Inspection on 30/06/05 for Ar-lyn

This inspection was carried out on 30th June 2005.

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 14/06/06

Ar-lyn 24/01/06

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 TR26 3JZ Lead Inspector Richard Coates Announced 30 June 2005 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 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 D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ar-Lyn Address Vicarage Lane Lelant St Ives TR26 3JZ 01736 753330 01736 759223 Telephone number Fax number Email 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 D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 January 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 provider offers long-term, shortterm and respite care as well as day 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. 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 D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over eight hours on Thursday 30 June 2005. The inspection was facilitated by the kind assistance of the registered provider, staff, residents and visiting relatives. The registered provider submitted the pre-inspection questionnaire. The inspection covers a number of the standards identified as key standards by the commission. The balance of the standards – for example the key environmental standards and daily life standards will be included in the unannounced inspection later in the year. The inspector spent time with the registered provider and the head of care, examined records and documents, spoke with residents and a number of relatives who came in to the home. The last inspection set three requirements, which have been met and four recommendations, of which two have been met and two are still being worked on. What the service does well: What has improved since the last inspection? The paintwork at the front of the building has been repainted. Two rooms have been redecorated and fitted with new carpets. All residents have been provided with lockable storage for valuables. The provider is awaiting delivery of locks to be fitted to the residents’ individual rooms. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 6 The provider has developed an induction training schedule which complies with the standard for the industry and which can be signed off in each area by the new member of staff and their supervisor. The provider has also sent out the first quality assurance questionnaire and is currently receiving responses. All posts in the home have job descriptions and there is a comprehensive staffing manual. 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 D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 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 standard(s) 3. In respect of standard 6, Ar Lyn does not provide intermediate care. The registered provider carries out a assessment of the care needs of prospective residents to determine whether the home can meet their assessed needs. EVIDENCE: The records for a resident admitted since the last inspection included a needs assessment and a moving and handling assessment. There was also a joint assessment summary form completed by representatives of health and social services. The provider has drawn up a care plan for daily living and the resident was aware of this documentation. The resident informed the inspector that she had visited Ar Lyn before making a decision to move in. She felt that she had settled in well and was positive about the care and support that she was receiving. A relative stated that her well being had improved significantly since her admission and he was very satisfied with the care and support provided. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10 All residents have care plans which direct and inform staff; some attention is required to making some directions and information for staff more specific and precise. The healthcare needs of residents are monitored and addressed. EVIDENCE: All residents have written care plans which set out the actions required to meet their assessed needs. There were some examples where direction and information for staff was insufficiently detailed or specific, and these were discussed with the provider and the head of care. Records demonstrate that care plans are reviewed monthly. Some residents were aware of their care plans and relatives stated that the care was appropriately discussed with them and they were kept well informed. The signature of the resident or their representative on the care plan or review would confirm their involvement. Daily notes record the delivery of care. Residents and their relatives reported that their healthcare needs were thoroughly monitored and services accessed when required. This is supported by reviews and daily notes which document the actions taken and contacts with healthcare professionals. The head of care had resolved with care staff some issues in respect of daily records and there were some very good examples of detailed recording. The current care plans Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 10 need reviewing to include a risk assessment for falls where this is appropriate. The head of care refers issues of tissue viability to the community nurses. One resident currently has an airwave mattress and cushion assessed for and provided by the community nurses. The arrangements for the storage and management of medication are satisfactory. There is a policy and procedure which includes drug errors. Staff have completed training in the safe handling of medication. The provider has a copy of the Royal Pharmaceutical Society guidance. There is a current agreement for advice from the pharmacist. The provider has a standard format for recording medication returned to the pharmacist. A sample of medication stocks checked against the record was accurate. Residents reported that staff were caring, sensitive and competent, and respected their privacy and dignity while delivering care. A resident commented “It is very nice here. They look after us well”. Relatives stated that the quality of care and assistance provided was consistently good. They expressed confidence in the staff and management and felt that there was a warm and welcoming atmosphere. Residents and their relatives appreciate the efforts made at the home to celebrate special occasions and discussed recent examples. Residents were also positive about the standard of the laundry service for their personal clothing. There is a telephone available for residents in the hall. Some residents have installed their own telephone. There are screens in the two double rooms. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 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 standard(s) These standards will be included in the unannounced inspection later in the year. EVIDENCE: Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16 and 18 Residents and their representatives have confidence that the provider would take seriously and address issues of concern. The policy and procedures in respect of adult protection are satisfactory but staff do not receive regular training to ensure that residents are fully protected. EVIDENCE: The complaints policy and procedure complies with the standard and regulation. The pre-inspection questionnaire states that no complaints have entered the formal procedure in the last twelve months. The provider submitted copies of written compliments from relatives on the care and service provided. Residents and their relatives who spoke to the inspector had not felt the need to complain formally and had confidence that the provider and head of care would resolve issues raised. The adult protection policy complies with the standard. The provider has a copy of the local multi-agency adult protection procedures. There is a policy and procedure on residents’ money, and a facility for safe keeping of small amounts of spending money. The staff training programme should include regular refreshers on adult protection. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 13 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 standard(s) These standards will be included in the unannounced inspection later in the year. EVIDENCE: The woodwork on the front of the building has been repainted and two bedrooms have been redecorated and the carpets renewed. The provider is planning to refurbish the laundry area in the basement, and replace the flooring in one bathroom and the staff scullery area. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The deployment of staff is currently meeting the needs of residents but needs to be kept under review. The arrangements for training have improved, but require development to ensure that staff are trained and competent to meet the needs of residents. EVIDENCE: The roster is maintained and up to date, but omits the hours worked by the registered provider. The registered provider and the head of care are resident on the premises. A minimum of two care staff are on duty during daytime hours. There is a cook each day and a general assistant works variable hours. The staffing cover in the evening needs to be evidenced on the roster. At night, staff sleep in on call. The provider records a risk assessment and analysis of the needs of residents at night. When a resident requires regular attention through the night, waking staff are provided. No residents or relatives identified the staffing arrangements at night as an issue. No staff currently hold NVQ in care at level 2; the provider plans to register staff for the award this year. Residents report that they feel safe and competently cared for. One member of staff has been recruited since the last inspection but is no longer at the home. A check against the POVA list was not obtained in respect of this worker before they began their employment. However, the provider did complete the required checks on identity and obtained other required Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 15 documents. Staff receive statements of terms and conditions of employment. There are detailed staffing policies and procedures for the home. The provider has developed an induction programme that complies with the Skills for Care programme and which can be signed off by the trainer and new staff as each section is completed. Records show that staff have recently attended training in food hygiene and first aid for nominated persons. Regular training in moving and handling has been lacking and is planned for this year. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 and 38 The arrangements for obtaining the views of residents and their relatives have improved. Records evidencing regular staff supervision were satisfactory so that staff have regular dedicated time with the head of care. The provider protects the health, safety and welfare of residents in most required areas, but the lack of regular moving and handling training for staff is a potential risk. EVIDENCE: The provider has recently sent out a quality assurance questionnaire and is currently receiving the responses. The results of the survey need to be summarised and made available to current and prospective residents and their representatives. The views of residents are sought through individual conversations and review, rather than in a group meeting. A number of relatives had been notified of the inspection and came to the home to talk with the inspector. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 17 The registered provider does not act for any residents in relation to their benefits or finances. He provides a secure facility for the safe keeping of small sums of money brought in by relatives and representatives who act for residents. Each resident has a balance sheet which records payments in and out. It is recommended that residents should sign for the receipt of cash, and where residents do not have capacity, relatives and representatives sign the records regularly. Residents have individual lockable boxes in their rooms. Records, which are dated and signed, show that staff receive regular formal supervision from the head of care. Staff stated that they also receive helpful and supportive informal day- to- day guidance from the provider and the head of care. The home does not provide a record for visitors to sign in. A requirement is set in this report. The home has a health and safety policy and procedure, with guidance and risk assessments for specific equipment and tasks. The provider submitted a detailed list of required safety checks and maintenance records in the preinspection questionnaire. Window restrictors are fitted in residents’ bedrooms. Records document the regular tests of the fire alarm system and the emergency lighting. The provider is working on the fire risk assessment for the next visit by the fire service. Care staff and cooks have attended training in food hygiene. Two staff have completed training in workplace emergency aid for appointed persons. Disposable paper towels and an anti-bacterial rub are provided at staff hand washing points. Staff have access to protective gloves and aprons. There is a new policy and procedure covering MRSA. The provider is developing a specific folder to include guidance on health and safety issues and COSHH. The lack of regular training in moving and handling has been noted in the section on staff training. The accident record had been correctly completed for recent incidents. The need to follow up incidents with a risk assessment and clear directions for staff was discussed with the provider and the head of care. Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 3 3 x 2 Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? 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. 3. 4. Standard 8 18 27 37 Regulation 12 and 13 12 and 13 17 and Schedule 4 17 and Schedule 4 Requirement Care plans must include a risk assessment for falls where this is appropriate. Staff must receive regular training in adult protection and moving and handling. The duty roster must detail all persons working at the home. Timescale for action 30.09.05 31.12.05 30.06.05 The registered person must 30.09.05 provide a record for all visitors to sign. 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. 3. Refer to Standard 7 7 35 Good Practice Recommendations Care plans should provide specific and precise information 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. Service users should sign to confirm receipt of money which has been held for safe keeping. Where a service user does not have capacity, a member of staff should witness the receipt of money. D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 20 Ar-Lyn Ar-Lyn D52-D04 S8949 Ar-Lyn V183285 300605 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell 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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