Inspection on 02/10/07 for Arbor House

This inspection was carried out on 2nd October 2007.

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

Arbor House 04/05/06

Arbor House 19/12/05

Arbor House 19/05/05

Arbor House 04/02/05

Arbor House 18/08/04

Similar services:

Applegarth

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

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

CARE HOMES FOR OLDER PEOPLE Arbor House High Street Evington Leicester Leicestershire LE5 6FH Lead Inspector Ms Rajshree Mistry Unannounced Inspection 10:05 2 October 2007 nd 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 Arbor House DS0000037704.V340535.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. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arbor House Address High Street Evington Leicester Leicestershire LE5 6FH 0116 2739033 0116 2739033 socis209@leicester.gov.uk socis209@leicester.gov.uk Leicester City Council 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 Julian Citroni Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (40), Physical disability over 65 years of age (4), Sensory Impairment over 65 years of age (10) Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User Numbers DE(E) & MD(E) No one falling within category DE(E) or MD(E) may be admitted into Arbor House when 20 persons who fall within categories/combined categories DE(E) or MD(E) are already accommodated within the home Service User Numbers PD(E) No one falling within category PD(E) may be admitted into Arbor House where there are 4 persons of category PD(E) already accommodated within the home Service User Numbers SI(E) No one falling within category SI(E) may be admitted into Arbor House where there are 10 persons of category SI(E) already accommodated within the home 4th May 2006 2. 3. Date of last inspection Brief Description of the Service: Arbor House is a care home providing care for up to forty older people. The home is owned and managed by the Department of Adult & Housing. Arbor House is a large purpose built property located in Evington Village, with shops and other local amenities close by. The home is within walking distance to public transport and fifteen minutes by car to the city centre. Communal areas and residents bedrooms are located on the ground and first floor accessed by stairs or the passenger lift. Bedrooms are on both floors with sufficient numbers of bathrooms/shower and toilet facilities. All areas of the home are accessible for people using wheelchairs and other walking aids. Information about the service is provided to prospective and current residents within the ‘service user guide’. The ‘service user guide’ and terms and conditions of the stay are also available in other languages and formats such as Braille. The monthly fees start at £386, and may vary dependent on the assessment of care needs. There are additional charges for hairdressing, newspapers, chiropodist, toiletries and a small contribution for outings. The CSCI published inspection report is available at the home and referred to in the ‘service user guide’. The residents are informed of the findings of the CSCI inspection through the ‘Residents Meetings’ and how they can view a copy of the CSCI published inspection report. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process consisted of pre-planning the inspection, which included viewing the last Inspection Report, reviewing and gathering of evidence from the Annual Quality Assurance Assessment (AQAA) – the Provider’s self assessment, and reviewing the service history of significant events since the last inspection. Surveys were sent from the Commission for Social Care Inspection to residents, their relatives’ health care professionals, and staff who were identified in the AQAA. The unannounced site visit commenced on the 2nd October 2007 and lasted 1 day. The focus of the inspection is based upon the outcomes for the residents. The method of inspection was ‘case tracking’. This involved identifying residents with varying levels of care needs and looking at how these are being met by the staff at Arbor House. Four residents were selected; with varying, care needs and including a new resident. Discussions were held with them and other residents living at Arbor House. Observations were made of other residents and visitors who were not part of the ‘case tracking’ process. The method of case tracking included the review of residents’ individual care records, discussions with staff with various responsibilities within the home and reviewing the records, training records and the minutes of team meetings. The CSCI sent out twenty-four surveys to residents and their relatives, of which 38 were returned. The majority of the comments were positive about the care received, staffing, access to health care services, and social activities of interests and indicated people were aware of the complaints procedure. There were positive about the homely environment and the day-to-day management. No surveys were received from health care professionals such as the General Practitioners, District Nurse Team and Care Management Team. Twenty surveys were sent to staff of which 10 were received after the site visit. The comments received were generally positive about the care people receive at the home and included comments as follows: “The home provides a homely feel to the residents. Activities for the residents and staff work well” “Need more staff always” “Need training related to dementia and Alzheimer’s. Extra training would help, use my common sense or ask staff who have had training” “We all work hard and try our best to accommodate residents and their guests needs to a high standard” Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 6 “There is a good rapport between all levels of staff” Comments incorporated within Service Users Comment Cards and direct comments included: “Emergency placement” “Its lovely here and they do look after me” “You couldn’t be cared for in a better place” I do enjoy the meals here, it’s made properly” Comments incorporated within Relatives Comment Cards included: “Occasionally I find I have to remind ‘the office’ about aspects of my mother’s care which have been overlooked. Especially during the frequent absences (due to ill health) of my mother’s key worker” “I visit the home three times per week. My mother is not capable of using the ‘phone’ on her own, is nervous of it and would never ask for help. To my knowledge the staff have never offered to help her, which is disappointing as I feel, in the past, with their encouragement, she may have spoken to her son in Australia” “A greater number of staff would allow more quality time to be spent with residents to achieve the improvements . . . More permanent staff rather than agency would also assist to allow residents time to build a relationship and therefore, confidence and trust in their carers. Older people appreciate stability”. “More staff” “Everything, nothing is too much bother for the home and all of the staff” “Doesn’t have to improve. “Since she has been at Arbor House she has improved a great deal because of the care she had there, also the food she has”. What the service does well: Arbor House is a well-managed care home that provides tailored care and daily living choices to the individual residents. Residents living at Arbor House enjoy a lifestyle of having their care needs met, being entertained with activities of interests and social gatherings. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 7 The assessment process of individuals is good. Residents and/or their family are involved in the assessment process that ensures the Arbor House and the care provided is suitable. Arbor House is well maintained, fresh and clean. There is a relaxed atmosphere in the home, residents move around freely with support if required and without restrictions. Arbor House has a team of staff that work as a team, have developed their practices to provide individual and personalised care services. Staff have specific responsibilities to ensure all residents needs are met timely whilst managing the running of the home. Staff demonstrated a good awareness of the people they care for, from addressing them by the preferred names, knowing individual daily routines to supporting people to maintain their own independence as far as possible. Comments incorporated within Relatives Comment Cards included: “Everything except communication” “They are all very kind” “Friendly; staff are approachable; clean environment; essential needs are taken care of; entertainment is good; great Christmas parties and mile-stone parties” “Good food and clean home. Staff are very caring” What has improved since the last inspection? The management team have developed the care planning process and have embedded the use of individual personalised care plans that looks at the whole person needs and lifestyle. The information is easy to read and clear guide for staff to follow, which enable the resident to maintain their independence and dignity. Arbor House has appointed a Handy Person, who is responsible for maintaining a safe environment and repairing minor faults. Environmental improvements have taken place: installation of automatic front door, decoration and furnishing of a number of bedrooms, foyer, bathrooms and toilets. Building works are continuing on the development of the four bedrooms with en-suite facilities with the assisted baths and walk-in shower rooms. External improvements made with a perimeter fence on the terrace, which allows people to access the terrace, whilst ensuring their safety. There is Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 8 continued development to form raised beds in the forecourt and a path leading to the local church, for residents to use. What they could do better: This was a positive site visit overall of Arbor House, indicating the residents received good quality of care in a safe home by trained staff. The management team and staff demonstrated a strong commitment to improving the quality of life for people living at Arbor House. The ‘Service Users’ Guide’ should be reviewed. The document to include information about Arbor House, the staff employed, information on how to raise concerns, residents’ views of the home, and a copy of the most recent Inspection Report conducted by the Commission for Social Care Inspection. A system for formalise the exiting quality assurance exercise. The views of the residents, their relatives and visiting health and social care professionals sought are reflected in the report produced, which is shared with the people that contributed and demonstrates the service monitors and improves the quality of life for the residents. The Local Authority should to set up a system where by Regulation Inspectors employed by the Commission for Social Care Inspection can confirm by the viewing of records that staff have had pre-employment checks such as Criminal Record Bureau disclosure. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of residents, relatives when asked what the home could do to improve the following comments were made: “Communication with each other between shifts. Better use of the continuity record. A better understanding of individual residents feelings and needs” “Bedrooms re-decorating” “I feel the home could do with more staff” “There can be improvements made here with information about ‘key worker’ who works with our . . . . . , i.e. change of carer; time to meet the carer, as not always on duty when we visit” “Notice board – photos and names of all staff” “Communicating needs of residents, book or e-mail between main carer or person who have closet contact with residents” Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 9 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. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 10 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 Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 11 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, 2, 3, 4 and 5. Standard 6 is not applicable. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with information about the service; and are involved in the assessment process that ensures their care needs are met. EVIDENCE: The information received from the Acting Manager before the site visit stated that prospective residents receive the Service User Guide and includes the ‘Statement of Purpose’. This document sets out the aims and objectives of the service, is provided to prospective residents before they move in. The information is available in other formats upon request and is set out in easy read style. Prospective residents and their families receive information about the home describing the range of care needs that Arbor House aims to meet. The document includes information in relation to social activities, hobbies and Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 12 leisure interests, and about specific policies and procedures, the staffing and management of the service including qualifications and experience. Whilst it sets out the Complaints Procedures and it should also refer to the most recent Inspection Report undertaken by the Commission for Social Care Inspection (CSCI) and existing residents’ views of the home. A new resident recently moved to the home described the process of moving into the home and being involved in the assessment process, with their relative. Other residents already living at the home for a number of years said they and/or their relatives were initially involved in the assessment process. The records of four residents living at the home were viewed as part of the case tracking, which included two new residents. All the records were found to contain their initial assessment identifying their needs, which had been completed by a Social Worker and involved the resident and/or their relative. Information gathered relation to the residents needs, history, medication, mobility and special requirements such as dietary needs, cultural needs, health care support for the Community Nurse and preferred choice of lifestyle. The admission process is good and involves the prospective resident and/or their relative or advocate. The new resident was aware that a review of needs would take place after the first four weeks to ensure that the needs of the individual are being met and that all interested parties have the opportunity to comment on the care being delivered. Unless a resident’s has change in circumstances or their needs change a review is then undertaken on an annual basis. Comments received from residents during the site visits included: “My . . . . . and I arranged this place through the social worker and so far, everything I anticipated has been provided”. Comments received from relative’s surveys regarding being informed about their relative living at the home and meeting their care needs: “Only when asked” Arbor House is not registered to provide intermediate care. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 13 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 and 11. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are well cared for having their tailored health and daily care needs met through personalised care and improved care-planning system. EVIDENCE: The records of four residents were viewed as part of the ‘case tracking’ process, this included looking at their care plans. In the first instance a care plan is produced by the Social Worker, following the initial assessment of the residents needs. Records for the two residents living at Arbor House for a number of years were well written and were presented to a good standard. The resident, their relative and key-worker had signed the care plans in two out of the four viewed and reflected the residents last wishes, where known. The care plans have significantly improved and written from the prospective of the individual resident, otherwise known as ‘person centred’. Care plans and records of four residents were read. Care plans also focused on residents’ Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 14 independence and abilities, and where assistance is required how this is to be delivered, with the views of the resident. The care plans were individual, giving clear guidance to staff providing the care, ensuring their routines, preferences are respected and their independence promoted. The care plans show what the residents can do safely for themselves and where they need encouragement to remain as independence as possible. Residents’ individual lifestyle, preferences and choices are known to enable the staff to support them. Where potential risks to residents exist for example the moving and handling of individuals, residents health care needs such a Dementia, or Diabetes puts them at potential risk, a risk assessment is conducted that details how the potential risk is managed whilst maintaining and promoting the residents independence. Care plans for the new residents were being developed using the social worker’s assessment and care plan. A dedicated member of staff who overseas the care of the resident referred to as their ‘key-worker’, part of this role is to review the care plan monthly with the involvement of the resident and/or relative. Where changes are noted a member of the Management Team is informed to update the care plan. Key workers spoken with for residents tracked demonstrated good awareness of the individual residents needs, ability, preferences and lifestyle. Residents who have specific health care needs for example Dementia can be confident that their care plan will provide information as to how their condition affects their daily lives, how staff need to be sensitive as to their daily care, and how this should be managed. Staff spoken with said they have residents they key-work and given specific responsibilities at the start of their duties. The daily task book showed deployment of staff to ensure the needs of residents were met. Daily records of the four residents whose records were viewed detailed their access to a range of health care professionals, which included Specialist Consultants, Optometrists, Dentists, Chiropodists, General Practitioners and Community Nurse and Specialist Nurses in Diabetes. Residents’ records details their visit to health care professionals and any follow up action that needs to take place. Residents said their care and health needs were met timely, in private and in a manner that suited them. Comments received from the survey and directly from the residents showed residents’ privacy and dignity was respected, and encouraged to maintain as much independence as possible. Residents survey confirmed that they received medical support when required. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 15 Residents were seen receiving their medication during breakfast and lunchtime, given by the trained Deputy Manager. The medication and medication records of the four residents who were ‘case tracked’ were viewed and were found to be in good order. Information as to residents prescribed medication is detailed on the individuals care plan. The system for storing, administering and recording controlled medication is good. Comment received from residents regarding the medication: “Has 10 tablets in the morning and evening, . . . I get my medication on time and it’s all correct so far” Comments received from the visiting General Practitioner and the Community Nurse: “Can’t speak highly about the care provided here by my colleagues, it very good” “I’ve been visiting patients her for a whiles and have found this home to be pleasant; patients are well cared for; staff do follow any instructions left, although can be over cautious and just want you to see a patient to be sure”. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 16 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 and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents continue to make choices about daily living, offered a variety of meals and individual social activities of interest to suit. EVIDENCE: The care plans of the four residents viewed identified their hobbies and interests, their likes, dislikes and requirements with regards to food, their preferences for daily living i.e. the time they wish to go to bed, importance of wearing jewellery; lipstick and identifying risk of misplacing their walking stick, information as to personal relationships, their religious observance. Information supplied by the Acting Manager before the site visit states Church of England Church Services are available monthly at the home and residents are offered Communion at these Services. The Catholic Priest visits residents of the Roman Catholic faith. Deputy Manager said although there is an Activity Organiser working Monday, Wednesday and Friday, a specific staff has the duty to organise activities. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 17 Records showed in-house activities ranging from sing-a-Long, music and movement, cake making, musical quiz, knitting clubs, board games and bingo, arts and crafts, music and quiz. The weekly activities are displayed in the foyer, along with photographs of recent social events. The next social evening planned for 10th October 2007 is ‘The Old Days’ music and entertainment evening. Information received from the Acting Manager before and after the site visit said, staff are encouraged to be creative with social activities, looking at individual residents interests, such as having a coffee in town. Residents’ meeting minutes read showed residents enjoyed a trip to Wistow. As people enter Arbor House there is a welcoming atmosphere, gentle music playing with some residents sitting in the foyer reading newspapers, talking or singing. There is a designated smoking lounge, where two residents were watching television. There is a visitor’s lounge and kitchenette, which residents can use to entertain their family and friends. There is a small shop where residents can buy toiletries. Residents were seen sitting in a number of other lounges, watching television or talking with other residents and staff including the library room where the public payphone is. Some residents receive daily newspapers and were seen reading the paper. Residents care plans showed their interests and daily records reflected how they spent the day. Residents said they were able to receive visitors at any time. One resident said arrangement was in place for them to visit a relative in hospital as often as they liked. Staff were observed supporting residents with their daily routines. Staff said they have specific responsibilities in relation to residents they key to meet the residents’ needs such as assisting resident with bathing or showering. Staff were seen offering residents a choice of meals mid-morning. Meals are prepared to suit dietary needs such as diabetes and served in the dining room. Resident’ said they enjoyed the meals, felt they were not hurried and were always offered a choice. Two staff were seen assisting residents with their meals in a sensitive and dignified manner. A new resident commented that they ‘really enjoyed having music playing at meal times and generally throughout the home, its pleasant and makes you feel happy’. The Deputy Manager said alternative ethnic meals have been provided for a residents initially, although they expressed a preference of having European meals prepared. All the residents spoke positively about the meals provided, including comments such as; “I‘ve put on a few pounds because the meals are lovely” Comments received in the surveys from residents: “Do not feel well enough to take part in some activities” Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 18 “ . . . . . likes it all. . . . . . particularly likes the tapes that are put on . . . . sings along with them” “I have a good appetite” “Good food and clean home” “Great Christmas parties and mile-stone parties” “They have indoor games (Bingo etc, also sing songs) but I do feel that they could arrange outdoor activities too” Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 19 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 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are protected by a robust and accessible complaints procedure and by staff trained in safe guarding adult processes. EVIDENCE: Residents when asked were confident that should they have any concerns, to whom they should speak with. Residents were aware of how to make complaints and the written complaints procedure, and how to contact Advocacy Services. The complaints procedure is displayed in the reception area. A new resident said they received a copy of the complaints procedure at the point of moving to the home and told they can speak with manager or staff on duty. Information received from the Acting Manager before the site visit stated Arbor House received 13 concerns/complaints. Records showed the concerns were investigated and resolved to the satisfaction of the complainant and resident. The Commission for Social Care Inspection received one complaint. The complaint was referred to the Responsible Individual for Arbor House to investigate and was resolved satisfactorily and promptly. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 20 The Acting Manager informs the Commission on timely basis incidents that affect wellbeing of residents and has pro-actively demonstrate the actions taken to reduce or prevent avoidable re-occurrences. Arbor House has had a number of safeguarding adults incidents. The management team and the Acting Manager demonstrated each incident was taken seriously. The actions taken were consistent with the local multi-agency procedure that protected the residents. Staff receive training in how to look out for signs of abuse and how they are to respond if they have any suspicions or concerns. Policies and procedures detail the action that staff are to take should that have any concerns about service user welfare. Staff demonstrated a good understanding of their responsibility and procedures to follow in relation to safeguarding adults. Agency staff said they had received training in safe guarding adults as part of the agency’s induction and part of their induction to the home in relation to reporting any concerns to the management team. All staff felt confident to whistle-blow poor or bad practice and tell the member of staff and report to the manager. Staff files examined contained evidence to show that staff have received training in safe guarding adults, part of the local authority induction training and attaining a National Vocational Qualification (NVQ) in Care. Survey responses from the residents indicated that they know how to make a complaint and know who to speak with if they were unhappy. Other comments received in the residents’ survey and the relatives / main carers included: “I tell my daughter who sorts things out for me” “ . . . . is not a moaner! . . . . is happy with the staff” “ . . . . tells Mrs . . . and she contact the home, referred to this in . . . . annual review” Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 23, 24, 25 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with a warm, homely, comfortable clean, and wellmaintained environment suitable for their needs. EVIDENCE: Arbor House has had environmental improvements to the home, with the installation of automatic doors at the entrance of the home. During the site visit, there was evidence to support information received from the Acting Manager in relation to the refurbishment and decoration of the bedrooms, bathrooms and toilets and the fenced patio area that allows residents at risk of wondering to have equal access to this area and ensures their safety. Arbor House has three lounges on the ground floor, a designated smoking room and a library where the public payphone is located and a two lounges on Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 22 the first floor, of which one is a visitors lounge, fitted with a kitchenette. Residents can sit out in the patio area that overlooks the greenery. Arbor House continues to develop the four self-contained en-suite rooms with assisted baths and walk-in shower room for people with greater care needs. Access to the first floor is via a passenger lift or by one of two stairwells. All communal areas are decorated to a good standard and were complimentary about the standard of décor and cleanliness of the home. Bedrooms are located on the ground and first floor, close to bathing, showering and toilet facilities. All areas of the home are accessible to residents with a physical disability, either through being level access in the case of showers or through the provision of specialist bathing equipment. Resident’s bedrooms seen were decorated to a good standard, co-ordinated décor, with movable bedroom furniture, lockable cabinet and personalised. Residents said they were offered a key to their bedroom when they moved in. Contracts are in place for the removal of clinical waste, and staff have undertaken training in infection control, policies and procedures are in place for the maintenance of infectious diseases including MRSA. Staff were observed wearing protective clothing when assisting residents with their personal care needs or handling food. Staff said that they had received training in infection control, demonstrated a good understanding and practice in health, safety, hygiene and infection control, which was consistent with the staff training records. There is a team of domestic staff responsible for the cleanliness of the home and the laundry. The monthly visits carried out by a representative of the local authority looks at the home environment and reported areas of concerns and safety are addressed. Information received from the Acting Manager after the site visit state that Arbor House secured a grant, which is being used to form raised beds in the forecourt and a path leading to the local church, for residents to use. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 23 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 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by experienced and trained staff in the delivery of care, having their needs timely and safely met. EVIDENCE: Residents spoke positively about the care staff saying that they are lovely, and that they always respond if you call them. During the morning and at lunchtime there are five members of care staff on duty; whilst in the afternoon and evening there are four members of care staff. Throughout the day, a member of the Management Team or a Senior Carer supports the care staff. At night time there are two care staff on duty, supported by Senior Carers who oversee the nine Older Persons Homes owned by Leicester City Council, by the way of an on-call service. Arbor House has a team of ancillary staff responsible for laundry, cleaning and cooking, to support the day-to-day functions of the home. The staff rota was reflective of the staff on duty including the senior staff and agency staff. The Deputy Manager said regular agency staff are used to provide cover for staff absences. Although Arbor House has an Activity Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 24 Organiser responsible for organising activities for residents, care staff are nominated to arrange group or individual activity in their absence. The information received from the Acting Manager before the site visit, showed the number of agency staff used. Discussion with the Acting Manager after the site visit confirmed regular agency staff are used mainly to cover for long term sickness and maternity leave, recognised this was not ideal but recruiting to temporary positions was difficult. The recruitment and selection procedure in place is supported by a Human Resource Team in accordance with the local authority equal opportunity policy and guidance. Staff spoken with confirmed they were recruited and appointed after receiving satisfactory pre-employment checks such as the referenced and Criminal Record Bureau (CRB) disclosures. Information received from the Acting Manager before the site visit stated that the Human Resource Team holds pre-employment checks centrally. The current policies and guidance issued by the Commission for Social Care Inspection identify that when a large corporation employs the staff, a system needs to be in place whereby the Inspector can verify that staff have had a CRB, it is recommended that the Local Authority establish such a system. Three staff training records were checked including a senior staff. All contained records of their induction and training, ranging from moving and handling, health and safety to specialist training such as dementia care and caring for older people and people with mental health. Staff that received dementia training recently. Arbor House employs thirty-four care staff, of which 97 have attained a National Vocational Qualification (NVQ) in Care level 2, with a further 3 working towards the NVQ level 2 in Care Award. This is a substantial increase since the last inspection of Arbor House. Staff spoken with said they are allocated specific duties and responsibility for the day that ensures all residents care needs are met. The agency staff said they were assigned to work with a permanent member of staff after being inducted into the home. Staff confirmed they received supervision and attended staff team meetings. Although minutes of the staff meeting were not available during the site visit copies of the minutes were forwarded to the Commission after the site visit. Comments received from residents directly and relative’s surveys included: “The staff are very good, very caring and attentive”. “I am not aware of what skills and experience each member of the care team has. My answer is based on observation of the interaction between staff and residents including my mother” “Staff are very caring”. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 25 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, 33, 35, 36, 37 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well managed home with good interim leadership, having opportunity to shape and improve the service, whilst ensuring their health, safety and welfare are promoted. EVIDENCE: Arbor House continues to be managed by the Acting Manager, who has been in post for approximately 2 years and experienced in working in care, in the absence of the Registered Manager. The Acting Manager has attained NVQ Level 4, in care and management. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 26 The Acting Manager manages a team of Deputy Manager, Senior Carers and has clear lines of responsibilities, overseeing the day-to-day management of Arbor House. The management team demonstrated openness towards listening to residents, their relatives/representatives, professionals and staff. The management team has investigated and acted on concern promptly. A representative of the management team of the Local Authority, who is external to Arbor House, visits the home on a monthly basis, representing the Responsible Individual. The reports generated from each visit, demonstrated checks are carried out monthly, detailed the evidence, the findings and the actions required to address any issues. Residents care needs are reviewed monthly by the staff at Arbor House and annually by the Commissioning Team. Residents meetings are held every two to three months and minutes of the meeting showed what information was shared, concerns and other topics discussed. A number of ‘thank you’ cards, letters and commendations were on site, complimenting Arbor House, the staff and the care provided. The information received from the Acting Manager stated that a representative from within the Local Authority conducts a quality assurance visit. However, whilst the Deputy Manager said a visit was carried out but was unable to say whether a report was produced and the findings shared with the residents. Information from the Acting Manager after the site visit stating that quality assurance questionnaires were simplified and distributed to the residents and their families, in July 2007. A sample of the completed ‘Resident Questionnaires’ were viewed. Although the Acting Manager stated the areas where concerns were expressed by the residents and the relatives, and the steps taken to address them, this process needs to be formalised to establish a Quality Assurance system. The report needs to be distributed to those that took part in the process and demonstrate that the Arbor House monitors the quality of the service in relation to the aims and objectives set. Residents said they manage their finances themselves or with support from their family or Solicitors. Where small amount of money is held on behalf of the resident, a record of the financial reconciliation is in place, which demonstrated procedures are in place for handling residents’ finances. Residents and staff records viewed were kept in good order, comprehensive, up to date, stored securely and was available for the purpose of the site visit. Staff were aware of where information, incident and accident record, policies, and procedures are kept. Staff spoken with confirmed that they receive regular supervisions from a member of the Management Team, and provide an opportunity to discuss Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 27 residents’ care, training, issues of concern and general practical issues about the day-to-day care of residents, staffing and management of the home. Arbor House as appointed a Handy Person, who is responsible for the repairing minor faults reported. During the site visit, the Handy Person was seen tending to faults. Information received from the Acting Manager before the site visit detailed the regular maintenance of health and safety systems within the home, including fire systems and equipment, environmental health visits, central heating systems and emergency call systems. Comments received in the surveys from relatives: “This has improved significantly since the change in management in October 2005”. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 3 3 3 Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 30 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 OP33 Regulation 24(1) Requirement The existing Quality Assurance process to be formalised, seeking the views of residents, their relatives/main carers and professionals, as to the care provided by Arbor House. The Quality Assurance process should be open and transparent, with participants being given a report as to the outcome of the process, which details any actions the home intends to introduce as a result of the audit. Timescale for action 02/11/07 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 OP29 Good Practice Recommendations It is recommended as good practice, consistent with CSCI policies and procedures that the Local Authority devises a system whereby Inspectors can ascertain and confirm that staff have had a Criminal Record Bureau disclosure. Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Arbor House DS0000037704.V340535.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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