Inspection on 14/06/06 for Ar-lyn

This inspection was carried out on 14th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ar-lyn 09/02/10

Ar-lyn 19/05/09

Ar-lyn 27/05/08

Ar-lyn 24/01/06

Ar-lyn 30/06/05

Ar-lyn 18/01/05

Ar-lyn 28/07/04

Ar-lyn 12/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ar-lyn Vicarage Lane Lelant St Ives Cornwall TR26 3JZ Lead Inspector Ian Wright Key Unannounced Inspection 8:30 14th and 15th June 2006 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 Ar-lyn DS0000008949.V296264.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. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ar-lyn Address Vicarage Lane Lelant St Ives Cornwall TR26 3JZ 01736 753330 01736 759223 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) Mr Peter Hubert Oxley Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Ar-lyn is a large detached property set in its own grounds in the village of Lelant near St Ives. The registered provider is Mr P H Oxley. The home provides personal care for up to 13 elderly people. There are nine single and two shared bedrooms situated on both the ground and first floors. There is a step at the main door; a ramped entrance is provided at a side door. A stair lift provides access to the first floor. The communal rooms are situated on the ground floor. Toilets and bathrooms are located on each floor. There are extensive secluded gardens around the home which house a range of aviaries and small caged animal enclosures. The garden provides seating areas for service users. A copy of the inspection report is not currently on public display, and it is suggested a copy is requested from management if required. The range of fees at the time of the inspection is £293-£325 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection took place in thirteen and a quarter hours over two days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track four service users. This included interviewing the service users about their experiences and inspecting their records. • Interviewing two staff about their experiences working in the home. • Discussion with other service users, their relatives and staff. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: Care in the home is to a very high standard. There are however three statutory requirements. Firstly, although medication is generally well managed, all medication must be always locked away unless it is being administered. Staff should avoid touching medication when they are administering it; for example they should use a medication pot to hand tablets to service users. Secondly, training required by regulation needs improving. This includes infection control and moving and handling training for all care staff. First aid Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 6 and food hygiene training also needs to be provided as necessary. It would be helpful if staff had some formal training regarding dementia, although staff do seem to care for service users with this diagnosis well. 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. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 7 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 Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Service users are issued with either suitable terms and conditions of residency or a social service contract at the time of admission. This enables service users to be aware of their rights and responsibilities. The pre admission assessment procedure is good and enables the registered persons to ascertain they can meet the needs of service users before admission is arranged. EVIDENCE: Copies of resident contracts (if privately funded) were available for inspection. Service users funded by statutory authorities only receive a social services contract. Mr Oxley or a senior member of staff assesses service users before they are admitted. Service users confirmed they or their relatives visited the home before formal admission was arranged. Service users said an assessment was completed before admission was arranged. Copies of assessments were available for inspection in service user files. It is suggested contemporaneous notes of pre admission assessments are retained for inspection. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this area is generally good. The judgement has been made using available evidence including a visit to the service. All service users have a suitable care plan which is regularly reviewed. This provides a basis for consistent care being delivered by staff. Healthcare support seems appropriate so service users can be assured they will receive suitable support from medical practitioners. The operation of the medication system is adequate, but some improvement is required regarding storage and administration of medication. Staff work with service users in a manner which respects their privacy and dignity. Issues regarding the diverse backgrounds of service users appear suitably addressed. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. The care plan format is suitable and care plans are regularly reviewed. Service users did not seem aware of their care plans but were happy with how care is delivered, and staff methods of delivering care are agreed with them. Service users said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. Service users said doctors are called when necessary. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 10 The registered providers have a satisfactory medication policy. Medication is administered from original packages transferred to dossetts. Although CSCI inspectors discourage secondary administration, (transferring medication from original containers), the system has been approved by the registered provider’s pharmacist. The registered provider said he is vigilant in checking medication is correct, and the system appears to work satisfactorily. Some service users also self-administer medication. Storage of medication is generally satisfactory, but dossetts for the day’s medication need to be stored in a secure place e.g. a locked cupboard. When staff administer medication they should administer medication e.g. via a medication cup, to avoid touching the medication. Staff have received suitable training regarding the storage and handling of medication. Service users said they felt staff worked with them in a manner which respected their privacy and dignity. All service users were very positive about their care. For example service users comments included that staff were ‘absolutely wonderful’ and ‘you cannot fault’ the home. All service users confirmed there were no abusive practices. There are currently no service users from ethnic minorities, although the registered providers stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from a ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Routines are individualised so service users can live a lifestyle according to their wishes and needs. Visiting arrangements are flexible. Arrangements to assist service users with their finances are satisfactory so service users can maintain choice and control over their lives. Meals are provided to a high standard, so service users are provided with a choice of wholesome and nutritious food. EVIDENCE: Service users said they could get up and go to bed when they wished, and staff were observed assisting service users to get up throughout the morning. Some service users spend the majority of their time in one of the lounges, while others choose to spend the majority of their time in their bedrooms. There are some organised activities available for example an occasional trip out and a regular entertainer. Service users are involved in knitting and various crafts. Service users are encouraged to participate in community events such as producing crafts for local fetes. The home has regular parties and a big effort is made to celebrate Christmas. Last Christmas service users put on a show for visitors and relatives, in which all service users participated. The event was reported on Radio Cornwall. Service users seemed happy how they spent their time. A visiting library service is offered. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 12 Service users said they could receive visitors when they wished. The inspectors spoke to several service users relatives who were all very positive about care. One relative said they ‘cannot rate the home highly enough’ and another said they were ‘very impressed’ by the care their mother received. Religious services take place at least on a monthly basis. The registered provider said he looks after small amounts of money on behalf of some service users. These are kept securely and suitable records are kept. Service users said they were happy with financial arrangements. Some service users look after their own monies or these are managed by their relatives / legal representatives e.g. via power of attorney arrangements. Service users are also provided with safety deposit boxes to store small amounts of money and /or valuables. Service users said they were able to bring small items of furniture and their belongings to the home. The inspector shared a meal with service users on both days of the inspection. On the first day this was roast pork followed by Bakewell tart. On the second day of the inspection Cornish pasties were provided followed by fruit and ice cream. Both meals were to a high standard, consisted of fresh produce, and quantities varied according to individuals’ appetites. Both meals were leisurely, with appropriate support provided by staff to help individuals. All service users said they enjoyed the food provided. Although there is not a choice of main meal, service users said staff are well aware of preferences and it was evident that an alternative was provided when requested. A choice of breakfast and evening tea is provided, and service users said drinks were available throughout the day. Special diets (e.g. pureed meals) are provided as required. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered providers have suitable procedures regarding complaints and adult protection, so service users and their relatives have suitable redress if they have an allegation of abuse, a concern or complaint. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say who they would approach if they had a complaint or were concerned about abuse. The registered provider said all staff were required to read the adult protection policy when they commenced employment. Staff are encouraged to attend courses regarding adult protection although available places are limited. Staff and service users all said they had not witnessed any bad or abusive practices. All staff have a Criminal Record Bureau / Protection of Vulnerable Adult check. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Ar-lyn provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. There is a pleasant garden, which service users can use. Garden furniture is provided outside for service users benefit. All communal rooms are homely and comfortable, and bedrooms are individualised and comfortable. A stair lift is provided for service users to gain access to the first floor. There are two bathrooms which both have a bath lift to enable access. The bathroom doors were not lockable, although both contain a toilet. However the registered provider said bathing is always supervised and there is a sign on both bathroom doors to state when the facilities are vacant or engaged. The kitchen is satisfactory and suitable laundry facilities are provided. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this area is adequate to good. The judgement has been made using available evidence including a visit to the service. There appears to be satisfactory numbers of staff on duty, although the registered provider is trying to recruit further staff. Recruitment checks are satisfactory so service users can feel the registered provider makes every effort to check they are in safe hands. Evidence of training needs improvement. Staff must receive appropriate training as required by regulation so service users can be assured staff have suitable skills to cater for their needs. Equal opportunities issues regarding recruitment and work practices seem appropriately addressed. EVIDENCE: Rotas show there are at least two members of staff are on duty until 1800. One care assistant is on duty from 18:00 until 23:00. They are however supported by the registered provider, and head of care who both live on the premises. The registered provider and head of care, sleep in each night. The registered provider said the ‘sleep in’ arrangement is kept under review, and a risk assessment is completed regarding this issue. The registered provider said where service users are, for example, unwell a waking night member of staff is provided. This arrangement will need to be kept under review, for example if the profile of people admitted to the home is of increasing dependency a waking night member of staff will need to be provided. However the arrangement is currently acceptable. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 16 The registered provider has a suitable approach to providing National Vocational Qualifications for care staff. The inspector spoke to one member of staff who said they had just completed an NVQ 2 and wishes to commence an NVQ 3 shortly. Evidence of training required by regulation is variable. Staff files inspected show some gaps in training required by regulation. All staff need to receive training in infection control, and manual handling. If staff handle food (e.g. from making a sandwich) they must receive suitable external training e.g. a food hygiene certificate. There must always be at least an ‘approved first aider’ on the premises at all times. Records show all staff appear to receive fire training delivered by the registered provider. The inspector suggests staff complete short courses e.g. from the health promotion agency / primary care trust (infection control), St John’s Ambulance (first aid), local college (food hygiene). This should meet regulatory requirements. Some service users are becoming increasingly confused and / or have been diagnosed with dementia. Subsequently staff should be provided at least with a short course in dementia so they can develop further understanding of these peoples’ needs. However staff approaches to working with people with dementia were observed to be to a good standard, and the Head of Care said she had extensive experience in this area. Suitable evidence must be available to demonstrate staff have received appropriate training. For example copies of certificates. Recruitment records were also inspected. Recent recruitment records were to a good standard. All staff had a criminal records bureau check, and a protection of vulnerable adults check. The CRB / POVA check number needs to be maintained after the disclosure certificate is destroyed. There is a copy of an induction checklist on some staff files inspected. The registered provider has appropriate policies regarding equal opportunities and anti discrimination. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this area is adequate to good. The judgement has been made using available evidence including a visit to the service. The registered provider appears to be suitably experienced and skilled so service users can be assured the service is well managed. The registered provider operates a suitable quality assurance system. The registered provider’s approach to handling service users monies is satisfactory, so service users can be assured their financial interests are safeguarded, where the registered provider is involved in this area of their lives. The management of health and safety issues is generally good, although improvement is required regarding health and safety training, and to ensure gas appliances and the boiler are tested annually. EVIDENCE: The registered provider appears to be approachable, competent and has appropriate experience to manage the care home. The registered provider, Mr Oxley, does not have an NVQ 4 in management or care. Due to his experience, the quality of management, and other circumstances agreed with the Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 18 Commission, CSCI has decided Mr Oxley does not have to obtain these qualifications. The staff the inspector spoke to said the provider is good to work for, and provided sufficient guidance and support to help them to do their jobs. Relatives of service users were positive about the registered provider’s approach. Service users found the registered provider supportive and approachable. One service user said the registered provider and head of care ‘give their all’ to provide a good service. The registered provider has a suitable quality assurance policy, and an annual survey is completed to ascertain service users’ views of the service. It is clear service users are regularly asked their opinions. All the service users, who the inspector spoke to, said they would have no hesitation approaching the registered provider or staff if they had a problem, and felt the problem would be put right. The registered provider looks after some service user monies for which appropriate records are kept. They said the service user / their representative/ next of kin is invoiced for any agreed expenditure. The inspector also spoke to several ‘next of kin’ of service users who paid fees for their relative. They said invoicing was clear and there was no issues regarding this. The registered provider does not act as an appointee or agent for service users benefits. The registered provider has a suitable health and safety policy. Records of health and safety checks are generally satisfactory. For example there are suitable checks regarding fire, moving and handling, and electrical equipment. A fire risk assessment has been competed. Suitable procedures are in place regarding testing water storage to prevent Legionella. The accident book is maintained, and there does not appear to have been any issues of concern. The registered provider has an adequate system of health and safety risk assessment. Although risk assessments have been reviewed, they will soon need completely rewriting as records are dated. The home has central heating. The registered provider is aware the system needs to be serviced and a landlord’s gas safety certificate needs to be obtained. This must be completed on an annual basis. There are some gaps in health and safety training are highlighted in the ‘Staffing’ section of the report. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 19 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 20 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 OP9 Regulation 13 Requirement The registered provider must ensure: • Medication is always kept in a secure place e.g. a locked cupboard. • Staff avoid touching medication when it is administered e.g. via a medication cup. The registered provider must provide staff with suitable training to do their jobs and meet regulatory requirements. Suitable evidence of training must be maintained. Training must include food handling (if food is handled), infection control, first aid (i.e. there must always be a member of staff qualified to appointed person level on duty), manual handling. Staff must also have training in dementia awareness. The boiler and gas appliances must be tested on an annual basis Timescale for action 01/07/06 2 OP30 OP38 13, 18 01/12/06 3 OP38 13, 23 01/08/06 Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 21 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. Refer to Standard OP3 Good Practice Recommendations Contemporaneous notes of pre admission assessments are retained for inspection. Ar-lyn DS0000008949.V296264.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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. 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