Inspection on 09/06/08 for Arcot House

This inspection was carried out on 9th June 2008.

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

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Arcot House Arcot Gardens Sidmouth Devon EX10 9HR Lead Inspector Michelle Oliver Unannounced Inspection 16 June 2008 10:00 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 Arcot House DS0000071048.V363791.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. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arcot House Address Arcot Gardens Sidmouth Devon EX10 9HR 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) 01395 514397 Guinness Care and Support Ltd Mrs Heather Elizabeth Lascelles Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 23. 19 June 2008 Date of last inspection Brief Description of the Service: Arcot House is a large detached property that is situated within a mile of Sidmouth town centre. The home has steps to the front door, once inside there is level access on each floor and a chair lift. Accommodation is provided in 23 single bedrooms, seven of which have en suite facilities. There are two lounges situated on the ground floor; one is home to the library; the dining room is also situated on the ground floor. Since the last inspection Guinness Care and Support Ltd have taken over the management of the service. The home provides personal care for 23 older people. The home’s statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home, a statement of terms and conditions and details about living at the home. This is made available to all potential residents before they make a decision about living at the home. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £360- £430 weekly. Services not included in this fee include hairdressing, chiropody, toiletries, newspapers and outings. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, in order to hear their confidential views of the service, prior to our unannounced site visit. Prior to this inspection we sent surveys to people living at the home and staff. We received completed surveys from 8 people and 4 staff expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent 8 hours at the home, speaking with people living there and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 5 staff, including the registered manager, and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the registered manager. What the service does well: People living at this home were generally very happy with life at the home; one person told us staff, “Care about the individual and are very friendly” another said, “I have no regrets about moving here”. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 6 People spoke highly of the staff; we were told that staff were “respectful, friendly, kind and caring”. During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. People’s health care needs are well met and the home works with other professionals, such as GPs and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were generally happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. There are systems in place to ensure that people living at the home are protected from harm or abuse. The environment is clean and comfortable and people were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Many people praised the staff team for their caring approach and attitude. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Staff are well trained and people living at the home were confident that they had the skills to meet the needs of the people living there. Comments made by staff in surveys confirmed that they were happy working at Arcot House, that they receive appropriate training to enable them to care out their role. One person in reply to what the home does well, “ care for the elderly” and another “ care for the residents. Extremely well fed with good diet”. The home is well managed, with systems in place to ensure that people have their say about the development of the service. Staff are recruited robustly to ensure that people are protected. Overall, health and safety is well managed and people are safeguarded from harm. What has improved since the last inspection? The home continues to work towards improving standards and have worked towards meeting the requirements and recommendations made at the last inspection. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 7 Staffing levels have improved; an activities person has been employed, an additional member of staff is on duty during the day and the manager now dedicates her time to management and administration. Some improvements have been made to the management of medication and to the care planning process. Redecoration and refurbishment have been undertaken at the home and people living there say they are happy with the care provided by all staff. What they could do better: 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 Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 6 Quality in this outcome area is adequate. Although a pre admission assessment is undertaken for all people before they move to the home, the assessments are inconsistent and not well applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a Statement of Purpose that clearly sets out their objectives and philosophy, gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. However, it does not include results of a recent quality assurance survey which would inform people who are thinking of living at Arcot House of the views, comments and experiences of people already living at the home. [Please refer to standard 33] Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 11 None of the people spoken to during this inspection had been actively involved in arranging their move to Arcot House and said that their relatives had arranged everything for them. All of them said that they were happy with the care and support they receive at the home. People are not admitted to the home before an assessment of their health and social care needs has been undertaken. We looked at the assessments of needs for 3 people during this inspection. The quality of the information gathered was not always consistent or well applied. For example an assessment of the health and social care needs of a person recently admitted to the home did not include any details about the persons dietary likes or dislikes, past occupation, what they enjoyed as recreation or their spiritual needs. We spoke to this person and they were happy to share with us details relating to these topics and how they would like them to be met. We looked at a pre admission assessments for two other people who had recently made Arcot house their home; there were no detail of health, social or welfare needs for one and no assessment had been undertaken for the other. Not having information about people before they move to the home means that they are at potential risk of their individual needs not being met by the home. The manager said that people who are considering making Arcot House their home are invited to spend time in the home, have a meal and meet other people living there. When people move to the home they are given a Contract if they are privately funded or a Statement of Terms and Conditions if they are funded by Social Services. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Three residents’ files were looked at during this visit; all included contracts or the home’s statement of Terms and Conditions for those who have a contract with Devon Social Services. The home does not admit people who need intermediate care. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 12 Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 13 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 good. Health and personal care needs are generally well recorded in individual plans of care. Further improvements would ensure that care is delivered in a person centred way. People’s health needs are well met with good multidisciplinary working, helping to protect people’s welfare. People feel they are treated with respect and that caring staff uphold their privacy. This judgement has been made using available evidence including a visit to this service. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 14 EVIDENCE: Each person living at Arcot House has a plan of their individual health, social and welfare needs and how these will be met at the home. A new format has been developed since the last inspection to make it easier for staff to access this information. Plans are reviewed monthly to ensure they are kept up to date and include any changes. However, there is little evidence of people living at the home being involved in the review of their individual plans. Several people said they are not aware of having a care plan and are not aware of when or why any changes to their care take place. Three people whose care plans we looked at could not recall being involved in care planning and two were unaware they had plans of how their care will be provided. All care plans included a “daily care plan” that provides information about the individuals mobility, any special needs, important anniversaries and a record of possessions brought to the home. However, information did not always include details of how identified needs would be met. For example details recorded in one plan stated “ Mobility. Sometimes seems to lose [their] balance”. No further information had been recorded to inform staff how to minimise the risk of the person falling although the person had a fall before being admitted to the home. We saw some good details recorded relating to how individuals liked to have their personal care needs met, their preferred routines and goals or objectives that had been set for them to achieve; for instance “to remain as independent as possible”. However, no information relating to how or whether these individual goals had been met had been recorded. This means that people are at risk of their health and social care needs not being monitored and therefore any improvement or deterioration not been considered when plans of care are being reviewed. Some plans of care included details such as “ history of depression”, Give reassurance”, “ needs monitoring to join in activities” with no details of how these may be carried out. Information of how staff can aim to meet these issues and progress would further promote person centred care. One care plan liked at in detail had no information relating to areas of high risk, self care skills or community skills being recorded and had not been reviewed regularly. This means that the information may not be up to date and that staff may not be aware of associated risks or levels of independence the person may have. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 15 No one currently living at the home has a pressure sore, there are few incidents of falling and these are mostly related to people wanting to be independent and staff supporting their wishes. All care plans show regular liaison with appropriate health care professionals such as chiropodists, opticians and specialists. It had been recorded in a care plan that a person had been prescribed a medication that needed regular blood tests to monitor its usage and subsequent dosage. There was no indication of how the routine tests would be organised or how their health care needs would be met. This means that they may not always be taking the correct dosage of medication. Staff demonstrated a good knowledge of how to meet peoples’ needs although not all needs were identified in individual care plans. This potentially puts people at risk of their needs not being consistently met in a way they wish. Daily notes were sometimes unrelated to identified issues in the care plan. For example staff record tasks such as tidying room, making a bed but no information about how people actually were feeling or what they wanted to do or took part in. People living at the home said that they always or usually receive the care and support they need and always receive the medical support that they need. When spoken with people say that staff are very quick to call for the doctor when they are not well People confirmed that they are treated with respect and their privacy is protected. We spoke to several people during this inspection and all confirmed that they receive personal and healthcare support in an individual manner and that staff respect their right to privacy, they feel they are all treated equally and as individuals. Care staff confirmed this when telling us about the home’s privacy and dignity policy, when seen knocking before entering peoples’ rooms and when seen being discreet in offering to provide personal care or assistance. All personal care was carried out in private and people wear their own clothes, which are very well cared for. People spoken with are generally happy with the care given However, it was disappointing to note that although a recommendation was made at the last inspection that locks be fitted to all toilet doors, to protect people’s privacy and dignity, no action has been taken. This means that people may enter a toilet when another person is already there which could compromise privacy and dignity. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 16 The manager has improved the management of medication at the home since the last inspection. All people living at the home have lockable, secure medicine cabinets in their rooms. A record of medication to be given and when is kept in the managers office. This means that medicines will be given to people when needed. We looked at the home’s register of controlled medication and checked the record of medication against the actual medication. The record was not accurate. We also noted that the prescribed administration regime had not been followed. A medication was prescribed to be applied every 72 hours [3days] but had been applied on 2 occasions at incorrect intervals ( e.g 5 days or 2 days). This means that the person is at risk of not receiving the prescribed medication to meet their needs. Whilst visiting several rooms opened containers of creams/ ointments were seen with no indication of when they had been opened or expire. Creams lose their efficacy when open for more than 3 months. This puts people at risk of being treated by creams/ointments that may be ineffective. We looked at medication records maintained at the home. Generally they were well recorded but improvement is needed. For instance not all medication prescribed for one person had been recorded, no record of medication had been recorded for a person recently admitted to the home and directions that had been hand written had not been signed by two members of staff to ensure accuracy. This means that people may be at risk of not receiving prescribed medication. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 17 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. People benefit from flexible routines at the home and being supported to exercise control over their daily lives. Social activities generally meet peoples’ expectations and preferences and people enjoy a balanced diet which takes into account the likes and dislikes of individuals. People benefit from being encouraged and supported to maintain contact with family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an organised activities programme and since the last inspection has employed an Activities Coordinator who works with people living at the home three mornings each week. We were told she has met everyone Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 18 individually and discussed their social needs and organises activities to suit group and individual activity. The home encourages outside entertainers to visit the home to provide musical programmes, various clothing companies visit the home and provide clothing shows, outings are provided through the voluntary transport service and a mobile library visits the home. At the time of this inspection several people were enjoying a quiz and other activities throughout the morning. However, there were several people who chose not to take part as the activities were not their choice and these simply sat either in their rooms or in the quiet sitting room. One person told us that they had “never been so bored”. This person had liked to paint before moving to the home but although paper and paints had been brought in to the home they could not find them. When we discussed this with the manager we were told that they were in the office and would be given to her later. One person said they would “like to do some shopping sometimes”, and another “It would be nice to have some activities” as most of those held at the home were not to their taste. Several people said that staff were always very busy and couldn’t stop to talk to them, and they would like to be able to do this more. Information provided by the manager before this, and the last inspection, states that included in the home’s improvement plan is to build on social activities and to organise more outside activity to re instate the use of the Sidmouth voluntary bus to enable this to happen. Monthly communion services are held at the home with two churches to meet peoples’ chosen faith and spiritual needs. Visiting congregation supports one person who can who can no longer attend their church. The home has an open door policy and relatives, visitors and friends are welcome at any time, made to feel welcome and have a meal if they wish. People are given the choice of being served their meals either in their rooms or in the comfortable dining room. Lunch served during this inspection was well presented and nutritious. Staff supported people, needing assistance with eating, sensitively and discreetly. Comments about the food provided included “food is very good”. All meals are cooked on the premises and use mainly fresh ingredients. Hot and cold drinks are available throughout the day and water dispensers are available on the ground and first floor as well as in the dining room. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 19 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 good. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff are aware of the procedure to follow to protect people from abuse or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has received no complaints about this service since the last inspection. The home has received one complaint, which was dealt with within the time period stated within the home’s complaints policy. This was confirmed by looking at records maintained of the investigation undertaken and the response to the person who had brought the matter to the home’s attention. During discussions, people said that they felt comfortable speaking with staff about any ‘grumbles’ and would report any complaints to the manager, or deputy, but “had not had cause to”. Staff confirmed that they know the importance of taking people’s views Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 20 seriously and of listening and responding to any issues raised. Staff said they would report back to the manager or supervisor any requests, comments or complaints made by people living at the home. A copy of the home’s complaint procedure is made available in the service user guide, one of which is given to each person living at the home. People spoken to said they feel safe and secure, staff are generally kind very helpful, respectful and that nothing was ever too much trouble for them. Staff have undertaken Adult Protection training since the last inspection and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice and were aware of the home’s “whistle blowing policy”. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 21 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. People enjoy a good standard of accommodation that is attractive, homely and well maintained. Improvement is needed to ensure that toilets are kept clean and that hand washing facilities are available throughout the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arcot House provides comfortable accommodation for people living there. This includes one flatlet, one room that has a lounge, bedroom and en suite and 20 single rooms, 5 of which have en suite facilities, a light, spacious lounge, a library, or quiet lounge, with a covered veranda overlooking the garden and a Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 22 spacious dining room. The house also has 8 additional toilets, two mobile hoists and two assisted hoist bathrooms and a shower room. Individual rooms were homely, many were personalised and all were reasonably decorated and fresh. People are encouraged to bring in personal items to make their room cosy and precious to them. The dining room is light, airy and spacious with plenty of space for people to move around. Tables were laid nicely with tablecloths, individual napkins, good quality cutlery, glasses cruets and flowers. The gardens are a particular feature of Arcot House and are well tended. Seating and shade, is provided at various spots in the garden and people told us of the pleasure they get from sitting out or by just looking at the various trees, shrubs and flowers. A programme of refurbishment has taken place since the last inspection including redecoration of toilet areas, library and office and several bedrooms have had carpets and curtains replaced. At the time of this inspection the home was bright and fresh Although most areas of the home were reasonably clean and fresh some areas needed improvement. Two toilets were not clean and neither had adequate hand washing facilities [no towels in one no soap in the other]. This puts people at risk of cross infection. One toilet door would not close. Staff spoken to described procedures followed at the home to prevent cross infection and to maintain adequate hygiene. They spoke about wearing protective gloves and aprons and how these are disposed of. They also spoke about the procedure followed when undertaking laundry tasks. All of the procedures met with current good practice guidelines. We were told that there are plans to convert a bathroom, which is not used, to a sluice room. This will further promote good infection control procedures at the home. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 23 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 good. Staff numbers and the skill mix are satisfactory and ensure peoples’ needs are met in a timely and proper way. People benefit from having experienced and friendly staff who have a good understanding of their needs and are further protected by the robust recruitment practice followed at the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is usually at the home from 8.30 – 4pm, but often stays later if needed. The manager told us that 2 carers and a senior carer are usually on duty throughout the day. Since the last inspection the manager has introduced an additional carer who works 3 days a week from 8.30am- 4.30 pm. This is to enable any additional baths that people may choose to have or to be able to assist people who only need minimal assistance in an unhurried manner. Arcot House currently employs 5 full time and 9 part-time carers and 8 other staff including a cook and kitchen assistant, 2 domestics and an administrator. Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 24 The manager told us that the home is currently recruiting staff and are advertising for 2 full time carers and 2 carers to carry out night shifts. If for any reason such as sickness or staff holidays, the home has been short of staff agency staff have covered shifts at the home. The manager told us that they always request the same agency staff to promote continuity at the home. The home operates a generally good recruitment procedure that clearly highlights the processes to be followed. Three randomly selected staff recruitment files were checked. These contained all the checks recommended to ensure that suitable staff are recruited. These include written references, a police check and proof of identity. Ensuring the recruitment procedure is consistent and that all required information is obtained for all employees will protects people, as only those who have undergone this robust procedure will be employed to work at the home. All new staff complete an induction training programme within the first 12 weeks of the start of their 6 month probationary period. All staff must also complete mandatory training including fire training, manual handling, basic food hygiene, infection control and first aid. This ensures they are given the right information to be able to do their jobs well. The manager has developed a training plan that should ensure that training is provided to staff throughout the year. This training will include ‘safeguarding adults’ as well as updating mandatory training to meet peoples’ basic needs, such as manual handling and health and safety. Staff were clear about their role, knew what was expected from them and showed a good understanding of the actions they needed to take to meet and promote equality and diversity. Arcot House DS0000071048.V363791.R01.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 & 38 Quality in this outcome area is good. This home is well managed, and run in the best interest of the people living there. Some improvement is needed to further promote the safety and health of people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has many years of relevant experience in the management of care homes and tries hard to work towards meeting National Minimum Standards. Since April 2008 she has become supernumerary, which means Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 26 that she is not included in the number of care staff on duty at the home and has more time to undertake managerial duties. The manager told us that people are consulted on all aspects of their life at Arcot House on a daily basis when she visits and chats with all of them individually. People living at the home spoken to confirmed this and said, “She is always so kind and friendly”. The manager told us she operates “an open door approach” to people living at the home, staff and visitors, which encourage good communication and standards. People spoken to during this inspection confirmed they are “listened to” and their opinions and views are sought and taken seriously by staff and the manager. This is done through regular “residents meetings”, which are held every 2-3 months, records of which are documented. The home also carries out an annual quality assurance audit, which is the basis for their annual review. This means that people have a say in the running of their home. A representative of the Company visits the home to undertake unannounced monthly inspections of the service. Records looked at during this inspection included, individual plans of care, including risk assessments, daily reports and monitoring records, administration of medicine records, staff files and rotas, menus and records of accidents at the home. Most records were well maintained and were securely stored. Some records of medication, including the Controlled Drugs Register were not accurate. The home does not deal with any financial affairs of the people living there other than to hold, if required a sum not exceeding £50 in the safe for them. Records are maintained of money held and safeguards are in place to ensure balances are checked. We looked at the money kept for people at the home. Records were accurate and well maintained and receipts are kept of all expenditure. The balances of three people were checked and were correct. Although radiators in public areas have to be covered to protect people from the risks of burns, several in peoples’ room have not been covered. Many had furniture placed in front of them to minimise risks and some were in rooms where people were not mobile. Risk assessments had been undertaken for individual rooms, which showed that people were not at risk at harming themselves on the radiators. We discussed with the manager the risks that we felt could still be presented to individuals by uncovered radiators. However on the day of the inspection the radiators were not excessivley hot. A heated towel rail in a bathroom was excessively hot. We pointed this out to the manager immediately. We were told that this bathroom was not used by Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 27 people living at the home and was going to be refitted as a sluice room. We were concerned that people could wander in to this room and sustain a burn from touching the towel rail. The room was immediately locked so it could not be used. Most windows on the first floor at the home have been fitted with restrictors to ensure that the risk of accidentally falling is minimised. However, we noted a window at the end of a corridor on the first floor that had not been restricted. We immediately drew this to the attention of the manager and it was shut. We requested a “do not open” notice be clearly displayed and work undertaken to restrict the opening. Information received prior to this inspection indicates that water systems are tested monthly for legionella. All equipment in the home is regularly tested in accordance with requirements, water temperatures are checked monthly in relation to the risk of legionella and water temperature is controlled by thermostatic valves and there is a maintenance plan for fire equipment, hoists, chair lift and call bell system. Arcot House DS0000071048.V363791.R01.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14[1][a] Requirement Before a person moves into the home an assessment of their health, social and welfare needs must be undertaken. This is to ensure that the home is able to meet people’s needs. The registered person must make arrangements for the recording, safe administration and disposal of medicines received into the care home. This relates to • Not all medication being signed for when received at the home, • Some records being inaccurate. Arrangements must be made to make sure that the management of medication at the home is safe and protects people living there ( previous timescale of 14/12/08 not fully met) All parts of the home must be, 14/07/08 as far as practicable, free from avoidable risks. DS0000071048.V363791.R01.S.doc Version 5.2 Page 30 Timescale for action 30/07/08 2 OP9 13[2] 30/07/08 3 OP38 13[4][a] Arcot House This relates to not all windows being restricted and a towel rail being excessively hot. 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 OP7 Good Practice Recommendations The home should continue to update care plans to ensure that details of peoples’ health, welfare and social care needs are comprehensive. Plans should include details of monitoring goals, or objectives, which have been set for people to ensure they are receiving appropriate, care and support. People living at the home and/or their representatives must be involved in developing and reviewing their individual care plan and a record must be made of this. This is to make sure that care is being carried out as people wish, in an individual manner. 3 OP9 A system should be devised to ensure that creams/ointments, once opened, are not used beyond their expiry date as they lose their efficacy. When medication is received at the home and is hand written onto medication records the medication should be checked and signed by two members of staff. This is to ensure that instructions for administration are correct. Toilets should be fitted with locks so that people’s privacy and dignity is not put at risk of being compromised. Arrangements should be made to engage those people who do not choose to leave their rooms or enjoy the current activities at the home, to engage in activities of their choice. Arrangements must be made to ensure that all areas of the home are kept clean at all times. DS0000071048.V363791.R01.S.doc Version 5.2 Page 31 2 OP7 4. OP9 5 6 OP10 OP12 3 OP26 Arcot House This relates to two toilets being is to make sure that people live in a clean, fresh and hygienic environment and any risk of infection is minimised. 4 OP33 The results of surveys should be published and made available to people living at the home, their representatives and other interested parties, including the CSCI. Radiators should be guarded or have low temperature surfaces to ensure that people live in safe surroundings. 5 OP38 Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Arcot House DS0000071048.V363791.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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