Inspection on 13/06/08 for Arden House

This inspection was carried out on 13th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Arden House 05/06/07

Arden House 17/05/06

Arden House 24/01/06

Arden House 19/07/05

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

CARE HOMES FOR OLDER PEOPLE Arden House 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG Lead Inspector Debbie Calveley Unannounced Inspection 13th June 2008 08:30 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 House DS0000062874.V364475.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. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arden House Address 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG 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) 01424 211189 www.angelhealthcare.co.uk Angel Healthcare Ltd Vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the number of registered places may not exceed thirty-five (35) That the category of registration be old age, not falling within any other category That person admitted be sixty-five (65) years, or older at the time of their admission 5th June 2007 Date of last inspection Brief Description of the Service: Arden House is a care home registered to accommodate a maximum of 35 older people. It is one of four residential care homes owned by Angel Healthcare Limited. The premises are situated in a quiet residential area of Bexhill on Sea, within walking distance of all local amenities and the sea front. Comfortable and spacious accommodation is provided over four floors and a shaft lift enables ease of access to all floors. There are 31 single rooms and 3 rooms that can be used as double rooms. All have en-suite facilities and there are 5 separate bathrooms and toilets. The Home has two general hoists and a bath hoist to support those residents who are less mobile. Two lounge areas, a spacious dining room and a large conservatory/sun lounge overlooking the rear garden, provide communal space. The home welcomes prospective residents or their representatives to view the premises and discuss their needs with the Manager. Weekly fees, as at 5/6/07, range from £350.35 to £420.00. The fees do not include hairdressing, chiropody, residents’ telephone calls and any sundries, such as newspapers: these are charged as extras. Information about the service, including a link to access the Commission’s inspection reports, is available on the Organisation’s website (Angel Healthcare) and from the Home’s Manager. Arden House DS0000062874.V364475.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 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Arden House will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 13th June 2008. There were seventeen residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises four other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the chef were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and one relative was spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. What the service does well: The atmosphere in the home is welcoming, friendly and homely and the interaction between staff and residents seen to be positive and fulfilling. The staff were supportive and knowledgeable regarding the people who use the service and were kind and courteous. The menus evidence a balanced diet with a varied choice of food in line with resident’s preferences. Residents’ comments regarding the food included: “very good” “ they cook me my favourite food” “lots of variety” Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 6 The dining area was pleasant and the mealtime observed was inclusive and support given discretely when required. Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents’ finances. Robust recruitment practices are being followed and the staff receive the necessary training to care and support their residents. People who use the service have access to an efficient complaints procedure. Whilst the homes processes and staff training should protect residents in the event of an allegation of abuse. Activities are provided and residents are supported and enabled to visit family and friends away from the home. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users Guide needs to be developed to ensure that all the facilities and services are included and clearly stated so as to allow a prospective resident to make an informed choice regarding the suitability of the home. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 7 The pre-admission processes need to involve a senior member of the homes staff team as discussed with the registered person. There should be information available to staff about incoming residents to offer staff guidance to help the resident settle into the home and indicate how specific care and mental health needs are to be met in the transition stage. All residents need to have a care plan in place to meet the needs of the residents living in the home and that risk assessments for specific residents are in place with an appropriate plan of action. Whilst medication practices in the home have improved and are checked and audited regularly, there are some requirements made in respect of the storage of controlled medications and of ensuring identification photographs of residents are available in the home. There is an on- going redecoration and refurbishment programme in place, but the communal bathrooms and toilets identified need priority attention. Some aspects of poor practice in infection control measures were identified and include communal tablets of soap and no aprons used in the kitchen whilst serving food. Advice is to be sought from the Fire Service Agency regarding the propping open of doors inappropriately. 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. Arden House DS0000062874.V364475.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 Arden House DS0000062874.V364475.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): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the home provides prospective residents with an adequate level of information about the home, its facilities and the services available, the information needs to be developed to include the terms and conditions of residency and the costs involved. The admission procedures do not ensure that all prospective residents are fully assessed by a competent person before admission and are not assured in writing that their needs can be met by the home. EVIDENCE: The statement of purpose and service users guide was available on request along with the last inspection report. The Statement of Purpose and service users guide are contained within a pack. They are written in a comprehensive and user- friendly format and are accompanied by photographs. Areas of the documents that need to be developed include updates of the staffs’ qualifications and terms and conditions of residency with the range of Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 10 fees clearly displayed. This was discussed in full and will be attended to so a requirement was not made at this time, but will be reviewed at the next key inspection. An assessment of the admission process included a review of the documentation used in respect of the last two admissions to the home. In both cases there was written evidence to confirm that an assessment had been completed prior to their admission to the home. A discussion took place regarding a senior member of the staffing team accompanying the provider on pre- admission assessments to ensure a smooth transition in to the home and to provide the prospective resident with a familiar face. Concerns were raised regarding that the latest admission to the home had been admitted with a diagnosis of dementia, the homes registration category does not include dementia and there is a need to ensure admissions to the home are safe and suitable within the admission process. There should also be information available to staff about incoming residents to offer staff guidance to help the resident settle into the home and indicate how specific care and mental health needs are to be met in the transition stage, this was a recommendation at the last inspection and is now a requirement. Although the home writes to new residents or their representatives confirming the terms and conditions of residency the home does not confirm in writing that the home is able to meet the assessed needs of any prospective resident. Residents always have with a trial period so they can assess whether the home is suitable for them. Where the resident is able, they are welcome to visit the home and meet other residents and staff. Two residents spoken with confirmed that they had visited the home before moving in and felt it enabled them to be involved in choosing their home. Intermediate care is not provided. Respite care can be provided if there is a vacant room, there are no designated short stay rooms, but staff indicated that there are certain rooms that are specifically used. The staff confirmed that respite residents are free to join in the daily life of the home. In this way they can ‘test’ the home and residential life before they commit to a permanent stay. The home is offering a day care service to older people in the community. This had been discussed with staff and residents last year, but as yet no formal structures are in place. The day care service also offers a bathing service and overnight accommodation. On discussion with the manager and from the information provided there are no clear policies and procedures in place in respect of: safe medication practices, G.P cover, designated day care communal space and continued assessments as to track changes in their health and mobility needs. These are in need of clarification. The services offered by the home all need to be to be included in the Statement of Purpose and Service Users Guide. Arden House DS0000062874.V364475.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 and 10 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although in most cases individual plans of care set out resident’s personal, health and social care needs with risk assessments being used these are not written in consultation with the resident or their representative and need to developed in certain areas to ensure a person centred approach is used. Resident’s health care needs are met with the advice and support of community health care professionals. Care is delivered in such a way that promotes and protects the residents’ privacy, dignity and individuality. EVIDENCE: The care documentation pertaining to five residents were reviewed as part of the inspection process and each of these residents were met with during the inspection visit to the home. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 12 Four of the care plans reviewed contained a good amount of information that provides guidance in meeting the individual residents needs. It was however noted that one resident that had been in the home for over a week had no plan of care or fully completed assessment of need. It was therefore unclear how here needs were being attended to. The care plan was produced later in the day was as yet incomplete, and was still being worked on by the deputy manager. It was discussed the importance of having plan of care in place for staff to follow based on an on-going assessment especially as this new resident has a diagnosis of Alzheimer’s. One resident has complex care needs that include epilepsy and the risk of seizures and is also managing her own medication These needs were not clearly recorded in the plan of care with associated guidelines for care and did not contain appropriate risk assessments. The documentation evidenced community health care professionals input when contacted and daily records are maintained and provide a record of resident’s activity, wellbeing and medical condition. The staff spoken with said that they receive a full handover on every shift and that the staff complete daily notes. Records indicated that the plans of care have been reviewed on a regular basis but there was no evidence to confirm that they are completed in consultation with the resident or their representative. Residents spoken to during the inspection visit were all positive about the care received. “ Staff are great” “ I like it here, the staff are very kind”. As discussed with the staff the care plan format of tick boxes does not allow for person centred care and individuality and would benefit from a review which also includes triggers to identify changes in health and social status. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. Medication is provided by a local pharmacy in blister packs with pre printed medication administration records. The systems for recording and checking controlled drugs were found to be thorough and improved from the last inspection. On the whole the Medication Administration Records (MAR) were found to be competently completed, staff need to ensure that all hand written entries/changes are signed and dated. Not all residents have an identification photograph in place on their MAR sheet or care plan and this needs to be in place for the safety of the residents. A suitable lockable medication trolley is used and when not in use is stored in the dining area attached to the wall. The trolley is too big for the lift shaft to the top floor and possible alternatives were discussed. There is a small medicinal fridge, which is kept, locked and stored in the dining room. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 13 Controlled medication is kept in a separate (not lockable) container in the medication trolley and this does not meet the current legislation. Advice is to be sought regarding the safe storage of controlled medications. Residents that self medicate and are prescribed ‘ as required medication’ need to have appropriate risk assessments in place that include triggers to monitor the use of these medications and individual guidelines need to be provided so that residents receive medicines, as they need them an example of this is the use of Diazepam or pain killers. During this visit staff were seen and heard to be kind and attentive to the residents who they clearly know very well. Staff spent individual time with residents finding out what they wanted and ensuring when they were assisting them that they were not rushed. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 14 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 and 15 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by residents at this time meets their expectations, choices and expectations. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: There are planned activities in the home, which are displayed on a notice board in the lounge area. It evidenced that on five days a week there is a planned event, such as exercise to music, shopping trips, music for health and a member of staff brings in guinea pigs for a petting session. Every Sunday residents get together for a glass of sherry. Feedback from talking to staff and the residents is that some have expressed an interest in gardening and this could be linked positively to the activity programme. Social care plans have been developed and are individual in there approach. Residents said that they are able to spend time where they want to with some Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 15 preferring to stay in their own rooms that are in most cases very personalised and seen as their own personal space. Resident’s religious needs are explored and responded to as the residents wish. Visiting is very much encouraged and it was clear from observation and contact with relatives that people are welcomed and feel comfortable when they visit. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. Many of the residents have individualised their bedroom with items from home and residents and relatives spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible, residents spoken with confirmed that they were consulted about all aspects of their lives. One resident regularly goes out and buys fresh fish and this is then cooked for her. The home has an advocacy policy in place and the information regarding this is available to all residents. The kitchen area is situated next to the dining area. The dining is pleasantly furnished and decorated with good quality furnishings; it has plenty of natural light and is spacious allowing for staff to assist residents if required. All the tables are set with tablecloths, napkins and water jugs. The meal provided was attractive and nutritious and was enjoyed by residents. There are two chefs employed with one working five days and the other working two days. The chef spoken with had a good understanding of resident’s needs and individual likes and dislikes, the daily menu is displayed on a board and residents confirmed that they can ask for an alternative if they should wish so. Residents confirmed that they are satisfied with the meals provided. Fresh fruit was seen in the communal areas. Staff were seen to be kind when assisting residents to eat, spending plenty of time ensuring residents were able to eat at a pace comfortable to them. The kitchen was seen to be clean; the storage areas for fresh produces are fairly limited and will be affected by the warmer weather. A recommendation is that advice be sought from a specialist organisation. The dishwasher is out of action at present, but it was confirmed that a new one has been ordered. At present the care staff are performing ancillary duties. The oven is need of either repair or replacement. The staff need to ensure that they are wearing appropriate aprons whilst serving food and entering the kitchen. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 16 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 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has received one complaint since the last inspection and the documentation evidenced that it was investigated appropriately. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. It was verbally confirmed that all complaints received are recorded and audited so that the home can demonstrate that it is using complaints as a qualityArden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 17 monitoring tool to review and improve the service that it provides. The registered manager confirmed that the home had not received any complaints since the last inspection. The home encourage residents to share their niggles and deal with before they become complaints. Resident meetings encourage residents to share their views. Residents spoken to said that any concerns that they had would be dealt with if they raised them with the manager. The home has a Safeguarding Vulnerable Adults and whistle blowing procedure along with the local policies and procedures. It was evidenced that some staff have received training on safeguarding Vulnerable Adults and it was discussed with the registered manager that all staff need to receive POVA training and that the refresher sessions be discussed with the provider of the training which will identify changes to the local policies and procedures. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service Whilst Arden House provides a comfortable, clean and safe environment for those living there and visiting, it would benefit from a continued upgrading and refurbishment programme so it could be utilised to its full capacity. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: Arden House is conveniently situated near to the main town area of Bexhill. It is a large detached property that provides accommodation over four floors, all of which can be accessed by stairs or shaft lifts. The home continues to follow an improvement programme that has benefited the residents and visitors to the home and provided a welcoming and comfortable environment. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 19 The tour of the home evidenced that a considerable amount of work has been done. The dining area has been refurbished and redecorated and is attractive and welcoming. The two lounge areas were clean and comfortable, the conservatory was comfortable and overlooks a good-sized garden, which looked well cared for. Residents’ rooms are individual in size, layout and furnishing. Residents can bring in their own furniture if they wish and this was evidenced during the tour of the building. There are a number of rooms that are unoccupied at present and some are in need of attention. It was confirmed that a number of bedrooms have been provided with new furniture; the remainder will be refurbished when vacant. There are a sufficient number of communal toilets and bathrooms. However not all were found to be welcoming and in good repair. The downstairs toilet near the dining room is in need of deep cleaning and decorating and the extractor fan was not functioning. This was identified to staff. The first floor bathroom is also in need of redecorating and soap dispensers are needed to ensure good practice. Six bars of soap were found to be partly used on the bath side. This practice needs to be reviewed as it contravenes infection control measures. Risks to residents from scalds or burns are minimised by radiator covers to radiators in high-risk areas and safe temperature valves to hot water outlets used by residents. Water temperatures are tested regularly. The home has two passenger lifts, which between them give level access to each floor. A small number of rooms require use of a small flight of stairs to access them. The home contracts with a lift service company who carry out any work needed promptly. Other aids and equipment are provided as needed including toilet riser seats, bath hoists, grab rails and mobility aids. A call system is installed with points in each bedroom and communal areas. A fire risk assessment has been carried out by an appropriate agency and was found to be thorough. The last visit had recorded deficiencies in the kitchen, also noted by the Environmental Health department. These shortfalls have been acted on. The laundry facilities were seen and were appropriate for the size of the home, with staff confirming that the washing machines have sluice cycles that can be used for soiled laundry. Some hand washing areas did not have liquid soap and paper towels and this could be improved with fixed appliances to ensure its availability. As previously mentioned staff need to ensure that there are wearing appropriate aprons when serving food and working in the kitchen area. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 20 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 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need. EVIDENCE: There are seventeen residents living in the home at present with additional day care clients on certain days of the week. The staffing rota was viewed and the staffing levels were seen to be three carers in the morning, two carers in the afternoon and one waking staff and one sleep in staff at night. However from talking to staff and residents, outcomes for residents would benefit from an extra member of staff to allow more time for positive interaction. These staffing levels should be kept under close review due to the layout of the home being on four floors, and the fact that they do have residents that wander and need supervision and one resident who is on the top floor and rarely leaves her room. The call system has been set up so that the call can be heard and identified on each floor. Senior carers, a manager and assistant manager offer a senior structure. Senior staff are on call on a rota basis. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 21 contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. There is a need to have a photograph of all staff employed as an identification check. The induction programme is now in place and has been introduced for all staff. Files seen confirmed this. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid, infection control, food hygiene and fire safety are being undertaken by all staff, the manager is to ensure that all staff receive timely refreshers. 50 of staff have a National Vocational Qualification (NVQ) with a further 50 undertaking an NVQ. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. EVIDENCE: The manager has been in post for 3 years and is in the process of submitting her application to be the registered manager. She has the necessary experience and skills to run the home and is due to commence her registered managers award qualification. The staff spoken with said that they felt supported by the management structure of the home. Residents were aware of who the manager is and of her role in the home and were seen to relate positively with her. Relatives and visitors stated that the manager was helpful Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 23 and efficient and that they felt that they could approach the management at any time. The ethos of the home is to focus on the residents and staff were observed doing this. The quality assurance systems in the home include questionnaires sent out to residents and relatives following admission to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The quality assurance results have recently been audited and action taken to address any suggestions of improvement. There are regular staff and resident meetings that contribute to the quality assurance systems as does the Regulation 26 visits conducted by a senior member of the Angel Healthcare Organisation. These were informative and also included an action plan section that is acted on immediately. There are residents who manage their own financial affairs and a relative or solicitor who acts on their behalf supports the others. The home does not act as the appointee for any resident. If staff are asked to shop for a resident, receipts and any monies held on behalf of that resident are kept in a locked cupboard. Staff supervision was discussed and staff supervision has been commenced. Staff spoken with confirmed that they receive supervision and a plan of the year’s supervision sessions was seen. The AQAA completed by the manager and received prior to the inspection stated that all the necessary safety checks for electricity, gas, equipment and shafts lift are in place and up-to-date. Incidents are reported to the commission as required. The accident book was viewed and there is still a need to audit accidents and follow through with a plan of action to prevent a reoccurrence. It was also discussed that expert advice be sought regarding those residents that have recurrent falls. There are systems in place to ensure that all staff are aware of the missing person policy and procedure. In the main good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. However from direct observation doors are propped open inappropriately and expert advice is to be sought regarding this practice. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 24 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 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) (c) Requirement That the Registered Person ensures that the Service Users Guide and Statement of Purpose accurately reflects the facilities and services available- this pertains to the day care service and staff qualifications. That the registered person ensures that the pre-admission assessment is completed by a suitably qualified and competent person before admission to the home. This will ensure the suitability of the placement. • That a senior member of the staff team working in the home accompany the registered person on the assessment visit. Timescale for action 31/08/08 2. OP3 14 (1) (a) (b) 31/08/08 3. OP7 12 (a) (b) That the registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That the registered person ensures that the care plans accurately reflect the needs of DS0000062874.V364475.R01.S.doc 31/08/08 Arden House Version 5.2 Page 26 the service users in respect of their health, social and behavioural needs and provide guidance for staff in meeting their needs. This pertains particularly to new admissions to the home and to respite care. That service users and/or their representatives are consulted regarding the formation of the care plans. That the registered person 31/08/08 ensures that risk assessments for specific residents are in place with an appropriate plan of action. • Continence promotion • Epilepsy • Self medication • Mobility • Day care The registered person shall make 31/08/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the Care Home. In that: That photographs of residents for identification purposes are in place, dated and updated regularly. That all verbal orders regarding changes to medications are signed by staff and dated to provide an audit trail. That the storage for controlled medication is in line with the current legislation and advice sought from the pharmacist. • Stored in appropriate lockable Version 5.2 Page 27 4. OP8 14 (1) (a) (2) (b) 5. OP9 13 (2) Arden House DS0000062874.V364475.R01.S.doc 6. OP21 13 (4) 7. OP27 18 (1) 8. OP38 23(4)(a) (c)(i) cupboard/container. That the registered person 31/08/08 ensures that all communal toilets and bathrooms are of good repair and suitable for use. That the Registered Person 31/08/08 ensures that there are sufficient staff on duty to meet the needs of the service users at all times. That the registered person seeks 31/08/08 expert advice regarding fire doors are not wedged open and appropriate self-closing devices fitted as required and that all fire doors close properly. That an audit of all accidents/incidents is completed and followed through with a plan of action to prevent a reoccurrence. Expert advice to be sought regarding those residents that have recurrent falls. 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 OP26 Good Practice Recommendations It is strongly recommended that hand drying facilities which reduce the risks of cross infection are put in place as a priority in communal toilets and bathrooms. Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Arden House DS0000062874.V364475.R01.S.doc Version 5.2 Page 29 - 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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