CARE HOMES FOR OLDER PEOPLE
Arden House 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG Lead Inspector
Mike Flint Unannounced 19th July 2005 10:00 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 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 H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Arden House Address 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG 01424 211189 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Angel Healthcare Limited Vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (OP), 35 of places Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the number of registered places may not exceed thirty-five (35) 2. THat the category of registration be old age, not falling within any other category 3. That person admitted be sixty-five (65) years, or older at the time of their admission Date of last inspection 8 February 2005 Brief Description of the Service: The care home is a large detached property in Bexhill-on-Sea, registered to provide care for up to thirty-five (35) older people. It is situated in a quiet residential area, within walking distance of all local amenities and the sea front. It provides comfortable and spacious accommodation on four floors, served by a passenger lift. The home has a large conservatory/sun lounge overlooking the rear garden. Arden House was sold and came under the ownership of Angel Healthcare (formerly known as Wilton Lodge Limited) in December 2004. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 6 hours, during a day in July, when there were twenty-five (25) residents. The acting manager was present and assisted throughout the visit. Seven of the residents were spoken with individually, as were three of the morning, duty staff and the cook. The Inspector was able to join the residents for their midday meal. The inspection included a full tour of the premises and an examination of records, including care plans and staff files. What the service does well: What has improved since the last inspection? What they could do better:
Work is in process around the premises to improve the environment for the safety and enjoyment of residents; many of the rooms need redecorating; some new dining room furniture is on order and more replacement furniture is required in residents’ private and communal rooms. The heating and hot water systems are not fitted with effective temperature controls. Since the home had a break-in, further security measures are recommended.
Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 6 Improvements in the standard of record keeping are also required, which the acting manager is aware of and working towards e.g. medications, risk assessments and health and safety checks; the appointment of a deputy manager will enable further progress work, both in this area and with the required formal staff supervision. There has been some staff training and team building sessions, though both the NVQ training and the required TOPSS induction and foundation training for staff have yet to be implemented. The Inspector has noted that much of ‘what they could do better’ has been inherited from the previous ownership and recorded in the inspection report on the performance of the home, at that time. This inspection showed that concerted efforts are being made to bring the home up to the good standards that the present owner wishes to see in place. 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 H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 5, 6 The home has procedures in place to ensure that the needs and expectations of those admitted can be met. EVIDENCE: At the time of registration, under the new ownership, a draft Statement of Purpose and Guide to the home was produced. In the seven months since then, much about the home has changed. The documents are being revised to reflect these changes. The organisation’s standard form for pre-admission assessment and of the Contract of Terms and Conditions has been introduced for all new admissions. Staff confirmed that prospective residents are invited to visit the home with their relatives, or representative prior to making a decision to move in on a trial basis. The service does not offer intermediate care facilities. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The quality of care observed in providing individual support to residents in the home helps towards maximising their well-being, dignity and respect. A small number of omissions noted in the record of medicines administered demonstrated the lack of adequate monitoring. EVIDENCE: During the inspection, the majority of the residents were seen; private discussions were had with four, each of who had favourably comments to make about the personal care they received; all of the others appeared to be content and well cared for. Care plan synopsise were seen to be place, available to staff in all of the rooms, occupied by residents. Daily notes are kept for each resident and many of the of the resident’s care planning documents have been brought up to date, since the change of ownership, others yet remain to be reviewed and completed with risk assessments. One of the residents has responsibility for their own medicines, where this had been agreed; a small number of omissions were noted in the record of medicines administered, where staff initials had not been entered on the record sheets. Staff spoke respectfully about the residents and were knowledgeable about their care needs. During an inspection of the premises staff were observed to knock on residents’ doors before entering their private rooms.
Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12, 13, 14, 15 Mealtimes and communal activities are well managed providing interest and social opportunities for those living in the home. The home encourages family visits for the enjoyment and emotional well-being of residents. EVIDENCE: The home provides a range of daily papers and residents are able to order these in advance. Various activities are organised by duty staff during the afternoons and the acting manager has arranged for a ‘motivation team’ to provide monthly sessions. Other entertainers e.g. music and drama, are booked from time to time. An activities organiser is to be appointed, who will work at each of the Company’s homes. The acting manager said that when Tai Chi had been introduced to residents it had been unsuccessful. It was clear to the Inspector that efforts were being made to introduce activities to residents, who had not previously been used to this at the home i.e. this had been a recommendation at the last inspection to the previous owner. A staff member commented that some residents liked to be involved in tidying their own rooms and other simple tasks within the home, which gave them a sense of purpose. Residents can have visitors as and when they wish; their choice of whom they wish to see is respected. Three of the residents spoken with said they were encouraged to retain responsibility for their own personal care and were able to come and go from the home as they pleased.
Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 11 Staff spoken with said that all the residents were encouraged to make choices i.e. what to wear, when to get up/ go to bed and what meals they preferred, and the residents confirmed this. The cook, who invited the Inspector to join residents for their midday meal, produces a four-weekly menu plan. This was nicely presented, tasty and nutritious; comments regarding the general quality of meals provided were positive. Alternative diets are catered for e.g. diabetic. Staff were seen to be on hand to assist residents at meal times, should this be required. A notice board was on display to advise residents beforehand as to the meal of the day. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These Standards were not assessed during this inspection. EVIDENCE: Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 20, 21, 22, 23, 25, 26 Improvements to the home’s environment are on-going for the benefit of those who live there. However, the security arrangements need reviewing for ultimate safety and well-being of residents; for similar reasons, hot water temperature controls are required to be routinely checked. EVIDENCE: There is an on-going programme of redecoration and replacement of furnishings and carpets to improve the environment; the acting manager confirmed that new dining furniture had been ordered and that lounge furnishings are due to follow. The garden is to undergo some improvements for the safety and enjoyment of residents e.g. the lily pond is to be filled in, and there was a current vacancy for a gardener being advertised. Some security lighting has been installed, though it is recommended that additional measures be put in place. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 14 Side passageways provide open access, on both sides of the premises, to residents’ private rooms at the rear of the building and the low fencing to the rear garden is an inadequate deterrent to would-be intruders. At the time of the inspection the home was clean and free from any offensive odours. Cleaners are employed at the home. All service users bedrooms have en-suite hand basin and toilet, and the majority additionally have either shower or bath facilities. Excessively high hot water temperatures were noted in two of the residents’ bathrooms. Communal facilities are provided on each of the four floors and there is a passenger lift giving level access for residents on all four floors. There is ramped access to the lower ground floor and rear garden. Assisted toilets and bathing facilities are provided and hand rails fitted where these are needed. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 Staff morale appeared good, under the new ownership, resulting in an enthusiastic workforce that works to improve the residents’ quality of life. EVIDENCE: The duty rota shows satisfactory care staffing arrangements, with three care assistants rostered throughout the waking day. There are two waking night staff with an on-call duty manager available. Ancillary workers are employed for cooking and cleaning. Due to the turnover of staff since the change of ownership, the manager said there was a need to re-engage staff with the NVQ training for care workers; other, relevant training sessions have been arranged and are on-going e.g. moving and handling, medications and food hygiene. A home-specific induction is provided to ensure for all new staff; the TOPSS induction and foundation training has yet to be introduced. From an examination of the application files of newly recruited staff, it appeared that satisfactory procedures are being adhered to, with particular regard to personal references and Police checks being taken up, prior to employment. Staff spoken with said they felt there was good team-working within the home. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 38 Residents benefit from living in a home, which is run and managed by a person who is fit to be in charge, of good character and able fully to discharge her responsibilities. Further measures are required to be put in place that will ensure, as far as practicable, the health and safety of residents. EVIDENCE: The acting manager, previously registered as manager at one of the organisation’s other homes in Bexhill, has achieved an Advanced Care Management Diploma and is an experienced and competent person to run this home and work with staff towards meeting its aims and objectives. The management approach is seen to be open and positive, communicating a clear sense of direction and leadership. This manager has made positive progress to improving standard of provision at the home, within the first few months in post.
Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 17 The acting manager readily accepts that there remains much yet to do in attaining the good quality of service desired, including vocational training for staff, the planned environmental improvements and the introduction of further quality assurance measures. The post of deputy manager remains vacant at present; the acting manager gives this reason for delaying the introduction of formal staff supervision and, likewise, the introduction of the TOPSS induction and foundation training that is required for all new staff, in respect of safe working practices. The Inspector recognises the need for additional day-to-day management support in the running of the home. There was no record available to show when health and safety assessments, fire safety checks were last carried out around the home. And it is recommended that the Environmental Health Officer should be invited to visit, there being no record, either, of such having taken place of recent times. The acting manager benefits from sound line management and administrative support from the organisation’s headquarters team. The required monthly visits to monitor the home’s performance are carried out and recorded satisfactorily by the owner’s representative. The Inspector recommends that an application to register the acting manager at Arden House should be expedited. Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 x 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 3 x x 2 x 2 Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 09 Regulation 17(1)(a) Requirement That the record of medicines administered is regularly monitored to ensure that duty staff are completing the required records satisfactorily. That all hot water outlets, used by residents, are regulated to safe temperatures and routine checks recorded. That the home continues to work towards achieving a 50 ratio of NVQ trained duty staff That staff receive formal supervision at least 6 times a year, covering all aspects of care practice, philosophy of care in the home and career development needs That all staff receive training in safe working practices, included in the TOPSS induction and foundation training for new staff. That health and safety and fire safety checks are carried out and recorded routinely and at regualr intervals. That all residents care plans and risk assessments are completed and reviewed at regular intervals, appropriate to their individual needs. Timescale for action On-going 2. 25 13(4c) On-going 3. 4. 28 36 18(C, i) 18(2) On-going 01.01.06. 5. 30 and 38 18(C, i) 01.01.06. 6. 38 13(4, a), 23(4,a), 23(5) 15(1, 2) With immediate effect 01.01.06. and ongoing 7. 07 Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 20 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 19 Good Practice Recommendations That advice be sought e.g. from Community Police, concerning additional security measures, in particular respect of the side passageways, for the protection of residents from intruders. That a visit from the Environmental Health Officer be arranged to ensure conformity with Standards is being achieved. That the acting manager completes an application to be registered as the manager of Arden House, without delay. 2. 3. 19 31 Arden House H59-H10 S62874 Arden House V235085 190705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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