in urgent need of refurbishment to ensure that staff can continue to
provide appropriate care services in a safe and hygienic environment.
As already noted, the issues of concern raised at this inspection, have already been
identified by the manager and are currently being addressed. The area manager also
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makes regular visits to the home and is involved with the changes being made.
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.
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Are there any outstanding requirements from the last inspection?
Outstanding statutory requirements
Yes R No £
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 12 16 A suitable range of activities
and stimulation must be
provided for all residents in
the home on a daily basis.
This requirement has been
partially met. A new due
date has been made. This
requirement has been carried
forward as continues to be
addressed. An new due date
has been made.
This is to ensure that
adequate stimulation is
provided so that all residents
are able to enjoy their lives
as fully as possible.
01/05/2010
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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 19 23 The clinical room in the home
must be refurbished.
This is to ensure that staff at
the home can provide care
and nursing services to
residents in a safe and
hygienic environment.
2 33 26 Regulation 26 reports must
be sent to the Commission.
Recommendations
This is to assess the progress
being made to address the
issues of concern in the
home.
01/05/2010
01/05/2010
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
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Reader Information
Document Purpose: Inspection Report
Author: Care Quality Commission
Audience: General Public
Further copies from: 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
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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:
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Email: enquiries@cqc.org.uk
Web: www.cqc.org.uk
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Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced
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