Inspection on 25/10/06 for Arboretum Nursing Home

This inspection was carried out on 25th October 2006.

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 24/10/05

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 Mr Richard Eaves Key Unannounced Inspection 25th October 2006 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.V316556.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. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 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.V316556.R01.S.doc Version 5.2 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 24th October 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. Fees currently range between £446 and £458 a week. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was undertaken by a single Inspector from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the unannounced inspection during October 2005, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire and records held at the home. The inspection involved a full tour of the home including, bedrooms, communal rooms, service areas and provided an opportunity to speak with many service users, visitors and staff. What the service does well: What has improved since the last inspection? A number of environmental improvements have occurred including replacing failed double glazing units, replaced some worn carpets and undertaken some decoration. A service user photograph has been included in the case file. The fitting of suited bedroom door locks has been commenced and a supply of locks are available to complete the programme. Staff hand wash points have been controlled to provide a safe supply of hot water. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standards 1 –5 were looked at. This judgement has been made using available evidence including a visit to this service. Service users, prospective clients 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. The staff group are stable well established and collectively have the knowledge and skills to assess needs and to meet the needs of the current service users. EVIDENCE: The statement of purpose and service users guide (Welcome pack) are kept under review and provide current and prospective service users with a good sources of information from which to make informed decisions about the suitability of the home and the services they offer. 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, these are kept under regular review, the assessment evidences the involvement of the service user and their relatives as appropriate. In all cases the home confirms that the Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 9 identified agreed needs can be met by the home in writing and a contract is issued at admission, copies are kept in the administration office with a copy of terms and conditions on file, this requires to include the room occupied. 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 does not currently provide intermediate care. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Standards 7 – 11 were looked at This judgement has been made using available evidence including a visit to this service. 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. Health care needs of service users are fully met. Administration of medication practice is good and service users medication needs are safely met. Service users are treated with respect and their privacy upheld and they can be assured that they and their family will receive care with sensitivity at the time of their death. EVIDENCE: The case files of 4 service users were case tracked in depth and showed 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. All service users are registered with a GP and other allied medical and chiropodist visits regularly The Home uses a monitored dosage system for the administration of medicines. An examination of the records demonstrates that the management Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 11 of medicines is of a good standard and in accordance with policy and guidelines. It is recommended that the medication policy be made available in the medicines room for easy access. A contract is in place for the disposal of pharmaceutical waste. The induction programme includes a section on treating service users with respect, this is also addressed in the customer care training package, privacy is upheld with locks fitted to bedroom doors, in addition staff were observed to knock before entering and interact in a friendly and open way using the service users choice of name. 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. The home has implemented the ‘Gold Standard Framework’ for end of life care for service users. 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.V316556.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standards 12 – 15 were looked at. This judgement has been made using available evidence including a visit to this service. 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. 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. The manager recently undertook dementia mapping of the service and this has given information for improvements such as improved seating arrangements such as ensuring those able and wanting to socialise sit together, identifying those who would benefit Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 13 from access to the day centre. Assisting in minimising day time sleeping and providing activity for service users receiving tube feeding at meal times. 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. In conversation with those in their rooms they said they did not feel isolated and occasionally joined other service users when activities of interest were provided. 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. Visitors spoken with were very complementary of the home and staff and said they were made welcome and kept informed of matters affecting their relative. The case tracking show the files 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 and demonstrate that the period between meals does not exceed 12 hours. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standards 16 and 18 were looked at. 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 which contributes in providing an environment safe from abuse. This judgement has been made using available evidence including a visit to this service. 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. The Home has a robust adult protection policy and actively promotes the policy and that of whistle blowing. Staff receive training including attending the Walsall Social Services training and know how to respond if they suspect or observe any aspect of abuse. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home provides a good standard of accommodation, décor, furnishings and managed services providing a safe environment and an attractive, comfortable and homely place to live. The home is clean, free from odours and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the building confirmed that the home was clean and overall in good decorative order. The house keepers work to a well developed cleaning schedule and have undertaken NVQ training which has assisted in achieving a very good standard of cleanliness. 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 and many were seen to be personalised with pictures, ornaments and some furnishings. A number of rooms have been redecorated and re-carpeted. Corridor carpets are badly marked and require changing, this is delayed awaiting building of the extension. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 16 No progress has been made to address previous environmental requirements these planned to be included in the extension these requirements are restated. In conversation with service users both in the lounges and in their own rooms they all commented that they were very happy with the environment of the home with pleasant outlook and comfortable. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. 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. This judgement has been made using available evidence including a visit to this service. 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 home is used for student nurse training and for nurse adaptation. Currently 70 of carers hold the NVQ qualification with further staff undertaking training. Other training provided includes, Fire safety, manual handling, first aid, health and safety, food hygiene, infection control, dementia care, wound care, continence care and gold standard framework palliative care. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 18 Recruitment and selection are completed to a good standard and includes all necessary checks such as CRB, POVA and nursing registration. The sample of four staff files inspected also show that two references are obtained and a record kept of the interview. New carers undertake an extensive induction and foundation programme. It is recommended that reference to the location of the CRB and POVA reports be included in the staff file. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standards looked at were 31, 33, 35, 36 and 38. Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities and service users benefit from this consistency. The home regularly reviews its performance which includes consultation and seeking the views of service users and their families and evidenced that it is acted upon. The arrangements for safekeeping of service users money safeguards their interests personal and financial. Staff receive supervision and direction to ensure that the service users receive consistent quality care. The safety and welfare of service users is protected. This judgement has been made using available evidence including a visit to this service. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager is a registered nurse with extensive experience in care home management and holds a certificate in management award and part completed Diploma in Management Studies. Many staff gave the view that morale at the home is high and that the senior staff are very approachable and work closely with staff. Regular staff meetings also support this with good communication. 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. 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. 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. A test of the alarm system for the lift shows this to be of very low volume and requires to be addressed by the servicing company. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 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 2 X X X X X X 2 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. Part met. (Previous timescale of 31.3.05 not met) The responsible person must ensure that the lift is fitted with an alarm that is audible to staff outside. The registered person must ensure the terms and conditions and or contract kept on file includes the room number to be occupied and evidence that any changes are agreed. The registered person must ensure that meals are varied by formalising the high tea and supper menu’s. (Previous timescale of 31.12.05 not met) The responsible person must ensure that the corridor carpets are replaced in a timely way. Timescale for action 31/03/07 2. OP24 23(2)(e) 31/12/06 3. OP38 13(3) 31/12/06 4. OP2 5(1)(b)(c) 31/12/06 5. OP15 16(2)(i) 31/12/06 6. OP19 23(2)(d) 31/03/07 Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations A copy of the homes medication policy should be available in the medication room for easy reference. Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 24 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: 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 Arboretum Nursing Home DS0000020787.V316556.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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