Inspection on 24/01/06 for Ar-lyn

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ar-lyn 09/02/10

Ar-lyn 19/05/09

Ar-lyn 27/05/08

Ar-lyn 14/06/06

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 Richard Coates Unannounced Inspection 24th January 2006 09:15 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.V270620.R01.S.doc Version 5.1 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.V270620.R01.S.doc Version 5.1 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.V270620.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: Ar Lyn is a large detached property set in its own grounds in Vicarage Lane off the main road in the village of Lelant. The registered provider is Mr P H Oxley. The home provides long-term, short-term and respite care for older persons requiring personal care. There are nine single and two shared bedrooms and these are situated throughout 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. The provider sets out the aims of the home and the services and facilities provided in the Statement of Purpose. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned unannounced inspection. The aim was to review compliance with the recommendations set in the last inspection report, dated 30 June 2005, and to focus on key standards in the areas of care planning, daily life and social activities, and the environment. The last announced inspection report included the key national minimum standards not inspected in this report; some standards have been included in both reports. The inspector was on the premises for seven hours. The methods used were discussion with the providers, staff and residents, inspection of records and documents and inspection of the premises. The inspector is grateful to the provider, staff and residents for their assistance in completing the inspection. What the service does well: What has improved since the last inspection? The duty roster details more clearly which staff are on duty. Staffing levels in the early morning have been increased to meet the needs of residents. Care plans and risk assessments pay increased attention to the risk of falls where Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 6 this is appropriate. The registered provider has acquired and is about to provide with accompanying instructions, a record of visitors as required by regulation. The gas boiler has been replaced and re-installed in the basement, which is a more suitable site than the kitchen where it was previously. 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. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 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.V270620.R01.S.doc Version 5.1 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): These standards were included in the last inspection report. EVIDENCE: Case tracking two recently admitted residents showed that the commissioning authority had provided assessment summary information and the provider had completed appropriate needs assessments. Both residents knew the home through attending day care. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 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 and 8 Written care plans direct and inform staff about how to meet the residents’ health, personal and social care needs. Some areas of care planning require further development. The healthcare needs of residents are monitored and addressed so that their needs are met. EVIDENCE: The other key standards in this group were included in the last announced inspection report. The records for two recently admitted residents were case tracked in detail. The records for other residents were also inspected. These contained written care plans setting out the actions needed to meet the residents’ physical, emotional and social needs. There was some evidence from the contents of daily records that the care plans did not detail all the care needs of each resident. Care plans were signed and dated and there were regular recorded reviews. Care plans included interests and activities, and family contacts. Records included basic moving and handling assessments and an assessment of risk of falls where this was appropriate. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 10 Residents reported consistently that they received care of a high standard. They felt safe when care was provided and had confidence in the staff. Records showed that health conditions are monitored and appropriate action taken and services accessed. Where there are issues or concerns in relation to tissue viability and continence, residents are referred to the local district nurse. One resident who has more complex needs has a suitable hospital type bed and pressure relieving equipment. Records also provided evidence of the appropriate involvement of a community psychiatric nurse in assessment and care planning. In conversation with the inspector, a resident stated that she had found care staff to be very attentive to her needs during a period when she was unwell. A member of her family expressed satisfaction with the care provided at the home. Where cot sides are in use on a resident’s bed, the provider should complete, with the guidance of the district nurse if required, a risk assessment setting out the potential risks to the resident from using and not using cot sides, and weighing up the balance of risk. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 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, and 15 Residents are supported in a lifestyle which accords with their expectations and preferences. The diet provided is appealing and nutritious with attention to individual preferences. EVIDENCE: Residents expressed satisfaction with the routines of daily living in the home. They felt that they were supported to make choices about their everyday lives and could pursue their preferred lifestyle. The interests, preferred activities and social contacts of residents are recorded. A number of residents take a daily newspaper. Residents discussed recent outings with family and friends. Residents were engaged in knitting and puzzle books. Residents stated that the provider is particularly good at ‘the social side’ and discussed their enjoyment of recent events with the inspector. These included a Christmas musical show put on by residents and staff and attended by an audience of families and supporters, an ‘at home’ day for residents and invited guests to celebrate the registered provider’s twenty years at Ar Lyn, and a memorable New Years Eve party. The flowers and pot plants in the rooms of two residents provided evidence of the engagement of residents in their interests. Residents and a visiting family member reported that visiting arrangements were relaxed and satisfactory, and visitors were made to feel welcome. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 12 Information is provided in the service users guide. The provider has obtained a visitor’s record and intends to provide brief written guidance before making it available to visitors, as required by regulation. Some residents have installed their own telephones; others have access to the pay phone in the hall. Incoming calls may be taken over the main office phone. The registered provider reported that family representatives or solicitors manage, or assist with, the financial affairs of all residents. Information would be made available to residents about possible advocates such as Age Concern and solicitors. Age Concern representatives visit the home to carry out reviews with residents on behalf of Cornwall Adult Social Care. The records of food served detail a varied and wholesome diet. Three hot meals are provided daily, with drinks and snacks. Residents reported their satisfaction with the meals and catering. The inspector enjoyed an appetising and well-presented lunch with residents. This was an unrushed and sociable occasion. For tea there is a choice of soups, sandwiches, savouries and cakes. There is an emphasis on using home made food. No residents were reported as requiring liquefied food or special diets, other than for diabetes, at present. One resident receives appropriate assistance to eat. No daily menu is displayed, but care staff inform residents of the lunch menu, and choices for tea are discussed individually. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 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): These standards were included in the last announced inspection report. EVIDENCE: The registered provider has not arranged training in adult protection for staff but is planning to do this during the year. The requirement from the last inspection report is renotified in this report. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 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): The home is well comfortable, homely, safe and well maintained. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: Ar Lyn is located in the village centre close to the amenities of Lelant. There is adequate car parking. The home is well presented, comfortable and homely. The main front door has a 4-inch step. There is a second entrance with ramped access. A stair lift provides access to the first floor. There is a ramp with handrails leading from one lounge to the larger lounge/dining room. One bedroom on the ground floor has step up provided with handrails. The gardens are spacious and attractive, with accessible areas for service users to sit. The grounds are well maintained, tidy and safe. The owner has a collection of birds and small mammals in enclosures in the grounds which are a source of interest to service users. Routine maintenance of the premises continues. The provider reported that he is completing further work on the home’s fire risk assessment following a visit from the fire service, and despite using the fire Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 15 service’s recommended format and system from the internet. Over Christmas, the provider had set up an impressive display of lights and attractions around the outside of the house and gardens which the residents reported that they had enjoyed. There is a smaller sitting room providing a television and accommodation for some birdcages with exotic occupants. The second communal area is a large room providing a dining area, and sitting area with a television. This is an attractive room with a bright sunny aspect and view of the gardens. It is much appreciated by residents. The communal space exceeds the original requirement for floor space. There have been no changes in the use of communal areas since 2002. There is outside space accessible to residents and users of wheelchairs. The furniture in shared areas is domestic in nature and of good quality. The lighting is domestic in nature, appears adequate and, during the day, there is plenty of natural light. There are two bathrooms. One is situated on the ground floor and one on the first floor. Both baths have assisted seats for access. This provision meets the original standard as set in April 2002. There are three toilets on the ground floor and one on the first floor. Two of the rooms on the first floor have ensuite toilets. All rooms have hand basins. Bathrooms and toilets are clearly marked. There are nine single and two shared rooms. Two of the single rooms are ensuite. The rooms meet the original requirements for usable floor space in preexisting homes as set in 2002. Service users’ rooms generally provide the furniture and fittings as listed in the standard, with some variations from individual preferences and residents bringing in their own possessions. Rooms are carpeted, comfortable and individualised. Residents expressed satisfaction with the facilities and comfort of their rooms. The two double rooms have screens. Lockable spaces are provided for service users to keep money, medication when self-administering, and valuables. The doors to the service users’ rooms are not lockable. The provider has purchased suitable locks. He plans for these to be fitted by a carpenter because of the individual natures of the doors in this older property. All rooms are naturally ventilated with opening windows. The windows are fitted with restrictors. The home has a gas central heating system. The main boiler had been replaced the week before the inspection. Radiators and exposed pipe work are guarded. Lighting is domestic in character and there is an emergency lighting system. The premises were clean. Service users stated that care staff kept their rooms clean and tidy. All bathrooms, baths, toilets, commodes and hand basins were clean and hygienic. There are hand washing facilities with antiseptic hand wash. No untoward odours were detected. The kitchen was clean, and the refrigerators clean and well ordered. The laundry is situated in the basement, Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 16 well away from food preparation areas with a separate entrance from outside. The washing machine is industrial standard with a sluicing facility. The laundry flooring is vinyl. There is an infection control policy and procedure. Gloves and aprons, for use during the delivery of personal care, were available. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 17 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 and 29 The staffing arrangements meet the needs of residents. Recruitment practices have not recently ensured complete protection to the service users. EVIDENCE: The other key standards in this group were included in the last announced inspection report. There is a written roster which details the hours worked by staff, and which needs to refer to the management time worked by the provider. An additional member of staff has been on duty recently to provide three care staff from 7.30 to 10.30 in the morning in order to meet the needs of residents. During the rest of the day and evening there are two care staff on duty. The registered provider and head of care work additional shifts as required by the needs of residents. An agency worker is used to work occasional shifts. A cook is rostered daily and there is a gardener. During the night there are two staff sleeping in on call. The provider completes a regular risk assessment of the needs of residents at night and submits this to the commission. When a resident needs care throughout the night, a waking night staff is rostered. No residents identified staffing arrangements at night as an issue. Records of the recruitment of two recent staff were inspected. These contained the documents and information required by regulation with the exception of: Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 18 - POVA first checks (and a CRB disclosure in one case) had been obtained, but after the date of starting employment; - the registered provider must ask for a full employment history (this was introduced by amendments to the regulations in 2004). The records for these staff included a record of their initial induction. Both records were in good order. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 19 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 The other key standards in this group were included in the last announced inspection report. EVIDENCE: In relation to standard 31, the home does not have in place a registered manager who has completed an NVQ at level 4 in care and in management or an action plan for achieving this. The commission’s guidance, based on the standard, is that this should have been achieved, or a plan in place to achieve this, by December 2005. The registered provider discussed his views and strategy with the inspector. A requirement has been set in relation to this standard. The accident record was inspected. Entries were satisfactory. The provider is aware of the need to investigate and review a resident’s risk assessment following an accident. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 20 Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 21 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 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 X 17 X 18 X 2 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X X Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes 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. 2. Standard OP18 OP29 Regulation 12 and 13 19 and Schedule 2 Requirement Timescale for action 31/05/05 3. 4. OP19 OP31 23 7 and 9 Staff must receive regular training in adult protection and moving and handling. The registered person must not 24/01/06 employ a person to work at the care home unless he has obtained a Criminal Records Bureau Disclosure or a ‘POVA first’ check for that person. The registered person must 31/05/06 complete the fire risk assessment for the premises. The registered person must 31/05/06 provide an action plan to provide a registered manager qualified at level 4 in care and in management. 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. Ar-lyn Refer to Standard OP7 Good Practice Recommendations Care plans should provide specific and precise information DS0000008949.V270620.R01.S.doc Version 5.1 Page 23 2. 3. OP7 OP8 and directions for care staff for the actions required to meet the needs of service users. Service users or their representatives should sign their care plans and reviews. Risk assessments should be completed where cot sides are in use. Ar-lyn DS0000008949.V270620.R01.S.doc Version 5.1 Page 24 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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