Inspection on 24/10/05 for Arboretum Nursing Home

This inspection was carried out on 24th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arboretum Nursing Home 14/10/08

Arboretum Nursing Home 25/10/06

Arboretum Nursing Home 12/04/05

Arboretum Nursing Home 15/11/04

Arboretum Nursing Home 15/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Arboretum Nursing Home Forest Lane Walsall West Midlands WS2 7AF Lead Inspector Richard Eaves Announced Inspection 24th October 2005 08:30 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 Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 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. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Arboretum Nursing Home Address Forest Lane Walsall West Midlands WS2 7AF 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) 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 (5) of places Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 41 physically disabled from the age of 50 years, of which up to 5 may require palliative care No number division between categories. Maximum number of service users must not exceed 41 (forty-one). Date of last inspection 12th April 2005 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 en-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 DS0000020787.V256982.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection visit was undertaken by an Inspector from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the unannounced inspection in April 2005, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire, comment card responses from service users and relatives and records held at the home. The inspection involved a full tour of the bedrooms, communal rooms and service areas and provided an opportunity to speak with most of the service users. Comment cards were received from 26 service users and 17 relatives/visitors to the home. Overall the responses were positive, where appropriate responses are include in the body of the report. What the service does well: What has improved since the last inspection? Care planning has been improved by ensuring that reviews and updating is kept fully up to date and reflects changes in condition and responses required as they occur. The home has surveyed the service users to assess their wishes in respect of the furnishing of their own bedrooms and furnished accordingly. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 6 A number of environmental improvements have occurred including replacing failed double glazing units, replaced some worn carpets and undertaken some decoration. The monitoring of the safe delivery of hot water at service user outlets has been improved by increasing the frequency and improving the recording to better show the history of each mixing valve. 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. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1–6 Service users and prospective clients including intermediate care users and their supporters are provide with good sources of information about the home and are invited to spend time at the home prior to admission to enable them to make an informed decision about entering the home this is confirmed at admission by contract. The staff group are stable well established and collectively have the knowledge and skills to assess needs and to meet these assessed needs of the current service users. Confirmation that assessed needs can be met furthers enables service users to make informed decision about entering the home as does the opportunity to visit and trial the services offered. A clearly defined area is available for intermediate care service users maximising the opportunities for rehabilitation. EVIDENCE: The statement of purpose and service user guide remain up to date and are a good information resource for current and prospective residents. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 9 Senior staff of the nursing home undertake assessments for prospective service users these include activities of daily living and a range of clinical risk assessments such as pressure areas, nutrition and falls. The home needs to demonstrate that the assessments are subject to regular review. In all cases the home confirms that the identified agreed needs can be met by the home in writing and a contract is issued at admission, copies are kept on file. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions, which are right for them but it is acknowledged that most service users are admitted from hospital. The home has 2 beds dedicated for intermediate care and these are fully utilised by the hospital. Service users spoken with expressed their satisfaction with the home, one lady previously met stated that she continued to be delighted with 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. Of 26 service user comment card respondents 21 said they liked living at the home while 4 indicated that they did not like living in a home, but in conversation with 2 of those it was clear it was not about the home in particular and all but 1 said they were well cared for, the exception being anonymous. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 11 Health care needs of service users are fully met. Care plans are derived from a comprehensive range of assessments and provide the basis for the delivery of care and detail the actions required of staff to meet the identified needs. Medications are well managed all facilitating the promotion of service users health. Service users are treated with respect and their privacy upheld. Staff have been developed to provide care at the time of service users dying with sensitivity and respect. EVIDENCE: A sample of case files were tracked in depth and show that they comprehensively identified problems requiring nursing and personal care interventions. 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. The previously identified problem of documentation not keeping pace with rapidly changing circumstances appears to have been addressed satisfactorily. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 11 The Home uses a monitored dosage system for the administration of medicines. An examination of the records demonstrates that the management of medicines is of a good standard and in accordance with guidelines. The public telephone is available in the lobby, which offers little privacy although the area is little frequented other than passing through. The manager advises that incoming calls are usually taken in the office. Service users wear their own clothes at all times and on the day of inspection everyone appeared neatly attired. The home has been selected by a national group to be part of the 2nd phase, 1 of 4 in the West Midlands, to implement the ‘Gold Standard Framework’ for end of life patients. This provides a formalised practice that includes advanced care planning in a care pathway format that is designed to ensure there is forward thinking and identification of personal choices in an objective way. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 The home provides well-organised and varied social and recreational activities that provide interest and pleasure for the residents. Visitors are welcome and help to keep service users informed about the wider community Many aspects of care evidences that service users exercise choice and control over their lives. The meals at Arboretum nursing home are good, offering both choice and variety and catering well for special dietary needs. Adjustments to the way the menu is promoted would improve the ability of service users to better make choices of which meals best meet their personal needs, likes and wishes. EVIDENCE: 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 spending a large part of the day there including taking lunch. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 13 During the inspection it was seen that a number of service users choose to spend their time in their room and it was observed that most rooms were personalised with ornaments, pictures and photographs. Some visitors were received in bedrooms while others remained in the main lounges, there are also a number of quiet areas that visitors can be received privately. The inspection of case files show these to include a section that identifies personal likes and wishes such as rising and settling time and their ability to make choices such as what clothes to wear. In conversation with service users it was clear that they feel that there wishes are fully taken into account by care staff in the way they deliver assistance. 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, while two comment card respondents indicated that they didn’t like the food. While supper is provided during the evening no reference to this is made in the menu’s, details of this provision would be helpful to service users in choosing there meals over the day as a whole. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 – 18 The home complaints and protection policies are robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded to. Service users rights are protected and staff demonstrate excellent knowledge and understanding of adult protection issues that contributes in providing an environment safe from abuse. EVIDENCE: The complaints procedure is readily accessible to service users and their supporters with reference in the contract, the statement of purpose and is on displayed. No complaints have been received since the previous inspection. Two comment card respondents indicated that they did not know of the complaints procedure but all service user respondents said they knew who to speak to if unhappy with care. The electoral roll has recently been completed on behalf of service users. 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 DS0000020787.V256982.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home provides a good standard of décor, furnishings and managed services providing a safe, disabled accessible environment and an attractive, and homely place to live. The home is clean, free from odours and hygienic. EVIDENCE: 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, this is with the documented agreement of service users. The rooms appear comfortable and uncluttered. No progress has been made to address previous environmental requirements these planned to be included in the extension these requirements are restated. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 The home has a good mix of staff in sufficient numbers to provide consistency of care that meets service users needs. The home has been proactive in developing a skilled staff group with understanding of service users needs. Recruitment and selection processes are to a good standard protecting vulnerable people. 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. Currently 54 of carers hold the NVQ qualification with further staff undertaking training. A sample of staff files were checked for thoroughness of completion and it was found to be completed to a good standard with all necessary checks undertaken. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 17 All staff have an individual training record and a training matrix is maintained of mandatory and other regular training required. These records show training to be up to date and the nursing staff have opportunities for professional updating. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36, 37 & 38 The home regularly seeks the views of service users and relatives to assess its performance in meeting their needs. The sound financial management of the home and arrangements for safekeeping of their money safeguards service users interests personal and financial. Leadership is good at the home with supervision and direction to staff to ensure that the service users receive consistent quality care. Records maintained by the home support the delivery of care and services that ensure consistency and safety for service users. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 19 EVIDENCE: An extensive range of audits are undertaken including service user surveys and reviews of clinical activities on a weekly and monthly basis monitoring pressure sores and clinical baselines. The manager has undertaken survey of service users views and is waiting for responses. An action plan was shown for the previous survey. The manager regularly leads service user and relative groups to examine focussed aspects of service. Families mostly manage service users personal allowances although a small number manage their own affairs. Where money is left for safe keeping full records are maintained of all transactions. The home gives high priority to the induction and ongoing training of its staff and has well-established formal supervisions, which informs the training and development requirements of individual staff. Records required by regulation are maintained, up to date and kept secure. Exceptionally currently no photographs are held of service users on their case files. The home has an up to date health and safety policy for safe working practice with a range of risk assessments. Staff receive training and regular updates in health and safety and fire safety. A fire risk assessment was available and this is subject to review as changes occur. Certification of a range of servicing and annual inspections undertaken of all utilities and equipment in the home are maintained and up to date. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 20 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 2 2 Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 meals are varied by formalising the high tea and supper menu’s. Timescale for action 31/03/06 2. op24 23(2)(e) 31/03/06 3. op38 13(3) 31/03/06 4. op37 17(a) schedule 3(2) 16(2)(i) 31/03/06 5. OP15 31/12/05 Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 22 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 OP3 Good Practice Recommendations The manager must formalise the process of reviewing the assessment of service users. Arboretum Nursing Home DS0000020787.V256982.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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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