Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Arbour Court Buxton Lane Marple Stockport Cheshire SK6 7QL The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Fiona Bryan Date: 1 5 1 2 2 0 0 8 Information about the care home
Name of care home: Address: Arbour Court Buxton Lane Marple Stockport Cheshire SK6 7QL 01614278599 01614271653 susan.ohara@barchester.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia 74 74 Over 65 0 0 Conditions of registration: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 74 Date of last inspection Brief description of the care home Arbour Court is a purpose built care home that provides 24 hour residential and nursing care and accommodation to 74 to service users over the age of 60 with dementia and/or mental health problems. The home is owned by Barchester Healthcare Homes Limited and is managed on a day-to-day basis by a registered nurse. The home is situated in Marple and is fairly close to Marple village. Local Care Homes for Older People
Page 2 of 11 amenities, such as shops, library, cinema and swimming baths are close by. Arbour Court is built in pleasant surroundings with attractive garden areas that are partly secure and accessible to the residents. Car parking facilities are provided at the main entrance to the home. Accommodation is provided over two floors. On the ground floor the original building is divided into three smaller secure units, each accommodating ten service users. Each area has its own lounge/dining area. An extension to the building was completed in February 2007, which provides accommodation for up to 14 people. The extension can be accessed via a separate entrance or through the main building. All the bedrooms in this part of the home are on the ground floor. On the first floor of the extension an activities room is provided, which is well equipped with resources to enable residents to enjoy social activities and maintain life skills, such as baking. A pleasant courtyard garden enables residents to enjoy being outdoors and participate in gardening if they wish. The first floor is arranged in an open-plan design, allowing service users to walk around the whole floor, excluding the extension. All the bedrooms are spacious single rooms providing en-suite facilities. A choice of bathroom or shower is available on each floor. The home has its own hairdressing room and the hairdresser visits once a fortnight. A wide variety of adaptations and aids are provided to assist in the nursing of the residents. Fees for accommodation and care at the home range from #550 to #92 Care Homes for Older People Page 3 of 11 What we found:
This random inspection took place on Monday 15th December 2008. Staff at the home did not know this visit was going to take place. We did this inspection because we had received information from a number of sources expressing concerns about inadequate staffing levels in the home and the impact of this on the standards of care being provided to residents. We spent a full day at the home and looked at whether the staff on duty were in sufficient numbers, how long they had worked at the home andd how experienced they were. We observed some care practices and the routines within the home. We spoke with the manager and other staff that worked at the home. We looked at how care was planned and monitored for some residents and a pharmacist inspector looked at the procedures in the home for managing medicines. What the care home does well:
During our inspection we observed staff working with and speaking to residents in a very caring and pleasant way. Staff were patient and friendly and from the response they got from residents we could see that residents were comfortable and relaxed and that this was the normal way in which staff spoke and dealt with people. We looked at the care files for several residents and saw that a number of reviews had taken place that had involved either the resident themselves or a representative. This meant that people had been given the opportunity to say what they thought about the care they or their relative was receiving. Care plans often contained specific details about individuals that gave staff good information about their likes and dislikes and preferences regarding their daily routines. Short term care plans had been written for some residents where new care needs had been identified. However, staff need to make sure that they do always follow the actions stated in the care plans; sometimes this did not happen, for example the care plan for one person said they should be weighed weekly but they were not weighed for a month and had lost a further 3 kgs in that time. We observed residents being served breakfast and lunch. Both mealtimes were calm occasions and staff were seen helping and encouraging residents sensitively. Staff were observed using safe working practices in respect of health and safety, for example ensuring that the footplates were in place when residents were using wheelchairs. A pharmacist inspector looked to see if medicines were being handled safely. Overall we found that although there were some shortfalls, medicines were mostly safely managed and the health and wellbeing of people who live in the home was protected. We looked at a sample of care plans to make sure that medicines were correctly Care Homes for Older People
Page 4 of 11 reflected in them. We found some good information about how peoples agitation and anxiety were to be managed. We found that two residents were given their medicines covertly (hidden from the resident in food or drink). We found that the relatives and the doctors had given their signed consent for this to happen and each resident had a completed risk assessment in their care file. We checked how controlled drugs (medicines that can be misused) were stored and recorded. A secure cupboard was used for storing them and accurate witnessed records were being made. We looked at how medicines were stored and found the areas to be clean and tidy. We looked at how medicines were checked and audited. The manager told us that medicines were formally audited twice a year. Updated medicines handling training had been provided to all nursing staff since the last inspection although nursing staff had not been formally assessed as competent in handling medicines. The manager told us that she was planning to do these assessments in the near future and to include a formal competency assessment in the homes induction procedures for new staff. Detailed recorded checks of the medicines, and regular training and competency assessment help to make sure medicines are handled safely and make sure that staff have the necessary skills. Staffing levels at the time we visited were adequate. On Ashwood unit there was a nurse and 3 carers on duty to care for 13 residents, on the rest of the ground floor there was a nurse and 5 carers on duty to care for 24 residents and on the first floor there was a nurse and 7 carers on duty to care for 26 residents. There was also 2 activities organisers who worked from 9am-5pm. However, of the 15 carers on duty at least 7 had only been working at the home for a matter of weeks and there were 3 agency staff. This is a situation that will rectify itself as staff become more experienced and used to their roles and we recognise that the manager has no quick fixes. What they could do better:
Although care plans were generally well written they were not always reviewed monthly. Risk assessments were also not always updated monthly. Care plans and risk assessments should be updated frequently to ensure that the information is accurate and properly reflects the residents abilities and identifies risks to the residents and how to minimise them. There were a number of gaps in the daily records for several residents. Detailed daily records are good practice as they help the manager check the care being provided and ensure staff are following the guidelines in the care plans. Daily records show what staff have done and provide the evidence on which to base the monthly review of care plans. Wound care records need to be more robust. One person had a pressure ulcer that still Care Homes for Older People Page 5 of 11 required dressing according to the daily report. However, it was not clear if the wound was improving, as the wound assessment chart had not been completed for nearly a month and there were no photographs of the wound. Taking photographs, with the residents consent is good practice as it helps staff to monitor the effect of treatment. The care plans for several residents required that their bowel function was monitored. However the records were not fully completed. This meant that there were shortfalls in the systems for monitoring residents and staff might not have identified when residents needed changes to treatment. We spent the day walking round the home and observing the daily routine. Carers were assigned to particular areas of the home and it was their responsibility to help residents get washed and dressed as they woke up and wanted to get out of bed. We noticed that a significant number of residents (about 14 across the home) remained in bed until very late in the morning. Whilst it might be the choice of some residents to stay in bed late, it was of concern to us that we were unable to tell if some of them had eaten breakfast, had drinks or been given any medication. We noticed that a number of residents were lying in the same position for several hours and there was nothing to indicate that any member of staff had been in to see them. Some residents had charts in their rooms for staff to record that they had checked that the bed rails were safely secured, or to record that the resident had been helped to move in bed to prevent skin damage. Some of the charts did not have any entries on them since early morning. We looked at the times that medicines were given to the people in the home. Because a large number of residents often slept until late in the morning this meant that frequently people did not get their morning medication. We found that sometimes people were offered their morning medication later in the day but most times it was not given at all. This could mean that in one month a resident may only get their medication on half of the days. This could have a significant effect on their health and well-being. We compared the medicines in the home against the records of what was administered and found that some medicines prescribed to individual residents were being used as general stock for homely remedies (medicines given for minor ailments with the prior agreement of the doctor) this is not allowed as it could lead to serious mistakes. We looked at the records of administration on the Ashwood unit. We found a significant number of gaps in the records. Gaps are where medication has not been signed as given, nor a record of non-administration made. This means that we could not tell if people had been given their medication as prescribed. We also found that a medicine that was prescribed to be given weekly had only been signed for fortnightly. Having accurate records is important so that all medicines can be fully accounted for to show that they are being given correctly and to prevent mishandling. We also found one medicine that was not given for two weeks because it had run out and had not been reordered. It is important to make sure that there is enough medicine at the home to enable continuity of treatment. Although risk assessments had been completed for the two residents who had their medicines administered covertly, staff had not assessed the residents capacity Care Homes for Older People Page 6 of 11 (ability) to make informed decisions about their medicines. This is important to make sure that people are not given medicines that they do not want. It is also a legal requirement under the Mental Capacity Act. A fridge was used for storing medicines that required cold storage, but the temperature was much too high on the day of the visit and records showed it had been too high for over two months. If medicines are not stored at the right temperature they may not work effectively and this may cause harm to the person taking them. We looked at how unwanted medicines were handled. The home has a contract with a licensed waste disposal company to remove unwanted medicines. However, when we spoke to staff they did not understand how medicines were disposed of. On the Ashwood unit we found a large quantity of medicines that were awaiting disposal. These medicines were not in a secure disposal container and we could not find a record of them. This means that the home would not know if these medicines were lost or stolen. It is important to make sure that unwanted medicines are recorded and secure so that medicines can be fully accounted for and to prevent mishandling. A small number of residents were very unkempt when we saw them, with dirty teeth, stained clothing or sticky eyes. One resident in particular had very dirty hands, which we told the carers about. Whilst we accept that some residents are resistant to being helped with personal hygiene the unit managers need to make sure that staff put personal hygiene as a high priority, as the inadequate hygiene of some residents could pose a risk of infection to others. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 1 27 18 The manager must ensure 15/06/2008 that there are sufficient staff on duty at all times to supervise and provide care to the residents that meets their needs. Prior to employment 30/06/2008 prospective employees suitable checks must have been undertaken to ensure that only suitable people are recruited to work at the service. Any accident or incident in the home must be recorded and reported. 15/06/2008 2 29 19 3 38 17 Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments and care plans must be updated regularly to reflect any changes to the residents condition. This will ensure that staff have access to the most up to date information about the care required. 30/01/2009 2 9 13 Medicines must be stored securely at the correct temperature recommended by the manufacturer. So that they are kept fit for use. 30/01/2009 3 9 13 The home must ensure that 30/01/2009 enough medication is kept at the home. To ensure continuity of treatment. 4 9 13 Clear and accurate records of 30/01/2009 medicines received into, administered and disposed of by the home must be maintained. So that medicines can be Care Homes for Older People Page 9 of 11 fully accounted for to show that they are being given correctly and to prevent mishandling. 5 9 13 Medicines must only be given 30/01/2009 to people that they are prescribed for and should not be used as general stock. This is not lawful and could lead to mistakes. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Daily records of the care given to the residents should be written. This will show what care each person has needed and can be used when reviewing care plans. Where residents spend a significant part of their day in bed, or in their rooms, systems should be in place that are robust enough to ensure that care needs are still consistently met. 2 7 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
