Inspection on 27/05/08 for Ar-lyn

This inspection was carried out on 27th May 2008.

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 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 14/06/06

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 Alan Pitts Unannounced Inspection 27th May 2008 10:00 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.V362466.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.V362466.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 Position Vacant Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 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 £308.09 - £360.00 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service potentially experience adequate quality outcomes. This inspection took place on 27th May 2008 over a period of approximately 4.5 hours. The inspector spoke with the registered provider, staff, a visiting health care professional, ten people that live at the home, toured the premises, and inspected records. Overall, Ar Lyn provides individualised care that more than meets the expectations of the people that live there. Comments from residents were, without exception, complimentary of the home, the staff, the owner, and the care provided. These comments were supported by the view of the visiting health care professional. There is no doubt in the inspectors’ mind about the high quality of individual attention and care provided, but the overall rating reflects the lack of attention to systems designed to protect residents (e.g. adherence to a robust employment procedure). What the service does well: What has improved since the last inspection? What they could do better: The care received by the people that live at Ar Lyn is of a very high standard, but more attention needs to be given to management systems in order to ensure residents’ protection. Similarly, improvement is needed in the area of staff training. There is one outstanding requirement from the previous inspection. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Ar-lyn DS0000008949.V362466.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.V362466.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information that enables them to make an informed choice about the home providing them with care and accommodation. Care needs assessments are undertaken prior to admission so that the home can ensure they can meet the needs of the service user. Intermediate care is not provided. EVIDENCE: There is a Statement of Purpose and Service User Guide, which is provided to each resident. These documents were seen to need updating. Case tracking of the records of the most recently admitted people show that a care needs assessment has been undertaken and detailed records are kept of this, though this was done at the point of admission in one instance and discussion took place about how best to use the communication facilities available (e.g. fax). We were told that each prospective resident is assessed to Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 9 make sure that the service is able to meet the needs of the individual and that the prospective resident and their relatives or representatives are invited to participate in this process. We were told that this service does not provide intermediate care or rehabilitation services, though respite care is offered. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have a suitable care plan, which is regularly reviewed. This provides a basis for consistent care being delivered by staff. Healthcare support was evident during the inspection, and residents can be assured they will receive suitable support from medical practitioners. Residents are protected by the homes’ adherence to its medication procedures. Staff work with the people that live there in a manner which respects their privacy and dignity. EVIDENCE: There is a care plan for each resident, which is comprehensive and informative. The care plan format is suitable and care plans are regularly reviewed. Discussion did take place about the preference for erroneous entries in records to be crossed through, rather than use whitening fluid to mask the error. Residents were happy with how care is delivered, and staff methods of delivering care are agreed with them. A visiting health care professional was also complimentary of the care provided by the staff. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 11 Residents said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. Each resident has a photograph held on their medication sheet to ensure their protection during the administration of meds. Records of medication received into the home and disposed of are kept. There are policies and procedures in place. Medication is administered from original packages transferred to individual dossett boxes. 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. Only the registered provider fills the dossett boxes. Secondary dispensing does raise some issues for the consideration of the registered provider: • If the care worker giving the medicines does not have the container with the label they cannot be sure that each person receives the right dose of the right medicine at the right time, as prescribed. • People might miss some medicines, for example, inhalers, eye-drops or as required medicines if the care worker giving medicines does not have access to all prescribed medicines. • The needs and choices of people would not be considered if as required medicines are prepared in advance. • Exceptional cases such as these need a robust risk assessment and written procedure. Details should include: which staff are permitted to do this, what containers the medicines are to be put in, how the containers are to be labelled and what other information is to be given. • A clear record should be kept of all staff involved in each stage of the procedure and the actions taken. We were advised that there is a designated fridge to store medication that requires this facility on order. Medicine Administration Records are free of unexplained gaps. Medicine Administration Records are hand written by the registered provider. The staff were observed to knock on resident’s doors prior to entering. There is a record of preffered names and these were seen to be used. We spoke with ten of the people that live at Ar Lyn, and without exception all were complimentary of the care and kindness of the staff. The residents also confirmed that they would feel able to express any concerns. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents largely determine their own lifestyle, and routines are individualised and flexible so that residents can live a lifestyle according to their wishes and needs. Visiting arrangements are flexible. Arrangements to assist residents with their finances are satisfactory. Meals are provided to a high standard, so residents are provided with a choice of wholesome and nutritious food. EVIDENCE: The registered provider and staff place emphasis on birthdays and holiday activities (e.g. Christmas, Easter). There are ad hoc activities arranged, which can include external entertainers, but residents are free to determine their own lifestyle and activities. The residents spoken with confirmed that they all felt that they had enough to occupy themselves. They said they could get up and go to bed when they wished, and staff were observed assisting residents to get up throughout the morning. Some residents choose to spend the majority of their time in one of the lounges, while others prefer their time in their bedrooms. Residents are encouraged to participate in community events such as producing crafts for local fetes and competitions. Books are provided by a mobile library service. Residents said they could receive visitors when they wished, and four have their own telephones in their rooms. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 13 Financial arrangements were not inspected at this time though this area was included at the previous inspection and found to be satisfactory. There is a record of food provided, though this does not show choices made by the people that live there. The registered provider and staff said that a choice is available to residents at all meals. The cook meets with residents every day, and discussion took place as to how a record could be kept to show the choices made by residents when an alternative to the main dish was preferred. Currently the staff use observation and their knowledge of the individual residents’ preferences to determine if a meal is being enjoyed, rather than taking the opportunity to actively inform residents of the alternative available and seeking their choice. Reliance is therefore on the resident to speak up rather than on the staff to find out. Residents confirmed that the food was very good and provided in generous portions. Special diets are provided as required. The kitchen was seen to be clean and orderly. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has suitable procedures regarding complaints and adult protection, so residents and their relatives have suitable redress if they have an allegation of abuse, a concern or complaint. However, more could be done in respect of staff training in this area. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection (minor additions amendments are needed, such as contact information). Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. Residents were able to say who they would approach if they had a complaint or were concerned about abuse, and those spoken to said that they would feel able to express any concerns. The registered provider said all staff were required to read the adult protection policy when they commenced employment. More could be done to ensure staff understanding of local safeguarding procedures by arranging relevant training (Paul Wilkins is the DASC coordinator for safeguarding training). Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ar Lyn provides a pleasant, homely, clean and well-maintained environment for residents to live and feel at home in. EVIDENCE: The registered provider advised that there had been no changes to the environment since the last inspection. The building is well maintained, clean, pleasantly decorated and homely. There is a pleasant garden, which residents can use. Garden furniture is provided outside for residents’ benefit. All communal rooms are homely and comfortable, and bedrooms are individualised and comfortable. Residents said that they were very happy with their accommodation. One resident in a shared room confirmed that it was their choice to share, and that they were happy with the arrangement. A stair lift is provided for residents to gain access to the first floor. There are two bathrooms which both have a bath lift to enable access. The bathroom doors Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 16 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. The registered provider said that they have had recent problems with the boiler, and the expected replacement part arrived during the inspection. This has caused some difficulties for staff, but the registered provider now anticipates a prompt repair. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are satisfactory numbers of staff on duty. The home must adhere to a robust recruitment procedure in order to protect residents. 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. EVIDENCE: There is a duty rota in use that is flexible to assist staff and to ensure sufficient numbers of staff for residents’ care needs. More staff are provided as the need arises. The duty rota shows 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 ‘sleep in’ arrangement is kept under review, and a risk assessment is completed regarding this issue. Where residents are, for example, unwell a waking night member of staff is provided. Residents commented that they felt there were sufficient staff on duty, and were complimentary of the care they received. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 18 There are eight staff employed, of which two have achieved NVQ Level 2 or above, and a further two are undertaking this training. Two staff personnel files were inspected. One staff member had commenced work (under supervision) without a POVA 1st check having been obtained. Two references had been requested. The registered provider knew another recent staff member prior to employment so no references were taken. The home’s job application form does not seek sufficient information from applicants (e.g. work experience, including dates of employment and responsibilities). The registered provider recognises that there is a need for more staff training, and all staff need to receive training in infection control, and manual handling. There must always be at least one 1st Aid qualified staff member on the premises at all times (two staff currently have 1st Aid training). Staff should be provided with dementia training so they can develop further understanding. Suitable evidence must be available to demonstrate staff have received appropriate training (e.g. copies of certificates). New staff should undertake a National Training Organisation compliant induction programme (www.skillsforcare.org.uk), as well as the home’s internal induction training. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider is suitably experienced and skilled so residents can be assured the service is well managed. Improvement is required regarding health and safety training, and to ensure gas appliances and the boiler are tested annually. EVIDENCE: The registered provider is 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 Commission, CSCI has decided Mr Oxley does not have to obtain these qualifications. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 20 Residents found the registered provider supportive and approachable. Residents said that they would have no hesitation approaching the registered provider or staff if they had a problem, and felt confident the problem would be put right. The registered provider and staff were observed to interact with residents in a friendly and professional manner. There is a clear management hierarchy, and the registered provider is open about the ethos of the home. The home’s quality assurance process and financial systems where not inspected at this time, both areas were found to be satisfactory at the previous inspection. We did not evidence an annual development plan for the home. There is current insurance cover provided and the insurance certificate is displayed. The registered provider has a suitable health and safety policy, though the health and safety poster on display needs completing. Records of health and safety checks are generally satisfactory with the exception of the overdue gas safety certificate (gas equipment maintenance and checks was a requirement at the last inspection). A gas safety certificate needs to be obtained. This must be obtained 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.V362466.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 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 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X X X 2 Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 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. Standard OP29 Regulation 18, 19 Requirement The registered provider must ensure that the home adheres to a robust employment procedure in all instances to protect residents. 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, manual handling. Staff must also have training in dementia awareness. The registered provider must operate a National Training Organisation compliant induction programme. The boiler and gas appliances must be tested on an annual basis. This requirement was made at the previous inspection. A gas safety certificate must be obtained (a copy provided to the Commission for Social Care Inspection). DS0000008949.V362466.R01.S.doc Timescale for action 01/06/08 2. OP30 13, 18 01/01/09 3. OP38 13, 23 01/07/08 Ar-lyn Version 5.2 Page 23 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. 2. Refer to Standard OP15 OP18 Good Practice Recommendations The registered provider should ensure that a choice is offered at meals. The registered provider should arrange for staff to receive safeguarding training. Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Ar-lyn DS0000008949.V362466.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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