Inspection on 29/04/08 for Arbour Court

This inspection was carried out on 29th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arbour Court 24/04/09

Arbour Court 15/12/08

Arbour Court 25/07/07

Similar services:

Sunny Bank (P.R.S.) Ltd

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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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Arbour Court Buxton Lane Marple Stockport Cheshire SK6 7QL Lead Inspector Mrs Fiona Bryan Unannounced Inspection 29th & 30th April 2008 21:00 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 Arbour Court DS0000069256.V362902.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. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arbour Court Address Buxton Lane Marple Stockport Cheshire SK6 7QL 0161 4278599 0161 4271653 susan.ohara@barchester.net www.barchester.com Barchester Healthcare Homes Ltd 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) Care Home 74 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No service user may be received in the home who is less than 60 years old. Male/Female. The registered person may provide the following categories 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; Dementia over 65 years of age - Code DE (E); Mental disorder, excluding learning disability or dementia over 65 years - Code MD (E); Mental disorder, excluding learning disability or dementia - Code DE. The maximum number of service users who can be accommodated is: 74. 25th July 2007 Date of last inspection Brief Description of the Service: 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 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. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 5 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 £925 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection, which included a site visit, started at 9pm on Tuesday, 29th April 2008 and continued the following day. The staff at the home did not know this visit was going to take place. Two inspectors undertook the visit. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of three members of staff were also checked to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, staff, residents and visitors were spoken with. Before the inspection, surveys were sent out to residents, staff and relatives asking what they thought about the care at the home. Five residents, nine relatives and seven staff filled the surveys in and returned them to the Commission for Social Care Inspection (CSCI) and this information has also been used in the report. Before the inspection, we also asked the acting 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 form was returned on time and we felt that the acting manager had tried hard to be objective about how the home was performing. Since the last inspection the previous manager has left the company and an acting manager has been in post. A permanent manager has been appointed and it is anticipated they will take up their position in August 2008. In the meantime, the company has kept the CSCI informed of the management arrangements and these are satisfactory as an interim measure. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Although each resident had a care plan in place, this did not always say how all the needs of the resident would be met, and sometimes they were inaccurate, as they had not been reviewed often enough. Staff need to make sure that care plans are written to address all care needs and must make sure the information is regularly reviewed, so everyone knows what care they have to provide and how the resident’s condition should be monitored. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 8 The monitoring of residents’ weight was particularly lax; several residents had not been weighed for some time, and had not always been monitored closely enough or received appropriate intervention when they had lost weight. The acting manager of the home was aware that this aspect of care needed improving and had started to put measurements in place to do this. Although an activities organiser is employed and a second one is to be recruited, how the social care needs of residents are met needs further consideration. There was a lot more scope for social stimulation and leisure pursuits to be provided that met individual preferences and abilities. Staff need to plan for this in a more person-centred way to take this into account. We started this inspection at 9pm because we wanted to check how many staff were on duty in the evenings. On the day, staffing levels were satisfactory but there was evidence that levels fell below this on a regular basis. Feedback from staff and relatives told us that in many people’s opinion, staffing levels were not always sufficient to meet the needs of the residents, as there were not enough staff to supervise the residents properly and residents were left on their own for too long. Staffing levels must reflect the dependency of the residents and must be maintained at all times, at sufficient levels to reduce the risk of harm to residents. Although the company does undertake its own quality assurance checks, in the form of audits and satisfaction surveys, relatives said they would welcome more face-to-face communication, especially at this time when there have been some changes in the management of the home, which has left some people feeling unsure about how the home is running. Consideration should be given to arranging more regular relatives’ meetings. Two accidents that we were aware of after looking at residents during our site visit, had not been recorded. Proper records of all accidents and incidents at the home must be maintained and used as part of the risk management process to identify potential hazards and reduce risks to residents where possible. 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. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 9 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 Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before coming into the home and this generally ensured their needs could be satisfactorily met. EVIDENCE: The acting manager confirmed in the AQAA that prospective residents were invited to spend time at the home before being admitted, if possible, and that each resident or their representative received a contract, which included the terms and conditions of residency. A statement of purpose and service user guide are given to all new residents. One relative who returned a survey and one who was spoken to on the day of the visit to the home said that although they had received a “brochure” they did not feel that some of the information about the services provided was entirely accurate, for example, with regard to the activities provided. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 11 Four residents were case tracked. Detailed assessments had been undertaken for all residents prior to their admission to the home. In most cases, corresponding care plans had been written for each resident to address care needs identified during the assessment process. However, information had not been fully used for one of the four residents whose care files were viewed, and they consequently did not have some care plans in place to address some of their care needs. The CSCI was made aware of one occasion since the last key inspection, when a resident was admitted to the home before an assessment by the PCT had been completed to determine the funding arrangements for the resident. This was discussed with the acting manager at the time, as admitting a resident before any relevant assessments from other agencies have been completed could result in a resident being placed inappropriately and having to move. Staff were very knowledgeable about the residents’ care needs and could describe their usual daily routines and preferences. Staff stated that they received a handover report at the beginning of each shift and used these occasions to discuss individuals’ changing care needs. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ personal care was being met by staff who were aware of their individual needs. Inconsistency in recording and monitoring residents’ health care needs presents a risk that these may not be met. EVIDENCE: Four residents were case tracked and the care files for several other residents were examined in relation to specific health care issues we identified on the days of the site visit. As stated in the previous section, care plans had been written for three of the residents that corresponded with the care needs identified during the inspection process. Some care needs that were described in the fourth resident’s assessment, such as risk of malnutrition and shortness of breath due to asthma and other lung problems, had not been addressed through care planning. This meant that for this resident staff might not be aware of these potential problems. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 13 The care plans for one of the other three residents were not dated and some of the information was inaccurate, for example, the care plan for mobility said that the resident needed an airflow mattress but on inspection of the resident’s room it was found that an ordinary mattress was in place. The nurse in charge said the resident’s mobility had improved and they no longer needed a specialist mattress. None of this resident’s care plans had been recently reviewed. Where assessments had identified the need for other health care professionals, these had been accessed for residents, for example, the podiatrist and dentist had been obtained for one resident shortly after their admission. Risk assessments had generally been undertaken for nutrition, falls, pressure areas and moving and handling, although one resident who had been admitted with a history of weight loss had not had a nutritional risk assessment completed. Care plans in place were quite person-centred and included information about particular likes and dislikes and favoured routines. Residents, in the main, looked clean and tidy; their nails and teeth were clean and their hair had been brushed. Some ladies wore jewellery and make-up and some had accessories, such as handbags. Since the last key inspection concerns had been raised from several sources about how staff were monitoring and managing residents who were losing weight. Residents’ weights were recorded in a separate book and then transferred to their individual care files. Examination of the records indicated that a number of residents had not been weighed monthly, either because they had refused to be weighed or because the scales were broken. Where residents had refused to be weighed, there appeared to have been no attempt between that date and the date that the next monthly weight was due to encourage the resident to be weighed, consequently, in some cases, many months had gone by without the resident being weighed. One resident was not weighed between August 2007 and February 2008 and when they were, they had lost a significant amount of weight. Staff had identified this and a care plan had been developed. However, the care plan was not being followed, as it said the resident should be weighed weekly for a month and this had not been done. Also, the GP had prescribed nutritional supplements but the records showed they had not been given to the resident and the staff said this was because the resident did not like them. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 14 The acting manager acknowledged in the AQAA that staff needed to manage the nutritional status and weight loss of residents better. When the findings described above were discussed, the acting manager said they had started to hold nutritional assessment meetings to try to address the shortfalls they had identified. Minutes of the first meeting were seen and showed that some changes had been suggested and implemented to encourage residents to eat well at meal times and have snacks between meals. However, the issue regarding the resident’s weight that we identified during the site visit had not been recognised. Examination of a number of residents’ medicine administration records indicated that medicines were generally stored, recorded and disposed of satisfactorily. As stated previously, the prescribed nutritional supplements for one resident were not being given and staff had not, at the time of the site visit, spoken to the doctor about changing the supplements to something the resident liked better, although they said they were going to. The AQAA said that weekly medicines checks were now undertaken to ensure procedures were being followed correctly and all the nurses had received refresher training in documentation and medicines management. A visitor said some staff were very good and they were pleased with the key worker allocated to their resident, as they said she spent a lot of time with the resident and had built up a good rapport with him. This visitor did say that, at times, they saw the staff sitting down in the lounges but not chatting with the residents, and said the weekend before the inspection, when they visited they had been forced to sit on the window sill, as the available seats were being used by agency staff who did not offer to let them sit down. Staff were observed to be very patient and respectful to residents and residents’ privacy and dignity were well maintained, for example, when we arrived at 9pm on the first day of the site visit, several residents were in their nightwear, but they were well covered with dressing gowns and slippers and looked comfortable and relaxed. We spoke to several residents who were happy with the care they were receiving. One resident said ‘I am very happy to be here’. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 15 Relatives who returned surveys made several comments including “Mum has had a series of key workers; sometimes nobody knows who the key worker is – we need this consistency”, “The majority of staff are good and caring – some sit in the lounge and do not communicate to any of the residents. Some of the staff take an interest and stimulate the residents”, “staff are pleasant” and “Such a lot more could be done – especially dealing with dementia and mental illness”. In answer to the question “What does the home do well?” one relative replied, “Cares for clients individually and professionally, and shows personal consideration to all their clients”. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 16 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Although efforts are made to provide social stimulation for residents, this is a developing area. EVIDENCE: We arrived at the home on the first day of our site visit at 9pm. At that time, many residents were still up watching television and staff were in the middle of serving supper drinks and sandwiches. Routines seemed flexible and led by the residents’ preferences. The AQAA said that two activities organisers had been appointed but by the time we visited one had left. Staff and visitors spoken to said that, for a brief period when there had been two activities organisers, social events and arrangements for residents had improved. However, now there was only one activity organiser there was a feeling that the opportunities for residents to be involved and stimulated socially had declined again. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 17 One carer said they planned to play a DVD on the afternoon of the second day of the site visit but when questioned as to how many residents would be able to concentrate enough to follow a full film, she said very few. The carer said that the planned activities for that week should be displayed on the notice board, however they weren’t. In one resident’s room a weekly activities timetable was pinned to the wall. This displayed information in words and pictures to help residents understand but, on closer examination, it was out of date and referred to activities held in March. The activities organiser spent some time in the first floor lounge trying to undertake an activity with some residents but the television was playing loudly at the same time and it would have been better to take the residents she was working with somewhere quieter. One visitor said the television was nearly always on when they visited, and they had noticed that the few times when music had been playing, the residents really seemed to enjoy it and responded well. On the ground floor the activities organiser spent some time with individual residents chatting about their lives and looking at memorabilia and towards lunchtime had a sing-along with some residents. Staff and relatives said there had been very few outings in the minibus. One visitor said their relative had only been out of the home once in the past year. Their relative loved being outside and had enjoyed his own garden. Once she had visited and he had been sweeping the paths very happily in the garden, but the relative said staff did not encourage or facilitate this often enough. Of the four residents that were case tracked, three had care plans to address their social care needs. However, the “Memory Lane” information had not been completed for any of them. Many of the staff received training in this at the beginning of 2007 but it did not appear to be being used as well as it could be. Where some preferences had been identified, daily records showed that staff had tried to meet these, for example, it was recorded that one resident wanted to maintain links with her church and it was evident that she had been taken to church by family and friends, and had enjoyed church services held at the home. Some of the care files contained evidence of residents having joined in with some activities such as bingo, music sessions and Easter services. Comments from relatives returning surveys included “We have been disappointed at the apparent lack of stimulating activities/outings which appears to be linked to the lack of staff”, “There has been a lack of organised activities but this seems to be improving” and “We attended a St Patrick’s day Dance which was wonderful – the residents thoroughly enjoyed themselves even those who could not dance were tapping their feet and smiles appeared on faces usually deadpan”. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 18 When asked what improvements could be made at the home, relatives returning surveys commented “with help X would probably be able to make and sign a card, e.g., at Christmas/Easter/birthday which to my mum would absolutely make her day” and “Improve the amount and type of stimulating activities available”. Visitors said they were made welcome and one resident said she often went out of the home with her husband. On the second day of the site visit breakfast on the first floor was a calm and pleasant experience. Tables were laid with cloths, flowers and napkins and about 11 residents were being served a choice of cereals or porridge and sausage and plum tomatoes or sausage sandwiches. We asked one resident if she was enjoying her porridge and she said “beautiful”. Staff seemed very aware of residents’ individual tastes, for example, one resident said she didn’t want cereal or porridge; she just wanted a marmalade sandwich. A carer gave her two small sandwiches, which the resident ate. The carer took her plate away and we asked the resident if she had had enough to eat. The resident said she had eaten plenty – she didn’t have a big appetite and didn’t want a cooked breakfast. It appeared that the carer was aware of what the resident ate normally and knew she wouldn’t want anything else – the resident was capable of asking for more if she wanted it. Staff were sitting with some residents helping them to eat and prompting others sat at the same table. Staff were chatting with residents as they helped them and the atmosphere was lively. Residents were offered a choice of tea or coffee and staff were patient and allowed them to answer in their own time without rushing them. Chilled fruit juice was also served from a machine kept in the dining room. Staff said there was also a chilled drinks machine in the satellite kitchen so they were able to provide residents with cold drinks whenever they wanted one. The day’s menu was not on display in any of the units except Ashwood. Menus should be displayed, although it was noted that staff explained the choice on offer to each resident before serving them. Lunch on the second day of the site visit was roast lamb or beef, mashed or fried potatoes, peas and buttered swede, berry and apple crisp or rhubarb fool. Tea was leek and potato soup, egg and bacon bake or pasta bolognaise, baked beans, garlic bread, banana and rum custard or cheddar, grapes and crackers or a selection of cheese and biscuits. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 19 We dined with residents and found the meal to be edible but lacking in seasoning (and in the case of the dessert, sugar). Bread and butter was offered to accompany the meal. Serving extra bread and butter had been implemented following the nutritional assessment meeting, as it was identified that a lot of residents liked this and it was a way to increase people’s calorie intake. Some of the presentation and serving of the food could have been better but again it was noted from the minutes of a staff meeting that improving the dining experience was on the agenda. Many residents did not eat much due to having a late large breakfast; further consideration should be given to the timings and types of food provided at each meal to ensure options meet residents’ needs, for example, some residents may prefer a lighter lunch to ensure they have the appetite for a larger tea. A small kitchenette area on the Ashwood unit included dining space for those residents who were able to make their own drinks and snacks. Fresh fruit was available and some had been cut up and given to one of the residents. One visitor said her relative liked the food and was eating well. Most residents spoken to felt the food was good but two complained that sometimes it wasn’t. One resident said ‘Staff know me well and what I like to eat’. Comments from relatives returning surveys included “Good menus”, “The food could be better”, “Breakfast very late, tea too early”, “My mother has said the food is not always hot” and “The standard of catering is in my opinion very high”. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place, which residents and relatives were familiar with and staff training ensured that, as far as possible, residents were protected from abuse. EVIDENCE: In the AQAA it was reported that complaints/compliments folders are made available and that information in the service user guide further explained the complaints procedure. The acting manager confirmed that all staff received safeguarding training, including whistle blowing, and the policy was reiterated in the staff handbook. One relative who returned a survey commented, “There were concerns about a particular member of staff. These were taken seriously and dealt with very well” and another wrote that they could not remember how to make a complaint, as they had never needed to. A record of complaints received at the home had been maintained. The record was detailed and showed how each complaint had been addressed. Two complaints that the CSCI was aware of had been recorded and responded to, although the response to one of the complaints was quite slow (due to the absence of the manager) and the complainant had to ask the CSCI to intervene and request a response. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 21 One relative who returned a survey and one who was spoken to on the day of the site visit both said they felt there had been a lot of managerial changes over the previous few months, which relatives were never told about. They had found this unsettling and would have appreciated more openness, where possible, about what had happened and what plans there were for dealing with any issues. Staff who were spoken to said that if they suspected abuse they would report this to their line manager and if they were not satisfied would take it to a senior manager within the company. Not all staff were sure about who they could report concerns to outside the company, if they felt issues were not being handled appropriately. It was noted that a copy of the Mental Capacity Act Code of Practice was provided in the nurses office, which discussed the two-stage test of capacity, fluctuating capacity, acting in people’s best interest and gave information about power of attorney and lasting power of attorney. This is a useful resource and staff should be encouraged to read and discuss it. Although there was space in each resident’s care file to document information about end of life wishes, advance directories and court of protection arrangements, etc., this was usually not completed and consideration should be given as to how a higher priority can be given to discussing these issues in order to ensure that residents’ rights are protected. Since the last inspection there have been three safeguarding investigations, which found that incidents had occurred where staff had failed to promote and secure the safety of some residents by not requesting reviews and failing to seek further advice from other members of the multi-disciplinary team in a timely manner. The acting manager at the time was very co-operative with the safeguarding team and an action plan was put in place to address shortfalls and ensure residents were protected in the future. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The physical design and layout of the home enable residents to live in a safe, well-maintained and comfortable environment. EVIDENCE: A partial tour of the home was conducted. The home was well maintained and furnished to a high standard. Although the décor had quite a “corporate” feel, a nice balance had been reached, in that, the overall ambience was still homely and provided a place that residents could relax and feel comfortable. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 23 A number of bedrooms were inspected. These were clean and tidy and residents or their relatives 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. One resident’s room was very hot; this was the resident’s choice and the heating had been raised at her request. 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 The design of the home was also very suitable for residents, especially the more recently added Ashwood unit, as it encouraged small group living, having a small kitchen area off the lounge, which enabled residents or their visitors to make drinks and snacks for themselves. The home smelled nice and fresh flowers were displayed in the communal areas. A hairdressing room was provided for residents and the bathrooms were very homely with chair lifts and showers so residents could choose their preference. One bathroom was being upgraded and there were plans to upgrade another. The laundry was inspected and was clean and tidy, with piles of well-ironed clothes waiting to go back to the residents’ rooms. The gardens were very pleasant, creating a non-restrictive environment, which was safe for residents to move around freely. An activity room was provided on the first floor that was also used as a private area for visiting relatives and for staff training. The AQAA said that ten bedrooms had been refurbished since the last inspection. The bedroom door locks had also been upgraded and some new equipment had been purchased, such as vacuum cleaners and mattresses. The acting manager also reported that new curtains and bedding had been bought and some new carpets and ten new profiling beds had been ordered. Some of the armchairs were dirty and this was discussed with the deputy manager who said the chairs were difficult to clean because of the material they were made from. A steam cleaner had been purchased to try to clean them more successfully. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing levels are not always sufficient to provide the supervision and support needed by the residents. EVIDENCE: We started this inspection at 9pm on 29th April 2008 because we had some concerns, from information we received since the last inspection, that the home may be short-staffed, in particular, in the evenings. When we arrived a calm and pleasant atmosphere was apparent, many residents were sitting in the lounges watching television and the staff were serving hot drinks and sandwiches for supper. There were 27 residents on the three units on the ground floor and one nurse and two carers were looking after them. There were five residents on the new Ashwood unit and one senior carer was on duty caring for them. On the first floor there were 25 residents with one nurse and two carers on duty. This was a total of seven staff to care for all the residents in the home. We asked staff if these staffing levels were the norm and they said that there were a number of occasions where there was one carer less. We examined the staff duty rotas for the weeks commencing 28th April and 5th May 2008 and these showed that a total of six staff in the home during the evenings was a regular occurrence. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 25 The nurse on the first floor said that a number of residents were quite dependent and several needed two carers to help them with personal care needs. Although when we visited, the atmosphere was calm and the residents were relaxed, we noted that residents were left on their own in the lounges for significant periods whilst the nurses were giving medicines to residents already in their rooms and the care staff helped people to go to bed. If there had been one carer less, as happens on other nights, residents would have had even less supervision. Staff said that residents tended to become more agitated and restless in the evenings and we felt a minimum of seven staff were needed during the evenings and overnight to maintain residents’ safety. This was discussed with the acting manager and deputy manager who were in agreement and said these levels would be maintained. During the day, staff rotas showed that sometimes there were as many as six or seven staff on duty on both floors; however there were also occasions when the staff levels dropped to five or even four on the first floor and this is not enough staff to care for all the residents properly. It was also noted that agency staff did cover a significant number of shifts. Comments from relatives who returned surveys included “The care home has not enough staff to cater for the needs of the residents in my mums unit”, “Not enough staff available to give the care and support my mum and all the others need”, “I find it hard when the home is so short of staff that anybody can provide the care for people with dementia and mental illness – one member of staff in the lounge where all the residents are is not enough – sometimes that member of staff is called out – one member of staff has to disappear to toilet residents and cannot get them a drink of water, etc.”, “The care workers appear to be very kind outwardly, there just aren’t enough of them. Often when I visit residents are left unsupervised in the lounge area and I have felt it necessary to intervene when a potential incident is about to happen. I wonder therefore what happens when there are no visitors present” and “The carers are extremely pleasant and appear to do the best job they can given their numbers”. When asked how the home could improve, one relative wrote “increase the number of staff qualified to work with dementia patients”. Given the high dependency levels of many of the residents and the difficulties staff encounter sometimes with behavioural challenges of residents, consideration should be given to staffing levels and the procedures in place to manage staff sickness and absence. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 26 Three staff personnel files were looked at. Two contained all the information and documents needed to ensure that the necessary checks had been made before the staff started work at the home. One employee had been recruited from overseas and their file only contained pre-written testimonials instead of references that had been requested by the manager. Pre-written testimonials are not sufficient, as their validity has not been checked. Staff spoken to confirmed that before employment at the home they had been asked to provide the names of two referees and apply for a CRB. The AQAA said that 21 of the 30 care staff employed at the home had achieved NVQ level 2 or above. This equates to 70 staff and a further two carers are currently undertaking the training. Staff training records showed that staff had received training in a range of topics, including moving and handling, fire safety, safeguarding adults, customer care, food safety and dementia care. Two staff spoken to said they had received training in managing challenging behaviour. One member of staff said her induction training had included moving and handling and health and safety training, which took the form of CD ROMS that she had to work through on the computer and answer questions at the end. Practical moving and handling training had then been given by the deputy manager and she had spent two days “shadowing” an experienced member of staff to learn the routine and get to know the residents. It was noted in one staff member’s personnel file that they had stated they had undertaken training in a wide variety of topics; however there was only one certificate on file to verify that the person had attended one of the training courses. New staff should provide documentary evidence of any relevant qualifications or training. In some of the records, although the trainer had signed to say that the training had been given, the candidate had not signed to say they had received it. Both parties should sign so that the records remain accurate. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 27 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Despite the absence of a permanent manager, the company has ensured that managerial support has been provided and senior managers have worked with other agencies to start addressing shortfalls identified since the last key inspection. EVIDENCE: Since the last inspection the previous manager had left her position and an acting manager has managed the home. A deputy manager has been appointed and suitable arrangements had been made to provide management cover until the new permanent manager, who has been recruited, is in a position to commence employment at the home. Barchester had kept the CSCI informed about the arrangements they had put in place. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 28 Staff generally thought they were well supported. One staff member said, “I can talk to management and they will listen”. It was reported that the new acting manager had come on duty early one morning so she could introduce herself to some of the night staff. Minutes from staff meetings showed that discussions had taken place about how standards in the home could be maintained and improved and showed that the experience for the residents was a high priority. Relatives said there had been few meetings with them and some relatives did not know who the manager was and said it was unsettling as they were aware there had been some changes at the home but had not been given any direct information. Comments from relatives that returned surveys included “There are no meetings for residents’ families and the only time information is given is when it is asked for, other than if there is a change in a resident’s medical state”. Another relative wrote that the home could improve by having regular meetings and one had described problems they had encountered in getting staff to complete administrative work related to the funding for their relative; they had been disappointed that they had had to chase up and remind staff to complete the necessary forms. The company conducts an annual Care and Quality audit completed by the company clinical development nurse. This was last done on 19th July 2007. The audit covers areas such as management of medicines, infection control, risk management, documentation and response to complaints. A satisfaction survey is also conducted once a year and surveys were sent out in December 2007 and analysed. A total of 24 people (mainly relatives) took part and questions related to the care provided by the home and people’s satisfaction with the atmosphere and social life in the home and the environment. Staff do not deal directly with residents’ finances. Invoices are sent to the residents’ representatives for sundry expenses, such as hairdressing and chiropody bills. Maintenance records showed that the building and equipment were checked and serviced frequently in accordance with health and safety guidelines. A fire risk assessment was available for each resident regarding his/her abilities and vacating the building. Staff were observed moving and handling residents. This was carried out sympathetically with consideration being given to each person’s needs. Staff were seen to be working using safe working practices. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 29 Two residents had received injuries from accidents/incidents that were recorded in their care files but not recorded on accident forms. A record of all accidents and incidents should be recorded and used as part of the risk management process. Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 30 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 Requirement The registered person must ensure that risk assessments and care plans are updated promptly to reflect any changes to a resident’s condition. This will ensure that staff receive the most up to date information on the care required. (Timescale of 7/9/07 not met). Timescale for action 30/06/08 2 OP8 14 3 OP27 18 4 OP29 19 Care plans must also be written that address all the resident’s identified needs. Staff must ensure that the 30/06/08 nutritional status of residents is properly monitored and recorded and must take appropriate action when a resident is identified as being at risk of malnutrition. The manager must ensure that 15/06/08 there are sufficient staff on duty at all times to supervise and provide care to the residents that meets their needs. Prior to employment prospective 30/06/08 employees suitable checks must have been undertaken to ensure that only suitable people are recruited to work at the service. DS0000069256.V362902.R01.S.doc Version 5.2 Page 32 Arbour Court 5 OP38 17 Any accident or incident in the home must be recorded and reported. 15/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should consider how staff can use the information they get about residents’ past histories, family contacts and interests to develop further individual social care plans for residents that meet their specific needs. Consideration should be given to the timings and types of food provided at each meal to ensure options meet residents’ needs. The manager should ensure that all staff know where to find the contact numbers for local adult protection referrals. The manager should ensure that new staff are asked to provide documentary evidence of any training or qualifications they submit on their application forms. The registered person should consider holding relatives’ meetings as another means of gaining their views about how the home is running and to ensure that relatives feel informed about changes to the management team. 2 3 4 5 OP15 OP18 OP29 OP33 Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Arbour Court DS0000069256.V362902.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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