CARE HOMES FOR OLDER PEOPLE
Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT Lead Inspector
Lesley Beadsworth Unannounced 25 August 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 E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Arden House Address 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT 01926 423695 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) Greensleeves Homes Trust CRH Care Home 33 Category(ies) of OP Old Age (33) registration, with number of places Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24 November 2004 Brief Description of the Service: Arden House is managed by Greensleeves Homes Trust, a not-for-profit charitable organisation who also manage a further 16 homes in England. Arden House is registered as a care home providing personal care for 33 older people although only 30 places are presently used due to the discontinuation some time ago of double bedrooms. Although a passenger lift is provided as well as chair lifts some areas of the home are only assessable via a small number of steps. The dining room is situated on a lower ground floor next to the kitchen. There is a large lounge, which can be divided with folding doors and small conservatory leading from it is located on the ground floor. Bedrooms are provided on the ground, first and second floor. Arden House is a Regency property which was originally three terraced houses forming part of a square with a small central park. The home is at the northern edge of the town centre with local shops nearby. Leamington Spa’s main shopping centre is within a five-minute bus journey. Warwick can also be reached by bus. Car parking is available off the road in front of the home. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day from the hours of 10.00 and 19.20. The acting deputy manager was present for most of the inspection and the acting manager was present for the remainder. Both managers and the other members of staff present cooperated fully with the inspection process. The inspection included a tour of the premises, talking with the residents, the managers and the staff; looking at resident and staff records; looking at policies and procedures. However a large proportion of the time was spent viewing the premises following the recent refurbishment and talking with residents either independently or in groups in the communal areas or in private. Nine residents and four members of staff were spoken with at this inspection. What the service does well:
The inspector spent some time observing staff at work and they were seen to be treating residents respectfully. Residents spoken with confirmed this and made no reference to the concerns they had about staff at the previous inspection. Discussion with the manager and residents indicated that people living at the home are able to make choices and exercise control over their own lives, with no deadlines for getting up, going to bed or for mealtimes. Several residents chose to have their meals in their rooms. Personal possessions, such as ornaments, pictures and plants were seen in all the rooms viewed with some bedrooms fully furnished with the occupant’s possessions. The meals provided are nutritious and varied, well presented and nicely served by the care staff in pleasant surroundings. Three choices are available at lunch and teatime. Residents made such comments as “the food is excellent” and “always very good” were made. The mealtime was unhurried and appeared to be a social occasion for the residents. The dining room is bright with plenty of natural light. It is attractively furnished, decorated, with good quality soft furnishings, fresh flowers on each table and with pleasing pictures on the walls, making the setting for mealtimes enjoyable. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 6 The large through lounge is also bright, attractively decorated and furnished. This room can be divided into two rooms by the folding doors if required providing more flexible living arrangements for the residents. The garden at the rear of the home is attractive and well maintained and residents said that they enjoyed taking walks around it. What has improved since the last inspection? What they could do better:
There has been only limited progress in implementing the new assessment format and care plans to be able to assess if the residents’ needs can be met at the home and to give care staff the information they require to meet the needs of people living at the home. this progress needs to continue. Whilst the home in general offers comfort and safety, the exception is a bedroom that had a badly leaking ceiling. The manager advised that this was being addressed at the time of the report but this had been a problem for several weeks before the inspection, causing some distress and discomfort to the occupant. An Immediate Requirement notice was served at the time of the inspection. It was evident that staff had breaks together, rather than staggered. This would mean that residents are without care staff present during these periods and presents considerable risk to their wellbeing. It was also noted that staff are provided with meals at the home but that these are not always the meals on the menu for residents. Cooking for staff, and particularly alternative choices, can be time consuming and as there are no extra cooking hours made available for this it is time taken away from services to the residents. The management need to consider the appropriateness of this. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 7 Whilst drinks are taken to residents at 10pm residents said that there are no snacks apart from biscuits. One resident pointed out that it was a long time to be without food until breakfast and made her own arrangements for supper. This is not meeting the nutritional needs of the residents and the interval between their final meal and breakfast is greater than the 12 hours required of this standard. The home has recently undergone a water risk assessment by a professional contractor and some areas of risk were highlighted. There was evidence available to show that this was to be addressed in the near future but the registered person must forward evidence to the Commission for Social Care Inspection (the Commission) that this has taken place. There is a portable ramp to assist residents in wheelchairs to be able to go out to the front of the home by a door to the side of the main entrance. This ramp was not seen in use at the inspection and there was no evidence available to show that access to and from the front of the building meets the Disability Discrimination Act, as was required at the last inspection. This ‘side’ door is labelled as a fire door but has several locks/bolts that might cause a problem if ever needed for fire evacuation. The registered person is required to contact the Fire Service to ensure that this is acceptable. The registered manager in post at the last inspection has since resigned. The deputy manager is currently acting as manager and a senior care is acting as deputy manager. This has resulted in an inadequate provision in the senior staff team with senior staff working extra hours/shifts to ensure that there is a suitable person in charge of the home. The inspector was advised that there had been no steps taken in the recruitment of a new manager. It is disappointing if this has not been addressed in the weeks since the previous manager resigned, and must be seen as urgent. The home has not yet met the requirement for 50 of all care staff to have achieved NVQ Level 2 in care (or equivalent) by this year, with only six out of 22 care staff having done so and a further six in the process. This qualification shows that the achiever is competent to carry out the role of care assistant and therefore that the residents are in safe hands. The registered person needs to forward an action plan to the Commission to show how this requirement will be met. There were several pieces of information regarding employees required by the Care Home Regulations 2001 that were missing in staff files examined, including proof of identity of the member of staff such as a photo, birth certificate and passport. These items are required to protect the residents from the employment of unsuitable people. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 8 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 E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 9 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 E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 10 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) 1,3 The home does not have an up to date Statement of Purpose or Service User Guide. Only limited progress has been made in introducing the new assessment format and implementing assessments that detail the needs of residents. EVIDENCE: The home’s Statement of Purpose and Service User Guide were required to be revised after the last inspection when the refurbishment was completed. This had not been completed but following the resignation of the registered manager this will need to updated again, therefore this requirement will be carried over. Assessment formats to include all the areas of need for residents are currently being implemented to ensure that all individual needs are met. There has been only limited progress in implementing the new assessment format and therefore this requirement will be carried over. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9,10 Limited progress has been made in revising all residents’ care plans. The home has a safe medication procedure and practice that protects people living at the home. EVIDENCE: The managers advised that only limited progress had been made in implementing the revised care plans based on detailed assessment and to give care staff the information they require to meet the needs of people living at the home. This requirement will therefore be carried over in this report. After the last inspection it was required that all medication was correctly labelled to prevent errors being made and this had been complied with at this inspection. Other checks made on the medication storage, administration and recording protected people living at the home from risk of errors being made in their medication. It was noted that senior care staff had spent time assisting a resident who self-administered her own inhaler, to ensure that she used it properly and gained full benefit from the medication. The inspector spent some time observing staff at work and they were seen to be treating residents respectfully. This was confirmed by residents spoken with
Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 12 who said that they were treated with respect and who made no reference to some of the concerns they had at the previous inspection. Discussion with the acting managers also advised that much of the disturbing concerns regarding the staff culture seems to have been resolved. However it was evident that staff had breaks together, rather than staggered. This would mean that residents are without care staff present during these periods and presenting considerable risk to their wellbeing. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 13 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) 14,15 People living at the home are helped to exercise choice and control over their lives. They are provided with a well-balanced and nutritious choice of meals but with a long interval without a snack being provided between teatime and breakfast the following day. EVIDENCE: Discussion with the manager and residents indicated that people living at the home are able to make choices and exercise control over their own lives, there being no deadlines for getting up, going to bed or for mealtimes. Several residents chose to have their meals in their rooms. Personal possessions, such as ornaments, pictures and plants were seen in all the rooms viewed, with some bedrooms fully furnished with the occupant’s possessions. Talking with residents and observation made at the inspection indicated that the meals provided are nutritious and varied. Three choices are available at lunch and teatime. The inspector joined residents at teatime. Such comments as, “the food is excellent” and “always very good” were made. The meal of sardines and toast or a variety of sandwiches, followed by homemade fruitcake or a dessert was well presented and nicely served by the care staff in pleasant surroundings. The mealtime was unhurried and appeared to be a social
Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 14 occasion for the residents. The portions at teatime were small but anyone who asked for more were given it without hesitation. Whilst drinks are taken to residents at 10pm residents said that there are no snacks apart from biscuits. One resident pointed out that it was a long time to be without food until breakfast and made her own arrangements for supper. This is not meeting the nutritional needs of the residents as the interval between their final meal and breakfast is greater than the 12 hours required of this standard. It was noted that staff are provided with meals at the home but that these are not always the meals on the menu for residents. Cooking for staff, and particularly alternative choices, can be time consuming and as there are no extra cooking hours made available for this it is catering time taken away from services to the residents. The home has had a recent inspection from the Environmental Health Department and the report seen confirms that it meets with the Department’s requirements, and provides safe and hygienic surroundings where food is stored, prepared and cooked for the residents. The kitchen was not fully inspected on this occasion but a toaster was in need of cleaning this was attended to immediately it was brought to the attention of the cook. The temperature of food is checked when cooked to ensure that appropriate temperatures are maintained, but not immediately prior to being served to ensure that the meal reaches residents at the correct temperature. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 15 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) x No standards were assessed from this section on this occasion. EVIDENCE: Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25,26 There has been good progress made in improving the décor throughout the home but there is one serious maintenance issue that puts a resident in uncomfortable, unsightly and potentially dangerous surroundings. EVIDENCE: The major refurbishment in progress at previous inspections has now been completed and this provides the people living at the home with comfortable, attractive and safe surroundings in both private and communal areas. However the ceiling in one of the bedrooms viewed has been leaking badly creating a very large stained and damaged area on the ceiling and requiring the person occupying that bedroom to need to place a bowl under the leak when it rains, as it was at the time the inspector visited the room. There were also other areas of the home, not occupied by residents, where the roof had leaked and caused problems. The home was issued with an immediate requirement notice for this to be addressed urgently.
Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 17 The home has recently undergone a water risk assessment by a professional contractor and several areas of risk were highlighted. There was evidence available to show that this was to be addressed in the near future. The home has the benefit of a maintenance person for five days a week who attends to maintenance concerns in the home and garden and carries out health and safety checks such as fire alarms and water temperature testing, this assists in keeping Arden House as a safe place to live. The garden at the rear of the home is attractive and well maintained and residents said that they enjoyed taking walks around it. The front of the home opens onto an access road with car park spaces. There is a portable ramp to assist residents in wheelchairs to be able to go out of to the front of the home by a door to the side of the main entrance. This ramp was not seen in use at the inspection and there was no evidence available to show that access to and from the front of the building meets the Disability Discrimination Act, as was required at the last inspection. This ‘side’ door is labelled as a fire door but has several locks/bolts that might cause a problem if ever needed for fire evacuation. Fixed ramps at the rear of the home provide easier access for residents to the outside of the building. Although a passenger lift is provided some bedrooms can only be reached by a small number of steps and therefore can only be occupied by people who are, and remain, mobile. Despite being in the lower ground floor the dining room is bright with plenty of natural light. It is attractively furnished, decorated, with good quality soft furnishings, fresh flowers on each table and with pleasing pictures on the walls, making the setting for mealtimes enjoyable for the people living at the home. The large through lounge is also bright and attractively decorated and furnished. This room can be divided into two rooms by the folding doors if required providing more flexible living arrangements for the residents. There is appropriate assisted bathing facilities in the communal areas, there being a bathroom on the ground and first floor and a shower room on the second and third floor, this provids an adequate number of facilities for the number of people living at the home. In addition there are seventeen bedrooms with ensuite facilities. Following the last inspection there was a requirement regarding the hoist on the ground floor bathroom. This has now been repaired and the risk to the safety of residents removed. The home was clean and free of offensive odours. Care staff were aware of the correct use and disposal of protective clothing, such as disposable gloves and aprons, as was required at the previous inspection, thus assisting in protecting residents from cross infection, but this has not been included in the infection control policy as was required in the last inspection report.
Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 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 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) 28,29 The recruitment practices do not offer adequate protection to the people living at the home. There is inadequate provision made in the senior staff team as a result of the acting manager and acting deputy manager arrangements. EVIDENCE: Following the resignation of the previous manager the deputy manager is now the acting manager and a senior care assistant is the acting deputy manager. This has created a shortfall of senior staff available to be in charge of the home for each shift to supervise staff and to ensure the standard of service offered to the residents, without too many unsocial or long hours being worked. As previously discussed staff breaks are not staggered leaving periods of time in the day when care staff are not immediately available to residents. Apart from the manager vacancy there are three care assistant posts vacant, two of which have been offered to applicants. These vacancies add further pressure to the existing staff as the inspector was informed that there is a reluctance to employ agency staff to cover the gaps in the rota. This can impact on the service received by residents when staff become tired and anxious when working more hours than planned. The rotas displayed in the home do not show what actual hours are worked as any absence cover is written in the diary. The acting manager is supernumerary to enable her to complete management tasks but the hours she works is not shown on the rota. Discussion with senior staff indicated that the rota would be revised.
Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 19 The home has not yet met the requirement for 50 of all care staff to have achieved NVQ Level 2 in care (or equivalent) by this year, with six out of 22 care staff having done so and a further six in the process. This qualification shows that the achiever is competent to carry out the role of care assistant and therefore that the residents are in safe hands. Three staff files were looked at and although Criminal Records Bureau (CRB) checks are now included in the files there were several pieces of information required by the Care Home Regulations 2001 that were missing, including proof of identity of the member of staff such as a photo, birth certificate and passport. These items are required to protect the residents from the employment of unsuitable people. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 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 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) 31,38 The home does not have a manager and temporary management arrangements are in place. There are some health and safety concerns that may EVIDENCE: There is currently no registered manager at the home and the inspector was advised that there had been no steps taken in the recruitment of a suitable replacement. The acting manager was trained as a nurse in Holland and has achieved the Registered Manager Award and so is suitably qualified to be carrying on the role. She advised that a senior member of the organisation is acting as a mentor and is available for support and guidance. Residents spoke highly of the acting manager and deputy and said that they are approachable, readily available and take their concerns seriously. However this temporary situation is not ideal for the service and unsettling for residents and staff. It is
Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 21 disappointing if this has not been addressed in the weeks since the previous manager resigned. In order to monitor the quality of the service offered at the home the registered provider or representative makes monthly visits to the home and forwards a report of this visit to the Commission and to the manager, in accordance with the requirements of Regulation 26 of the Care Home Regulations 2001. The home is aware of the dates of the visits rather than them being unannounced as required in this regulation. As previously mentioned the maintenance person takes responsibility for the weekly testing of fire alarms and includes the testing of the battery operated hold-open door devices. The outcome of this testing needs to be recorded alongside that of the fire alarm testing. These devices are not considered ideal in high-risk areas because they are not guaranteed fail safe and it is suggested that the home liaise with the fire service to ensure that the one near the laundry area is considered suitable to minimise the risks from any possible fire. It is mentioned in a previous section that the water risk assessment carried out by an outside contractor highlighted some concerns regarding the storage of cold water and the temperature that hot water is stored and circulated. The inspector was shown documentation that showed that the contractor was to address these concerns within the following two weeks. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 22 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2
COMPLAINTS AND PROTECTION 2 3 3 x x 1 2 2 STAFFING Standard No Score 27 2 28 2 29 2 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 2 x 2 x x x x 2 Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 23 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 1 Regulation 5 Requirement The registered persons must ensure that the service users guide is reviewed in order that it meets the required standard and that a copy is supplied to each service user. (the previous timescale of 31/01/05 not met). All residents must have an assessment in place that includes the specifications of Standard 3.3 and these are kept under review and revised as circumstances change. The registered person must ensure that care plans set out in detail how each service users needs are to be met (the previous timescale of 31/01/05 not met). A snack meal must be offered in the evening and the interval between this and breakfast must be less than twelve hours. The manager must ensure that food is served at the correct temperature The registered person must ensure that all areas of the home are safe and wll maintained, including repairs to all areas of the roof as required. Timescale for action 30/10/05 2. 3 14(1) 30/10/05 3. 7 15 30/10/05 4. 15 16(2)(4) 30/09/05 5. 6. 15 19,38 16(2)(i) 13(4) (a)(b) 30/09/05 15/10/05 Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 24 7. 19, 38 23(4) 8. 22 23(2)(n) 9. 25, 38 13(3)(4) (a)(c) 10. 26 13(3) 16(2)(j) 11. 27 17(2) Schedule 2 12. 27 18(1) The registered person must ensure that the building complies with the requirements of the Fire Service, and seek their advice regarding the hold-open door devices and the door locks/bolts on the fire exit identified in this report and at the inspection. The registered person must seek advice to ensure that service users have access to and from the front of the building, including by means of a wheelchair, and that the home is compliant with the Diability Discrimination Act. The registered provider must ensure that adequate hot waterr is supplied to service users, and that hot water is stored at 60 degrees C, circulated at 50 degrees C and delivered at 43 degrees C. (the previous timescale of 31/01/05 was not met) The home must also provide the Commission with evidence that work required following the Water Risk Assessment has been completed. The infection control policy must include directions regarding the single use and disposal of personal protective equipment (gloves and aprons). (the previous timescale oof 31/01/05 was not met) The registered person must ensure that the home keeps an up to date duty rota showing which staff are on duty at any time during the day or night , in what capacity they are working and whether the rota was actually worked. The manager must be included on the rota. The registered person must ensure that at all times there are 15/10/05 15/10/05 15/10/05 15/10/05 30/09/05 30/09/05
Page 25 Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 13. 28 18(1) 14. 29 19(1) Schedule 2 15. 31 9(1)(2) 16. 33 26 24(1)(2) (3) 24(1)(2) (3) 17. 33 suitably qualified, competent and experienced persons working at the home in such numbers as are appropriate to meet all the needs of the residents. 50 of the homes care staff must have completed the NVQ Level 2 in Care qualification (or equivalent) by 2005. An actiion plan as to how this is to be achieved must be forwarded to the Commission. The registered person must ensure that the relevant documents and information, as specified in Schedule 2, relating to staff are obtained and kept in the emloyees file at the home. The organisation must appoint a suitably qualified and experienced manager, and apply for registration promptly. The visits to the home by the registered person, related to the Regulation 26 reports, must be unannounced. The results of surveys regarding customer satisfaction must be included within the Service Users Guide and forwarded to the Commission. 31/12/05 30/09/05 15/10/05 15/10/05 15/10/05 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 3 Good Practice Recommendations The home should consider the use of a recognised assessment tool for the risk of pressure sores, such as “Waterlow”. (This recommendation has been carried over from the previous inspection report) The home should explore the possibility of remote calling system for service users at risk of falls at night, where the service user does not want frequent checking.(This
E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 26 2. 8 Arden House 3. 4. 8 14 5. 38 6. 38 recommendation has been carried over from the previous inspection report) Staff should be trained in care of diabetic service users, (including catering staff).(This recommendation has been carried over from the previous inspection report) The Registered Person should make information on advocacy services available in the home.(This recommendation has been carried over from the previous inspection report) The registered person should undertake a regular audit of accidents in the home and take action to address any issues identified.(this recommendation has been carried over from the previous inspection report) The results and subsequent action pan of the contracted Health and Safety audit should be forwarded to the Commission. Arden House E53 S4200 Arden House V246778 250805 stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa Warks CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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