Inspection on 13/11/07 for Archmoor Care Home

This inspection was carried out on 13th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Archmoor Care Home 08/07/09

Archmoor Care Home 03/11/08

Archmoor Care Home 30/08/06

Archmoor Care Home 02/03/06

Archmoor Care Home 20/09/05

Archmoor Care Home 01/03/05

Archmoor Care Home 22/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Archmoor Care Home Archmoor Care Home 116 Sandy Lane Middleton Manchester Greater Manchester M24 2FU Lead Inspector Jenny Andrew Unannounced Inspection 13th November 2007 08:15 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 Archmoor Care Home DS0000042848.V351887.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. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Archmoor Care Home Address Archmoor Care Home 116 Sandy Lane Middleton Manchester Greater Manchester M24 2FU 0161 653 2454 0161 653 6698 enquiries@archmoor.co.uk www.archmoor.co.uk Mrs Margaret Elizabeth Pilkington Mr Andrew Pilkington Mrs Margaret Elizabeth Pilkington Care Home 20 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) Category(ies) of Old age, not falling within any other category registration, with number (20) of places Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the maximum registered number 20, there can be up to: 20 Older People (OP) The service should at all times employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 30th August 2006 Date of last inspection Brief Description of the Service: Archmoor provides personal care and accommodation for up to 20 older persons. Nursing care is not provided, except by arrangement with the district nursing service. The home is purpose built and accommodation is provided on two floors in 16 single and two double bedrooms. Seven bedrooms have the added provision of an en-suite toilet. A passenger lift serves both floors. A lounge, dining area and conservatory are provided on the ground floor. A pleasant and attractive garden/patio area can be easily accessed from the rear of the home. Archmoor is situated approximately three miles from Middleton town centre. A regular bus service to the town centre can be accessed within several minutes walking distance of the home. A small car park is provided to the front of the home, and on street parking is also available. The home’s Client Guide advises residents and their relatives that the most recent Commission for Social Care Inspection (CSCI) report is available in the office. At the time of this inspection weekly fees were £334.98 per week. Additional charges were for hairdressing, chiropody, toiletries and outings. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted ten hours. 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 some of the staff were also looked at 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, the manager, deputy manager, eight residents, three care assistants, the cook and two relatives were spoken with. Before the inspection, comment cards were sent out to service users, staff and relatives/ carers asking what they thought about the care at the home. Eight service users, seven relatives and four care staff filled the cards 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 asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager did not complete this in as much detail as we would have liked and did not show us how they thought they could improve on their present service. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. What the service does well: Relatives and residents spoke well of the care provided. Comments made included: “I can’t fault the care that’s been given to my father so far”; “I visit on a regular basis and feel that not only is my relative looked after well but generally the residents all appear quite happy”; “The home caters for individual needs”; “My relative is very happy and my mind is at ease knowing he is well cared for”; “I am looked after and happy to be here”. Staff were described by residents as “good”, “nice”, “very good”, “ok”, “friendly” and “they treat you well”. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 6 The health care needs of the people living at the home were being met. The staff reported any problems and health care professionals were requested to visit. The staff made sure that their instructions were followed so that they would receive the right care. The building was homely, safe, well maintained and clean, and residents were happy with their rooms. Good systems were in place to make sure residents were protected, as far as possible, from picking up infections. What has improved since the last inspection? What they could do better: Further improvements were needed to make sure the care plans accurately reflected the needs of the residents. Risk assessments needed to be done for moving/handling of residents, nutrition and skin, so as to make sure that the right action was taken by the staff to reduce the risk areas. The way controlled drugs were stored needed to be changed in line with new legislation, so they would be stored more safely. When complaints were made, the manager needed to make sure a complaint log was kept showing when the complaint was made, what the complaint was about and how it had been investigated. This was so the Commission for Social Care Inspection could check that complaints were being properly investigated. Before new staff started work, the manager was not always doing the right checks so she could be sure that the staff were safe to work with vulnerable people. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 7 Whilst new staff were doing the home’s own induction training programme, it was not thorough enough and the manager needed to make sure it met the Skills for Care Common Induction Standards. This would make sure that new staff would get all the training needed to help them care safely for the people they were looking after. Some staff still needed to do health and safety training (food hygiene, fire, infection control, first aid) and certificates or evidence needed to be kept to show this. Other than resident/relative questionnaires, the manager did not have an effective system in place for checking the quality of services offered so she could assess what the outcomes were for the people living at 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. Archmoor Care Home DS0000042848.V351887.R01.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 Archmoor Care Home DS0000042848.V351887.R01.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): 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 to live at the home to make sure their needs would be able to be met. Standard 6 was not assessed, as intermediate care is not offered at the home. EVIDENCE: The files for the two most recently admitted residents were checked. One person was self funding and the Local Authority was funding the other person. Both contained pre-admission assessments, one done by the manager of the home and the other by a care manager. The manager said she or the deputy manager always visited people who were privately funded before they came to live at the home, to make sure they would be able to meet their needs. If they were able to visit the home to look around, then the assessment would be done at this time. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 10 Feedback from staff was mixed in respect of whether they were given sufficient information about residents’ needs. One person commented, “Sometimes we get new service users in before we have any information at all concerning their condition or needs”. Residents were encouraged to come and look around the home before moving in. One resident was spoken to who said, “I came for a few hours to see if I liked it. I was made welcome and liked the home because it was small and friendly”. When people had medical conditions that the staff were unfamiliar with, the manager said she tried to find training courses for them to attend. An example was given where some of the staff had done some awareness training in how to support people with Parkinsons and, more recently, an optician had given eye care training. A dementia DVD had also been bought but very few staff had actually watched it. The deputy manager said this would be promoted to all staff. Archmoor Care Home DS0000042848.V351887.R01.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 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were being met but lack of risk assessments for health and safety issues could put both staff and residents at risk. Personal support was offered in such a way as to promote and protect residents’ privacy and dignity. EVIDENCE: Three care plans were looked at for people with different needs. Staff had a working file readily accessible, which contained care plans for all the people living at the home. Another file was kept separately which contained all other relevant information about each person. In the main, care plans reflected the care needed to meet the needs of the individuals but some omissions were noted. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 12 One resident was currently under the GP in respect of a medical condition and was being looked after in his bedroom. Whilst this was a precautionary measure, there was nothing recorded on his care plan about the possible infection and how staff should be supporting him. It was, however, clear that the correct care was being given and good infection control practices were observed. He was also under the GP for another medical condition and whilst the care plan recorded the problems and what needed to be done, the daily records did not detail whether the condition was improving or not. On the care plan it was recorded he was non-weight bearing. He had not therefore been weighed on admission, as the home did not have sitting scales. Another resident, who was being cared for in bed, was being visited regularly by the district nurse. There was a short-term care plan in place but the district nurse’s more recent instructions had not been transferred to this plan. From checking through other records, it was noted that this person was, however, receiving the correct care. Good practice was noted in respect of staff keeping accurate turning and fluid/dietary charts so that her care could be closely monitored. Due to this person’s health, the district nurse and social worker were presently re-assessing her needs and a review meeting had been planned. One care plan showed that good progress had been made in respect of a resident gaining weight. The dietician had been involved initially and a letter on file showed that she was satisfied with the progress this person had made. Returned resident questionnaires were mixed in respect of whether they felt they received the care and support they needed. Three thought they always did, four said they usually did and one person felt they sometimes did. Those people spoken to were generally satisfied with the care, but two people said they would like the staff to spend more time with them. The returned relative comment cards indicated satisfaction with the overall care provided at the home and all commented they were kept up to date about the health care of the person they visited. One relative completing a comment card said the person they visited always looked well cared for and another commented, “My Dad is very happy here and my mind is at ease knowing he is well looked after”. Another person said, “Staff are attentive to people’s needs and nothing seems to be any trouble to them”. The home provided care for one resident who was not of white-British origin; she indicated satisfaction with her care. The deputy had attended an Equality and Diversity course and had applied her learning at the home. Discussion took place about the deputy passing her learning to the staff team, perhaps when the next staff meeting was held. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 13 An area of concern was the absence of risk assessments in respect of moving/handling, nutrition, falls, etc. Whilst the care plans had identified areas of concern, the risk assessment process had not been followed and none of these documents were in any of the three files that were checked. Given that one person was being cared for in bed with the use of a hoist and another person was recorded as non-weight bearing, this could place them at high risk of being inappropriately supported. Risk assessments had been done for other identified risks, such as dehydration and using the lift unaccompanied. Whilst staff had been trained in the use of the Malnutrition Universal Screening Tool (MUST), this was not being utilised. The manager must now ensure that all residents upon admission are assessed in respect of moving/handling and nutrition. Skin assessments must also be in place for people who are assessed as being at risk. Care plans recorded GP, District Nurse and other professional healthcare involvement. Healthcare professionals were called as and when needed. Pressure relieving equipment was available and the owner/manager had purchased two new mobile hoists over the past 12 months. Continence needs were appropriately assessed and addressed through consultation with the Continence Nurse. Likewise, care plans showed that the dietician was consulted for advice in respect of individual residents. Residents said the home called their GP when they needed them and the services of opticians, chiropodist and audiologist were accessed either at the home or in the community, as and when necessary. The care plan files showed evidence of such visits. Medication policies and procedures were kept in front of the medication administration records (MAR). All the staff responsible for giving out medication had received training and a signature list was maintained for staff authorised to handle medication. The manager/owner said they were in the process of transferring to the Boots monitored dosage system and were awaiting delivery of the necessary paper work. The requirements made at the last inspection in respect of medication issues had been met. However, it was noted that a recommendation made to ensure that all handwritten MAR entries were signed and countersigned had not been fully implemented. One or two handwritten entries had no signatures. New legislation had recently been introduced in respect of the safe storage of controlled drugs and those currently held were being inappropriately stored. A controlled drug cabinet suitable for purpose was not being used and this was discussed with the manager. It was agreed that controlled drugs would be transferred to this cabinet. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 14 The deputy manager had been on the Rochdale MBC course “Dignity in Care” and said she would be sending staff on further courses. Residents interviewed considered their privacy and dignity was respected at the home. One resident said, “They always keep me covered up with a towel when getting me in the bath”, and another said, “They’re very respectful”. During the visit, good practice was noted in respect of staff knocking on bedroom doors before entering, closing toilet doors that residents had left open and discreetly asking people if they needed to go to the toilet. A male carer worked at the home, which meant that the male residents were able to choose to be assisted by someone of their gender. He did not provide personal care to female residents without their agreement. Safety locks were provided to bedroom doors and residents who wished to have a key did so. The home was adequately equipped with necessary aids and adaptations, which promoted people’s independence. At mealtimes, whilst assistance was given where needed, residents were prompted by staff to continue to eat their meals themselves. Two people had plate guards so that they could remain independent at meal times. Archmoor Care Home DS0000042848.V351887.R01.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 good. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives, although social stimulation was in need of further improvement. EVIDENCE: The more independent residents spoken to said they were able to make daily choices in respect of what time they went to bed, what to eat, whether to use the lounge or their bedrooms and what to wear. Those people who were reliant upon staff for all their personal care needs were also satisfied with their daily routines, although one person commented they would like to be able to stay in bed for longer in the morning. Observations made during the visit included a resident being assisted to go back to her room during the morning, being asked about choice of food and lunch being saved until later at the request of two residents. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 16 A requirement was made at the last inspection for more activities and stimulation to be provided for the residents. An activity diary was looked at which had recorded some activities, such as dominoes, table games, cards, films, sing-songs, going to the shops, nail care and occasional entertainment and visits from a physiotherapist, but there were many days when no entries had been made. The entertainer and physiotherapist had not visited on a regular basis over recent weeks for differing reasons but the physio had restarted monthly visits. The owner/manager said she was going to try and sort out the entertainment in time for Christmas. The staff spoken to said they tried to spend some time either on a one to one basis with the residents or organise games, but that the personal care duties left little time for this. Discussion took place with the owner/manager in respect of implementing an activity programme and identifying one person on each shift to be responsible for making sure some form of stimulation was offered. There was little evidence that armchair exercises were still taking place, even though at the last inspection, residents had said they enjoyed this exercise. Trips out for meals were being planned leading up to Christmas but they had not been booked, as numbers of residents wanting to go had not yet been finalised. The owner/manager said they would be having a special Christmas lunch with the staff dressing up and a buffet would be laid on for Boxing Day when relatives would also be welcome. Feedback from speaking to residents and from questionnaires indicated they would like more to keep them occupied during the day. Comments made included, “I would like it if the staff had more time to talk to me”, “I would like to do more activities”, “I do think more activities could be organised”. Of eight returned service user questionnaires, five said activities sometimes took place, one said usually and one said they never took place. Feedback from the returned relative questionnaires also identified this was an area the home could improve upon. The following comments were made: “I do think more entertainment could be laid on for the residents”; “There could be more activities in the day as nothing is done to keep my mother’s mind active”; “Residents need more to do. They sometimes seem fed up just sitting there all day”; “The residents would like to have more chats with the staff and entertainment to keep their minds active”. The religious needs of the present resident group were being met. A lay preacher regularly visited the home and a Church of England vicar visited to give communion. The owner/manager said the religious needs of the residents were recorded as part of the admission process. Whilst residents could choose to handle their own finances, at the time of the inspection, the relatives were tending to have control in this area. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 17 Relatives spoken to said they were made to feel welcome by the staff. They also said they were notified when their relative was ill or any changes to their condition were identified. Other comments made by relatives included, “We are always offered a cup of tea” and “There is a sense of a small family unit in the home”. Residents went out with relatives as and when they wished and staff assisted them in preparing for these trips. Feedback from residents spoken to and responses on returned comment cards was generally positive about the food. Since the last inspection and in response to a requirement made, a four-weekly menu plan had been implemented. The owner/manager said that residents had been asked about what they would like to see on the menu and their wishes had been respected. A variety of meat, fish, fresh and frozen vegetables and fruit were included. A choice of two meals were offered at lunch time together with dessert and either sandwiches or a hot snack were available at teatime. The choice of meal at lunch on the inspection day was braised steak, mashed potatoes, peas and cabbage or beefburgers in gravy, followed by mandarin oranges and cream or icecream. We sampled the steak and vegetables and found the steak tender and tasty and the vegetables not over-cooked. The cook said she was still changing the menus around, dependent upon whether or not the meals were being enjoyed by the residents until she was sure the menus were right. A large menu board, just next to the serving hatch, displayed the choices of meal. The special dietary needs of the residents were being met and the cook was knowledgeable about people’s individual needs. Observations made during the inspection included the following: one resident was poorly in bed and staff were assisting her with all her meals. This was done in a caring and sensitive way; another carer explained to a visually impaired resident what was on her plate so that she could manage independently; one resident, seen to enjoy their dessert, was offered second helpings and this was clearly appreciated. One resident who was of a different culture, enjoyed the food provided by the home but also liked food being brought in by her family. Archmoor Care Home DS0000042848.V351887.R01.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 available evidence, including a visit to this service. Residents and their relatives were confident that their complaints would be listened to, taken seriously and acted upon, but poor recruitment practice could place service users at risk. EVIDENCE: The complaints procedure was included in the Client Guide – a copy of which was provided in each bedroom and the home’s Statement of Purpose, displayed in the home also contained a copy procedure. Six of the eight residents and all but two relative returned questionnaires/comment cards knew who to speak to if they had a complaint. The CSCI had received a copy letter from Rochdale MBC written by a resident’s relative, alleging the home had not followed their specific wishes in respect of the care they wished the person to receive. As the outcome of the complaint had not been notified to us, this was discussed during the visit and it was concluded that the investigation had been thoroughly dealt with. It was noted that the owner/manager was not keeping an accurate written complaint log showing complaints received and action taken to address the complaint. One complaint was on the computer and printed off during the visit. It was agreed that, in future, hard copies of complaints would be retained, showing the date received, details of the complaint and what action had been taken to resolve it. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 19 Both an internal abuse procedure and the Rochdale Inter-agency Protection of Vulnerable Adults (POVA) procedure were held at the home. Ten staff had undertaken some training in this area as part of their NVQ training. The deputy manager had also done a full day’s training on protection with Rochdale Social Services Department. The owner/manager had purchased a set of DVD’s, one of which included abuse awareness and the deputy manager said she would use this to train the remaining staff until they could attend a more in-depth course. Archmoor Care Home DS0000042848.V351887.R01.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 available evidence, including a visit to this service. A safe, clean, pleasant, hygienic and well-maintained building was provided for residents. EVIDENCE: Inspection of the building during this site visit confirmed that the home was safe, well maintained and clean. Returned questionnaires from both residents and relatives and feedback from speaking to residents, all indicated full satisfaction in respect of the cleanliness of the home. There was no malodour present in any areas of the home that were checked and it was evident the domestics worked hard in respect of this. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 21 Since the last inspection, a visit by the Environmental Health inspector had taken place. The owner/manager said she was presently liaising with this person, as they had not understood one of the issues raised in the report. Other shortfalls identified had been addressed. The home was well equipped with the necessary aids and adaptations needed to meet the needs of the people currently living there. As previously highlighted, two mobile hoists had been purchased over the last 12 months. Level access was provided along with a passenger lift and handrails in corridors. Since the present owners purchased the home in 2003, an ongoing, planned maintenance and renewal programme had operated, ensuring the home was kept in good decorative order and furnishings and fittings were renewed as necessary. The owner/manager said that when bedrooms were vacated, they were usually re-decorated and, if needed, new carpets fitted before anyone new was admitted. Since the last inspection, at least three bedrooms had been re-decorated. A pleasant, safe, rear garden was provided which residents could enjoy in the better weather. Residents spoken with were pleased with their individual rooms and there was evidence they had brought in a number of personal possessions to make them feel more homely. All bedrooms were fitted with door locks and lockable storage space to ensure residents’ valuables were kept safe. An infection control policy was in place and good practice observations were made during the visit. Care staff used white disposable aprons to provide personal care, blue aprons for serving food, used disposable gloves when giving out medication and assisting with personal care tasks and used alcohol based gel for cleaning hands. Liquid soap and papers towels were supplied throughout the home. The laundry was clean and tidy and fitted with one large industrial washer and drier. The washer was equipped with a sluice programme. The home had invested in an OTEX laundry system, which was designed to kill all infection during the laundering process. The owner/manager said the system worked well. One resident spoken to especially commented on the laundry saying, “I get my clothes back really well ironed”. Archmoor Care Home DS0000042848.V351887.R01.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 adequate. This judgement has been made using available evidence, including a visit to this service. Sufficient trained staff were on duty to meet the needs of the residents but poor recruitment practice could place residents at risk. EVIDENCE: Inspection of rotas showed that sufficient staff were provided to meet the needs of residents. This was also confirmed by speaking to the staff on duty. They said there were always three staff on each shift and felt this was sufficient to meet the needs of the people currently living at the home. Feedback from residents and relatives mainly supported the view that there were enough staff on duty each shift to meet residents’ needs. However, the following comments were made: “Staff are so busy I would like more staff”, “The staff are helpful and try their best but they are very busy”, “More staff would be helpful to give the older people more attention such as talking to them”. Residents and relatives spoke well of staff describing them as ‘good’, ‘very kind’, ‘friendly’ ‘nice’ and ‘brilliant’. One relative commented, “I have no complaints about Archmoor, the staff are friendly and approachable”. Another comment made was, “Archmoor staff are caring and supportive to the needs not only of residents but also of relatives”. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 23 Feedback from staff questionnaires indicated they did not always feel valued by the management team. One person commented, “Staff should get more praise as a little thanks can work wonders”. The staff team felt they provided good quality support to the residents and that they tried their best to understand and listen to any problems they had. It was evident that those on duty during the visit were committed and enthusiastic about their roles. Three care staff files were checked, one for someone who had worked at the home for some time and two for people who had started working at the home this year. All three files were in some disarray and there was no proper system in place to ensure that all the required paperwork and checks had been completed before staff started working at the home. One file contained a completed application form, two references and evidence that a Criminal Record Bureau (CRB) check had been done. The other two files were incomplete. One did not contain any evidence of a Pova first or receipt of a satisfactory CRB check having been done, although a transported CRB from another home was in the file. A phone call made during the visit identified that whilst this person had started working at the home in July 2007, the Criminal Records Bureau had not received the completed CRB form until 11th November 2007. The manager/owner said she could not understand what had happened to this application as it had been sent off much earlier but there was no system in place to show any evidence of when the check had been sent. The third file contained no evidence of either a Pova first or full CRB having been obtained. The owner/manager said this person had previously been employed by them, had written to ask for her job back, stating that she had not been employed anywhere in the interim. Because of this, both the manager and deputy had thought they did not need to re-apply for new checks. These people had therefore been working unsupervised in the home during this time. The deputy manager said she would apply for all necessary checks immediately and in the meantime, would make sure that neither of the staff were on rota until the Pova First checks had been done. The day following the visit, an email from the deputy manager was received confirming this action had been taken. It was also noted that application forms were not fully completed and gaps in employment history were not being explored. This was discussed during the visit. The owner/manager said they had acquired the services of an employment firm, dealing with staff personnel and legal issues so they would be able to get the right advice in the future, which would assist her in improving their employment practice. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 24 Inspection of files showed that induction training provided was still the home’s own programme which did not meet the Skills for Care standards. Staff said that, on appointment, new workers shadowed an experience staff member until they felt confident enough to work alone. During this time, they were put on as extras to the rota. One returned questionnaire felt that their induction had not been thorough and that they had been expected to work unsupervised before they were ready to do so. The deputy manager said she was familiar with the Skills for Care Common Induction Standards and was able to bring them up on the computer screen. However, both she and the owner/manager said they were unaware that new staff should be doing this training, although this had been highlighted in the last inspection report. Discussion took place about purchasing a Skills for Care booklet so that they would have the information they needed to be able to adequately assess competency skills. Staff who have started working at the home this year and all new future employees must undertake this training. Information recorded on the Annual Quality Assurance Assessment showed that out of a team of 15 care staff, ten had completed their NVQ Level 2 training giving an overall percentage of 67 . Discussion took place with the owner/manager and deputy about cross-referencing NVQ and other relevant training on the Skills for Care induction record when inducting new staff in order to avoid going over units that people had already completed as part of their NVQ training. The deputy manager confirmed that all staff had now undertaken moving/ handling training and the staff spoken to said they had all done this training. The three staff personnel files looked at all contained evidence of moving/ handling training. It was difficult to determine when refresher training was due as the matrix did not identify dates when the training had originally been completed. The deputy manager agreed to review the form so that this would be clear. However, there were still gaps in the provision of other health and safety training. A range of DVD’s and questionnaires evaluated by the manager and deputy were available at the home and whilst some staff had watched them, they had not been widely used. They covered a range of areas including dementia care, death and dying, abuse, and risk assessment, as well as health and safety issues. It was emphasised to both the owner/manager and the deputy that all staff who had not yet completed the mandatory training, such as food hygiene, fire, infection control and first aid, should complete this as quickly as possible, either by use of DVD training or by attending relevant courses. Some staff feedback indicated that they found the use of the video for training unsatisfactory as they found it hard to concentrate due to the television in the lounge being in earshot. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 25 If more regular staff meetings took place, some time could be spent on staff training or discussions in respect of individual residents. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 26 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Whilst the home operated adequately, the service would benefit from an increase in management monitoring, reviewing and staff supervision, which would improve the outcomes for the people living and working at the home. EVIDENCE: The registered manager was also one of the registered provider’s of the home. She held a nursing qualification and had many years’ experience working in the NHS and private care homes. She had started the Registered Manager’s Award (RMA) course in 2004 but had not completed it as she had felt the course had been poorly co-ordinated. Since this time she had not done any other management courses and the benefit of attending short courses was discussed during the visit. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 27 In July 2007 the deputy manager had enrolled and started the Registered Manager’s Award with a view to applying to become registered manager. She had also experienced course problems but these had now been resolved and a new assessor had been appointed who was to visit her on 22 November 2007. In respect of quality initiatives, the home had the Investors in People Award that was due for renewal in November 2007. The owner/manager had made a decision not to apply for renewal of the award due to the expense involved and the fact there was no financial benefit from the Local Authority. The only other quality monitoring tool being used was the circulation of annual relative and resident questionnaires. These had very recently been circulated and, up to now, four relative questionnaires had been returned. Resident/relative meetings were not being held; no staff appraisals had been done this year and regular formal one to one supervision was not being undertaken. Only one staff meeting had been held in April 2007, the minutes of which were not available. Staff feedback indicated they would appreciate more meetings being held. Given the poor practice identified in respect of staff recruitment, the manager should incorporate the monitoring of staff files as part of her quality initiatives. The Annual Quality Assurance Assessment (AQAA) that the owner/manager must now complete on an annual basis could also be a useful tool in the self monitoring process. It was clear from the lack of detail on the returned form that little thought had been given to how the home had improved, what they could do better and plans for improvement over the next 12 months. If this form was used as a working document over the next 12 months and completed as and when improvements or future plans were agreed, it would be a comprehensive document when it was next due to be sent to the CSCI. Staff feedback indicated the manager and deputy did not have much contact with the residents on a day to day basis and did not work on the floor. Again, the manager should be having this contact so that she can assess whether the residents are satisfied with the service they are receiving. The manager should now take action to address these shortfalls and look at other ways of monitoring the quality of the service they are offering. From the Annual Quality Assurance Assessment (AQAA), it was noted that the home did not have some of the required policies. This was discussed with the manager who said she would do them in respect of the following: access to files by staff/users, annual development plan for quality assurance, code of conduct, continence promotion, and physical intervention/restraint. The home did not act as appointee for any residents although they managed personal monies handed to them by relatives for residents’ use. Records in relation to three residents’ monies were inspected and seen to be in order. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 28 Incomings, outgoings and running totals were clearly recorded and receipts held. Residents’ monies were held separately and securely. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 29 Whilst all care staff had completed moving/handling training, they had not all done the mandatory health and safety training, such as infection control and food hygiene. As previously stated, DVD’s had been purchased with questionnaires to be completed following the training and the manager said these would be used to complete the training programme. Fire drills had been done and the deputy manager said all staff had taken part, although this could not be confirmed from the matrix. All staff who cooked at the home had received food hygiene training. The deputy manager confirmed that sufficient staff had completed first aid training so that someone with first aid knowledge would always be on duty. No health and safety hazards were noted during the inspection. Regular maintenance checks were undertaken in line with legislation and building/ COSHH risk assessments were written as required. The AQAA recorded that maintenance of equipment was up to date and observations showed that the building was well maintained. Fire precaution checks were undertaken on a regular basis in keeping with Greater Manchester Fire Officer’s recommendations. Random checks were made of the gas certificate, lifts and mobile hoists servicing and these were in order. Archmoor Care Home DS0000042848.V351887.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 2 17 X 18 2 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Archmoor Care Home DS0000042848.V351887.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 15 Requirement Timescale for action 14/12/07 2 OP8 13(4)(c) 3 4 OP9 13(2) 22(8) OP16 Care plans must be accurate and reflect the up to date needs of the resident so that the staff will know what care and support to give to them. Risk assessments must be in 14/12/07 place for moving/handling, nutrition, skin and any other identified risk areas so that staff are clear about how to make sure the risks are reduced so that the residents’ health and safety needs are being fully met. Controlled drugs must be stored 07/12/07 in a secured metal cabinet so they are safe. Information must be kept 07/12/07 showing when the complaint was received, the problem and the action taken and outcome of the investigation, as such information may be requested by the Commission for Social Care Inspection. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 32 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. 5 Standard OP29 Regulation 19 Requirement Timescale for action 07/12/07 6 OP30 18 7 OP38 18 8 OP33 24(1) Criminal Record Bureau /Pova First checks must be undertaken before new staff start work so the manager can be sure the person they are going to employ is safe to work with vulnerable people. Induction training to the Skills 28/12/07 for Care Common Induction Standards must be implemented for all new staff so they receive the training needed to ensure they can care for the people in their care competently. Staff must receive training in all 28/12/07 aspects of health and safety, including food hygiene, fire, infection control, and first aid and certificates or other evidence be held on their training files. (Previous timescale of 30/10/06 not met). The manager must establish and 28/12/07 maintain a system for evaluating the quality of the services provided at the home so that outcomes for the people living there can be accurately measured. Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 33 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 2 3 Refer to Standard OP8 OP9 OP12 Good Practice Recommendations Sitting scales should be purchased so that the frailer residents will be able to be regularly weighed. Handwritten MAR entries should be signed and countersigned. In order residents will receive more social stimulation, an activity programme should be written which meets both the individual and group needs of the people living at the home. A carer on each shift should be identified who would be responsible for making sure the programme was followed. Arrangements should be made to ensure the staff who have not yet had any protection training receive it so they will be familiar with what to do in such situations. The manager should make sure that job application forms are fully completed and also ensure that any gaps in employment are explored as part of the interview process. The manager should keep herself updated in respect of new legislation and management practice. Staff meetings should be held on at least a three-monthly basis. Staff supervision should be undertaken at least six times a year. The policies and procedures identified as not being in place on the home’s AQAA should be written and implemented. The Annual Quality Assurance Assessment (AQAA) must be completed in detail to reflect what measures have been taken to improve the quality and delivery of the services provided in the care home. 4 5 6 7 8 9 10 OP18 OP29 OP31 OP31 OP36 OP37 OP33 Archmoor Care Home DS0000042848.V351887.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Area Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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. 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