Inspection on 24/04/09 for Arbour Court

This inspection was carried out on 24th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arbour Court 15/12/08

Arbour Court 29/04/08

Arbour Court 25/07/07

Similar services:

Sunny Bank (P.R.S.) Ltd

Ashwood Court Unit 1

Thornton Lodge

Alfred House Residential Care Home

Barkerhouse Road (123)

Fernhaven

Thames House

Creative Support

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key 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:   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. Lead inspector: Fiona Bryan     Date: 2 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 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): Barchester Healthcare Homes Ltd Name of registered manager (if applicable) Mrs Helen Colaco Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: 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 Care Homes for Older People Page 4 of 31 care home 74 Over 65 0 0 74 74 Brief description of the care home day-to-day basis by a registered nurse. The home is situated in Marple and is fairly close to Marple village. Local 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 provides accommodation for up to 30 people. 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. A pleasant courtyard garden enables residents to enjoy being outdoors. The first floor is arranged in an open-plan design, allowing service users to walk around the whole floor. All the bedrooms are spacious single rooms providing en-suite facilities. Bathrooms and showers are available on each floor. The home has its own hairdressing room. 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 £481 to £950. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection, which included a visit to the home, took place on Friday 24th April 2009. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people living at the home, visitors, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to six people were looked at in detail, looking at their Care Homes for Older People Page 6 of 31 experience of the home from their admission to the present day. A selection of staff and care records was examined, including care plans, medication records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home and staff asking what they thought about care at the home. Six relatives completed surveys on behalf of people living at the home and two staff returned their surveys. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form well and showed us that she had ideas for how she would develop the service. What the care home does well: What has improved since the last inspection? What they could do better: Care plans were often quite detailed and were reviewed regularly. However, despite this the information provided by care plans and risk assessments was not always up to Care Homes for Older People Page 8 of 31 date and did not always reflect that the needs of people had changed. We made a requirement about this at the last key inspection and repeated it at the random inspection but we still found that it was not being met. Furthermore staff were not always fully aware of what the care plans said and did not always follow the care plan in practice. This meant that people were not always getting the care they needed and we had concerns that some people were left for long periods of time without drinks, medication or food. As the numbers of staff seemed to be enough for the numbers of people being cared for we were of the opinion that there was at times a lack of leadership. As staff are trying to move away from delivering care as tasks and more to delivering care on an individual basis according to what each person needs, this needs strong organisation and coordination to ensure that people dont get missed out and are not left waiting for care for long periods. As a relatively new staff team develops following a high staff turnover and subsequent recruitment drive, ongoing staff training, practical supervision and a system to check how the daily routine is operating is essential to ensure that all staff fully understand their role and are accountable for the care they give. It was reported in the AQAA that 43 of staff had achieved a National Vocational Qualification. This qualification is obtained following training in providing personal care and the manager should continue to encourage staff to undertake the training. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received enough information to understand the persons needs. Evidence: The manager confirmed in the AQAA that detailed information was given to all potential service users, and people making enquiries were encouraged to visit the home at anytime. Six people living at the home returned surveys we sent them before the inspection. Of these, 5 said they had received enough information about the home although one wrote that the information given did not match up to the reality. Another person wrote, prior to (my relative) going there we had ample contact with the home regards to her assessment and admission. Care Homes for Older People Page 11 of 31 Evidence: We looked in detail at the care provided to 6 people living at the home. Detailed assessments had been undertaken for each person prior to their admission. In some cases specialist mental health assessments were also undertaken. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made which deliver positive outcomes for many people but systems are still not robust enough to ensure that everyone has care that meets their individual needs. Evidence: Since the last inspection a lot of work and staff training had been undertaken to try to change the emphasis of staff towards a more person centred way of working with people, with a focus on creating a very homely and visually stimulating atmosphere. A butterfly principle was being used where staff spent short snaps of time with people but tried to make each interaction meaningful and give complete concentration and attention to that person at that time. Staff were very enthusiastic to tell us about the new approach to dementia care that they were learning about and trying to adopt and it was encouraging to see their commitment to improving their practice. Staff also outlined improvements that had been made in respect of the quality of care plans and the initiation and maintenance of health care checks such as pressure area care, food charts and administration and storage of medication. Care Homes for Older People Page 13 of 31 Evidence: We looked in detail at the care provided to 6 people living at the home. Examination of each persons care file showed that care plans and risk assessments had been developed for each person. Care plans were often quite detailed in respect of physical health and personal care, although the mental health needs for some people were not as clearly explained and we found that the support and management of challenging behaviour was very basic with no system for recording and monitoring behaviour and no specific person centred guidance for each person in their care plans. Care plans and risk assessments were generally reviewed regularly. However, there was evidence that care plans were not always followed in practice by staff and although risk assessments were reviewed monthly, they were not always updated following specific changes in peoples conditions, therefore they could be inaccurate for several weeks until the next routine review was due. Care plans also did not always contain up to date advice from other healthcare professionals, for example one person had been assessed by the Speech and Language Therapist (SALT) but their advice was not in the care plan and although their key worker knew a referral had been made for them to see SALT they were unsure whether or not they had been seen. On the first floor another carer also was unsure as to whether there was advice from SALT that needed to be followed and it was unclear how people who had swallowing difficulties were assessed and we saw poor practice in terms of how people were supported to eat when in bed, as they were not helped to sit up properly which meant there was an increased risk of them choking. From our observations and from the records in peoples rooms it was apparent that several residents did not receive timely care interventions throughout the course of the morning. We saw one resident who had been sat in her chair at 10am still sitting in the same position, without socks, slippers or dressing gown at 12 midday. Staff had not followed the care stated as being required in her care plan in respect of her nutrition. Two other residents were left in bed until late in the morning. We saw one resident sat in the dark in his room at 11.15am and another resident sat in the dark in her room at 11.30am. Neither resident had been given breakfast or a drink and from the records it appeared that staff had not been into their rooms since 6.35am and 6.20 am respectively. We spoke to one member of staff who said it was not the policy to wake people up. Whilst we acknowledge the importance of choice for people, we are concerned that promoting peoples choice is not balanced sufficiently with the need to ensure that people receive appropriate care to meet their needs and prevent additional health problems, for example from being left in bed too long. Care Homes for Older People Page 14 of 31 Evidence: We spoke with one visitor who was concerned about their relative as they had developed a pressure ulcer. We looked at the records for this person and whilst the pressure ulcer was noted in the daily record, the wound was not photographed for another 6 days and a wound assessment chart was not completed until 10 days after the wound was first noticed. This meant that staff did not have enough information to properly evaluate the treatment they were delivering and assess if the wound was improving or deteriorating. The care plans for some people on the ground floor said that their food and fluid intake needed to be monitored but there were no recent records of their dietary intake so it was unclear how staff were assessing if their nutritional intake was sufficient for their needs. On the first floor records were kept more accurately. We looked at a sample of medicines records and medicine stocks for a number of people throughout the home. On the ground floor we saw that medicines had not been given to a number of residents on several days throughout a 19 day period. The reason given for non-administration of the medicines was that the residents were asleep. Medicines that were not given included dioxin, fireside, Dniepers, thyroxine, and auroral. Although the medicines were only prescribed for once a day, the person responsible for administering them had only given them later in the day when the resident was awake, on one occasion. This meant that 2 residents did not receive their medicines for a total of 4 days, one resident did not receive their medicines for a total of 6 days and one resident did not receive their medicines for a total of 7 days out of the 19 days we looked at. We wrote to the manager following this inspection to highlight the serious concerns we had in respect of medicines and the timeliness of care, as both these issues were raised during our random inspection in December 2008 and have not been fully addressed. We have since received a detailed action plan telling us how these issues were going to be addressed and have been assured that Bar chester Health care takes them seriously and is committed to ensuring good outcomes for people living at the home. All the people that returned surveys said they always or usually got the personal and medical care and support they needed. One person wrote To the best of our knowledge (she) receives excellent care and support and another wrote much better now since new manager and deputy have recruited new staff. Of the 6 people that returned surveys 5 said staff listened and acted on what they said although one commented not always. Staff change so often that they forget what they said they will do. Care Homes for Older People Page 15 of 31 Evidence: One person we spoke to during the inspection said she did sometimes have to ask staff several times to do things such as cut her relatives nails or arrange a dental visit and she did not feel people that were incontinent were checked often enough to make sure they were clean and comfortable. Another person we spoke to said she felt more confident that her relative would be properly cared for as there were some fantastic staff on the unit. Another visitor agreed with this and said staff had changed and things had improved. They felt their relative had improved in health and was more mobile. We spoke to one person by telephone and they also felt that the care being delivered at the home had improved. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are moving towards providing social activities in a more person centred way so individual needs are met in line with peoples abilities and the manager is committed to developing this area of the service. Evidence: There was one Activities Organiser and the manager told us that another Activities Organiser had just been appointed and she was waiting to obtain references so that person could start working. The unit manager on the ground floor said the television was not usually switched on in the mornings as most people did not seem to enjoy the typical programmes that were on. Instead relaxing music was playing and the unit manager said they were trying to build up a collection of Cds according to peoples preferences and tastes. On the day of our inspection the Activities Organiser was encouraging some people to help her plant up hanging baskets and was planning a canal trip for some people. The Activities Organiser also spent some time with one person on an individual basis, listening to music and reading to her. One visitor we spoke to said there had been Care Homes for Older People Page 17 of 31 Evidence: more entertainers invited to perform at the home since Christmas which people enjoyed as a number are not able to go on trips out of the home. The environment offered excellent facilities for people to find stimulating and interesting ways to spend time. For example there were plenty of items that people could look at, touch and pick up to examine, soft toys, pictures on the walls (some with different textiles for texture), games etc. The garden had some sensory features such a windmills, again to encourage people to take an interest and enjoy. Most people did have some information within their care files about their social preferences and interests, although these varied in detail. Each person had an activities information form, where staff recorded any social event they had participated in. These could be more detailed as it was sometimes recorded that staff had spent 1:1 time with someone but did not specify how the time had been used and whether the person had enjoyed the activity. A programme of activities was displayed in the ground floor lounge but on closer examination it was out of date referring to activities in January. Activities recorded in April included quizzes, a trip to Southport, a country drive, a church service, baking, walks, hand therapy and glass painting. Of the 6 people that returned surveys, 4 said there were usually or always activities and 2 said there were sometimes activities that they could join in with. Comments included, There are frequent activities, mum often doesnt wish to take part, the main area in need of improvement. Better than before but still needs more activities and nothing takes place regularly. There should be a weekly/monthly schedule of activities which should happen. Hardly anything is planned. There is nothing to do. In the AQAA the manager reported that there were plans for the next 12 months which included developing the kitchen area for the ground floor unit, utilizing the grounds and gardens much more into everyday life, making sure that activities were led by service users rather than what staff thought was suitable and the aim was to provide meaningful occupation for each person within the home for at least 30 minutes every day. Breakfast across the home was served at approximately 9.30am. People were given a choice of a cooked breakfast or had porridge or cereal and toast or sandwiches. Dining tables in all the dining areas were attractively laid with serviettes, condiments, cutlery and crockery. Staff were seen helping or prompting some people to eat and were attentive and Care Homes for Older People Page 18 of 31 Evidence: patient. At the last key inspection we recommended that further consideration was given to the timings and types of food provided at each meal as there was a relatively small timespan between breakfast and lunch, meaning that some people may not be hungry at lunchtime. We recommend again that mealtime routines are reviewed in general, as some people had still not had breakfast when it was nearly lunchtime and were hungry when we asked them. One of these people had lost weight and we were concerned that if they consistently missed a meal this would contribute to their weight loss. At lunch, people were given a choice of fish and chips or cottage pie, broccoli and peas - both looked appetising and most people seemed to be eating well and enjoying their food. Of the people that returned surveys 1 said they always liked the food, 3 said they sometimes liked the food and 2 did not answer. Comments included, staff making better efforts to encourage eating and providing different diets I do not find the food appetising. The food is warm but not hot. I would like breakfast at 9am. 9.30 onwards is too late. One visitor said they thought the quality of the food had improved recently. Staff served people that were sat in the lounges and dining room tea and coffee mid morning and mid afternoon. However, staff need to make sure that where people are still in bed they are offered and have access to regular drinks, as some people went without a drink all morning and one person had a jug of juice in their room but it was not within reach for them. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has demonstrated a willingness to work with other agencies to safeguard people living at the home and improve care practices. Evidence: In the AQAA it was reported that a detailed complaints procedure was displayed in the reception area of the home. The manager confirmed that all staff received safeguarding training, including whistle blowing, and the policy was reiterated in the staff handbook. Staff that we asked during our inspection and the 2 staff that returned surveys all said they were aware of the complaints procedure and knew how to report concerns about peoples safety or welfare. One staff member said Barchester had a confidential phone line that staff could use to report concerns. All the people that returned surveys said they knew who to speak to if they were unhappy and two people we spoke to during the inspection said they felt more confident since the new manager had been appointed that concerns would be taken seriously and acted on. A record of complaints received at the home had been maintained. The record was detailed and showed how each complaint had been addressed. Care Homes for Older People Page 20 of 31 Evidence: Since the last inspection there have been a number of safeguarding referrals and several investigations into circumstances surrounding these incidents. Most of the cases related to people living at the home displaying challenging and aggressive behaviour to others living at the home and the investigations centred on whether staff had acted appropriately to protect people living there. Multi agency meetings were held and the manager was able to provide information about what actions had been put in place to ensure the future safety of people living at the home, for example staff training and the reassessment of some service users. One investigation took place following an alert raised by Stepping Hill Hospital into the condition of someone admitted from the home. The enquiry circumstantially upheld the allegation that there had been a failure in the care of this person which resulted in their hospitalisation and highlighted poor practice in the documentation and monitoring of the persons healthcare needs. The management of the home accepted these findings and are continuing to work towards improving service delivery in the areas where there were shortfalls. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enable people to live in a safe, wellmaintained and comfortable environment. Evidence: A partial tour of the home was conducted. The home was well maintained and furnished to a high standard. Since the last inspection kitchenette areas have been installed on both floors and more profiling beds had been purchased. In the AQAA the manager reported that Barchester Healthcare provided a generous budget to re-invest in the home. Plans for further improvements included refurbishing the garden areas and replacing some carpets. A number of bedrooms were inspected. These were clean and tidy and people had been encouraged to personalise them with photographs, ornaments and small items of furniture. On the Ashwood Suite all the rooms had letterboxes and knockers on the doors. Specialist equipment was provided where necessary, for example, pressure mattresses, and the environment was designed to help residents recognise their whereabouts by the use of names and pictures on the doors and signage for the bathrooms, etc. Great efforts had been made to create as homely, warm and Care Homes for Older People Page 22 of 31 Evidence: interesting environment as possible. The home smelled nice and fresh flowers were displayed in the communal areas. All the people that returned surveys said the home was always or usually fresh and clean. A hairdressing room was provided for residents and the bathrooms were very homely with chair lifts and showers so residents could choose their preference. The gardens were very pleasant, creating a non-restrictive environment, which was safe for residents to move around freely. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home receive care and support from a relatively new staff team who have gone through a robust recruitment process but who are not always supervised closely enough to ensure they have the ability to meet peoples care needs fully. Evidence: On the day of our inspection there were 6 staff on duty on the ground floor caring for 20 people, 3 staff on the Ashwood unit caring for 6 people and 6 staff on the top floor caring for 22 people. We were told that these staffing levels were the norm. Of the 6 people that returned surveys 1 said there were always staff available when they were needed and 5 said staff were usually available. Comments included It seems much better over the last few weeks with consistent staffing, better ratio now and somebody is always around. Staff that returned surveys said there were always enough staff to meet peoples needs. One staff member wrote, We have had a big recruitment drive and are now fully staffed. In the AQAA the manager reported that since September there had been a successful Care Homes for Older People Page 24 of 31 Evidence: recruitment campaign, eradicating over 1000 hours of agency usage a week. It was also reported that 43 of care staff had achieved a National Vocational Qualification level 2 (NVQ). We found that staff were employed using a robust recruitment and selection process. Four staff files were examined and each held Criminal Record checks and references from two sources and additional proof of identification. The manager confirmed that all the new staff had undergone a comprehensive induction process. A home trainer is employed who works with all new staff to ensure they are competent in their role and complete all the required training. The staff that returned surveys said they felt their induction had been thorough and that they were given ongoing training that was relevant to their role. The manager said that training was delivered in a number of formats such as CD roms, e-learning, competency assessments and internal and external training. However, we did have some concerns that relatively inexperienced staff were not supervised sufficiently to ensure that peoples needs were consistently met. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced manager in place and Barchester have policies and procedures in place for general health and safety topics; however, procedures for the actual day to day running of the home are not robust enough at unit level to ensure people consistently receive the care they need. Evidence: Since the last inspection the manager has been registered with us. She was able to demonstrate that she had a good understanding of the role of a Registered Manager. She is a Registered General Nurse, has a City & Guilds Further and Adult Teaching Certificate, and has achieved the Registered Managers Award. The manager is currently studying for a certificate in Leadership in Dementia Care. This is being done through Barchester Healthcare and the University of Surrey, and will lead, ultimately, to a Diploma in Dementia Care. Staff generally thought they were well supported. In one of the surveys one staff member wrote Arbour Court is now a happy place to work. The new permanent management team make sure that it is a home for the Care Homes for Older People Page 26 of 31 Evidence: residents to live in. We all work as a team and give 100 . People that lived at the home who returned surveys made comments such as regular meetings are held for relatives to meet the management, problems last summer/autumn are now on the whole resolved. Care much better, toileting and changing taking place. Could be better attention to detail ie hair - blowdrying etc. Activities improving as care staff are carrying out adhoc activities and I dont see much of the staff but when I do they are usually kind and pleasant. One person we spoke to during our visit said, I feel I can go to the manager with a problem and she would do something about it. Things are moving along nicely. I have attended relatives meetings, every one aired their view and the manager tells us about changes. The company conducts an annual Care and Quality audit. The manager was waiting for feedback about the most recent audit. Various other audits looking at topics such as health and safety, infection control and nutrition were undertaken regularly. Relative meetings were held to make sure people had the opportunity to ask questions and make suggestions about how the home was running and other initiatives had been started to increase the amount of information available for relatives, such as the introduction of a relative information board which displayed helpline numbers, patient information leaflets, advocacy details and facts about medical conditions etc. Staff do not deal directly with residents finances. Invoices are sent to the residents representatives for sundry expenses, such as hairdressing and chiropody bills. The manager confirmed in the AQAA that the building and equipment were checked and serviced frequently in accordance with health and safety guidelines. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. 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 Care Homes for Older People Page 28 of 31 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 15 Care plans must be written that where appropriate address each persons mental health needs. This will ensure that staff have the information to manage, minimise and monitor challenging behaviour. 15/06/2009 2 8 12 Where people 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 all their care needs will still be consistently met. This will keep people comfortable and maintain their health and welfare. 15/06/2009 3 9 13 A system must be developed 01/06/2009 to ensure that people receive their medicines at the time prescribed or as near as possible afterwards. Care Homes for Older People Page 29 of 31 Omitting medicines on a regular basis may put peoples health at risk. 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 10 Training and supervision should reinforce for staff the ways in which peoples dignity can be promoted and upheld, so people are left appropriately dressed etc. Staff should continue to look at ways in which peoples social care needs can be met, that take into account their abilities and preferences. Systems for checking that care is being delivered according to peoples care plans should be developed, to ensure that people are not missed throughout the day and receive care within appropriate timescales. This will ensure the quality of the service being delivered. 2 12 3 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 31 of 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. 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!