CARE HOMES FOR OLDER PEOPLE
ARBORETUM NURSING HOME Forest Lane Walsall West Midlands WS2 7AF
Lead Inspector Richard Eaves Unannounced 12th April 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. ARBORETUM NURSING HOME Version 1.10 Page 3 SERVICE INFORMATION
Name of service Arboretum Nursing Home Address Forest Lane Walsall West Midlands WS2 7AF 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) 01922 725 276 01922 644 082 Mr John Luke & Mrs Mary-Ann Luke Lesley Sheila Tipper Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (41), Terminally ill of places (5) ARBORETUM NURSING HOME Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 16th November 2004 Brief Description of the Service: Arboretum Nursing Home is a 41 bed home, first registered in July 1990, it is situated in a residential area close to local amenities and public transport. Set in well-tended grounds it shares the site with a day centre, sister business; the building has been extended and refurbished, providing care on two floors it is serviced with a passenger lift. The facilities include both single and shared rooms some with èn-suite, a number of lounge and dining areas allow service users to have a change of environment and company. The home provides all support services in-house including catering, housekeeping and laundry. The categories of service users provided for are adults and older people from age 50 and palliative care in the same age range. Two rooms have been allocated to the local NHS Trust for aided recovery (intermediate care). ARBORETUM NURSING HOME Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken by one inspector over one day. The focus of the inspection was on the delivery of care and included case tracking of four service users including recently admitted, established with specific conditions and one currently with an acute episode of ill health. The inspection also included a tour of the building, meeting with service users and inspection of records. The home was found to be functioning calmly and efficiently in the absence of the manager. In conversation with the service users they were happy to confirm that they were content with life at the home. One lady said that she was experiencing pain from arthritis, staff advised that pain relief had been adjusted and that they were actively trying to control the level of pain. What the service does well: What has improved since the last inspection?
The proprietors have commenced a programme of work to address outstanding requirements for physical environment improvements, these had been planned for inclusion in the new development, which is experiencing delay. The care plans have been developed to include precise details of equipment used in the delivery of care such as the type of pressure relieving mattress and cushion to address the assessed level of risk for each service user. ARBORETUM NURSING HOME Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ARBORETUM NURSING HOME Version 1.10 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 ARBORETUM NURSING HOME Version 1.10 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) 1,2,3 and 5 The home provides good information and undertakes assessments to ensure potential service users are appropriate and provide for preadmission visits and a trial period at the home so that potential residents can make an informed choice whether they might wish to live at the home. EVIDENCE: The statement of purpose and service user guide remains up to date and are a good information resource for current and prospective residents. Individual records for the three most recent admissions and a sample of those established residents were examined and all observed to include a full assessment of needs. The recently admitted residents spoke of their welcome to the home, one stating she was delighted to be at the home and that her needs were being met and that staff responded to the call bell promptly. Another stated that he enjoyed his daily visits to the day centre on the site and said that the activities there were more to his liking. He was also planning with staff to go out farther a-field. ARBORETUM NURSING HOME Version 1.10 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 and 8 Care planning and delivery were observed to be generally of a good standard but delays in updating care plans in line with changes in needs could put residents at risk. EVIDENCE: A sample of case files were inspected and case tracked, these showed that comprehensive care plans had been derived from the assessments detailing the actions required by staff to meet the care needs of the service users. A range of risk assessments including that of falls and nutrition were included and plans derived to address these. Plans of care are subject to monthly reviews. A care plan for one service user had not been updated fully to include details of increasing need, being shown to be currently eating and drinking well but was in fact receiving subcutaneous fluids to support her hydration. The care plan for the most recent admission shows all aspects of care needs are included in the plan, however some information was not included which staff identified would be included at the review set for day 7 since admission. It was clear that the initial assessment had provided sufficient information for the care plans to be more complete. It was observed that those assessed needs were being met in particular pressure relief.
ARBORETUM NURSING HOME Version 1.10 Page 10 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) 12 to 15 The home provides well-organised, varied social and recreational activities that provide interest and pleasure. The meals provided are an important part of the day for most of the people at the home and are well received. EVIDENCE: During a tour of the building it was seen that many rooms had been personalised with possessions and many spoken with said they could receive their visitors in their room or in the quiet areas on each level. Two activities leaders provide in-house activities and social events on a daily basis and regular outings during the good weather. The Home has a day centre on site, which a number of service users like to attend and two of the men left during the morning, one indicating that he would take his lunch there. During the morning of inspection an outside entertainer was present and service users were seen to be enjoying singing along. The menus provide for a balanced and nutritious diet with account taken of individual likes and dislikes and any special dietary needs. A number of residents including those most recently admitted said they really enjoyed the meals at the home and that they were offered choice for each meal. ARBORETUM NURSING HOME Version 1.10 Page 11 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) 18 Adult protection procedures are satisfactory and provide a safe environment for the protection of the residents from abuse EVIDENCE: The Home has a robust adult protection policy and actively promotes the policy and that of whistle blowing. Staff receive training and know how to respond if they suspect or observe any aspect of abuse. ARBORETUM NURSING HOME Version 1.10 Page 12 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) 19 - 26 There has been no change in the presentation of the home since the last inspection. While there are outstanding improvements required these do not present a significant risk to service users at this time. EVIDENCE: Since the last inspection the home has been on hold waiting for planning approval for an extension and a number of requirements have been held back. It has been agreed that most of these should go ahead without further delay. Decoration was underway during the visit in a first floor shower room, each room has had a lockable facility provided by fitting of a lock to bedside cabinets. The tour of the building confirmed that the home was clean and overall in good decorative order. Rooms were furnished with good quality furnishings but not all having a second chair and table to sit at. The proprietor stated that people were happy with the level of furnishings; the inspector advised that this should be documented in the individual case file. The rooms appear comfortable and uncluttered.
ARBORETUM NURSING HOME Version 1.10 Page 13 Mixing valves control residents’ hot water and monitoring of temperatures achieved are recorded. A recommendation is made to increase the frequency of monitoring and to introduce annual anti scald testing. It was also recommended that an individual record be kept to provide a clear history for each valve unit. ARBORETUM NURSING HOME Version 1.10 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 and 29 The home has an appropriate skill mix and allocated numbers of staff over the full day and night to offer good consistent standards of care to meet the assessed needs of the service users. EVIDENCE: The numbers and skill mix of nursing and care staff are sufficient and appropriately allocated to meet the care and activity needs of service users. Sufficient numbers of ancillary staff are employed to meet the domestic, laundry, catering, maintenance and gardening needs of the Home. The file of the most recent employed staff was checked for thoroughness of completion and it was found to be completed to a good standard. The home has recently been audited and approved for the placement of nursing students and adaptation nurses. ARBORETUM NURSING HOME Version 1.10 Page 15 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) 31, 32, 33 and 36 The manager provides clear leadership and is supported by the proprietors and senior staff to ensure residents’ care is delivered with skill and in a timely way. The home reviews this performance by seeking the views of residents, relatives and staff. EVIDENCE: The manager is well qualified and experienced and has a clear vision and personal philosophy in her approach to managing the home that promotes a clear direction that is open and inclusive for all staff. Regular staff meetings are held and notes kept of the discussions and actions decided. All staff receive a copy of the Code of Practice issued by the General Social Care Council. Regular quality assurance surveys of service users views and audits of clinical events, such as falls and pressure areas are undertaken. The report of the most recent survey was not available in matrons’ absence but the previous report for 2004 was seen.
ARBORETUM NURSING HOME Version 1.10 Page 16 Staff receive regular supervision and qualified nurses receive monthly clinical supervision. These supervisions include the topics of work activities, home philosophy, individual care planning and observed practice. While not assessed in detail on this occasion the environment was observed to be safe with clear passageways, records showing the fire testing and staff training and drills, the emergency lighting tests and hot water monitoring records were seen to be up to date. The training records show that health and safety is a topic included at induction and continued for all staff. ARBORETUM NURSING HOME Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 3 3 x x 3 x x ARBORETUM NURSING HOME Version 1.10 Page 18 yes 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. Standard op26 Regulation 23(2)(k) Requirement The registered person must provide the facility of sluicing disinfector. (Previous timescale of 31.3.05 not met) The responsible person must provide each bedroom with suited door locks to an approved standard. (Previous timescale of 31.3.05 not met) The responsible person must make arrangements to provide a safe supply of hot running water at all staff hand wash outlets. (Previous timescale of 31.3.05 not met) The registered person shall include a photograph of each service user in the case file. (Previous timescale of 31.12.04 not met) The registered person must ensure that care plans are completed as thoroughly as the assessment identifies and that reviews are undertaken in a timely way to reflect service users condition changes The registered person must obtain confirmation that rooms are furnished to service users requirements and a signed
Version 1.10 Timescale for action 30 June 2005 30 June 2005 2. op24 23(2)(e) 3. op38 13(3) 30 June 2005 4. op37 17(a) schedule 3(2) 15(1), 15(2)(b) 30 June 2005 5. op7 30 April 2005 6. op24 16(2)(c) 31 May 2005 ARBORETUM NURSING HOME Page 19 record maintained on file 7. op16 22 The registered person will make available the record of complaints for inspection by the Commission at all times. 31 May 2005 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 op19 op25 Good Practice Recommendations The responsible person should prepare a programme for the timely replacement of worn carpets and failed doubleglazing units. The responsible person should increase the frequency of monitoring hot water temperatures and introduce annual anti scald tests and servicing and maintain records in a way that provides a clear history for each mixing valve unit. 3. ARBORETUM NURSING HOME Version 1.10 Page 20 Commission for Social Care Inspection Mucklow Office Park West Point Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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