CARE HOMES FOR OLDER PEOPLE
Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT Lead Inspector
Sheila Briddick Unannounced Inspection 16th February 2006 09:30 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 DS0000004200.V284341.R01.S.doc Version 5.1 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.V284341.R01.S.doc Version 5.1 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 Greensleeves Homes Trust Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th August 2005 Brief Description of the Service: Arden House 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. Although a passenger lift is provided as well as chair lifts some areas of the home are only assessable via a small number of steps. The dining room is situated on a lower ground floor next to the kitchen. There is a large lounge, which can be divided with folding doors and small conservatory leading from it is located on the ground floor. Bedrooms are provided on the ground, first and second floor. 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 Spa’s main shopping centre is within a five-minute bus journey. Warwick can also be reached by bus. Car parking is available off the road in front of the home. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one-day in February from the hours of 9:30 a.m. to 5 p.m.. The registered manager was present for most of the inspection of the assistant manager supported for part of the day. Both managers and the other staff members of staff present co-operated fully with the inspection process. The inspection included a tour of the premises, talking with the residence, the managers and the staff; looking at resident, staff and home records; looking at the policies and procedures. The views of residents, family members who were visiting at the time of the inspection and staff are considered in this report for start What the service does well: What has improved since the last inspection?
There has been significant progress in implementing the new assessment format and care planning and these now provide staff with sufficient information they require to meet the needs of people living in the home. Repairs identified at the last inspection to of badly leaking ceiling had been completed and the occupant is soon to return to their room.
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 6 Staff breaks have now been staggered to ensure that residents are not left alone at these times all at the time of change of shift to the staff team. Meal provision for staff at the same as the meals on the menu for residents. Residents confirmed that they are able to have snacks between the evening meal and breakfast the next morning. Action required following the water risk assessment by professional contractor has been implemented, the water Company was attending at the same time of the inspection visit as part of the regular quarterly monitoring of water services in the home. A new manager has been appointed to the home and their application to be the registered manager is currently in the process of assessment by the Commission for Social Care Inspection. There continues to be an active programme of NVQ assessment with over 50 of the homes care staff now having completed or being assessed towards the NVQ level 2 or above in Care. Recruitment records for staff working in the home have been reviewed and amended to ensure that they include proof of identity as a member of staff such as the photo, a birth certificate and passport however, further monitoring systems are necessary to ensure that the standard is maintained as new staff come to work in the home. The manager can demonstrate that action is being taken to provide full access to and from the front of the building, including by means of a wheelchair to ensure that the home is compliant with the Disability Discrimination Act. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Perspective service users are provided with sufficient information they need to make an informed choice about whether to live in the home. There is a clear, consistent needs assessment and care planning system in place and this is adequately providing staff with the information they need to satisfactorily meet service user needs. EVIDENCE: The service user guide has been reviewed to ensure that it meets the required standard and copies were available in the home. Information packs for perspective service users were examined and found to be informative and clear about the service provision. The Greensleeves Home Trust has recently amended their medication policy and the manager intends to ensure this change is reflected in the information going out to perspective service users. Since the last inspection visit the assessment process has been reviewed to ensure that it includes all areas of needs for residents and the amended process has now been implemented. Three care plans were examined on this occasion, these included the care plan assessments for two recently admitted
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 9 residents. In both instances full assessments had taken place and needs properly identified in all areas of health and social care. The preferred daily routines of residents are clearly identified with them and care planning is starting immediately so that staff have sufficient information to meet identified needs and assist the resident to the change of lifestyle when coming to live in the home. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs. EVIDENCE: Since the last inspection visit the revised care plans, based on detailed assessment, have now been implemented and examination of three care plans, selected at random, show that care staff have sufficient information they require to meet the needs of people living at the home. Care plans are being reviewed on a monthly basis and where possible there is full involvement of the resident in the review of their care plan. The good practice in the review process is clear and includes, recording action that is necessary to meet unresolved issues and this is reviewed again at the following review meeting. Each area of care is individually reviewed and the resident’s views are included. Care plans contain a record of all key worker activities that must take place for each resident between monthly meetings and these include care of clothing, their room and personal appearance needs such as hair and nails. Risk assessments are in place on care plans were
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 11 necessary and are being reviewed regularly, e.g. after falls and change in skin condition. The ‘Waterflow’ risk assessment tool is being used for monitoring risk of pressure sore. Staff have recently completed care planning training, which, the registered manager feels has been supportive during the implementation of the new care plans. There is documented evidence to show that all staff, including kitchen staff, are to attend training in March in Diabetes Awareness as was recommended at the last inspection. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The people living in this home can be sure that meals are well-balanced and nutritious and that snacks can be accessed throughout the day and night time. EVIDENCE: A requirement was made at the last inspection for snacks to be readily available to residents between teatime and breakfast the following day and only the elements relating to this were examined on this occasion. Talking with residents indicated that they could access snacks and drinks throughout the day and evening. Some residents were aware that this information was on display for them in their rooms whilst other residents were quite comfortable in the knowledge that they could ask staff at any time for a snack or drink. Residents and staff were all complimentary about meals provided in the home. Examination of food temperature records show that food is checked when cooked to ensure that appropriate temperatures are maintained and again, immediately prior to being served, to ensure that the meal reaches residents at the correct temperature. Records seen were up-to-date and in good order.
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 and 26 Recent investment has significantly improved the appearance of this home creating a comfortable and safe environment for those living there and visiting. EVIDENCE: A full repair has taken place to the roof of the property since the last inspection and this has resolved the problem of rainwater leaking into a resident’s bedroom and other rooms below. All stained and damaged areas on ceilings, in particular the room occupied by the resident, have been repaired and redecoration has taken place. The resident was very pleased with the action that had taken place, including the new décor of their room. Control of risks from Legionella and the regulation of water temperatures is managed by a professional contracting company and the representative was visiting on the day of the inspection to attend to routine maintenance and checks. All risks highlighted at the initial water risk assessment had been addressed.
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 15 Discussion with the manager and examination of records demonstrate that the service is taking appropriate steps to ensure that the front of the building meets the Disability Discrimination Act by the provision of a permanent ramp for wheelchair access to the front of the home. The building control planning officer has visited the property, which is a Listed Building, and planning approval is being sought prior to the work take place. This was a requirement made at the last inspection and the timescale for action is amended. Examination of the infection control policy shows that this now includes directions regarding the single use and disposal of personal protective equipment (gloves and aprons], this was a requirement made on the last occasion and has now been met. A staff member spoken with confirmed their understanding of the disposal of aprons and gloves as indicated in the infection control policy. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 There has been steady progress made to ensure recruitment practices offer adequate protection to the people living at the home and that at all times there are sufficient to persons working in the home as is appropriate for the needs of the residents. EVIDENCE: The system for managing staff breaks has been reviewed and these are now staggered so that care staff are always available to residents, although residents still feel that staffing levels could be better, especially at change over of staff shifts. It was explained by the manager that arrangements in place at this time identify which staff are to stay with residents ‘on the floor’ until handover is completed. A good practice recommendation is made regarding reviewing this process with residents. There are currently two staff vacancies in the home, one full time and one part time, one agency staff is being used to cover some of these staffing hours. The remaining hours are being managed satisfactorily within the current staffing and not putting pressure on the remaining staff team. The duty rota clearly identifies the times that a manager is on duty in the home, this was a requirement made at the last inspection and has now been met. There continues to be an active NVQ in Care assessment programme in place and this is ongoing to ensure that all people working in the home are competent to carry out their role as a care worker. A staff member said that
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 17 NVQ expectations were discussed with them at interview, saying that ‘Greensleeves’ wants to employ people with qualifications in NVQ to meet care needs’. Three staff files were looked at and in general these were found to be up-todate with the required information, this included evidence that Criminal Records Bureau (CRB) checks had taken place. One of the staff files however did not have a copy of proof of identity of the person from either a birth certificate or a passport if available. A good practice recommendation was made regarding any disclosure being found as a result of the CRB check and how this should be managed. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 33 Steady progress is being made through the registration process to ensure that a Fit Person is registered to manage the home. Advice is properly sought from the fire services as part of the management of fire safety in the home to ensure compliance with legislation. EVIDENCE: Since the last inspection visit the then ‘acting manager’ has been recruited by the registered provider, Greensleeves Home Trust to manage the service and a Fit Person application has been forwarded to the Commission for Social Care Inspection by the recruited manager. This was a requirement at the last inspection that has now been met. The application is in the process of being assessed. The manager for the home explained the process and planning that takes place prior to a Registered Provider monthly visit to the home, and clearly
Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 19 demonstrated that all visits are unannounced. The deputy manager confirmed during discussion with them that ‘the Reg 26 visitor just turns up’. There is significant documented evidence to show that the manager is seeking appropriate advice from fire safety officers as part of the management of fire safety in the home. This has included seeking advice regarding the hold/open door devices and the door locks/bolts at the ramped fire exit to the side of the building. The manager demonstrated the locks and bolts on this fire exit to show that there is only one door closing mechanism that is actually in working order. The manager said that the visiting fire officer agreed the door did not infringe on fire safety and was satisfactory. The bolts and one door lock are out of order and do not function however, visibly the door looks as though it is securely bolted and locked and this could cause confusion in the event of emergency exit being necessary and an alternative route may be sought. A good practice recommendation was made that the unused bolts and door lock be removed and for written confirmation to be sought from the fire service. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 3 Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 21 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 OP22 Regulation 23(2)(n) Requirement 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. (Timescale of 15/10/05 amended) The responsible individual must ensure that staff recruitment records include proof of the persons identity. Timescale for action 30/07/06 2. OP29 19 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 OP29 Good Practice Recommendations It is recommended that the views of staffing levels in the home be sought on a regular basis with residents and this could be at a residents meeting. It is recommended that in the event of a disclosure on a Criminal Record Bureau check and a decision being made
DS0000004200.V284341.R01.S.doc Version 5.1 Page 22 Arden House 3. OP38 4. OP38 that continuing with the recruitment this does not pose a risk to residents that the reasons why, and any discussion with employee be documented on the staff members personal file. It is recommended that the unused and a broken locks and bolts on the side door fire exit are removed or documented confirmation be sought from the fire service that the door is meeting fire safety requirements. The results and subsequent action plan of the contracted Health & Safety audit should be forwarded to the Commission. Arden House DS0000004200.V284341.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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