Inspection on 18/06/07 for Arbrook House

This inspection was carried out on 18th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arbrook House 31/05/06

Arbrook House 05/12/05

Arbrook House 25/08/05

Arbrook House 26/10/04

Arbrook House 07/06/04

Arbrook House 25/05/04

Arbrook House 01/04/03

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arbrook House 36 Copsem Lane Esher Surrey KT10 9HE Lead Inspector Suzanne Magnier Unannounced Inspection 18th June 2007 08:00 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 Arbrook House DS0000013300.V339224.R02.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. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arbrook House Address 36 Copsem Lane Esher Surrey KT10 9HE 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) 01372 468246/7 01372 470760 MILLARK@BUPA.com www.bupa.com BUPA Care Homes (BNH) Limited Ms Keena Sinclair Millar Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 44 Residents accommodated, 4 may also fall within the category TI(E) Terminally ill, Elderly 31st May 2006 Date of last inspection Brief Description of the Service: Arbrook House is situated close to Esher town centre and Claremont Landscaped gardens. The home is situated in its own landscaped grounds with its own lake. The home is registered for forty-four older people and the accommodation is provided over two floors and can be accessed by a shaft lift. All rooms are for single occupancy and all have en-suite facilities. The home has a large communal sitting room, a large dining room and conservatory. There is a patio area to the rear of the house overlooking the grounds and the lake. Parking is available at the front of the building. Fee’s range from: £ 980.00- £1,100per week. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and the deputy manager represented the service. For the purpose of the report the individuals using the service are referred to as people living in the home. The inspector arrived at the service at 08.00 and was in the home for eight and a half hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The inspector spent time talking with people living at the home in order to seek their views about the home and the care they receive. Responses to questionnaires that the Commission had sent out and written comments have been included within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, the terms and conditions of residency in the home, care/person centred plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, and several of the services policies and procedures. Following the previous random inspection in November 2006 the service has met all the requirements made. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, some details of which have been added to the report. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. In discussion with the deputy manager he told the inspector that a major refurbishment of the home was being undertaken to offer improved facilities for people living at the home. The inspector would like to thank the people living in the home, the staff and the manager for their time, assistance and hospitality during this inspection. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: All risk assessments must be updated following any related incident to ensure individuals safety and well being as far as reasonably practicable. Due to the feedback received regarding the home leisure and meaningful activities it has been recommended that the home continue to undertake further consultation with people in the home regarding their views about taking part in social, religious and recreational activities in the home and local community. Improvements must be made with regard to the recording and management of complaints in order to demonstrate that effective responses have been made following the home receiving a complaint. All staff must receive mandatory training and safeguarding adults awareness in order to promote the wellbeing, protection and safety of people in the home. The management of the home must undertake a full review of the staffing numbers and the deployment of staff in the home to ensure that the current staffing arrangements meet the needs of all people in the home. The home must review the current arrangements regarding the restrictions of people’s money and clarify the homes insurance liability cover in order to protect all people in the home. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 7 All staff working in the home must receive appropriate supervision of their work in order to ensure the safety, competency and well being of all people in the home. All staff must be made aware of the infection control policy and procedures of the home and also the appropriate storage of chemicals in order to ensure the safety and well being of all people in the home. 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. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5,6. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. People who use the service have information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individual’s needs are appropriately identified and met. Terms and conditions/contracts of stay at the home are available to all individuals. People are encouraged to visit the home prior to residency and respite care is available. EVIDENCE: The inspector sampled the homes Statement of Purpose and Service User Guide. It was noted that both documents had been recently updated, were written in plain English and were accessible to prospective individuals and people living in the home. The home is considering offering information regarding the home via e-mail. The homes new brochure was published at the end of 2006 and will be re-published following the planned refurbishment in 2007. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 10 The deputy manager explained to the inspector the procedure undertaken by manager, deputy manager or clinical night manager with regard to assessing an individual prior to admission to the home in order to ensure that the home could meet the individual’s needs. The deputy manager explained that people are encouraged to visit the home prior to admission and during the inspection the inspector noted that several visitors were having a tour of the home with a view to seeking the services offered. The home offers a variety of types of stay depending on the level of support required by the individual which include long stay care for those who need daily nursing, respite care for a short period and post operative and convalescent care. The inspector sampled the homes terms and conditions which are given to each person on admission to the home. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The health and personal care that people receive is based on their individual needs set out in their care plans. Monitoring of risk assessments must be maintained to ensure the safety of people in the home. There was clear demonstration that medication was administered to all individuals in a safe and appropriate way. Disposal/procedures of medicines were appropriate. People’s dignity and respect is promoted. End of life choices and preferences are discussed and documented with individuals and their significant others. EVIDENCE: Since the previous inspection BUPA have introduced a care planning system called QUEST and all individuals in the home have this system for their individual plans of care. The inspector sampled four individual’s plans of care and found them to contain well-documented care plans and a variety of risk assessments Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 12 including moving and handling. The individual or their representative had signed each care plan. The plans included the preferred name of the individual, their next of kin or significant person, documents regarding medication, their GP (general practitioner) and any other health care professionals support. The individuals choices regarding gender specific care, their communication abilities, preferred lifestyle and daily living choices, their support needed regarding personal care, sleeping patterns, their emotional, nutritional needs and preferences. The home has strong links and support with local general practitioner (G.P.). who visits the home regularly. The home also has links with the out of hours Thames Doc service for emergencies. The manager stated that there is also good health care support from other practitioners, which include the Macmillan nurses, tissue viability nurse, physiotherapist, dietician, opticians and chiropody. The inspector noted that each file contained healthcare professional records including the GP, which had been signed and dated following a consultation visit. A variety of comments from people living in the home and from relatives regarding the healthcare provided by the home included ‘they need to communicate in a systematic way with relatives re appointments and results of appointments and assessments’ ‘They provide good nursing care’; ‘main complaints have been with outside agencies e.g. bladder nurse, dentist and optician. On all these occasions the home has failed to properly inform us of appointments, on the occasions that they have (informed us) the appointments have never occurred’. ‘ I feel that they provide the basic nursing care; they have always acted promptly if an urgent medical problem has arisen. They are very professional in this respect. Where they fall down is making the person at ease for example helping them to make a phone call, ensuring they can work the television’. ‘ Communication is good- nursing staff will keep me appraised of any health development issues’. ‘I was impressed by their continual supervision of my relative’. ‘Some carers can be (unintentionally) rough with washing etc but they listen to my relative and usually take more care next time’; ‘Everyday care is usually good’. ‘On the whole care is good’. The care plans indicated that they were under review to reflect the changing needs of any individual and daily notes were well documented to reflect the care and support offered and provided by staff. Whilst sampling the care plans the inspector noted that documented risk assessments had been completed where individuals and staff had identified hazards in the individuals daily life. In general the risk assessments were well written and had been reviewed however one individuals file detailed that they had had a fall from their wheelchair whilst unattended. The home had not updated the risk assessment Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 13 following the person’s fall in order to reflect that the hazard had been reassessed and measures were in place to ensure the individuals safety. It has been required that all risk assessments are updated following any incident to ensure that their safety and well being is promoted as far as reasonably practicable. The inspector sampled other risk assessments, which included histories of falls and the assessments had been developed and reviewed following the identified hazards and perceived hazard. The deputy manager stated that the home has the support of a local pharmacy for all their medication needs. The home has a monitored dosage (MDS) system and blister packs are used and delivered every month. The medication is stored in the locked clinical room and all medication policies and procedures are available for the nurses. The nurses confirmed that arrangements are in place with a clinical waste company for the removal and destruction of unused medicines. The inspector sampled two medication rounds in the morning and observed that the trained staff undertook the administration of medicines appropriately. The medication administration charts were well recorded and all records contained a recent photograph and known allergies of the person. One staff member raised a query regarding one individual’s medication, which was appropriately discussed with the deputy manager. During one medication round the inspector observed one person living in the home exercising their right to refuse their medication, which was acknowledged by staff. The refused medication was discarded appropriately and the medication chart completed to note the refusal. The staff told the inspector that privacy and dignity is a topic discussed on induction for all new staff. The inspector observed staff knocking on bedroom doors and seeking permission prior to entering an individual’s room and speaking courteously to individuals. Arrangements are also in place for individuals to receive their visitors and visiting professionals in private. One comment regarding dignity and choice stated ‘the carers try their best to give my relative choice and respect and I am pleased they have all been made aware that she is youngish but disabled not old and infirm. The difference is very important’. Each care plan documented the individuals end of life arrangements and included the relatives or significant others expectations of the home regarding the individuals end of life arrangements. The home is planning to commence the Gold Standard Framework Programme in June 2007 to continue to improve the provision of end of life care. A comment form a relative stated ‘my relative recently died in the home and the staff were helpful, supportive, Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 14 compassionate and attentive during their last few weeks and showed understanding for them which needs to be recorded and congratulated’. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. Not all people in the home felt that the service promoted their rights to exercise choice in the daily lives. Bonds are maintained with family and friends. Further consultation with people in the home regarding taking part in social, religious and recreational activities could be improved. The home provides a healthy and balanced diet in a pleasant spacious dining area. EVIDENCE: The home employs an activities organiser who works thirty-five hours per week. All people spoke highly of the activities co-ordinator in the home and their friendly approach. The inspector noted that activity programmes were displayed throughout the home and new programmes of events were distributed to individuals on a weekly basis. The programme detailed a variety of activities, which included resident’s individual time, group activities including crosswords, art workshops, scrabble, church services, sherry party, gentle exercises, sing along and supper socials. The home have arranged small group tea parties which enable people to get to know each other and have established PAT dog visits. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 16 Comments received from people in the home and their representatives regarding the activities in the home were varied and included ‘Too many hours in our chairs’. Activities are not working; constantly altering or cancelling activities. They could improve by taking the resident’s outside for a walk in the garden. This is only ever done by relatives. (I have only seen two residents outside)’ ‘I think the activities are excellent’. ‘Other homes take residents out to places this home does nothing. Even just going to Wisley RHS 20 minutes down the road would be lovely but they just don’t even try to arrange any outings’. ‘ The crosswords and scrabble are good’ ‘ I was promised a newsletter and to be put on the mailing list. I gave the manager my address but have never received anything’. ‘My mother is a Catholic and there has been no attempt to contact the local priest. This was done by us’. ‘When some residents were taken to a local garden centre for a visit and my relative did not know about it and would probably have liked to have gone.’’ I do feel that sometimes more varied ‘pastimes’ and ‘occupations’ could be devised to give residents more variety in their lives and more mental stimulation to those who are able to benefit from it’. The home have recognised through their annual quality assurance assessment (AQAA) that they need to make sure that individuals are able to attend activities in a timely fashion and that all staff should be included in the planning and provision of activities. Several of the people in the home advised the inspector that they felt that the routine of the home did not fit with their preferences of lifestyle and choice for example sitting in the dining room for an hour waiting for their meal, following support and care in the morning being left in a lounge area without support water or call bell. Due to the feedback received it has been recommended that the home continue to undertake further consultation with people in the home regarding their views about taking part in social, religious and recreational activities in the home. On the day of the inspection the inspector observed several people visiting the hairdresser and having nail manicures, the individuals stated that they felt this was a good service. Daily newspapers are available to individuals throughout the home. Several visitors were seen during the inspection day and people were observed moving freely around the home. Several individuals spoken with told the inspector that they felt that they were able to exercise choice in their daily lives, with one person saying ‘it is home from home’. During lunchtime it was observed that one person living at the home had a guest invited to share lunch and tea and coffee was offered to visitors in the home. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 17 The home employs a full time chef and menus are available to all people in the home to choose from on a weekly basis. The inspector met with the deputy chef who explained that the chef’s write a menu plans using a points system to ensure that all individuals in the home receive a nutritious well balanced diet. Comments received from people in the home regarding the meals included ‘the foods excellent,’ ‘portions are rather large and we are told to eat what we can. Doing this means a large deal of waste. I wonder what happens to this! The deputy chef advised that she was aware that several people had raised concerns regarding the size of meals and this had been raised with the homes chef in order that the concerns could be addressed and meal sizes reduced according to individual preferences. The inspector noticed that some individuals had written specific meal sizes on their menu choices. One person told the inspector that they have their vegetables cooked just how they like them. The inspector observed the lunchtime and noted that all people were offered a choice of wine or soft drinks. The dining area was well lit, spacious and clean. Dining tables were available for people to sit at with up to two or three people. Condiments and appropriate crockery was available. Staff were available to support people with their mealtimes should they need any assistance. The inspector spoke at length with the deputy manager regarding some people’s feedback regarding mealtimes. Written comments and peoples direct feedback included ‘ My mother complains of being left ‘waiting for lunch’ in the lounge for long periods’. Several people stated the home ‘did not like them to have their meals in their rooms as it was easier for staff to support people in the dining room’. The inspector observed that some people were sitting up to twenty-five minutes at the dining tables. The deputy manager advised that this issue had been discussed with people in the home and that the home endeavours to meet all the needs and preferences of individuals at meal times. The inspector was advised that this matter would be brought to the manager attention. The home have recently received the gold star award for catering and have had an environmental health visit with no requirements. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure however improved management of complaints must be implemented to ensure that people know their complaints will be fully investigated. People who use the service are not fully protected from abuse and all staff must receive safeguarding adults training to ensure that people in the home are protected. EVIDENCE: The home complaints procedure was updated during the inspection and the new BUPA policy and procedure was placed in the complaints file. The file also contained a document relating to the NHS complaints procedure dated 1996, which the deputy manager was unsure of the relevance to the service. No complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. The AQAA details that thirteen complaints have been received since the last key inspection. Whilst sampling the complaints log the inspector noted that there was generally not a detailed clear chronology of events for example dates of correspondence and outcomes regarding complaints received by the home. Some correspondence to a complainant disclosed information, which did not need to be disclosed. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 19 The home have been proactive in addressing concerns or complaints which people may have regarding the general facilities and their bedrooms. The concerns are addressed by the hotel service manager and documented in a complaints book. The concerns are addressed with the manager on a weekly basis to ensure that appropriate action has been taken and the concern/resolved. These observations were discussed with the deputy manager during the inspection and also to the manager in a telephone conversation the following day after the inspection. It has been required that improvements are made in the recoding and management of complaints in order to demonstrate that effective responses have been made following the home receiving a complaint. The inspector asked people in the home if they knew how to make a complaint and responses included ‘I direct any complaints to the management’ ‘To make a complaint I’d go through a relative’. Written comments included ‘Complaints can be made but are not investigated’, ‘I will say that there are certainly language problems. ‘ The problems there have been are usually ironed out quickly’. ‘ The key nurse is always willing to deal with any concern/issues that arise’. The inspector sampled that the home has the local authorities multi agency procedures for safeguarding adults and the deputy manager advised that the home follows these procedures. The home has confirmed that there have been no safeguarding referrals under these procedures since the last inspection. Staff spoken with during the inspection demonstrated an understanding of the procedures for safeguarding adults. The deputy manager was unable to locate staff training records and following the inspection the manager emailed training records to CSCI. The records indicated that not all staff had undertaken safeguarding adults training and it is required that this training is made available in order to ensure that staff are aware of the protocols regarding reporting and detecting abuse in order to safeguard people in their care. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The physical layout of the home enables people who use the service to live in a safe and well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The home is currently undergoing a full refurbishment, which includes painting, decorating, and some additional carpentry works and replacement furnishings. On the day of the inspection it was noted that the home was busy with contractors for example decorators and electricians undertaking work in the home. The home has a documented plan regarding the refurbishment and the completion is targeted for August 2007. In general the home is managing the refurbishment plan well and people in the home stated that they did not feel Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 21 that the refurbishment was too disruptive. One comment from a relative included ‘ the home does try to keep relatives informed of events especially regarding the current renovation’. The inspector met with several housekeeping staff that were undertaking their duties. The home was noted to be clean and hygienic throughout. The laundry of the home was orderly and well managed. The laundress explained her role within the home and advised that she had had a full induction regarding the safe use of equipment in the laundry. A system was noted to be in place to safeguard loss of people’s clothes however the laundress showed the inspector some clothes that had not been claimed by individuals in the home. The inspector observed that there was adequate facilities for washing hands around the home with gel hand rub available for all staff. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. The staffing numbers need to be reviewed to ensure there are sufficient numbers of staff to support the people who use the service. Staff recruitment practices have improved to safeguard people in the home. Staff training must be improved to ensure all staff receive mandatory training in order to ensure the safety and wellbeing of people in their care. EVIDENCE: The inspector was advised that the home is currently supporting 32 residents. The staffing numbers on the day of the inspection were three registered nurses and nine carers. The deputy manager advised that there were usually twelve staff on a morning shift and six carers and two registered nurses on the afternoon shift. Written and oral comments received regarding staffing levels were varied and included ‘ A few more carer’s would benefit everyone. BUPA to my way of think should be able to afford this. ‘Staff shortages cause difficulties at times’. Help is not always available when needed’. ‘ 2 carer’s coming together to provide the necessary requirements talk to each other and the residents questions are often ignored more staff would alleviate this problem, the majority of staff are very caring people doing their job well. Occasionally you get one who is abrupt and will not listen to the resident. The care staff need a Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 23 little more time to listen to the needs of the resident and maybe they need more staff’. ‘The staff have very little time to listen,’ ‘ fewer agency more permanent staff’.’ ‘Having more carers.’ ‘ Sometimes care is rushed if the home is short-staffed’, ‘Some of the carers (as opposed to the nursing staff) can be unaware that some residents can be in pain and that they need to be more careful and less quick to undertake certain tasks for example need to be carefully lifted etc’. ‘ The care staff always seem to be over stretched in their work yet with fees in excess of £1,000 per week I would hope that there were sufficient funds to employ a suitable number of staff’ ‘As residents spend a large amount of time in their rooms it would be pleasant if staff had time to have a couple of minutes chat with the residents rather than rush in and rush out after a task. My relative certainly enjoys the company of the staff when they have time’ Some of the comments received prior to the inspection were discussed with the deputy manager who stated that he would pass the concerns to the manager. Staff views regarding the staffing numbers were also varied with some staff stating they felt stressed and unable to offer quality whilst others felt there were sufficient numbers to assist them with their work. The home have a ticket system, which details the time that a call bell is ringing and then, answered. The inspector sampled the ticket for the day of the inspection and noted that the majority of calls were answered within two to five minutes with one call at 07.17 not being answered for fifteen minutes. Written comments from people living in the home regarding response to the call bells included ‘The bell system needs to be improved as time delay is supposed to be 3 minutes. It is often very much longer and this can be very upsetting when they wish to use the commode. ‘The staff often take quite a while to answer my bell’. In view of the variety of the comments and above observation it has been required that the management of the home undertake a full review of the staffing levels and the deployment of staff. The review should be documented and recorded and include ongoing monitoring detailing the outcomes and actions taken to address any identified shortfalls. Comments regarding staff as a whole included ‘Compliment re a tribute to the professionalism of your organisation and standard of care given. All staff rose to new levels of care and support for their relative just when she needed it most.’ ‘It was so nice to be treated in such a friendly, helpful and caring way’. Comments from relatives regarding the competency of staff stated ‘ Some staff lack confidence to deal with moving my relative from their wheelchair to her chair. Perhaps confidence building and more one to one training may need to be considered.’ Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 24 The inspector sampled four staff recruitment files. The files evidenced that the home had met the previous requirement regarding the safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of people living in the home. The deputy manager was unable to locate staff mandatory training records and following the inspection the manager emailed training programmes to CSCI. The manager advised that the administrator puts staff attendance of training in the BUPA employee diary on the pay roll system and that the home has not had a training coordinator for some time. A clinical night manager has this month taken over the role of training staff and will spend one day per week supporting all the house training courses especially the statutory work booklets. CSCI have requested clarification regarding the qualifications of the training facilitators for example Train the Trainers in order to ensure that the homes staff are suitably trained and competent in their duties. The records indicated that not all staff had undertaken the necessary mandatory training for example basic food hygiene, moving and handling and health and safety. It is required that all staff undertake the mandatory training in order to ensure that people in their care are supported in a safely and competently. The training records indicated that nine Care Assistants have achieved their National Vocational Qualification (NVQ) Level 2 in care, two are in progress and four waiting to start which constitutes 55 of staff who have or will have an NVO qualification. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. The management and organisation of the home needs to be improved in order to reflect the best interests of people who use the service. The homes arrangements for people’s financial affairs need to be improved. All staff must receive supervision. Improvements need to be made regarding the promotion of health and safety in the home and clarification of the homes insurance policy in order to promote protection from risk of abuse. EVIDENCE: The manager of the home was not present during the inspection. Written comments regarding the management of the home included ‘ The management is not good’ ‘I have had several meetings with the manager and assistant managers. The manager agrees to change things but it does not happen’. ‘The Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 26 home needs to be better equipped to deal with ‘difficult’ relatives. I sometimes feel that although I have been always informed well about my relatives situation others, less informed, make issues which need to be put in context and as a result would not be so difficult to deal with’ ‘There’s a lack of organisation and communication’. ‘Management not good, nursing care OK. Shortages of staff at weekends and nights’. ‘Communication is not always the highest quality, whoever writes letters/newsletters needs to have them proof read for clarity’. During the inspection the inspector observed that staff were making every effort to meet the needs of the people living in the home. The Annual Quality Assurance Assessment (AQAA) states that the home undertake an quality assurance programme based on the company’s policy and procedure yet this was not evidenced by the inspector on this occasion. The receptionist explained that the homes bursar keeps some people’s money within the home. The Bursar was not available on the day of the inspection. The receptionist advised that the bursar did not work on Mondays and when questioned if people should want access to their monies on that day the inspector was informed that people could make a prior arrangement with the bursar to have their money or staff would lend them money until the bursar returned to work. This was confirmed with the deputy manager and it has been required that the arrangement of staff lending people money and the restriction of access is reviewed in order to protect all parties concerned. With regard to staff supervision three staff files were randomly selected and sampled. Two of the files contained no supervision records and one staff file contained one document. The deputy manager explained that the managers were aware of this shortfall and plans were in place to commence formal staff supervision within the month. It is required that all staff working in the home receive appropriate supervision of their work in order to ensure the safety, competency and well being of all people in the home. The inspector noted that housekeeping trolleys had been left unattended in corridors and one contained chemicals. It is required that all chemicals be removed from trolleys or stored in the locked storage container on the trolley when they are unattended. The hotel service manager advised that housekeeping trolleys were stored in locked cupboards overnight and linen trolleys were stored overnight in the corridors. The inspector was advised that there was not a documented risk assessment regarding the storage of the linen trolleys and as a measure of good practice it was recommended that the current storage arrangements for the trolleys are risk assessed in order to ensure the safety and well being of all persons in the home. The inspector was advised that the housekeeping staff were emptying the hoover manually as the home had no hoover bags for the last month. The hotel service manager was advised of this shortfall and advised that it would Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 27 be addressed with immediate effect. The manager showed the inspector an order form, which demonstrated that the bags had been ordered and were due to be delivered to the next day. Whilst touring the kitchen the inspector noted that several areas for example the wall by the cooker required deep cleaning and it is required that this is attended in order to ensure that all areas in the home are kept clean. One comment card received stated that improvements would included ‘ Clean the bathrooms. The rooms are usually OK but the bathrooms are left in a mess. Commodes left full with no lid on, the lid left dirty resting on clean chairs. Flannels towels dumped wet on a chair’. Whist this may not be general practice a requirement has been made that all staff are aware of the infection control policy and procedures of the home to ensure the safety and well being of all people in the home. Information received by the commission stated that staff at the home had broken an item of furniture on three occasions belonging to a person receiving care in the home. The commission were advised that the individual paid for the repairs. This arrangement must be reviewed by the home and the outcome to be informed to the commission setting out whether the home has an insurance policy where repairs could be reclaimed if items are broken by members of staff or whether the policy of the home is not to accept responsibility. Matters raised during this inspection including the planning and provision of activities, arrangements regarding meals and meal portion sizes, staff deployment and response times to some call bells, recording of information about complaints, some shortfalls in staff mandatory, safeguarding training and supervision, some concerns regarding the cleaning and infection control, individuals financial arrangements and clarification of the homes insurance policy indicate that systems within the home are either failing or not being fully followed in order to ensure the health and welfare of all people in the home. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 2 X 2 Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 13.(4)(b) Requirement All risk assessments must be updated following any related incident to ensure individuals safety and well being as far as reasonably practicable. Improvements must be made with regard to the recording and management of complaints in order to demonstrate that effective responses have been made following the home receiving a complaint. All staff must receive safeguarding adults awareness in order to ensure that they are aware of the protocols regarding reporting and detecting abuse to safeguard people in their care. The home must undertake a full review of the staffing numbers and the deployment of staff in the home to ensure that the current staffing arrangements meet the needs of all people in the home. The home must review the current arrangements regarding the restrictions of people’s money in order to protect all DS0000013300.V339224.R02.S.doc Timescale for action 25/07/07 2 OP16 22.(3) 12/07/07 3 OP18 13.(6) 18/08/07 4 OP27 18.(1)(a) 18/07/07 5 OP35 13.(6) 07/07/07 Arbrook House Version 5.2 Page 30 6 OP36 18.(2)(a) 7 OP38 13.(4)(a) (c) 8 OP38 23.(2)(d) 9 OP38 23.(2)(d) 16.(2)(j) 13.(3) 13.(6) 10 OP38 parties concerned. All staff working in the home must receive appropriate supervision of their work in order to ensure the safety, competency and well being of all people in the home. All chemicals must be are removed from housekeeping trolleys or stored in the locked storage container on the trolley when they are unattended. The wall by the cooker in the kitchen must be cleaned in order to maintain appropriate levels of hygiene and safety. All staff must be made aware of the infection control policy and procedures of the home to ensure the safety and well being of all people in the home. The home must clarify the insurance policy regarding reclaiming repairs of items, which are broken by members of staff or whether the policy of the home is not to accept responsibility in order to protect the individual from risk of abuse. 18/09/07 22/06/07 18/08/07 12/07/07 18/07/07 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 It is recommended that the home continue to undertake further consultation with people in the home regarding their views about taking part in social, religious and recreational activities in the home. It is recommended that the current storage arrangements for the house keeping and laundry trolleys in the corridors are risk assessed in order to ensure the safety and well DS0000013300.V339224.R02.S.doc Version 5.2 Page 31 2. OP38 Arbrook House being of all persons in the home. Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Arbrook House DS0000013300.V339224.R02.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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