CARE HOMES FOR OLDER PEOPLE
Arden Court Care Centre 76 Half Edge Lane Eccles Manchester M30 9BA Lead Inspector
Elizabeth Holt Unannounced Inspection 23rd November 2005 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 Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 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. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Arden Court Care Centre Address 76 Half Edge Lane Eccles Manchester M30 9BA 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) 0161 707 9330 0161 707 9698 ardencourt@ashbourne.co.uk Ashbourne (Eton) Limited Mrs Theresa Ann Largent Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (2) of places Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Minimum nursing staffing levels as specified in the Notice issued in accordance with Section 25(3) of the Registered Homes Act on 4th December 1996 shall be maintained. Up to 35 service users requiring nursing care may be accommodated. Up to 12 service users requiring personal care only may be accommodated in a designated area on the first floor only within the maximum occupancy of 47. Two named service users requiring nursing care are accommodated by reason of physical /learning disability. If a service user leaves the home or the primary reason for requiring care becomes old age, the registration will revert to OP for service users aged 65 years and over. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 14th March 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Arden Court is a care home providing nursing and personal care for up to 47 older people. The registered owners are Ashburn Eton Ltd. The single room accommodation is provided on two floors with communal day areas on both floors. Access to the first and second floors is by a passenger lift. Entry to the building is via steps or an access ramp and a manned reception is provided. The grounds include a large garden area with some car parking to the rear and side of the building. The home is on a main bus route, is close to the motorway network and a train station is five minutes away in Eccles town centre. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was an unannounced inspection, conducted by two inspectors that took place over four and a half hours on Wednesday 23 November 2005. During the course of the inspection time was spent talking to residents, staff members and the home’s manager. Records were examined and a tour of the building was carried out. During this inspection only a selection of the key National Minimum Standards were assessed, therefore in order to gain a full picture of how the home meets the needs of the residents, this report should be read with the previous and any future reports. What the service does well: What has improved since the last inspection?
Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 6 Due to some concerns regarding the documentation the home had actioned staff training regarding care plans. The care plans for all the residents accommodated, had been reviewed and updated. Since the last inspection some redecoration had taken place. The upstairs hall and landing and some bedrooms had been repainted. A new activities organiser had been appointed since the last inspection. It was pleasing to note she had a particular interest in activities associated with residents with dementia. The public telephone had been replaced since its earlier theft. 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. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 7 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 Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 and 6. A planned admission procedure is available for prospective residents. An assessment of prospective residents’ care needs is undertaken by the home prior to their admission. Relatives/residents are able to visit the home before making the decision to stay. EVIDENCE: The Statement of Purpose and Service Users Guide were available at the time of the inspection. Residents’ needs were being assessed before they moved into the home. The assessment included the involvement of the prospective resident, his/her representatives and any relevant health professionals. A copy of the Care Management assessment was available for residents who are referred through Care Management arrangements. Where possible, prospective residents and their family/representatives were encouraged to view the home prior to making a decision about admission.
Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Arrangements were in place to ensure that the health care needs of residents are identified and met. Residents were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: A sample of care plans were seen and these had improved since the last inspection. Following some concerns raised, staff had received training in documentation recording. All care plans had been reviewed to ensure they reflected changes in the residents’ condition. The daily nursing statements were detailed and indicated the care given. Risk assessments were included within the individual plans of care and there was evidence these were reviewed on a monthly basis. Improvements had been made in the recording of nutritional risk assessments and the monitoring and recording of weekly weights. Four residents were receiving their nutritional input via a gastrostomy site at the time of the inspection. The records were satisfactory for these residents.
Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 10 One resident had been admitted to the home with a deep pressure sore. It was pleasing to see this was healing well and the staff had the appropriate support from the tissue viability nurse. The appropriate pressure relieving mattress had been provided in line with the resident’s assessed needs. Medication administration record charts (MAR) were completed accurately. Controlled drugs recordings were accurate. A new policy was in place for the disposal of medication. One resident was self-medicating. A policy was in place for self-medicating. The staff in the home were seen to treat residents with respect and dignity. Staff were observed talking to residents in a respectful manner. Privacy and dignity had been included in the care plans and in the Statement of Purpose. One relative spoken to said he felt the staff provided “good quality“ care to his relative and it was evident that the staff had a good rapport with this resident. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Social activities were available but limited. Meals were varied, appeared well managed and nutritious. EVIDENCE: A new activities organiser had been in post for one week at the time of the inspection. She was undertaking an induction programme. A planned activities programme was available for the Christmas period, however there was no evidence of any activities on the day of the inspection. When activities had taken place there was a log held within the individual care plans. It was pleasing to see that care plans included detailed life histories. A number of residents on the first floor were left unattended in the lounge during the inspection due to staff on lunch breaks and attending to other resident’s needs. Menus were in place and were balanced and varied. These gave the residents choice, and nutritional needs were assessed within the care plans. One of the inspectors tasted the food which he considered to be “tasty, hot and nutritious.” Lunch on the day of the inspection was a roast dinner. Two residents said the “food was marvellous.” The cook had been in post for 9 months and she asked the residents about their individual preferences. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents were confident that their concerns would be taken seriously and acted upon. Policies and procedures were in place to protect residents from abuse. EVIDENCE: The home had a complaints procedure that was on display in the entrance hallway. The information required updating to include the Commission For Social Care Inspection rather than the National Care Standards Commission. Since the last inspection the Commission has received two complaints that were partially upheld. As a direct result of the complaints made, improvements have been made in the care planning documentation, including risk assessments, staff supervision and Moving and Handling training. Requirements made were responded to in a timely manner and the concerns were addressed. At this visit the home’s complaint record showed there had been 9 complaints since the last inspection. These had been dealt with in an appropriate manner and the manager showed a positive attitude towards the concerns raised. A Copy of Salford’s Multi Agency Policy for the Protection Of Vulnerable Adults was available for staff to access. Staff had received training in the action to be
Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 13 taken in the event of an allegation of abuse. A Whistle Blowing policy was held on file and staff had been reissued with a copy of this. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24 and 26 The home is accessible and suitable for its stated purpose. Some improvements in the décor had been made and the home generally provided clean, comfortable surroundings for the residents. EVIDENCE: The home was accessible by a ramp and a passenger lift offered access to both levels of the home. Since the last inspection the home has continued with a programme of redecoration. Redecoration carried out included the upstairs hall and landing and some bedrooms. Bedrooms were personalised and residents spoken to liked their bedrooms. Plans in the next few months included redecoration of the upstairs lounge. The home was clean and the environment had no malodour at the time of the inspection.
Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 15 Although the home is registered to accommodate a maximum of 47 older people, changed use of some rooms has resulted in only 39 places being available. The Commission will be negotiating with the provider to address this registration issue in line with the variation request for an increase in nursing places. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The number and deployment of staff was not always sufficient to meet the residents’ needs fully. The home’s recruitment practices supported and protected residents. Staff had undertaken a high level of training to protect the health and well being of residents. EVIDENCE: At the time of the inspection, the home accommodated 28 residents assessed as requiring nursing care and 3 residents assessed as requiring personal care only. The home’s duty record showed that there were 2 qualified nurses and generally 2 care assistants working on each floor. (The home’s manager was extra.) Throughout the inspection, there were periods of times when the residents’ alarm calls were left ringing for lengthy periods of time and staff were not present in the lounge areas (ie.4 lounge areas over both floors). One resident required a lot of reassurance particularly when her husband was not visiting her; another resident required assistance and the inspector went to look for a staff member to provide assistance. Some of the staff spoken to did express the view that they were not always able to spend time talking to the residents or engaging them in any activities and they confirmed that it sometimes took a long time for staff to answer the alarm. Due to the mental health status (a number of residents with a dementia type illness) and
Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 17 considering the dependency needs of a number of residents spoken to, it was not always possible for the staff on duty to sufficiently meet the needs of the residents accommodated. Staffing levels must be reviewed to ensure that resident’s health social and personal care needs are met at all times. Staff were being supported by the home to start their NVQ awards. 2 carers had completed NVQ level 2, a further 6 had enrolled on the course and 3 overseas care staff were registered nurses in their country of origin. Some of the staff had recently followed a course in dementia awareness at Trafford College, which they had found valuable in meeting the needs of the residents. Qualified staff had received appraisal and supervision sessions were being undertaken for the care workers. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 The manager appears competent to run the home. The health, welfare and safety of the residents were generally promoted. EVIDENCE: The registered manager is committed to improving standards within the home and clearly took complaints seriously. Mrs Largent had not commenced NVQ level 4, the Registered Managers award at the time of the inspection and a requirement was made. The manager was approachable and the staff said she created a positive atmosphere within the home. Fire safety checks were generally being carried out within the recommended timescales however the last record of a fire drill was in August 2004 and this must be addressed in line with the recommendations from the fire officer. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 19 The inspection from the Environmental Services carried out in November 2005 highlighted 4 requirements in the kitchen. CSCI must be notified these have been fully actioned. Accident records were clearly recorded and audited on a monthly basis. Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 3 X 3 Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18 Requirement Timescale for action 20/02/06 2 OP38 12 The staffing levels must be reviewed in line with the dependency and the needs of the residents accommodated. The Registered manager must 30/03/06 undertake an appropriate management qualification. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arden Court Care Centre DS0000006693.V262763.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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