CARE HOMES FOR OLDER PEOPLE
Arbrook House 36 Copsem Lane Esher Surrey KT10 9HE Lead Inspector
Lisa Johnson Unannounced 25th August 2005 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 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 H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Arbrook House Address 36 Copsem Lane Esher Surrey KT10 9HE 01372 468246 01372 470760 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Ms Keena Sinclair Millar Care Home 44 Category(ies) of OP Old Age (44) registration, with number of places Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Of the 44 residents accommodated, 4 may also fall within the category TI(E) Terminally Ill - over 65. Date of last inspection 26 October 2004 Brief Description of the Service: Arbrook house is situated close to Easher town centre and Claremont Landscaped gardens. The home is situated in its own lanscaped grounds with its own lake. The home is registered for forty four older people and the accomodation is provided over two floors and can be accessed by lift. All rooms are for single occupancy and have en-suite facilities. The home has a large communal sitting room, a large dining room. There is an art room and separate smoking area for residents who wish to smoke. 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 Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection carried out in 2005/2006. This inspection was unannounced which meant that the staff and residents didn’t know that the Commission for Social Care Inspection was visiting. The inspection took place over seven hours and was carried out by one inspector. The main focus of the inspection was to review any requirements made at the last inspection. A tour of the premises took place. Care plans, staff files and policies and procedures were sampled. The inspector spoke to five residents, two visitors and three members of staff in the home and comments are included in the report. The inspector would like to thank the residents and staff for their hospitality and cooperation during this inspection. What the service does well:
The home provides a well-maintained and pleasant environment in which to live. The home and holds regular consultation meetings with residents and relatives and informs them about changes and developments. Minutes of these meetings were maintained. There is also a residents/relatives committee. The home has an activities coordinator in place and a range of activities is provided with a timetable on display. During the inspection a gentle exercise class was being held and in the afternoon a number of residents were attending choir practice. It was evident that the registered manager is motivated to make any continued future improvements in the home to improve the quality of life for residents. The home has initiated comprehensive quality and development audits looking at feedback gained from residents and relatives. Outcomes are fedback to residents and relatives and action plans have been initiated with implementation dates. Comments received from residents were generally positive about care in the home. One resident stated, “The staff are helpful and caring and the food is good”. Another resident stated, “The staff are friendly and very good”. One visitor described the staff as “pleasant and willing and friendly to visitors”. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
Although there were detailed care plans in place it was seen that a number of care plans had not been signed by residents and/or representatives. A requirement has been made that that plans must be drawn up with the involvement of the residents and signed by them where possible. The registered manager is currently reviewing response times to call bells and four comments were received by the inspector from residents and one visitor in respect of delays. One comment received was that “Staffing levels were insufficient”. Although there has been extra support provided in the mornings and evenings the comments received from residents and relatives appeared to be around high peak times in the mornings and evenings. A requirement has been made that the registered manager must review the response times to calls and review the staffing levels. The outcome of this review must be made available to the Commission for Social Care inspection. A recommendation has been made that one downstairs bedroom had a slight mal-odour and the registered manager should consider deep cleaning the carpet if necessary. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 &5 Adequate information was available that would assist prospective residents and relatives make an informed choice as to whether the home would be a suitable place to live. Pre- admission assessments were completed. EVIDENCE: The home has a comprehensive Statement of Purpose, which clearly describes the aims and objectives, services and facilities it is able to offer. The home provides a service users guide, which was issued to all residents and was evident in individual bedrooms. New residents in the home receive a welcome pack. There is a clear admission policy and prospective residents are visited and assessments are completed prior to admission to the home. Prospective residents and relatives are offered the opportunity to visit the home. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 & 10 The home demonstrated that detailed individual care plans based on comprehensive assessments were in place that meet the health and personal needs of residents. However the home must ensure that plans are drawn up with the involvement of residents. Residents were protected by the homes policies and procedures for dealing with medicines. Residents were treated with dignity and respect. EVIDENCE: Residents have a key nurse appointed. Comprehensive care plans are in place generated from assessment with reviews updated and recorded. A new ability assessment for older people has been recently implemented and all assessments were in the process of being updated. The assessment package is comprehensive and covers all aspects of care. Four plans were sampled and found to contain nutritional assessments, risk assessments for residents identified at risk of falls. Two residents had been admitted with pressure areas and treatment plans and monitoring tools completed. However the plans sampled were found not be signed by residents and/or representatives. A requirement has been made that where possible plans must be drawn up with the involvement of residents and signed by them or their representative where possible. All residents are registered with a G.P and arrangements are in place
Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 11 for residents to have access to a local dentist and optician where necessary. A chiropody and physiotherapy visits the home. Accident/ incident records were sampled and were seen to be maintained adequately and regularly reviewed. Medication records were sampled and completed correctly. The controlled medication was stored correctly and the register recorded appropriately. Staff were observed to be maintaining residents privacy and speaking to residents in a respectful and friendly manner. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 15 Residents have the opportunity to exercise their choice in attending a range of leisure and recreational activities. Residents maintain links with family and friends. Individuals are supported to maintain control and make choices in their lives. Residents receive appealing and balanced meals. EVIDENCE: The home provides a range of recreational and on display. An activities coordinator is in place and an activities questionnaire has been introduced. Activities available include relaxation, reminiscence groups, sherry parties, aromatherapy, a choir and an art and crafts workshop is available. A hairdresser visits the home, facial treatments are available and church services are provided. The home also held a recent garden party. At the time of the inspection a number of residents were attending the gentle exercise group and in the afternoon a choir practice was being held. It was pleasing to see that staff were supporting residents to attend who require physical assistance ensuring that all residents who wished to attend could do so. Residents spoken to confirmed that there are no restrictions on their relatives/friends visiting and that they are able to visit in private. Some residents had access to their own telephone to maintain links. The home regularly consults with residents and relatives with regular meetings being held. The home also has a residents/residents committee which works on projects for the home.
Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 13 The home offers a varied menu and arrangements have been reviewed for residents being able to choose their options from four weeks to one week ahead and residents are also offered a further option of changing their choice on the day if they so wish and the new chef regularly consults with residents to discusses dietary requirements and likes and dislikes. Residents were seen to be offered choices at lunchtime and the meals offered were of a good standard, nutritious and well presented. Residents were offered a choice of red or white wine or soft drinks with their meal. A tray service is available and some residents were having their meals in their rooms. Staff are allocated to provided to support to residents who require assistance with eating and these meals are provided to residents at the same time as those served in the dining room. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a complaints procedure in place and the manager actively acts upon complaints and concerns. Procedures are in place, which ensures the safety and protection of residents from abuse. EVIDENCE: The home has a detailed complaints procedure in place. The procedure is made available in the Statement of purpose and service user guide. The homes complaints register was sampled and all complaints recieved have been logged. There was evidence that the registered manager has proactively responded to complaints and records were available. At the time of the inspection the registered manager stated that there were some concerns about the response times to call bells, which is being monitored. The inspector received concerns from four residents and two visitors in respect of this and a requirement has been made that that this is reviewed in conjunction with looking at staffing levels during peak periods of the day. A protection of vulnerable adults and whistle blowing procedure is in place and the home has obtained the updated version of the local authority protection of vulnerable adults policy and information is on display. Two members of staff spoken to confirmed that they had attended appropriate training and it is provided during the induction process. Arrangements are in process to update the training for all staff. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 The home is well maintained and provides comfortable indoor and outdoor facilities. Toilet, washing and bathing facilities are provided to meet the needs of residents. Residents are provided with specialist equipment. Residents have comfortable bedrooms with their own possessions around them. The home is clean and hygienic. EVIDENCE: The home is well maintained and employs a maintenance person. The grounds of the house are pleasant and provide a comfortable place for residents to enjoy. A patio is available with garden furniture for the comfort of residents. The home has its own lake in the grounds and a new path has been installed. a Risk assessments have been implemented with respect to the lake. The home is spacious and provides a range of communal space. There is a large lounge, a large dining room, an arts/crafts room, a separate smaller lounge. A separate small room is provided downstairs for residents who wish to smoke.
Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 16 All bedrooms have en-suite facilities and there are additional assisted bathrooms and toilets throughout the home. A staff room is provided and training area is available in the bursars office A nurse system is in place for residents to access and works on a pager system, which also provides a print out on calls received. The home has a passenger lift. Hoists and assisted baths are installed. Doorways into bedrooms and communal rooms are accessible to allow for wheelchairs. Bedrooms are pleasantly decorated and furnished and decorated with individual’s personal possessions. The home was clean and appropriate hand washing facilities in place. The kitchen was clean and hygienic and a visit from environmental health has taken place recently and a positive report was received. One bedroom on the bottom floor had a slight mal-odour and a recommendation has been made that the carpet is deep cleaned. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28,29 & 30 A review of staffing levels must be reviewed at peak times during the day to meet the needs of residents and to improve the response times in responding to call bells. Staff are supported to attend training and development to ensure that they are competent to carry out their jobs. The home is able to demonstrate that its recruitment procedures protect the welfare and safety of residents. EVIDENCE: At the time of this inspection there were three qualified staff on duty and eight carers. On the afternoon shift there is two qualified staff and six cares. Two qualified and two carers are provided on night duty. There has been a review in relation to staffing at nighttime and the outcome was that extra support has been put in place from six to eight thirty in the evening and from seven thirty to eight thirty in the morning to assist with breakfast. The home has some vacancies for care staff and is currently advertising. However some concerns have been made by residents in relation to response times to call bells, which is currently under review. A requirement has been made that the staffing levels must be reviewed particularly around peak times such as morning, after lunch and evenings. The home also employs an activities coordinator, domestic, catering, laundry, maintenance man, gardener, senior housekeeper, bursar and receptionist. Training and development of staff is supported such as National vocational qualifications. One member of staff spoken to stated that she had attended fire training, moving and handling and protection of vulnerable adult training. Training takes place internally and externally and records of training
Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 18 undertaken are recorded. The homes induction programme is based on the TOPPS guidelines. Five personal files were sampled for more recent staff that had joined the team. All the required documentation was in place including protection of vulnerable adult (POVA) and police checks. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 & 38 The home has an open management approach. Effective quality assurance systems are in place. Staff are appropriately supervised. The manager ensures the health, safety and welfare of residents. EVIDENCE: The manager is a qualified nurse and a diploma in nursing studies. and has many years experience of managing a care home and has completed the Registered managers Award. The manager also holds the National examination Board for Supervisory Management qualification. An open and positive atmosphere was found in the home with the registered manager making herself accessible. The registered manager clearly communicates and involves residents, relatives and staff in the development of the home effectively. Two staff spoken to confirmed that they attend regular staff meetings and one senior staff meeting stated that she has weekly meetings with the registered manager. The manager holds residents and relatives meetings on a regular
Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 20 basis in the form of supper meetings to pass on information and to obtain feedback. There is an effective quality assurance system in place formulated in questionnaires, which has been undertaken this year. Feedback is gained from residents and relatives and outcomes are communicated back to residents and relatives. A self audit tool is also completed annually which is analyzed and action plans are completed with implementation dates recorded. The responsible individual carries out monthly quality visits and reports and these are made available to the Commission for Social Inspection. Two staff spoken to confirmed that they receive annual appraisals and formal supervision and dates were displayed in the nursing office. Fire records were sampled and records were updated with fire drills taking place. Risk assessments have been implemented including moving and handling. Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 4 x x 3 x 3 Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 22 No Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(2) (a)(c) Requirement The registered manager must ensure that individual care plans are drawn up with the involvement of the resident and is agreed and signed by resident wherenever possible and/or a representative The registered manager must review the response times to residents call bells and to undertake a review of staffing levels in the home over peak perods. This should address the delays in responding to residents calls. The outcome of this review is to be made available to the Commission for Social Care Inspection. Timescale for action 2 months 25/10/05 2. 27 18 2 months 25/10/05 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 26 Good Practice Recommendations The registered manager should consider deep cleaning a carpet in one bedroom to ensure that the enviroment is free from offensive odours.
H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 23 Arbrook House Arbrook House H58 s13300 Arbrook House v221150 260805 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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