Inspection on 24/01/06 for Arden House

This inspection was carried out on 24th January 2006.

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

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

Other inspections for this house

Arden House 13/06/08

Arden House 05/06/07

Arden House 17/05/06

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 Mike Flint Announced Inspection 24th January 2006 11:00 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.V266713.R01.S.doc Version 5.0 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.V266713.R01.S.doc Version 5.0 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 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.V266713.R01.S.doc Version 5.0 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 19th July 2005 Date of last inspection 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 spacious rear garden. Arden House is one of four residential care homes owned by Angel Healthcare Limited. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out over 5 hours, during a day in January, when there were twenty-two (22) residents. The acting manager was present and assisted throughout the visit. Six of the residents were spoken with individually in private, as were three of the duty staff. The Inspector joined the residents for their midday meal. The inspection included a tour of the premises and an examination of records, including menu planning and medications administered. Additional information was provided in the preinspection questionnaire, completed by the acting manager. What the service does well: What has improved since the last inspection? What they could do better: An examination of staff records showed that, whilst some Criminal Records Bureaux checks were being satisfactorily completed for newly appointed care staff, checks had not been completed for a significant number of staff, already working in the home, in contravention of the National Regulations. Although staff appear to be well managed by the experienced acting manager, formal staff supervision has yet to be put in place and there is a current lack of NVQ training opportunities. Staff meetings at regular intervals are also recommended. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 6 At the time of the inspection, improvements to the home’s cordless telephone system were being tried out in order to improve the range for transmission, throughout the building. The Inspector has experienced difficulty in contacting the home on a number of occasions, over previous months, when the phone has remained unanswered. 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.V266713.R01.S.doc Version 5.0 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.V266713.R01.S.doc Version 5.0 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): These Standards were not re-assessed as part of this inspection. At the time of the last inspection, carried out in July 2005, the Standards in respect of Choice of Home had been met. EVIDENCE: Arden House DS0000062874.V266713.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 Personal support in this home is offered in such a way as to promote and protect the residents’ privacy, dignity and independence. EVIDENCE: A revised system of care planning and risk assessment is being introduced. Daily progress notes are used and kept updated for reference by duty staff e.g. at shift handover. Residents spoken with commented favourably about the general quality of care provided by the day staff at Arden House. When asked about night staff, residents said they were unable to express opinions, as they did not see so much of them. The administration of medicines in the home is satisfactorily managed to promote good health. Residents who so wish, and have been assessed as competent, may manage their own medicines; a lockable facility is provided in such cases. The staff spoken with said that not all staff, who have the responsibility for dispensing medications, had received accredited training for this purpose. Staff observed in the course of their duties, were courteous and respectful towards residents e.g. during the course of the lunchtime meal. Residents may have a private phone line fitted in their rooms if they so wish. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15 The home provides a relaxed and supportive environment that enables residents to pursue their interests and autonomy within a socially orientated setting that is beneficial to their wellbeing. The meals in this home are of good quality, offering both choice and variety, catering for any special dietary needs. EVIDENCE: Residents’ views regarding activities varied considerably i.e. there was a request voiced for more quiz-type games and others who were not interested. The acting manager confirmed that some activities are carried out by staff with residents on the individual pastimes and that monthly ‘motivation’ session take place also social events e.g. like the most recent and very successful Christmas party. Regular, monthly church services are held at the home and visiting members of the church help to support residents’ spiritual needs. It was apparent that the routines of daily living were flexible to suit the residents’ needs e.g. taking meals in their private rooms, entertaining visitors, or attending events outside the home. Many of the residents have regular contact with family and friends. Visitors are welcome to the home at any reasonable time. There are two resident domestic cats, which adds to the homely atmosphere; following some comments made by residents concerning hygiene, the Inspector recommended that a cat-flap be fitted. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 11 On entering residents’ rooms it was clear that many bring personal items with them on admission, including their own furniture. The Inspector was shown the menu plan, prepared by the cook, which appeared to be sufficiently varied to provide an appealing, nutritious and wellbalanced diet. Daily mealtime choices are discussed with residents and posted up, with records being kept of all meals served. The Inspector sampled the midday meal and found it to be tasty, nourishing and of good quality; the cook was complimented. Residents spoken with said that they always enjoyed the nice meals, provided at Arden House. New dining furniture was seen to enhance that environment for the overall enjoyment of mealtimes. It was noted that staff were on hand and attentive to the needs of residents during the mealtime. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 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 the following standard(s): 16, 18 Any matters of concern are handled appropriately, reassuring those involved that they are being listened to and that action will be taken, as necessary. Not all staff, currently working at the home have been Police checked, incurring potential risks to residents’ safety and well being and possible future action against the home. EVIDENCE: There have been no complaints recorded, or received by the CSCI since the last inspection. The home has a written procedure that advises residents, or visitors to the home how to make a complaint. Residents said that the staff and acting manager were very approachable and responsive, should issues arise that required action. There are detailed policies and procedures in place relating to adult protection and abuse; there was some evidence of recent training for staff in these areas of their work, the importance for all staff to receive this training is stressed. Satisfactory Police checks have been completed for some staff only. It is a requirement that these be completed, or updated where necessary for all staff employed to work at the home. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 The home provides a pleasant environment that is accessible and satisfactorily maintained, meeting residents’ individual and collective needs in a comfortable, homely style. EVIDENCE: The layout and location of the home is well suited for its purpose. The large rear garden is maintained for use by residents, weather permitting. Following incidents, where intruders have gained access to residents’ private accommodation and where vulnerable residents have gone missing on occasion, there has been a review of the home’s security arrangements, which has included the fitting of additional security equipment e.g. security lights, fitted at the rear of the building. In the case of the confused resident, who went missing, a more suitable residential placement had been secured, following a re-assessment of need. Within the home, there is a choice of communal seating areas that appeared to be comfortably furnished and pleasantly decorated. The separate dining room has recently been upgraded with new furnishings of good quality. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 14 There are sufficient toilets, bathrooms and a shower room on the accommodation floors; the Inspector was informed that the bath hoist is used, when assisting residents with their bathing. However, it was noted that there was no indication of this piece of equipment having been serviced, as is recommended for the safety of users. Grab handles and stair gates have been fitted and wheelchairs provided, where these are needed for residents’ safety. Most residents’ private rooms are furnished and decorated to a satisfactory standard; there is an on-going programme of improvements and redecoration of those rooms, where this is needed. Arrangements are in place for the safety of a small number of residents who are smokers, whereby their cigarettes are held centrally so that staff may always be aware of times when some supervision may be required. The Inspector recommends vigilance in this area, having seen several carpet burns. The Environmental Health Officer last carried out an inspection in March 2005, when recommendations were made concerning the home’s food operation; health and safety procedures and (related) training records were found to be satisfactory. The overall standard of cleanliness in the home appeared to be good; the home employs two cleaners. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 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 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, 30 The staff appeared to have a good understanding of the residents’ support needs, evident from the positive relationships, which have been formed between staff and residents, observed during the inspection. EVIDENCE: The duty rota shows satisfactory day-time care staffing arrangements, with three care assistants rostered from 8.00 a.m. to 8.00 p.m. At the time of the last inspection two waking night staff were recorded. However, the Inspector was subsequently informed that one waking, one sleep-in staff were undertaking night duties. For the number of residents accommodated, some of whom are at risk from wandering at night, these arrangements are considered unsatisfactory. The Inspector was told that the waking night staff would be reluctant to call the sleep-in, unless it was an emergency, furthermore that the waking night’s duties included laundry tasks, in the basement of the home. Ancillary workers are employed for cooking and cleaning. At the time of this inspection there were no care workers undertaking, or signed up for NVQ training; six of the staff have achieved NVQ awards, or an equivalent qualification. Staff informed the Inspector of some training sessions that have been arranged e.g. moving and handling, medications and food hygiene, though not all staff have received this training. From an examination of staff files it was noted that for a significant number of those employed to work at the home as carers Police checks had not been completed. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 16 Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 17 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, 32, 33, 36, 38 The acting manager holds a suitable management qualification and has many years of experience in the day-to-day running of care homes; she has established an open and positive approach, whilst maintaining a clear sense of leadership, which staff and residents understand and have responded to positively. EVIDENCE: The acting manager has been previously registered with the Commission, after a year in post it is now required that she be registered as manager at Arden House. Commendable progress has been made in improving the standard of care at the home, since the change of ownership in December 2004. Further improvements in attaining the high quality of service desired, include vocational training for staff, environmental improvements and additional quality assurance measures e.g. the introduction of residents’ meetings. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 18 Since the last inspection a deputy manager has been appointed and the introduction of formal staff supervision is now required; the acting manager stated that annual staff appraisals have taken place, as part of this process. Not all staff have received the recommended training in safe working practices. In speaking with staff and the acting manager the Inspector is of the view that a greater emphasis on staff training is required. Although records show some improvements in the home’s fire safety measures, regular fire safety and health and safety checks should be carried out to ensure as far as practicable the safety and welfare of residents. The acting manager receives 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. Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 19 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 X X X X X x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 X X X 2 X 3 Arden House DS0000062874.V266713.R01.S.doc Version 5.0 Page 20 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. 01 Standard OP9 Regulation 13(2) Requirement That the training for staff responsible for administration of medicines must be accredited and include: basic knowledge of how medicines are used and how to recognise and deal with problems in use; the principles behind all aspects of the home’s policy on medicines handling and records. That all staff receive appropriate training in the protection of vulnerable adults and adult abuse. (Courses available through Social Services) That in consideration of the size of the home and the number of residents accommodated, the registered person is to ensure that there are at all times sufficient waking night duty staff to meet the needs of residents. The registered person is to ensure that no person is employed to provide care to vulnerable adults prior to having completed a satisfactory Police Check and that Police Checks are in place for all current staff by DS0000062874.V266713.R01.S.doc Timescale for action 01/04/06 02 OP18 13(6) 01/04/06 03 OP27 18(1, a) 01/04/06 04 OP18OP29 19,12(1a) &CSA par 82 01/04/06 Arden House Version 5.0 Page 21 05 OP30 18(1, a) 06 07 OP31 OP36 12(1, a) 18(1, a) 08 OP38 12(1) & 13(2) the given date. That NVQ training be made available to all care staff and that a minimum ration of 50 NVQ trained staff are on duty at any one time. That the home shall have a registered manager. (Subject of previous recommendation) That care staff receive formal supervision at least 6 times annually. (Subject of previous recommendation) That all staff receive training in safe working practices, including moving & handling, fire safety, first aid, food hygiene and infection control. (Subject of previous recommendation) 01/04/06 01/04/06 01/04/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 01 02 03 Refer to Standard OP22 OP19 OP38 Good Practice Recommendations That the bath hoist be routinely serviced as per the manufacturers specification. That the arrangements for the safety of those residents who smoke and others living in the home are kept under review. 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.V266713.R01.S.doc Version 5.0 Page 22 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.V266713.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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