Inspection on 17/05/06 for Arden House

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 13/06/08

Arden House 05/06/07

Arden House 24/01/06

Arden House 19/07/05

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

CARE HOMES FOR OLDER PEOPLE Arden House 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG Lead Inspector Liz Daniels Unannounced Inspection 17th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Arden House DS0000062874.V289359.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.V289359.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 01424 210509 www.angelhealthcare.co.uk Angel Healthcare Limited Vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Arden House DS0000062874.V289359.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 24th January 2006 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 also 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 17/5/06, range from £324 - £375. 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.V289359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. It included a visit to the Home by an Inspector, which began at 10am and lasted for a period of just under eight hours. The Manager facilitated the visit and it provided the opportunity to talk with her, the Deputy Manager and two care staff, before spending time with several residents sitting in the lounge areas and meeting three of them within the privacy of their own room. No visitors were available to meet with the Inspector during the site visit but the Inspector was able to speak with one relative by telephone after the visit. The Inspector also toured the premises and examined records that included resident’s files, medication records, staff files, training records, the accident log and the complaints log. Evidence contributing to this inspection has also been gathered from previous inspections, surveys circulated to residents and their relatives, (five of which had been returned to the Inspector), and from data provided by the Manager of Arden House. All of the key standards, together with those where concerns had been raised at the last inspection, were inspected. There are currently 18 residents at Arden House. What the service does well: What has improved since the last inspection? Arden House is being nicely re-furbished and this is being sensitively managed to reduce any inconvenience for residents. Four Requirements from the last inspection have been met, whereby all staff are now trained in Adult Abuse, the staffing cover at night has been reviewed and staff have had training and been assessed in Medication, the Control of Infection, Food Hygiene and Moving and Handling. The Recommendation that the bath hoist should be serviced has also been met and similarly smoking arrangements for residents have been reviewed and residents are being well monitored. In addition the Home has made good progress in the development of Care Plans, although this needs to be introduced for all residents. Recruitment procedures are improving thereby protecting residents and the improved call bell and Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 6 telephone system ensure that all residents and staff can now be heard throughout the building. 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 DS0000062874.V289359.R01.S.doc Version 5.2 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 DS0000062874.V289359.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good information about the service provided at Arden House has been produced, and a thorough assessment of prospective residents now takes place to ensure a resident’s individual needs can be met. EVIDENCE: The Resident’s Guide has just been updated to reflect the service provided since the change of ownership of Arden House. It also explains how to make a complaint and gives the contact details for the Commission. It does not contain the Commission’s Reports, although a link to view and download these is on the Company website. The Manager also plans to publicise the current Report by arranging for it to be available in the Main Entrance of the Home, once the current re-decoration has been completed. The Resident’s Guide is currently in draft form but once published the Manager confirmed that it will be available for prospective residents and a copy will be put in each bedroom for current residents. As has been found at previous inspections, it is usual practice that, following an enquiry, prospective residents or their relatives are invited to visit the Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 9 Home and spend time with the Manager and staff, view the available rooms and discuss the Home’s suitability. If they then wish to pursue an admission, the Manager undertakes an assessment in their own home or if they are in hospital, she visits them there. She then completes a comprehensive proforma, which has recently been introduced. A completed copy, for a gentleman admitted three weeks previously, was shown to the Inspector. The Manager confirmed that she also asks for information from nursing and medical staff before accepting residents from hospital, but written information is not usually available. The resident is admitted, initially on a 4-week trial basis and the assessment information that has been gathered is used to underpin the Care Plan for that resident. Four other resident’s files were viewed during the inspection. All had comprehensive assessments in place: two were not signed or dated and the other two residents, who had been at the Home prior to the change of ownership, had no admission date recorded in their files. The Manager was able to confirm their admission dates, thereby confirming that one of those residents had been assessed pre-admission and the other on the day of admission. Two of the four files had plans of care and all had Risk Assessment profiles and Daily Record Sheets. The care needs identified from the assessments could be found within the files but in differing formats. Discharge Link Letters outlining changes in care needs were found in two files for residents who had been admitted to hospital for short stays. The Manager explained that all the residents’ documentation is currently being updated as some records were missing when the Arden House went under new ownership. One resident who met with the Inspector had come to the Home seven months previously. She could recall being in hospital prior to admission and that someone had come to see her. She commented that ‘the staff are wonderful and I am very looked after. They care for us as much as anyone could’. The gentleman who had been at the Home for 3 weeks said he had chosen his room having had a choice of three and commented that ‘the Manager came to meet with me before I came in’. A third lady also remarked ‘It’s very good here – they look after us better than we can in our own home’. Arden House does not provide Intermediate Care, although residents can be admitted for respite care. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 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, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Arden House is making good progress in developing comprehensive Care Plans but the storage of medication must be improved to ensure residents are not put at risk. EVIDENCE: Four resident’s files were reviewed. As mentioned earlier in this report, new documentation is being introduced but the Manager explained that it has not yet been completed for all residents. Two files contained Care Plans but all contained Risk Assessment profiles clearly identifying areas of need for each person. These had been reviewed three monthly and were all due for review now. The Manager explained that it has been usual practice to share Care Plans and information about the residents with them, but this is not recorded. The new style Care Plan shown to the Inspector provides a space for the resident and/or their relative to sign that they agree with it. The new Plan also identifies social and emotional needs and provides space to record resident’s personal and social targets. Some of this information can be found in the residents’ current records but it is in varying formats. Weights are monitored and the Risk Assessment profile includes an assessment of mobility and the risk of falls. All the files had Daily Record Sheets. Hoists and bath hoists that Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 11 have been annually serviced are available. Residents are able to access a chiropodist, dental care and opticians as required. The Manager confirmed that where possible residents remain registered with their own GP or register with a GP of their choice. District nurses or nurse specialists are contacted for any particular concerns and the district nurses have recently provided training for staff in the administration of insulin, to support those residents who have diabetes. One resident self-medicates and keeps a month’s supply in her room, locked in a cupboard. The staff order the medication for her and they record on the Medication Administration Record (MAR chart) that she selfadministers. One resident gives himself insulin although the staff draw it up for him. The staff should sign his MAR chart, although on the morning of the inspection and the previous morning this had not happened. A record of the insulin given and the blood sugar recordings that are also kept in his room had been signed. The MAR charts for the remaining residents had been correctly completed. The name of each resident with their photo, accompanies their MAR chart: the Inspector suggested resident’s preferred name should also be clearly recorded under the photograph and the relevant details were then added during the inspection. Any ‘over the counter’ (OTC) medications that are administered are recorded on the back of the relevant MAR chart and the reason for the OTC medication is noted. Medication for the Home is stored in a small locked cupboard in the dining room. The majority of medication is dispensed in blister packs. As space is limited the remaining medicines cannot be easily separated and visible for each resident. Medication that is ready for disposal is also left in the cupboard until the end of the month’s cycle. It is then removed and put into a blue bag in the office to await collection. Medicines that need to be stored in the fridge are kept in the kitchen fridge and although kept in containers these were found to be sticky and had ice on them. The fridge temperature is recorded daily but the regular opening of the kitchen fridge raises doubt as to whether the medication is being kept at the correct temperatures. All staff except one carer have completed medication training by using a training package purchased by the Home. Staff complete multi-choice tests and the Manager, who attended medication training in February 06, then marks them in house, before sending the last test to an external examiner. A Certificate is issued if a pass mark is attained. The Manager then assesses staff administering medication before they can administer alone. The Boots pharmacist undertakes a medication audit every three months. Some residents choose to have telephones in their rooms and many of the residents at Arden House need minimal help with their personal care. Staff confirmed that the ethos of the Home is to support residents in caring for themselves as far as they are able but also to provide privacy and show respect when residents are undergoing examinations or personal care. One resident explained that he had needed particularly personal care but despite his initial embarrassment, staff had made it much easier by being so sympathetic and understanding. During the inspection, staff were observed to be attentive and courteous to the residents. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A good selection of pastimes and activities are provided but the programme is unstructured whereby the lifestyle experienced by residents does not always match their recreational needs and preferences. The menu provided must be publicised to enable residents to make choices. EVIDENCE: There are two lounge areas at Arden House, one used as a television lounge and the other a quieter area where residents can read or listen to music. Videos and various games are available as well as jigsaws, a music centre and a selection of books. A large conservatory/sun lounge, overlooking the rear garden, and beyond to a bowling green, is also accessible from the lounges. Some residents prefer to spend more time in their rooms and all the occupied rooms that were seen, had been personalised with resident’s possessions including small items of furniture. Friends and relatives can visit anytime and staff re-arrange meals for any resident who wishes to go out. One gentleman said he liked to watch the quizzes and nature programmes on his own television although he goes downstairs each day for lunch and does join in the Home’s quizzes: he also walks the short distance into town or to the seafront each day. Two of the residents receive Communion in their rooms each month, from the visiting clergyman, but none of the residents who spoke with the Inspector are involved with local community groups or activities. The Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 13 Manager confirmed that residents are supported to be involved with local clubs if they wish and that two residents attend the local bowls Annual General Meeting although they no longer feel they can play. Activities are organised by the care staff and held in the lounge. The staff confirmed that they are not always planned in advance but they include professional shows every 3 months, weekly in house Bingo, monthly motivation sessions and animal therapy sessions when a rabbit and guinea pig are brought in. A clothes show had been arranged last month and the Manager also buys flowers each week, which she asks the residents to arrange if they wish to. Two young cats that were bought as kittens live at the Home and both the residents and staff commented how popular they are. One resident commented that she’d ‘like there to be a bit more therapy or entertainment’. The value of a structured programme, which is publicised in advance, enabling residents to plan ahead and choose to join in, was agreed. An Activities Board is already in place in the lounge and the Manager agreed that sessions such as Communion, flower arranging and animal therapy will be publicised on the board in advance, to ensure that residents are aware of all the activities that are available. Most of the residents manage their own financial affairs or a relative or solicitor act on their behalf. The Home collects the pension for one resident and she then signs that she has received her personal allowance, but 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. Previous inspections have found the food provided at Arden house is varied and enjoyed by the residents and that meals can be eaten in the dining room or in resident’s rooms if they prefer. Again at this inspection one resident commented that ‘the food is very good and wholesome’ and another that ‘there’s too much food really but it’s very good’. There has not been a permanent cook in post since February: the Home has therefore employed agency, or care staff have been the cook for the day. When this has happened they are not included in the care staff numbers for the day. The Manager was hopeful that the position would be filled imminently. On the day of inspection the food was nicely served and was seen to be appealing, wholesome and nutritious. The record of previous meals showed that in general they had been varied and equally nutritious, although one relative commented after the inspection that some evening meals could be more interesting and varied. The menu for the day is written on a Board outside the lounge: on the day of inspection the meal was not recorded until just before lunch. The Manager said this was unusual and the details are usually written sooner although a relative confirmed that details of the menu are often not written up until late morning, allowing little time for residents to request an alternative. One choice of meal is prepared, but residents are asked to let the staff know if they would prefer something different. The value of circulating information to the residents about the meals to be provided was discussed and agreed with the Manager, who hopes this can be introduced when a new cook is appointed. Food that had been opened had not all been labelled in the fridge and freezers. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints procedure and residents are confident that their views are listened to and acted upon. Safe measures are being put in place to ensure residents are protected from abuse. EVIDENCE: Previous inspections have found that there is a complaints procedure in place, which is publicised in the Residents Guide, and that residents or their relatives have felt confident to raise any concerns. Residents seen during this site visit unanimously expressed confidence in the Manager and confirmed that they can raise anything with her. They also said they know she listens and feel reassured that she will follow through their concerns. Of the five surveys received by the Inspector, two identified that they always know who to speak to if not happy, two that they usually do and one never does. Of the five, one said they always know how to make a complaint, two usually do and two did not answer that question. The Commission has not received any complaints about the service since the last inspection. The last entry in the Home’s Complaints Log was in November 05 and prior to that in May 05. Details of the investigation and the outcome reached were both documented and the Manager confirmed that the outcome is discussed with the complainant to ensure they agree. Adult Protection policies and procedures continue to be in place and Criminal Record Bureau (CRB) Disclosures are now applied for as part of the recruitment process. CRB disclosures have also been applied for, for all staff in Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 15 post as was the Requirement from the last inspection, although not all have been received. The staff have used a training package purchased by the Home to train in Adult Abuse. The training is modular with multi choice questionnaires at the end of each module, which are marked in house and then a final test, which is external marked, before a Certificate is issued. All staff who met with the Inspector could explain the action to take if they had any concerns about a resident’s welfare. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 16 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, 24 and 26 Quality in this outcome area is good. This judgement has been made using evidence including a visit to the service. Arden House provides a comfortable, pleasing environment that is satisfactorily maintained whereby it provides a safe home for residents and meets their individual needs. 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 lift. There is a good size garden to the rear that can be reached via a level path from the lower ground floor or by steps from the ground floor. On the ground floor there is a dining room, two lounge areas and a conservatory/sun lounge for residents to relax in and there are bedrooms on each floor. As with past inspections the Home was found to be comfortably furnished, clean and free from any odours. The last inspection recommended that the bath hoist be serviced; this and the portable hoist were both serviced in March 06. Resident’s bedrooms that were seen contained many personal possessions and staff were seen to be respecting residents’ privacy by knocking before entering. One resident was finding that she did not Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 17 have enough wardrobe space but confirmed that the Manager was arranging a bigger wardrobe for her. Two residents who spoke with the Inspector had changed rooms since being at the Home and all said they liked their rooms and had chosen some of their own furniture and belongings to bring with them to make them feel more homely. The Manager confirmed that all of the rooms have a lockable cabinet and that each of the rooms has a lock on the door; residents are offered a set of keys when they arrive at the Home. The last inspection also recommended that smoking arrangements should be reviewed. Arden House does allow people to smoke in their room or outside, either in the garden or by the door from the dining room. Residents are assessed, to ascertain their suitability to keep their own cigarettes, but if appropriate the staff hold the cigarettes and provide them as needed to monitor the resident’s safety whilst smoking. One lady who was smoking during the inspection said she was happy with the arrangements but was unclear that she could smoke in her room. A refurbishment programme is underway and the back fence of the garden is currently being replaced. The main entrance was being painted on the day of inspection and some of the bedrooms have already been re-decorated and recarpeted whilst they have been vacant; the programme therefore appears to have been sensitively managed to reduce any inconvenience for the residents. Radiator guards are in place throughout the Home and windows are restricted except in one room. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although recruitment procedures are improving, they are not yet robust to ensure that residents are protected. The home is appropriately staffed and residents benefit from the training opportunities available for staff. EVIDENCE: Four care staff are rostered to work during the day at Arden House and three in the afternoon and evening. The Manager is also present during the mornings and afternoons, Monday to Friday. A Domestic and Cook are also employed, although as recorded earlier in the report the cook’s position is currently vacant. Agency staff are employed if required: information from the Manager identified fifteen day shifts and one night shift, over the four weeks of April, when an agency care assistant had worked. As found at the last inspection there is one waking carer and a carer who sleeps in at night, who can be woken if needed. The Inspector had previously expressed concern that the waking carer could not hear call bells throughout the Home and the second carer could not be contacted easily when in the laundry room on the lower ground floor of the building. The Manager confirmed that the call bell system has been improved, whereby it can now be heard throughout the Home and the resident who did wander at night has now moved to another Home. Telephone boosters have also been bought for the Home to ensure the telephone can be heard throughout. She therefore believes these numbers are adequate for the number and dependency of the residents currently in the Home. However, the Manager explained that the staffing at night is being kept under review and was discussed at the recent staff meeting at which the owner Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 19 was present. Of the twelve care staff at Arden House, two have recently completed NVQ Level 2 and one has just started NVQ Level 3. One carer has just completed her ‘Skills For Care’ Induction and once she receives her Certificate, will be starting her NVQ Level 2. It is not known whether the agency staff who work at the Home have any NVQ training. Four staff files were inspected during the site visit. Three contained CRB disclosures and data received from the Manager identified that the CRB for the fourth person had been received. However the Manager confirmed that she has not yet received the CRB disclosure for an ancillary member of staff who had started two months previously and works a few hours at the week-ends: he does not provide direct care and is never unsupervised with residents. This practise has been evident at past inspections, but progress has been made in that all staff have now had a CRB disclosure applied for, although there are five still outstanding. The value of applying for a Protection of Vulnerable Adults First (POVA first), to enable staff to start employment and work under direct supervision until the CRB is received, was discussed. Two files did not contain written references; both staff had been at the Home prior to its current ownership. It was therefore agreed with the Manager that a statement of competence would be written by the Home and held in their files. One file had only one reference, all the files had copies of Terms and Conditions that had been given to the staff and three of the four files had evidence of identification. As mentioned earlier in this report the Home has purchased a training package with many different modules for staff to study. The Manager confirmed that new staff undertake the Induction training and that staff attend training within work time. Two of the staff are now trained as First Aid trainers and one as a Moving & Handling trainer. Certificates are held for staff training in individual files. The Manager aims to develop a matrix to help with monitoring training. Specialist training is also arranged as required, to meet residents’ specific needs. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Arden House is well managed in general, but quality assurance systems and staff supervision need to be developed to ensure that the Home is run in the best interests of residents. EVIDENCE: The Manager at Arden House who has now been in post for fifteen months has not yet applied for registration, as she will soon be undertaking Extended Leave and will not therefore be applying for registration with the Commission. She has experience working in caring for older people and has attained the Registered Manager’s Award (RMA): the Manager confirmed that the Owner is arranging cover for her Maternity Leave but as yet plans have not been finalised. A deputy Manager supports her in leading a team of carers and ancillary staff: it is anticipated she will soon be undertaking her NVQ Level 3. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 21 The Home has just produced a survey to ascertain resident’s views about the service provided. It is anticipated this will soon be circulated to residents and their relatives and returned to the Organisation’s Head Office to be analysed. The importance of publicising resident’s feedback for other prospective residents and users of the service was discussed and agreed. Last year Arden House undertook a service user survey, facilitated by a lead service user, as part of a pilot study, organised through the Commission. Residents’ meetings are held annually and the next one is planned for June 06. The Manager and owner both attend and the Manager confirmed that they are generally well attended. A senior member of the Organisation undertakes monthly visits and there is evidence that any problems identified during these audits are actioned. As stated earlier in this report, most of the residents manage their own financial affairs or a relative or solicitor act on their behalf: the Home does not act as the appointee for any resident. If staff are asked to shop for a resident, receipts are kept and any monies held on behalf of that resident are kept in a locked cupboard: these were seen by the Inspector. Formal staff supervision is now being developed at the Home. All staff have had an appraisal and the Manager has introduced supervision sessions for some staff. This needs to be extended and the sessions become planned and more frequent. The content of supervision and the need to separate it from clinical teaching was discussed. Both the Owner and the Manager attend staff meetings that are arranged every six months: although they are essentially for information giving, they are also an opportunity for staff to meet together and share concerns. Some staff have now been made senior carers to provide a system of mentorship for more junior staff. Each senior carer has been given a specific area of responsibility. The Manager is meeting with them weekly to assist them in the development of their role. She also meets monthly with the Managers of the other three Homes in the Organisation and the Owner. She confirmed that the Owner is based locally and that although she does not have formal supervision, she is very accessible. Staff were last trained in Fire Safety in December 05 and February 06. Staff are also undertaking the fire modules in the Home’s training package. The fire alarms are tested every 3 months, but currently unplanned fire drills are not manageable as there are no test switches on the Home’s break glasses. As discussed earlier in the report two of the staff are now trained as First Aid trainers and one as a Moving & Handling trainer. All staff have had training in Moving & Handling and a programme to ensure they are updated is being planned. All staff have been trained in Food Hygiene and all staff have had training in the Control of Infection. Records of maintenance checks were not examined in detail at this site visit but previous inspections have found that maintenance checks have been undertaken as required. The Health & Safety Risk Assessments recommended at the last inspection for areas of the Home where residents have access, have not all been completed. The Accident Log Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 22 was seen and had been completed for minor slips, trips & falls: the Manager reviews all accidents recorded. Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 23 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 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement The storage of medications needs re-consideration to ensure that the correct medication is visible for each resident and those medications that need to kept in a fridge are not contaminated by food and are stored at the right temperature. The registered person is to ensure that no person is employed to provide care to vulnerable adults prior to a satisfactory CRB Disclosure and that CRB Disclosures are in place for all current staff. This Requirement is outstanding from the previous inspection. A minimum ration of 50 NVQ trained staff are on duty at any one time. This is part of a Requirement, outstanding from the previous inspection. Robust management arrangements to manage the service must be put in place whilst the current Manager is on Extended Leave. DS0000062874.V289359.R01.S.doc Timescale for action 30/06/06 2. OP18 19,12(1a) & CSA par 82 17/05/06 3. OP28 18(1, a) 30/09/06 4. OP31 12(1, a) 30/06/06 Arden House Version 5.2 Page 25 5. OP36 18(1, a) That care staff receive formal supervision at least 6 times annually. This Requirement is outstanding from the previous inspection. 30/09/06 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. 3. Refer to Standard OP12 OP15 OP38 Good Practice Recommendations Activities provided should be publicised in advance to ensure residents are aware of all that is available. A choice of menu should be publicised in advance to enable residents to make a choice about the meals they receive. That an environmental risk assessment and subsequent health and safety checks be carried out and regularly recorded for all areas of the home, where residents have access. (Subject of previous recommendation) Arden House DS0000062874.V289359.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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.V289359.R01.S.doc Version 5.2 Page 27 - 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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