Inspection on 26/08/08 for Arbory Residential Home

This inspection was carried out on 26th August 2008.

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

Similar services:

Fountain View

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

CARE HOMES FOR OLDER PEOPLE Arbory Residential Home London Road Andover Down Andover Hampshire SP11 6LR Lead Inspector Kima Sutherland-Dee Unannounced Inspection 26th August 2008 08:40 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 Arbory Residential Home DS0000071777.V369498.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. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arbory Residential Home Address London Road Andover Down Andover Hampshire SP11 6LR 01264 363 363 01264 363 363 christine@arbory.co.uk 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) ABC Shelf Ltd Mrs Christine Anne Hanwell Care Home 64 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0) of places Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 64. Date of last inspection Newly registered service. Brief Description of the Service: Arbory residential home is a large care home on the outskirts of Andover. The home is split into two with the old house connected to a three storey extension by a covered walk way. The home is in large secure gardens with extensive staff and visitor parking and security entrance systems. The home is registered to offer personal care for up to 64 male or female Service users who have dementia or mental disorders, excluding learning disabilities. The home was purchased by ABC Shelf Ltd in February 2008 and the new manager was registered in May 2008. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection included a visit to the home for eight hours and fifteen minutes. The manager, service users, staff, and a relative were spoken with and a sample of the documents and records were reviewed. The visit included the assistance of an ‘Expert By Experience’ who stayed for 5 hours and forty five minutes and spoke to staff and service users as well as observing the care and facilities. This expert accompanied the inspector to add to the available evidence, and the report they produced will be incorporated into this report. This report will also include information from the homes own assessment, which the commission required them to complete (AQAA) as well as any information we have received about the service. 15 Service users and 13 staff completed the ‘Have Your Say’ surveys and this information will also be reviewed and included. The current Fees for this service are between £415 per week and £540 per week. What the service does well: The service is good at maintaining the service users health and making sure people have access to health professionals including a visiting optician and audiologist. A particular strength of this service is the high level of activities available, the service users and a relative said this had improved over the last few months. The staff had organised a pretend cruise and decorated the home according to different destinations, with themed food, films and activities. One service user said ‘ I like the music and decorations.’ Another service user said they liked to keep busy. Three different groups of service users were involved in card games, making card shapes and ball throwing all with staff assistance. The staff also commented how the increase in activities had helped the service users to keep occupied during the day and that the service users appeared more settled. The staff are also aware that a number of service users do not participate and this is recognised as their choice. A family member said ‘ The last family day was well organised and enjoyable.’ Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 6 Comments from the staff surveys included: ‘ The new manager has had to contend with negative obstruction from some staff. Thankfully things are improving in leaps and bounds in recent weeks.’ ‘ The staff offer the correct care, respecting the rights and dignity of each resident.’ Comments from the service users surveys included: ‘ I visit my relative regularly and have found unfailing support and care for them.’ ‘We feel that support and care has greatly improved recently.’ ‘ Our relative is not a particularly good eater but seems to eat more since a change in the home ownership.’ ‘The cleanliness has greatly improved.’ ‘Since the change in ownership we feel that all aspects of the care have improved for both the residents and their relatives.’ These comments and the available evidence demonstrate that the home has undergone a period of transition that some staff have found difficult but the changes the new manager has made have benefited the service users and the staff team. What has improved since the last inspection? This is a newly registered service since the new owners and manager were registered with the commission earlier this year. There is evidence from existing staff and from documents that show how the service has improved. Comments from the service users and their relatives also enable a comparison to be made between the level of service previously and the positive impact the new manager has made. An example of this came from a member of staff who spoke to the expert by experience, they said ‘The changes seemed drastic and I was worried about them, but now I can see it’s working well.’ She added, ‘It was so bad here before the new management that I hated going over to the main building to help. I used to be left to toilet residents by myself while three carers were sitting around doing nothing, but it has all changed now’. Three service users said they had noticed a difference in the home since the new manager started. They said that the food was better and there was more to do. The five staff spoken to said that the home had improved for the benefit of the service users. They said that everything had improved including the number of staff, the training, the care standards and the level of activity. The expert Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 7 by experience said they met only one member of staff who wasn’t happy with the changes, but they stated this was because they had extra work to do. The manager has made changes to the environment to assist people with dementia. These include colour-coding areas of the home and the bathroom doors for easy identification. Lighting has also changed in one corridor and the results are being monitored before further changes. The manager and the staff team have worked hard to implement new detailed care plans and to increase the activities. The food has improved because the chef is able to purchase more fresh ingredients. The service users health has improved through the availability of water coolers and drinks and through the reduction in infections. The manager has also arranged health reviews including a G.P review of medication, visiting opticians and audiologists. 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. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 8 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 Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 9 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): 1,2,3,5 Quality in this outcome area is adequate. The service users benefit from having their needs fully assessed and from the opportunity to visit the home. Prospective service users and their relatives will be better able to make an informed choice about the home when the newly developed statement of purpose and service users guides are published and when the new contracts are finalised and signed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that ‘Admissions to the home are well managed and an effective assessment procedure takes into account peoples needs, including those regarding equality and diversity, and social & leisure requirements, care is then planned to take into account these needs. ‘ Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 10 Two of the new style assessments were seen and they had been used effectively to assess the needs of prospective service users who had since moved into the home. The assessments were then used to form the basis of the service users care plans and they covered all areas of their needs and how these could be met. The manager stated that prospective service users are encouraged to visit the home and stay for a meal before they make a decision. During the assessment and visit the staff show the service user and their relatives around the home and explain about the services and facilities. This process will be clearer when the new service users guide and statement of purpose have been published. The manager said they will be available within the next month. New contracts have also been developed to reflect the new ownership and management and these will be signed over a period of time in consultation with each service user and their relatives. A copy of the new contracts were seen and they included the terms and conditions at the home. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. The service users benefit from an improving care planning system that ensures their needs are met. The medication is stored and administered safely and people are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eight care plans were reviewed; four of these had already been transferred onto the new care planning system. The new system includes all the details that the staff need to care for each service user, including health monitoring and risk assessments. The staff complete notes on the care and any changes twice each day, and these notes were useful and detailed. The manager said they were training the staff to use the new care plans and all of the old ones will have been updated and improved within two months. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 12 The staff knew the needs of the service users well and the expert by experience reported that The carers, despite some of them being at the home for only several weeks or months, seemed to know the names, preferences and histories of the residents. The service users health has improved in the last four months ( since the new manager started at the home), and the manager said that the local G.Ps were being called out less often. The manager had also been monitoring the number of times service users were falling this had decreased considerably since the manager had installed water dispensers in the lounges and encouraged the staff to assist the service users to have more to drink. The care plans also reported that there had been a considerable reduction in the number of service users with Infections and with infectious skin conditions. The manager said that they had identified people with infections and the G.P had treated people. They also said that recent changes to infection control measures had stopped the spread of infections or contained them without contaminating other people. A visiting relative said that their family members health had greatly improved since they had been at the home and the staff keep them informed of any changes. The manager has arranged for visiting opticians and audiologists to come to the home, and a full health and medication review in co-operation with the local G.Ps had been arranged for September 2008. The medication storage, recording and administration were seen and this was correct and according to the homes new policy, which the manager had developed. The policy takes into account the latest guidance for safe practice. The staff who administer medication are trained and there are plans to update this training and to train new staff. The expert by experience reported they had observed, One resident in the entrance hall notifying a senior carer that he needed to take his tablets at 1130, as he did every day apparently. The inspector saw that the carer gave the medication straight away. The expert by experience spoke to a service user who said about the staff, ‘They’re very kind. We have our nails cut.’ But the expert noted one lady who did need her nails cut and cleaned. Other service users were having their hair done by carers as the hairdresser was on holiday. The expert said I observed two residents having their hair dried and styled by carers in one of the lounges. Some residents had hand-massages given by carers. All the observations during the day demonstrated that the staff were kind and respectful to the service users. The expert reported their observations and these included, Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 13 A carer was taking a lady up to her room after lunch and stopped to explain very carefully and thoughtfully to her that she just had to let me out of the front door. There was very good rapport between the two. One resident knew the name of one of the senior carers saying, ‘She’s good’. I witnessed carers using the footplates when assisting people who used wheelchairs and ‘handling’ the residents carefully when moving them. One gentleman said, ‘I’ve nothing against the staff.’ One lady said, ‘No-one’s showing off or being nasty; they’re so funny. Everyone is laid back. It’s an ideal place.’ At lunch a senior carer asked a resident before taking her plate away, ‘Have you finished your main course? Are you alright?’ The manager told the inspector that the chiropodist used to treat people in the lounges, this had been stopped to afford people more privacy. The AQAA includes the plan to develop a room in the home as a treatment room to allow people to be seen in private outside their bedrooms. This room was seen and the manager spoke about the schedule in the near future to fit the room and make it usable. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is good. The service users benefit from a wide range of activities which meet their needs. The service encourages involvement by family and friends and makes them welcome. The service users can choose how to spend their time and this is respected. The service users are offered a well balanced diet of their choice in improving dining areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the strength’s of this service is the availability of a wide range of activities. Two members of staff said that there had been an improvement in the level of activity since the new manager started. They said the home was busier and this had benefited the service users. The expert by experience commented that although there was plenty going on the atmosphere was calm. The staff asked a service user if they wanted to wash up and to lay the dining table. This service user smiled and said they liked to keep busy. The expert Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 15 by experience also talked to a service user who was making themselves a drink they said ‘Time flies when you’re busy’. The home was decorated like a cruise ship and for two weeks the staff had organised different destinations with themed activities, films, food and music. The expert by experience said that one lady asked, ‘Which country are we in next?’ and a gentleman was laughing with the manager when she reminded him of his go at belly-dancing when they were ‘in’ Egypt . Three different small groups were involved in playing cards, cutting out shapes and playing ball throwing. The service users said they enjoyed the activities. The service users who choose not to participate are offered individual time in their rooms, this may include hand massages, reading or chatting with staff. The service users are encouraged to use the secure garden areas and there is a covered seating area. The service users said they enjoyed bowling on the games consul and eight people had recently gone on a day trip to Bournemouth. Photographs in the hall showed many service users enjoying the company of a P.A.T (Pets as therapy) dog. There were adverts in the home for forthcoming events and two service users said they really enjoyed the film matinees that included cinema style snacks. The manager said they intended to introduce more activities that are specific for people with dementia. Activities are also individualised wherever possible. One service user likes jigsaws and the staff have been finding a supply in local shops, this person also told the staff how they used to play an instrument, the staff discovered they still had the instrument and they have organised for it to be repaired and cleaned. The written information about the pretend cruise included an invitation to family and friends and the notice boards included other information about the home to keep relatives informed. The manager has introduced relatives meetings and there have been two in recent months, the manager hopes that a number of relatives will take on the responsibility of running a ‘ Friends of Arbory’ group. A visiting relative said the staff were friendly, they were made to feel welcome and the staff contacted them about any changes in their relatives health. The care plans included information about peoples chosen religions and the home ensures that people can access local churches or attend the in house religious services. The expert by experience noted other examples of the service users being offered choices. They reported that A carer said, ‘It’s up to the individual what they like to do. Some like the bingo.’ One lady although not playing dominoes was partaking in the social interaction between the carer and gentleman playing dominoes. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 16 The experts report also included There were lots of different areas for residents to sit in with different outlooks, whether it was in a lounge area or on the terrace or by a window in a corridor. One gentleman had a tray for his lunch next to him where he was sitting as he did not like sitting at the tables. The Expert by Experience included the following observations and details in their report about the food at the home. There was a three-weekly menu in the kitchen. The chef said, It’s better since the new management as there has been better nutrition and better meals with nearly everything fresh with ‘no expense spared’ and ‘I am given a free rein’. With discussion with the manager, he tweaks the menus every 2 months. He said ‘The residents like the fish and chips on Fridays’. He mentioned that there were sometimes smoked salmon and cucumber sandwiches in the evening. During the pretend cruise the chef had served some themed food for different destinations. The chef said he would do sweet and sour pork whilst ‘in China’ as the residents liked it. The home serves breakfast, lunch at 12.30, supper at 5.00p.m and sandwiches at 8.30p.m with cakes and biscuits with hot drinks in between. Lunch on the day of the visit was either fresh sausages with onion gravy or chicken fricassee with batons of carrots, peas and mash followed by apple crumble and cream. Residents are given the choice at the time of the meal. Portions were good and looked appetizing and residents seemed content eating their meals. The chef said they planned to put up blackboards in every dining-area with the daily menu up. For supper, there was going to be pasta tuna-bake or home-made carrot and basil soup. In the very clean kitchen after lunch I saw a box of fresh broccoli and a tray of cauliflower from a local supplier. One resident said, ‘ I like the beef best. The food’s quite good.’ Another said, ‘Excellent food.’ One said, ‘I’ve nothing against the food.’ The chef showed genuine interest in his work and was left preparing for the next day as well as for supper. The tables were laid with paper napkins and there were jugs of juice on each table. The manager said to the inspector that since they started to ask staff to encourage the service users who are able to make their own hot or cold drinks in the kitchenettes, the service users who are able have made free use of this facility. A service user was seen making a cup of tea and they said they liked to do this. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 17 Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 18 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): 16,18. Quality in this outcome area is good. The service users and their relatives are encouraged to give their views and they can be assured that the manager and staff will follow the proper procedures and take their complaints seriously. The service users benefit from a staff team who are trained to protect them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that We acknowledge that most of our residents are either very frail, experiencing dementia or have a physical disability, this may present a barrier to them making their views known, so we have fostered an open approach for family, friends or advocates. The manager and senior staff are in day to day contact with a lot of families or representatives, any areas of dissatisfaction or unhappiness are dealt with immediatly to prevent them developing into greater concerns. The complaints procedure is displayed in the home and a relative said they would go to either the manager or social services if they had any complaints. The expert by experience reported that, No residents I spoke to had any complaints when asked. One resident said he would go to the office if he had Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 19 a complaint. Another said that her daughter would talk to the manager if there was a problem, but added that her daughter was satisfied with everything. One resident said, ‘No grumbles here. They’re looking after me as best they can’. A lady said, ‘I have no complaints but would go to a team leader if I had one.’ The surveys recorded that people knew how to make complaints. The commission has received three anonymous complaints about the home in the last two months. These complaints were explained to the manager who was able to prove through documentation that either the information in the complaints was incorrect or that there were explanations as to why practice had changed to improve the outcomes for the service users. The manager explained at the beginning of the inspection that since the transition to new ownership and management, a number of the staff who had been at the home had chosen to leave because they did not like the changes that were being made to care practices. This was borne out by statements from staff who had chosen to stay at the home, and these staff said that although the changes had been difficult at first they saw the benefits for all the service users, but that some staff had left. There had been a concern from a social worker who contacted the commission following a meeting with a relative, this related to accounting practices within the home along with a number of care issues. This social worker said they would revisit the home. The manager was able to explain what had happened and what measures had been taken to reassure relatives or to improve previous practices. There had also been one safeguarding alert in May 2008, which the manager had dealt with appropriately, they had sought advice and informed all the concerned agencies. They had followed their own procedures and since then they have used the experience to train staff. The staff said they have had training in Protection of Vulnerable adults. The staff were able to describe what they would do to protect people and to report any concerns. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 20 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): 19,20,22,24,26. Quality in this outcome area is adequate. The service users benefit from an improving environment that meets their needs. The home is comfortable and clean and the bedrooms are suitable. The home will be improved further by reducing the unpleasant odour in one area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager explained that detailed plans have been submitted to refurbish the home and the gardens. This includes linking both parts of the home with a proper corridor and building a new front reception area including seating. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 21 The AQAA states that Plans for refurbishment in the garden and indoors have been sought from specialized designers who have experience with dementia. It also said that the service would experiment with lighting, colours and carpets and then seek feedback from residents, relatives and staff, on their preferred choices. The refurbishment has been started by re painting some of the corridors and bedroom doors so these are now colour coded. The bathroom and toilet doors are all being painted the same colour to assist the service users to identify these rooms and to find their way around the home. The lighting in one corridor has been changed and the reactions and opinions of the service users are being reviewed before this scheme is extended. The garden is being redesigned to extend the access and provide a sensory garden. Raised beds are also planned so that the service users can be involved in gardening if they choose. A courtyard will also link to a room where relatives can be entertained and have access to refreshments. The home is large but there are several areas where the service users can sit and the gardens are fully secure. The manager said they had changed the use of the lounge/diners so that these areas are now separate, this has created movement between the lounge and dining room and the staff could see the advantages to the service users. The expert by experience reported that, One of the changes a carer wasn’t so sure about was to make separate areas for dining, as she thought the residents would find it difficult to find their bearings. However they now see the benefit of creating movement and a change of scene for the residents. The service users bedrooms are comfortable and the expert by experience noted that a service user who had used a key to get into her room was proud to show me her pictures on the wall and said they made it feel like home for her. The AQAA states that Bedrooms reflect that residents are encouraged to personalise their own space and in fact relatives are encouraged to bring in items before the new resident arrives, creating a sense of ownership from the very beginning. In one service users room, an air-extractor was dangling from the ceiling because of a flood above. This had been reported to the manager. The expert by experience had this pointed out by the service user and the manager had this drawn to their attention again. The manager assured the service user that it would be repaired. The AQAA states that The home is kept safe, clean and freshly aired by dedicated housekeeping employees and two maintainence personel, ensuring Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 22 the environment and equipment are constantly maintained. The home has infection control procedures in place and all staff have access to protective clothing. The equipement for infection control was seen and the expert by experience noted that The new Ty-Bag laundry sytem had reduced infections. Staff had gloves, aprons and other equipment available to them and they have had training in infection control. In one area of the home there was an unpleasant odour. Two service users surveys and the staff said that the unpleasant odours in the home had significantly reduced since the new manager started. The manager is aware that further work needs to be done to reduce the odour and they are finding ways of achieving this. The cleaning staff were seen around the home and although one was unable to verbally communicate effectively in english they knew their role and they were able to complete all of their tasks. The manager has increased the number of domestic staff and a service users survey said the home was cleaner than before. Arbory Residential Home DS0000071777.V369498.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): 27,28,29,30 Quality in this outcome area is good. The service users are cared for by a safely recruited and trained staff team. There are enough staff available to meet the service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has developed new staff duty rotas so that plenty of staff are available at core times during the day. This includes a handover period when two shifts of staff work together each morning, afternoon and evening. The staff said there were enough people to meet all the service users needs and the number of agency staff has reduced since the new manager has recruited local staff. The expert by experience reported that The staff seemed to have a good rapport between themselves as well as with the residents. They also noted that There was a calm atmosphere. The carers were quietly going about their work. The residents seemed to be content. The manager stated that staff not being available to work due to sickness has reduced from five or six per month to one per month. A member of staff said they had taken sick leave over the period of transition when the owners and Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 24 manager changed but they now felt more confident and could see the benefits for the service users. The AQAA states that at least 50 of the care staff have National Vocational Qualifications (N.V.Q) in care and other staff have specific qualifications in such as a certificate in mental health. Six staff files were reviewed and they contained all the information to show that staff have been safely recruited and that checks have been carried out. New staff said that they had had an induction period to learn their roles and the manager has developed new more detailed job descriptions. The manager has employed a training co-ordinator and they have developed a programme to ensure that all the staff are trained in all the core areas of care. Recent courses have included; Dementia care, Mental capacity act, Control of substances hazardous to health, Food hygiene and challenging behaviour. Two staff are now qualified as Manual Handling trainers and they are in the process of training other staff. The expert by experience discussed the possible introduction of a uniform with a member of staff who said they were a bit unsure of the new possible ‘uniform’ but saw the point, and they were interested and informed about the different materials and colours of shirts on trial. The expert also reported that An auxiliary carer who had been there for 9 years was happy with the changes and certainly was very good with the residents whether serving food or playing cards. I noticed that she and other members of staff were not in a rush to go off duty. One senior carer had been there for one year and was happy to recommend a friend to come in as a senior carer, which they did. I met four new members of staff who had been recruited by the new management, and all seemed happy with the way things were going and were looking forward to go into other areas of the home, so that they could meet all 62 residents in time and thus be able to help out if needed. This reinforced the idea for the home not to be run as two separate homes as in the past. There was a calm atmosphere. Arbory Residential Home DS0000071777.V369498.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): 31,33,35,38 Quality in this outcome area is good. The service users and the staff benefit from a manager who is qualified and experienced to manage the service. There are systems for seeking the views of the service users and relatives. The home is maintained safely and records are managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in their post since April 2008 and they have been registered as the manager with the commission since May 2008. Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 26 The manager is qualified and experienced and they have worked hard to improve the service for the benefit of the service users. The manager has developed new policies and new care practices and during this process a number of the staff who were at the home before have decided to leave. Other staff have stayed and new staff have been recruited. The staff were all positive about the leadership of the new manager and they said they were approachable and supportive. The AQAA states that The residents opinions are listened to in a variety of ways including surveys, resident/relatives meetings and by the day-to-day contact between residents and the management team. The manager said they are developing a new way of seeking the views of the service users and their relatives, and a survey will be sent out in the next two months. The manager had also developed an instant feedback form which they make available, the form can be left at the home or handed to the manager or sent to the owner. The manager pointed out that they make it clear that the service users or their relatives can approach the staff or manager at any time. A relative was seen approaching the manager in the office and they were listened to and dealt with in friendly manner. The providers also visit the home to carry out a monthly visit and the reports for these were seen. These visits provide support for the manager and time for the providers to ensure the service is adequately managed, they also spend time talking to the service users and staff. One of the recent concerns from a social worker regarded the way the service users money is managed. The manager explained that they inherited a system that did not have proper accounts and it also pooled the money given each month by the service users or their relatives which is unacceptable. The manager is in the process of changing this system in consultation with all the relatives and service users. Since the manager has started they have used a system that allows for each persons money to be individually accounted for with receipts for any purchases. The service had records that showed that the homes equipment and fittings are services. The AQAA states that all service checks are carried out to protect and promote the health, safety and wellfare of people living and working in the home. The contracts were seen for maintenance of the nurse call bell system, electrical checks, waste control and the passenger lifts. After lunch the fire alarm went off, the staff assembled and a member of staff informed the manager that it was due to steam from the dishwasher. The expert by experience noted that this member of staff said It happens all the time. I worry that one day, if the fire alarm goes off for real, nobody will notice.’ Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 27 The fire records were checked and the servicing of the alarms and tests were up to date. Arbory Residential Home DS0000071777.V369498.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 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 X 3 X 3 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 3 X 3 X 3 X X 3 Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 16(2)(c) (k) Requirement The manager must ensure that all parts of the home are free from offensive odours. Timescale for action 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Arbory Residential Home DS0000071777.V369498.R01.S.doc Version 5.2 Page 31 - 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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