Inspection on 16/04/07 for Arden House

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arden House 16/04/09

Arden House 08/06/06

Arden House 16/02/06

Arden House 25/08/05

Arden House 24/11/04

Arden House 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT Lead Inspector Sandra Wade Key Unannounced Inspection 16 April 2007 09:00 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 House DS0000004200.V334880.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 DS0000004200.V334880.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arden House Address 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT 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) 01926 423695 01926 315769 sharnbrook@greensleeves.org.uk Greensleeves Homes Trust Mrs Charlotte Schram Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8th June 2006 Brief Description of the Service: Arden House is a Regency property which was originally three terraced houses forming part of a square with a small central park. The home is at the northern edge of the town centre with local shops nearby. Leamington Spas main shopping centre is within walking distance or a five-minute bus journey. Warwick can also be reached by bus. A car park is located to the front of the home. It is managed by Greensleeves Homes Trust, a not-for-profit charitable organisation who also manage a further 16 homes in England. Arden House is registered as a care home providing personal care for 33 older people although only 30 places are presently used due to the discontinuation some time ago of double bedrooms. Each bedroom has a TV point, wash-hand basin and shaving socket. 28 of the rooms have ensuite facilities and there is an assisted bath on the first and second floors. The home also has two wet-room showers. Although a passenger lift is provided as well as chair lifts, some areas of the home are only accessible via a small number of steps. Access into the home is via steps but planning permission has been agreed to install a ramp to allow level access for wheelchair users and people with mobility difficulties. The dining room is situated on a lower ground floor next to the kitchen. There is a large lounge on the ground floor which can be divided with folding doors. A small conservatory leads off the lounge which overlooks an attractive and well maintained garden. Bedrooms are provided on the ground, first and second floors. The fees at the time of this inspection ranged from £410.00 per week to £570.00. Extra charges are made for hairdressing (£6.50 – 36.00), chiropody (£10 – 25.00), incontinence pads £3.50 – 3.75 per pack (if not assessed as needing them in which case they are free of charge). Variable charges are made for newspapers, activities, transport, care assistant escorts to hospital or appointments and social trips. The home provide information packs to prospective residents which detail the care and services provided as well as the summary inspection report for the home. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Arden House for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. It took place between 9am and 7.25pm. Three service users were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (if possible) about their experiences, looking at service user care files and focusing on outcomes. Additional care records were viewed where issues relating to a service users care needed to be confirmed. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Seven service user comment cards were returned, eleven relative comment cards and one comment card from a professional visitor. Comments received are included where appropriate within this report. A pre-inspection questionnaire was received from the home on 3 April 2007; some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. What the service does well: The manager is committed to raising standards within the home and has been actively reviewing the care and services provided so that residents receive effective care. Staff were fully co-operative and helpful throughout the inspection process and were observed to make visitors feel welcome to the home. Staff were observed throughout the visit to interact well with residents and had a sensitive and caring approach when offering them support. Resident choices are being respected and the majority of residents spoken to on the day of inspection said they felt well cared for. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 6 The manager has sourced numerous training courses for staff and over 50 of the staff now have a National Vocational Qualification in Care to help them provide more effective care to the residents. Since the last inspection the home have purchased a new call bell system. The hand held devices have large “call” buttons and can be used portably around the home including the garden making it easier for residents to summon assistance when required. The home has an attractive dining area and has developed table menus which list all meals as well as snacks and drinks available so residents know each day what meals are available and what snacks they can have. What has improved since the last inspection? Action has been taken to write to residents following their assessment to confirm the home can meet their needs. Care plans have been reviewed and now contain more comprehensive information about the resident’s health care needs plus risks associated with managing their care. A review of medication has been carried out so that medication is now stored appropriately and managed safely. A hearing loop which allows hearing impaired people with hearing aids to hear more clearly has been fitted to the lounge. The provision of social activities has improved and activity schedules are in place detailed weekly activities. The management of resident monies has improved in that clear records are now being kept and monies available are accurate in line with these records. The level of training provided to all staff has increased and training is encouraged within the home to maintain and improve upon staff competencies to meet the needs of residents. Staff files have been reviewed to ensure all of the required recruitment information is available prior to new staff working in the home. This includes the receipt of criminal record checks to ensure the safety of the residents is not compromised. Storage of food in the kitchen has improved in that dried foods are now in sealed containers to ensure they are pest proof. New low surface radiators have been fitted around the whole home to help prevent the risk of burns to residents. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 7 What they could do better: Level access to the front of the home remains outstanding due to delays in this being addressed by the builders. This means access to the home is difficult for people with mobility difficulties and prevents independent wheelchair access. A firm date for completion of this work must be agreed to ensure this does not continue to impact on residents. During the tour of the home it was noted that there are some areas with bubbles in the carpet or cuts in the carpet (due to new radiators being fitted) which could present a trip hazard to residents. This needs to be addressed promptly. Record keeping in the home needs review. This applies to:• Medication records, these need to be fully completed consistently so that medications can be audited and it is clear whether residents have received their medication. Complaints records so that they clearly show actions taken by the manager to address them as well confirm these have been addressed within the stipulated timescales. The Statement of Purpose/Service User Guide so that information provided to prospective residents is up-to-date. Care plans so that these clearly show all care needs and how these are to be addressed. Duty rotas so that it is clear what staff roles are in the home and that sufficient hours are allocated to care and services being provided in the home. • • • • A review of the homes resuscitation policy is required to ensure this is managed appropriately and resident wishes can be respected as far as possible. There needs to be separate baskets in the laundry for dirty and clean items to ensure infection control is managed effectively. 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 DS0000004200.V334880.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 DS0000004200.V334880.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): Standard 1, 3 and 4 were assessed. Quality in this outcome area is good. Service users are given detailed information about the home and receive an assessment of their needs prior to their admission to ensure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. The service does not provide intermediate care so standard 6 is not applicable. EVIDENCE: A Statement of Purpose for the home is included within a Resident Information pack which is given out to prospective residents. This contains detailed information about the home and the services provided. It was found that some of the information in the Information Pack was not fully up-to-date such as the last inspection report details and the scale of charges. This should be addressed to ensure service users receive accurate information. All residents are assessed prior to their admission to the home and this information is then used to develop care plans on how the resident’s needs Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 10 should be met. viewed. Assessment records were available on care plan profiles Since the last inspection the manager has devised a letter to send out to residents following their assessment to confirm the home can meet their needs. Copies of the letters sent were available within care plan records viewed. A comment card received from a relative of a person who was recently admitted to the home commented “I was impressed when I arrived unannounced to request a brochure and was immediately shown around the home” “So far everyone has been very kind and caring to my relative”. Arden House DS0000004200.V334880.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): Standards 7,8,9, 10 and 11 were assessed. Quality in this outcome area is good. Service user health care needs are set out in individual plans but the organisation of medical information needs to be improved to ensure it is clear how these needs are being met. Residents feel they are treated with respect and their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents looked well cared for and were positive about the care they receive. A relative comment card received by the Commission stated “the care workers are caring and responsible and also treat their clients with respect, I do not think you can ask for much more”. Since the last inspection care plans profiles have been reviewed and now contain more comprehensive information about residents. They have been reorganised into separate sections so that staff can easily locate information when needing check care needs of residents. Although this action has been taken and it is evident medical needs are well met, further improvements in Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 12 the organisation of these records would help staff to demonstrate these needs are being met consistently. The care plan profiles for three residents were viewed and discussed with staff. The manager said that due to a medication change for one resident this had decreased the residents appetite and they had lost weight. She advised the doctor had been informed of the weight loss and had prescribed ‘Caloreen’ to be used. On viewing the care plan for this resident this information was confirmed. The weight of the resident had been documented monthly and since the introduction of the ‘Caloreen’ the weight of the resident had increased. A risk assessment had been completed for falls and smoking and staff actions required to manage these risks had been documented. The manager provided information about residents with diabetes and the care records for one of these residents were viewed. Care plan records showed this condition was diet controlled and initially district nurses had been involved in monitoring the blood sugar levels for this resident. The manager advised that staff had been trained on how to take the blood sugar readings but the resident was to insert the “pen” into themselves. The resident confirmed that this procedure was being followed. The care plan records stated that the resident would need support three times per week but it was not evident from records in place that blood sugar readings were being completed this frequently. Staff said this had changed to once a week but records in place also did not confirm this frequency. There were also no guidelines as to the days and times when the blood sugar readings should be taken to ensure a consistent approach in managing this condition. A care plan for diet and weight indicated that if the blood sugar readings exceeded a certain level then the doctor should be informed. There were no indications within the care plan records of symptoms associated with high and low blood sugar levels and what actions staff should take such these symptoms present themselves. A body chart had been completed showing the location of wounds to this resident legs which is good practice but it was not evident a care plan had been devised to show how these wounds should be managed. It was noted that the care plan was due for review on 19.4.07. Daily records had been completed each day to show staff support given in regard to care needs identified. Night staff had completed records hourly to confirm checks carried out which is good practice. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 13 The resident said that they were happy in the home and felt well supported by staff. It was observed that the resident had a sight and hearing impairment. Care plan records confirmed an appointment had recently been organised for this resident to see an Optician. The resident was wearing a hearing aid to help with their hearing impairment and the manager confirmed a hearing loop was available in the lounge to assist the resident with improved hearing. One resident spoken to said that they visited the foot clinic regularly and had a medical condition which affected them daily. On viewing this persons care records it was not evident that a specific care plan had been devised for the management of their medical condition or foot care problem. On speaking with the resident, it was clear that these conditions were being managed. Care records confirmed that the resident had Parkinson’s disease and did contain an instruction for medication to be given to this resident before they got up in the morning so that the medication could begin to work and make it easier for them to get dressed and ready for breakfast. Staff spoken to were aware of the need for frequent medication and the importance of ensuring this was given on time. Equipment needed to assist this resident with their mobility was clearly indicated in the care plan profile. This included a rope ladder and mobility aid. Clear instructions on how the ladder was to be used were also included on the file. This resident had recently fallen in the home and a risk assessment had been completed with details as to how this risk should be managed to prevent this happening again. It was evident that specialist health care is being accessed when required. The manager discussed the mental health needs of one resident and confirmed input from the GP, Community Psychiatric Nurse and a hospital consultant. A family member visiting the home confirmed this specialist input and confirmed they were happy with the support their relative was receiving in the home. On the day of inspection two residents required medical support in the home. Staff promptly called for medical assistance which the residents received from paramedics. Comment cards forwarded to the Commission from residents stated that they “always” received the medical support they needed. A review of medication was undertaken, it was evident that improvements had been made since the last inspection. Controlled drugs were being stored and recorded appropriately. The carer administering medication was observed to Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 14 follow the correct procedures by checking the medication to be given, ensuring the resident took the medication and signing the medication administration record (MAR) to confirm this. No gaps on medication records were observed. Staff had carried forward the number of remaining medications from the previous medication period in the majority of cases but not all. This is important so that it is clear how many the home has to start with for the new medication period and medications can be effectively audited. One resident was half a tablet short to complete their medication cycle. Staff confirmed this had been requested from the GP but there had been a delay in this being actioned. It was found that where one or two tablets had been prescribed the number given was being written into the same box as the signature which made records difficult to read and audit. It was advised to develop a protocol whereby staff sign for either one or two tablets and record others given on the back of the medication administration chart. Staff are using codes if for some reason a medication is not given but sometimes the code is not always being defined so that the reasons why the resident has not had their medication are clear. The privacy and dignity of service users was observed to be respected. Staff were seen to knock doors before entering bedrooms. Residents confirmed that staff knocked their doors and no concerns were raised regarding their privacy. Residents were smartly presented and looked well cared for and no concerns were noted regarding the management of their dignity in the home. One exception was a resident who was seen partially dressed during the early morning . Staff were seen to promptly ask the resident if they would like some assistance to get dressed in their room and staff explained this was not the norm for this resident. It was noted when reviewing care plan files that the home has a policy of “No Resuscitation” in the event of an expected death and service users had signed disclaimers stating whether they would wish to be resuscitated or not. This matter was discussed with the manager with a view to ensuring the homes policy reflects the Department of Health End of Life Care guidance. The homes current policy will need to be reviewed in regard to this matter to ensure any decisions made regarding resuscitation are made appropriately. A comment received from a relative stated that residents should have resuscitation explained to them and be invited to declare whether or not they would like to be resuscitated if their heart stops. This demonstrates there are concerns around this issue and the importance of this being managed in an appropriate way. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. Residents are offered and supported to take part in social and leisure activities and to maintain contact with their families and friends so that they have a meaningful lifestyle. Residents receive wholesome and appealing meals to maintain their health and are afforded choices in how their care is delivered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities are provided within the home and an activities schedule is in place which shows there is an activity being provided each day. These include bingo, skittles, board games, manicures, glass painting, pot painting and physical fun. Some of the pots painted by residents contained plants and were on the doorstep to home. Outings do take place when possible; at Christmas visits were made to see the lights in Stratford. Links with the community include schools and churches, communion is held in the home. The manager advised that they were advertising for an Activities Co-ordinator to further extend activities provided, the advert for this position was seen Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 16 confirming this vacancy. On the day of inspection bingo took place in the lounge during the afternoon. Some residents were seen to read newspapers or watch television. Residents spoken to confirmed that activities take place regularly in the home and a white board in the reception area confirmed in large print the activity for the day. Care plans were noted to include detailed information on the social interests of residents as well as preferred social activities and whether they would like to be told when they are taking place in the home. The care plan for one resident stated they enjoyed painting and it was evident that staff were supporting this resident to be able to do this by purchasing painting materials and making an area available in their room for them to paint. Five of the seven comment cards completed by service users responded to a question asking if there are activities arranged by the home they can take part in. Four responded “always” and one responded “usually”. One person wrote “there is a choice but I prefer to stay quietly in my room and no-one pressures me to join in”. Care plan profiles have been written taking into consideration resident choices on how they would like their care to be given. This includes times they would like to get up and go to bed, what drinks they would like and when plus information about their daily routine so that staff know to try and support this routine where possible. Most of the care staff are female but duty rotas show that there is usually a also a male carer working in the home to support any resident who may choose to have gender specific care. During the inspection visitors to the home were seen to come and go freely and were made to feel welcome. Residents confirmed that family and friends were able to visit when they wished. The main meal of the day is served at lunchtime and the inspector joined the residents for lunch. The dining room is situated in the middle of two kitchens, the far kitchen is where the food is prepared and is referred to as the “Clean” kitchen and the second kitchen is mainly used to wash up dirty items. The dining room is pleasantly decorated and spacious so that residents can easily move around. The dining area had tables laid with tablecloths napkins, glasses, condiments and a central table decoration plus a menu. The menu showed clearly all meals for the day including a hot choice of breakfast in addition to the cereals, fruit and juice provided. The menu also detailed snacks and drinks available to residents at any time. Residents said that they were happy with the choices available as well as the food provided. One person said the food was “very nice” and “you get several choices”, another person said “you get three choices each day with a drink”. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 17 The choices on the menu included pork in a mushroom sauce, pasta bake or omelette with vegetables. This was followed by ice cream or egg custard. Vegetables are provided in covered dishes on each table so that residents can help themselves. All residents were observed to enjoy their meal and staff were on hand to assist anybody who needed support. Staff cut up the meat on some resident’s plates so that they could independently eat their meal. One resident accidentally spilt their drink onto another resident and a member of staff was quick to assist the resident and clear up the spills. Staff confirmed that special diets such as soft, liquidised meals are provided as required. The manager advised that the Dietician had seen the menus for the home and had confirmed these were suitably nutritionally balanced. Residents who did not feel well enough to go to the dining room were given meals in their rooms. Comment cards received by the Commission from residents showed that out of the seven received, six felt they “always” liked the meals and one “usually” did. One person wrote “the food is excellent”. It was not evident that up-to-date information was available in the kitchen on resident likes and dislikes but the manager had undertaken a quality review exercise in regard to the food and advised this information was due to be collated and provided to the cook. The kitchen assistant advised that separate deserts are prepared for those residents who have diabetes but it was not evident from the records that specific deserts were being given. The manager agreed to ensure records reflected this information. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. Service users know who to complain to and feel confident any concerns would be acted upon but records need to be further developed to show that residents concerns and complaints have been acted upon. Systems are in place to support the protection of residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is in place, which is confirmed in the Statement of Purpose and Service User Guide for the home. This gives contact names and addresses if a resident, visitor of relative wishes to make a complaint. The address for the Commission will need to be updated following the closure of the Leamington office. No complaints have been received by the Commission for this home but the home had received one complaint from a resident regarding the attitude of a member of staff. It was not clear from the complaints register what actions had been taken since the complaint had been received. The manager advised that the complaint had been dealt with and details of discussions with the member of staff concerned had been placed on the staff file. The manager said that the member of staff concerned had left shortly after the complaint was made and the staff record had been archived although this could be accessed if required. It was advised that the complaints register details actions taken including timescales so that the home can clearly demonstrate Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 19 the complaint investigation process and it is clear the complainant has been responded to. Comment cards received by the Commission from residents showed that they all knew who to speak to if they were not happy. Those spoken to had no concerns to report and gave positive comments about the care and services they receive. The manager said that all staff who commence at the home are required to read the Department of Health Guidance “No Secrets” as well as other guidance documents in regard to how abuse is identified and managed. These documents were seen in the manager’s office. Staff spoken to confirmed that they had been required to read these documents during the time of their induction to the home. Training records provided to the Commission by the manager showed that most staff had completed training in regard to abuse. Records available in the home confirmed that additional training dates had been organised for those who had not completed this training. Staff spoken to were aware of what was required of them should abuse be reported to them or be identified by them. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 22, 25 and 26 were assessed. Quality in this outcome area is adequate. Service users live in a clean, pleasantly decorated home but some of the carpets present a potential trip hazard to residents and places them at risk. Access for people with mobility difficulties needs improving so that the home is fit for purpose for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home has four floors all of which can be accessed by a passenger lift. The first and second floor also have a stair lift. There are three lounges and a dining room, which were clean and tidy and pleasant decorated. All rooms have an en-suite toilet with the exception of four single rooms. There are also two communal bathrooms with a bath hoist to assist those residents who are less mobile and two “wet rooms” where residents can have a shower. One of these is based on the top floor and the other is on the second floor. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 21 Since the last inspection there have been some bedrooms that have been redecorated, those seen had been completed to a high standard. All bedrooms seen had been personalised by residents to make them more homely and residents spoken to said they had everything they needed in their room. The manager advised that all pipework and radiators have been replaced and this was observed during the inspection. Radiators have been changed to the low surface temperature type to prevent burn risks to residents. In addition to this the electrics have been replaced where necessary. All of this work has resulted the walls needing redecorating and carpet areas needing securing and replacing. This is still ongoing. The carpet in the lounge on the ground floor had been cut and a section removed in order to fit a new radiator but this has left a potential trip hazard for residents and needs to be addressed. It was observed that the carpet in the entrance hall and dining room has bubbled which also presents a potential trip hazard for residents. The manager has subsequently advised that the organisation has authorised for this to be addressed with immediate effect to prevent any safety risks to residents. Despite ongoing decorating works, the home was found to be clean and tidy and areas newly decorated had been completed to a high standard with quality furnishing and fittings. A new call bell system has been purchased which is portable and can be taken into the garden by residents so they can alert staff if they need assistance. The call bells have large buttons so residents can easily locate them and these were available in all rooms viewed. Hot taps tested randomly in bedrooms and bathrooms were found to be at safe levels to prevent scalding residents. Since the last inspection builders have been sourced to build a ramp into the home to allow for wheelchair access and easier access for those with mobility problems. The organisation had authorised works to be carried out but due to the builders completing other work in the home, there has been a delays in this being completed. The manager acknowledged that this now needed to be made a priority and agreed to obtain a new date from the builders for this to be done. No unpleasant odours were identified during the tour of the home demonstrating effective cleaning and odour management in the home. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 22 A sluice room is available to deal with the cleaning of any commodes pans or incontinence pads and staff were able to explain the process for cleaning this appropriately. Gloves and aprons were available for staff. Since the last inspection a hand-wash basin, liquid soap and paper towels have been made available in the sluice room and laundry area for staff to wash their hands to maintain good infection control practices. The laundry area was clean and organised and each resident had a named box for small items of clothing to prevent items being misplaced or lost. Red and green baskets were available and these were labelled according to which floor they belonged to. Washing was being soaked in two of these baskets. It was not evident that there were labelled baskets for dirty and clean items to prevent any cross infection. The manager advised that the baskets should have been appropriately labelled according to the homes infection control policy. Since the last inspection the manager has made contact with the Water Authority to request an inspection to confirm the home were operating in compliance with the Water Supply (Water Fittings) Regulation 1999. An inspection of the home was varied out and actions were identified which the home has addressed. The home is now fully compliant with these regulations. Arden House DS0000004200.V334880.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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. There are sufficient staff available to meet the needs of residents accommodated in the home but records do not confirm this consistently. Robust recruitment procedures are in place to safeguard residents and staff complete training on an ongoing basis to ensure residents are managed safely and effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were 30 residents in the home. The manager advised that they aim to have one senior carer and three carers on each day in addition to the deputy manager and manager of the home. This is in accordance with, agreed staffing levels for the home. At the time of this inspection the home were advertising for a part time cook and night care assistants. Due to the cook vacancy, other staff were covering these duties but this information was not clear on duty rotas seen. When the home is operating with a full complement of staff, there is a full time cook, part time cook and one kitchen assistant. The duty rota for ancilliary staff which includes cleaning and catering staff did not detail staff designations so that it was clear which duties they were completing. Due to staff vacancies some of the care staff said they had been helping with the laundry and cleaning. The manager explained that there is usually a laundry person on Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 24 duty five days per week from 9am to 1pm and two domestics to clean the home six days per week. She advised that carers would do “light” cleaning on a Sunday. There should be clearly identified staff to clean the home seven days per week so that satisfactory levels of hygiene are maintained. Due to staff covering different duties and duty rotas not accurately reflecting this, it was difficult to get an accurate picture of staffing for the home on an ongoing basis. If care staff are carrying out duties other than caring, this needs to be indicated on rotas as this reduces the number of care hours available to residents. No concerns regarding staffing for the home were raised by resident’s. One person said that they felt “well supported” by staff and another said that they could “always” get hold of a member of staff when they needed to. The manager advised that the home had managed to operate without agency staff so that residents had continuity of care from existing staff within the home. Duty rotas provided did not show the managers hours to demonstrate the manager is working in a supernumerary capacity. Comment cards received by the Commission from residents confirmed that they all felt staff were available when they needed them except one person who felt they were “usually” available. Comment cards sent to relatives and professionals included the question “Does the care home give the support or care to your relative/friend that you expect or agreed”. Out of the six questionnaires returned, five responded “always” and one responded “usually”. New staff complete detailed induction training and once this is completed they are then enrolled onto an appropriate training course to complete the National Vocational Qualification (NVQ) II in Care. New staff spoken to confirmed they had completed induction training and were in the process of completing all of the statutory training so that they have the skills to meet residents needs. At the time of inspection there were 20 carers working in the home and eleven of them had achieved an NVQ II in care to help them provide more effective care to the residents. Statutory training is being addressed by the home on an ongoing basis and includes, moving and handling of residents, first aid, basic food hygiene, and fire. Training records provided show that other training is being sourced such as bereavement, health and safety, abuse, dementia awareness and medication as well as training linked to the care needs of the residents. Training certificates were available on files to confirm training carried out. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 25 Comment cards received from relatives and professionals showed that in response to the question “do care staff have the right skills and experience to look after people properly”? Three responded “always”, three responded “usually” and one responded “sometimes” and stated that staff “do not all have the experience and skills needed to care for people with mental illness”. A review of staff files was undertaken to establish recruitment procedures carried out by the home. Since the last inspection the manager has reviewed the content of all files and organised these with a checklist to ensure they contain all of the required information. Staff files contained criminal record checks, two written references and completed application forms. Contracts had been issued to staff and protection of vulnerable adult checks (POVA) had been carried out. Action had been taken to obtain work permits where these were required. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 were assessed. Quality in this outcome area is good. Service users live in a home, which is run in their best interests and which is managed by a person of good character who is able to discharge her duties fully. Health and safety matters generally are being addressed to ensure the welfare of service uses is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is a qualified nurse and has also attained the Registered Managers Award. She is currently undertaking an Executive Diploma in Management – Level 7 and the A1/A2 Assessors Award but has also completed numerous other training courses including a distance learning qualification in Dementia Care, CIEH level 4 Award in Food Safety and Catering, Health and Safety for Supervisors plus all of the statutory training courses. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 27 Since the last inspection the manager had undertaken a great deal of work to raise standards within the home. This is demonstrated through actions taken to address requirements made at the last inspection. The manager was very aware of those areas in the home which needed to be improved and described proposed actions to address these, in most cases records were available to confirm these proposed actions such as a maintenance plan for the home. Satisfaction surveys had been completed for 2006 and responses from service users, family and stakeholders had been collated and responses made available in the Service User Guide for the home. Questions asked were around staff attitude, organisational approach, care needs, accommodation and facilities and concerns. Responses were mostly positive in regard to these areas. The manager showed the inspector evidence of a new survey for 2007 and advised that responses were still in the process of being received. One of these was linked to the food provided in the home. The manager said she would collate responses once they had all been received and publish the results. The manager said that she proposes to hold resident/relative meetings on a monthly basis and she would be writing to relatives to suggest this. The manager advised that informal meetings had taken place in the interim with groups of residents and these had proved to be very successful although notes of these meetings had not been kept to confirm discussions held. A review of the systems to manage resident’s personal monies was undertaken and this was found to be satisfactory. The manager advised that the accountant for the home had left and she had taken over the management of this for the time being. All residents had separate wallets, records and receipts. The money available tallied with the records in place and records showed all transactions carried out. Formal staff supervision is being carried out and the organisation has a supervision policy and contract which staff are required to sign to confirm their agreement to this. The manager advised she aims to provide formal supervisions 6 times per year in line with the standard unless there is a need for this to be provided more often. Records in place showed that discussions with staff included staffing, residents, health and safety, physical/verbal abuse monitoring and personal development. Staff spoken to said that they had attended formal supervision and a completed supervision schedule was seen for the deputy manager. In regard to health and safety, the pre-inspection record for the home confirmed that checks are being carried out. This includes gas – 7.12.06, fire alarm 23.3.07 and fire equipment 28.3.07. Checks made during the inspection included: Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 28 Electrical Wiring Certificate – 15.2.07 Bath hoists – 31.1.07 Aid Call (call bell system) – 10.1.07 Lift including stair lift inspection – 31.1.07 The kitchen was viewed and was clean and tidy and organised. All dried food had been placed in sealed containers to prevent pest contamination. Fridge and freezer temperatures had been recorded on a daily basis and were operating at the correct temperatures to ensure food safety. The eggs in the fridge were not dated so that it was clear when these needed to be used by. The manager said that this was an oversight as usually the trays were dated that the eggs were delivered in. Some actions are required in regard to securing carpets in the home to ensure they do not present a trip hazard to residents. This is explained in detail in the “Environment” section of this report. Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 29 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 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 3 2 X X 3 2 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 X 3 Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 5 Requirement The registered manager must ensure the information in the Statement of Purpose/Service User Guide is up-to-date. This includes the most recent inspection report details, current fees for the home and the new CSCI contact address. The registered manager must ensure care plans are developed for each identified need with staff actions required to meet these needs. Records must demonstrate that the care needs identified are being met consistently. 3. OP9 13 The registered manager is to ensure all medications received and carried forward are clearly recorded on the MAR. Codes on MARs must be defined consistently so that it is clear whether the resident has received their medication. A protocol is to be developed for Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 31 Timescale for action 31/07/07 2. OP7 12 31/05/07 31/05/07 use when prescribing instructions are for one or two tablets to be given. This is to prevent the number of tablets given being written into the signature boxes on the MAR. 4. OP11 12(1) The registered person is to review the current policy on resuscitation in the home to ensure this is managed appropriately eg in line with the Department of Health guidance “Introductory Guide to end of Life Care in Care Homes”. The registered manager must ensure that complaints records clearly show the investigation process, timescales to action the complaint as well as evidence of the response to the complainant. The registered manager is to take action to ensure the carpets in the lounge, dining area and entrance hall do not pose a trip hazard to service users. The responsible individual must ensure that service users have access to and from the front of the building, including by means of a wheelchair, and that the home is compliant with the Disability Discrimination Act. (Outstanding from previous inspections) The manager is to advise a date for the above to be addressed. (Outstanding from June 2006) 31/07/07 5. OP16 22 31/07/07 6. OP19 16,13 31/05/07 7. OP22 23(2)(n) 31/05/07 Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 32 8. OP26 13(3) The registered manager must 31/05/07 ensure there are suitable storage facilities for dirty and clean items in the laundry. Laundry baskets need to clearly indicate which are for dirty and clean to prevent the spread of any possible infection. The registered manager must ensure that duty rotas show consistently all staff designations, shifts worked and any care staff completing other duties such as the laundry for the home so that it is clear how many staff hours are being provided to support service users. (issue outstanding from June 2006) 31/05/07 9. OP27 17(Sch4) 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 OP33 Good Practice Recommendations It is advised that actions taken following the receipt of quality satisfaction surveys are clearly indicated within the report which publishes the outcome results. Food stored in the fridge should be appropriately dated to ensure it is clear when this needs to be disposed of eg eggs. 2 OP38 Arden House DS0000004200.V334880.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 DS0000004200.V334880.R01.S.doc Version 5.2 Page 34 - 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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