Inspection on 05/06/07 for Arden House

This inspection was carried out on 5th June 2007.

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 17/05/06

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 Mrs Ann Block Key Unannounced Inspection 5th June 2007 9:00 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.V339434.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.V339434.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 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.V339434.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 17th May 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 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 5/6/07, range from £350.35 to £420.00. 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.V339434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block which included an unannounced visit to Arden House on Tuesday 5th June 2007 between 9.00 am and 4.30 pm. This is the second inspection of 2006/2007 and will continue to determine the frequency of visits/inspections hereafter. The commission is committed to inspecting for improvement, this inspection was based primarily on reviewing areas needing improvement raised at previous inspections and acknowledging areas where quality of life for residents has improved. The day was spent talking to residents, a visitor, the assistant manager and staff and looking at a sample of records including residents care plans and daily records, medication records, staff recruitment records, accident and incident records. At the time of the site visit there were 14 residents accommodated. Three residents were case tracked which included talking to the resident concerned, talking to staff about their care and looking at a sample of associated records. Judgments have also been made using observation of practice. The manager currently works three days a week and was not available at the time of the site visit. To obtain clarification on some issues the manager was later contacted by phone. The home changed ownership some two years ago, the current owners are working to improve the standards at Arden House in line with their other three homes. Where judgments made at previous inspections remain the same, these have been included in the assessment of standards in this report. Due to timescale limitations surveys to residents, relatives and professionals were not used as part of this inspection. What the service does well: A particular strength of Arden House is the friendly, homely and welcoming atmosphere of the home. The individual needs of residents are well met and there is effective liaison with other agencies such as health. Sufficient staff are on duty each day with time to provide care, catering and domestic tasks. Residents know that any requests for care or support will be responded to promptly. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 6 Staff feel supported and have a real commitment to caring for older people. Choice, privacy and dignity are seen as very important and residents express a high level of satisfaction regarding their care. Residents and visitors consider they are listened to and find the manager and staff approachable. Communication between the manager, staff, residents and relatives is good and serves to manage any concerns so that they do not become complaints. What has improved since the last inspection? What they could do better: Residents must be able to have their medication managed safely. Medication which requires chilled storage must be done safely, staff must have suitable medication training and records must be accurate, including ‘as required’ medication Residents have the right to received a good quality of life. They should have meals which are varied, where they have a choice and from clean and hygienic premises, the kitchen must be upgraded in line with Environmental Health Officer requirements and food stored safely. Activities should be publicised. Residents rights to a safe environment must be met by providing bathing and shower facilities where hazards have been removed and the risks of cross infection are minimised, where fire safety measures include professional input and there is evidence that electric supplies and equipment are safe. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 7 Residents rights to know the home is suitable for them will be better evidenced when sound assessment and admission procedures are put in place, there is access to a copy of the contract as part of pre admission information, changes to care and support needs are recorded and risks are assessed, monitored and recorded. Residents or advocates will have better evidence that confidentiality is maintained when the manner of recording complaints meets data protection principles. That residents have suitable and safe staff to support them will be better evidenced through improved recruitment systems. Relatives and professional would have more opportunities to express their views of the service if they were included in the quality assurance process. 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. The summary of this inspection report can be made available in other formats on request. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 8 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.V339434.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is good. Residents have good systems to know whether the home is suited to them and can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An updated statement of purpose/service users guide is given to each service user on admission. The document contains detail of the service include staffing, facilities and services but does not include a standard form of contract or a copy of the last inspection report. The manager said that she would put a notice in the hallway stating that a copy of the service users guide was available on request. It is also planned to put a copy of the statement of Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 10 purpose/service users guide in each bedroom. A copy of the current statement of purpose/service users guide must be provided to the commission. The care files for the most recently admitted residents contained an assessment of need. The owner had carried out the assessments. In all three cases, the assessments were being used as the initial care plan. No detail of how the resident would be settled into the home was included, staff found that after admission care needs for one person differed from those recorded on the assessment. Residents confirmed they had met the owner before they were admitted and had talked about their needs, likes and dislikes. They felt that, even though they had only been at Arden House a short time, their needs were being met and they were satisfied with home. It was reported that each resident has a statement of terms and conditions and an example was seen in one file. The statement gives good detail of the rights and responsibilities of the owner and the resident, including the room to be occupied and fees. Long term stays start with a trial period so residents can assess whether the home is suitable for them. Where the resident is able, they are welcome to visit the home and meet other residents and staff. In one case, the resident said that family had come to view the home on their behalf. One resident said that he had been visiting a friend in the home for a couple of years so when he needed care he chose the home for himself. Staff felt this in itself was a good recommendation. Intermediate care is not provided. Respite care can be provided if there is a vacant room. There are no specific short stay rooms; residents are free to join in the daily life of the home. In this way they can ‘test’ the home and residential life before they commit to a permanent stay. The owner plans to offer a day care service to older people. This has been discussed with staff and residents. There were mixed views about the proposal. A number thought it would be good to have more people in the home, they realised they were very low in numbers and welcomed having more people to talk to and new faces. People also thought that there would be more activities. Day care may also offer a bathing service and overnight accommodation. The manager said this would be in a designated room on the middle floor. She was aware that she would still need to assess day care attendees. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. Residents’ health and care needs are well met but will be improved when recording and medication storage is reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of residents have a full care plan which includes key information relating to their care and how this will be provided. There remains room to develop the care plans to give more specific detail of how individual needs will be met. For three recently admitted residents, the pre admission assessment was being used as a care plan. Staff were using the daily record sheets to pass on additional information about the residents. Staff spoke of having good handovers where such information would also be shared. It is recommended that a basic care plan be set up ready to be amended as part of the transition into care process. Care plans record dates when they were reviewed. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 12 Staff spoken to and practice seen evidenced that staff have a good understanding of individual need. They made sure that care and support was given as the resident wished or in their best interests. Residents confirmed that the staff were ‘excellent’ and knew how health and personal care was to be given. Daily records are made for each resident. Many records are simple and record activities of daily living such as ‘slept well’ or ‘had a good day’. Where there have been events of note the depth of recording was more useful and showed that the person’s welfare was being tracked through subsequent days. Risk assessments are carried out with action needed to reduce or remove the risk. Staff were aware of risks to individuals and of the rights of older people to take risks. The missing person policy is implemented when required. There is no system to carry out falls monitoring from daily records or the accident book or to update risk assessments from periodic screening. Residents spoke of attending local and area health services. One was going to see his general practitioner that afternoon, another said that he felt reassured as if he needed to see a doctor one visited promptly. There was evidence that support networks are used, such as the NHS Direct line, to obtain advice to promote residents’ health. Residents are satisfied that staff attend well to personal hygiene activities and reduce potential embarrassment. Care files contain space to record health appointments but it would be helpful to routinely include outcomes from these visits and updating of care plans if the need dictates. Care plans could usefully contain detail of triggers which might result in mental or physical health problems and who would be contacted if the situation arose. Medication is provided by a local pharmacy in blister packs with pre printed medication administration records. On the day of the site visit a cupboard was being used for storage, the manager said that a drug trolley arrived the following day. There is no separate controlled drugs storage, staff said there were no controlled drugs in use at the moment. Residents who are able and risk assessed as safe may self medicate. A few residents self medicate part of their medication regime but have staff help with other medication. One person said that staff didn’t check that he was taking his medication but he knew what he was doing. Eye drops were stored in a metal lockable tin and in the salad tray in a domestic fridge in the kitchen where foodstuff is also kept. The use of this fridge is a risk both from temperate fluctuations, as the fridge is in constant use, and the risks of contamination by foodstuffs. It is therefore a Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 13 requirement that a designated lockable fridge be obtained for storage of medication needing refrigeration. Medication records did not confirm that medication was being given as directed by the prescriber. Prescribed creams were not routinely recorded as being administered, there were gaps without explanation in the records. Medication was recorded as being administered when in fact the course had been completed. This suggests that staff are not completing the medication record at the time of administration. This was discussed with the manager at a later phone call. There is no system to record triggers to administer ‘as required’ medication. Whilst information provided records that all staff administering medication have had training, the training a number of staff received was basic and didn’t give offer confidence in the quality of training. This was further evidenced in the inaccurate use of the medication administration record. Residents confirmed they are always treated with dignity. Care is taken to return the right clothes to the individual. Privacy is maintained when personal care is given. Residents have a phone they can use in private, a number have their own private phone line. Residents’ rooms are recognised as being private and staff were observed to knock before entering. All rooms have a lockable cabinet, each room has a lock on the door; residents are offered a set of keys when they arrive at the Home. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Residents live a life where they are the decision makers with some social stimulation. They are let down by some poor quality meals and lack of choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents confirmed they are able to make choices about their daily lives including when they get up and when they go to bed. Staff have a good understanding of preferred lifestyle. The majority of residents have limited need for help with personal care 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 south facing conservatory/sun lounge overlooking the rear garden and beyond to a bowling green, is accessible from the lounges. Some residents prefer to spend more time in their rooms which Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 15 are personalised with resident’s possessions including small items of furniture. Two residents said they liked to go up to their rooms in the afternoon for a rest and appreciated being able to do so. A number of residents like the setting of the home being so close to the town and the seafront. Residents talked about making trips into the town, meeting up with friends or having a look at the shops. Festivals and birthdays are celebrated. An activities coordinator provides activities twice a week. Staff said that the person would do group activities, take people out or just spend time chatting on a one to one basis with people in their rooms. Some staff take time to provide activities but generally activities are not provided in a structured manner. Both staff and residents felt that the proposal of offering a day care facility would give residents more opportunities to join with a wider range of activities. External entertainment is brought in periodically. One resident spoke of having a visiting priest and of communion services being held. Visitors are welcomed to the home. Residents spoke of visits from family and friends. A number have local contacts and like to keep in touch with them. Visitors are also welcome to stay for a meal. If visitors prefer not to use a residents room to meet, they have the conservatory for use. Catering is provided by two chefs, one working two days the other, a newly recruited chef works the remaining five. A number of residents commented that food prepared by one chef was significantly better than that prepared by the other. They said that on most days the food was good. General complaints about the food prepared on two days a week, which were confirmed during the site visit, were undercooked veg, lack of choice, and no notification of what was on the days menu. Special dietary needs such as vegetarian and diabetic foods are provided in a manner which ensures equality is well managed although on the day of the site visit there was potential to show more flair in the omelette prepared for the vegetarian. Normally residents have notice of the meal of the day and can ask for alternatives, on the day of the site visit residents did not know what was for lunch hence didn’t know until it was served whether they would like it. As the food is already plated up this further restricted choice. Choice was offered for supper. As will be detailed later in the report, general standards in the kitchen were poor. Meals can be taken in the dining room which was refurnished last year and is bright, spacious and attractive. The use of chipped china let the standards down. Tea or coffee is provided after lunch using individual teapots. Residents said that their breakfast trays had individual tea or coffee pots on as well. Afternoon tea is taken round and includes cake or biscuits. Some residents prefer to eat in their rooms and this is well managed. Residents currently like to have their breakfast in their rooms although staff said they would be welcome to come down to the dining room if they wanted to. Freshly topped up water jugs are provided in bedrooms. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 16 Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to said they felt they had a number of people who they could talk to. Mention was made of talking with the manager about minor niggles and of action being taken, in this way often these niggles are dealt with before becoming a full blown complaint. A complaint procedure is included in the service users guide which gives contact details including external agencies. A hardback complaint book was found in the staff room drawer. This system does not promote confidentiality and is not in line with Data Protection principles. Complaints have been recorded and some detail has been included as to the outcome. Better recording would reliably show what action was taken and whether the complainant is satisfied with the outcome. Additional paperwork relating to a complaint cannot be held in one location using the current system. The majority of staff have now received training in adult protection. Staff said that the training was by workbook with questions. They had a good awareness Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 18 of the forms abuse might take and ensured that any action which might constitute abuse was properly addressed and residents safeguarded. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. Residents have a homely, well maintained and comfortable environment in which to live but which will benefit from further upgrading and renovation. Residents are at risk from poor standards in the kitchen. This judgement has been made using available evidence including a visit to this service. 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 of the house. The garden can be reached by 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 Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 20 relax in and there are bedrooms on each floor. Residents’ rooms are individual in size, layout and furnishing. Residents can bring in their own furniture if they wish. One resident pointed out the items he had brought in, including photographs, which made him feel more ‘at home’. There are double rooms which can be shared on request. Residents may also move room if one they prefer becomes available. A number of bedrooms have been provided with new furniture, the remainder will be refurbished when vacant. Arden House changed ownership some two years ago. The manager said that at the point of sale there were many improvements needed to the fabric of the building and in general administration systems. The owners are improving the environment as budgets allow. So far, they have refurnished the dining room, had a new fire alarm system and nurse call system installed and redecorated bedrooms as they became vacant. There remains work to be done including refurbishment of the lounge, especially the seating which is looking very tired, repairs to the damp in one bedroom and replacing the carpet in the dining room. At the time of this and previous site visits, the home has been found to be warm, bright and clean. A recent Environmental Health Officer visit had recorded deficiencies in the kitchen, also noted by the inspector, including torn flooring, debris in the runners of a metal cupboard, dirty walls and surfaces behind the cooker and a faulty dishwasher. Staff use the kitchen as a through route although there is access through the lounges. Food was stored on an open shelf when it should have been refrigerated. Residents have use of gardens to rear of the house. At the time of the site visit the gardens did not offer a suitable environment as the lawn required cutting, there was very limited seating and the pool, whist very attractive with its lilies in flower, presents a risk as there are no rails or similar restrictions to prevent falls. A member of care staff works additional hours as gardener. Risks to residents from scalds or burns are minimised by fitting radiator covers to radiators in high risk areas and fitting safe temperature valves to hot water outlets used by residents. Water temperatures are tested regularly. It was noted that one shower room had a temperature at outlet recorded as 50 degrees C yet no action to reduce the temperature was recorded. Whilst it was reported that this shower was not used, residents have access to it. The home has two passenger lifts which between them give access to each floor. A small number of rooms require use of a small flight of stairs to access them. The home contracts with a lift service company who carry out any work needed promptly. Other aids and equipment are provided as needed including toilet riser seats, bath hoists, grab rails and mobility aids. A call system is installed with points in each bedroom and communal areas. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 21 The manager carried out a fire risk assessment. Updated guidelines from the Fire Office state that the fire risk assessment has to be carried out by a person qualified to do so. Each bedroom is en-suite. In addition, there are bathrooms and shower facilities. Not all the bathrooms are available for use as they are being used for storage and need attention to minor repairs. There is multiple use of fabric towels in communal facilities which increases the risks of cross infection, it is strongly recommended that hand drying facilities which reduce the risks of cross infection are put in place as a priority. Staff have use of a spare bedroom which doubles as an office, where there is a bed for the sleep in person and a toilet with washbasin. Suitable laundry facilities are provided on the basement level. Staff carry out laundry in manner which ensures residents clothing is well maintained and safe practice reduces the risks of cross infection. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. Residents have staff whom they like and provide a caring service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents like the staff and they feel they are treated well. Generally good relationships were seen during the site visit. A roster is held giving names of staff on shift. Staffing levels include three care staff on duty each morning and two in the afternoon and evening. There is one waking staff are on duty at night and one sleep in person. Staffing levels have been reduced due to the low numbers of residents currently accommodated and the reduced need for personal care. These staffing levels should be kept under close review due to the layout of the home being on four floors. The new call system has been set up so that the call can be heard and identified on each floor. Senior carers, a manager and assistant manager offer a senior structure. Senior staff are on call on a rota basis. Residents felt that generally there were sufficient staff to meet their needs, call bells were answered quickly when they were used although more often staff knew the residents routines hence there was little use of the call system. Agency staff Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 23 are used to provide a full staff complement, the home tries to use the same agency and where possible staff who are familiar with the home. Recruitment is taking place for care staff. Files for three recently recruited staff were seen. Each person was recorded as having completed a criminal records bureau check and reference to the Protection of Vulnerable Adults (POVA) list being made. All have evidence of identity. The recruitment procedure includes asking for a health declaration, full rehabilitation of offenders’ declaration and employment history. Small improvements to the reference request system would offer better evidence that the employee was suitable including identifying in writing that the address of the referee should be recorded on the application form, checking that any person given as a referee as an employer was also recorded as part of the employment history, questioning when only mobile phone numbers are provided for employer references. Applicants attend for interview but the interview questions are not always recorded, in this situation there is no evidence that employment history is verified. The current manager assures that standard practice is to record interview questions however the interim manager had failed to do this. It was noted that staff contracts are issued under the name of Wilton Lodge Ltd with a Head Office in Mayfield whereas the provider is Angel HealthCare with a Head Office in Ashburnham. The manager said that following the change of Company all documentation was being revised. It was difficult to locate the date the employee started work, this could usefully be included in the recruitment checklist on file. Employment procedures include a disciplinary and grievance process. Where necessary steps are undertaken to follow the disciplinary procedure and to involve other agencies as necessary. Staff referred to training they had undertaken. A number of staff have completed NVQ level 2 in care and two said they were starting level 3. Staff spoke of areas of learning they had obtained through NVQ training. Records of induction were seen in one file. The induction covered topics necessary to prepare the person to work with older people. The assistant manager said that the home was using workbook based training. The manager was moving more towards external training, on the day of the site visit four staff had attended a an intermediate care and control of medicines course in the morning and the assistant manager was due to attend the same course in the afternoon. As already mentioned the current training for medication did not provide staff with the necessary skills. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. Residents live in a safe and well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed by a person who has the experience and skills to manage a home for older people including professional care qualifications and managerial experience. She has just returned from extended leave when an interim manager temporarily managed the home. The manager is working towards her Registered Managers Award qualification, attends regular training Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 25 to update her skills and knowledge and is in the process of applying for registration with the commission. Staff and residents spoke highly of the manager considering she had the best interest of residents at heart. They said she was accessible and ready to listen to them. Staff and resident meetings are held. Relatives and friends have opportunities to talk with the manager. Quality assurance surveys are provided regularly to residents with completed copies seen on file. Since the managers return no surveys have been sent to relatives or professionals. A senior member of the Angel Healthcare undertakes monthly visits and writes a report on the findings which includes space to record any action needed. Most of the residents manage their own financial affairs or a relative or solicitor acts on their behalf. The home collects the pension for one resident and she is given her personal allowance. At present, she doesn’t routinely sign receipt of the money. It is recommended that where she chooses not to sign a witness signs that the transaction takes place. 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. Staff said that they now receive regular 1: 1 supervision, both planned as an appraisal and when they feel they need support or guidance. The manager and assistant manager spend time alongside staff and in this way provide on the job supervision. The manager meets monthly with the managers of the other three homes in the organisation and the owner. Staff say they have had core training to include moving and handling, infection control and basic food hygiene. The manager is a qualified moving and handling trainer and six staff are qualified first aiders. Those spoken with knew the correct procedures in the event of fire but said there had only been a limited number of fire drills and practices. There is no system for an external qualified fire trainer to provide regular fire safety training. Fire break glass testing is now recorded as being done regularly since the new fire alarm system has been fitted. With the exception of kitchen standards as mentioned in a previous section, practices are in place to reduce the risks of cross infection. The assistant manager found some records of servicing of supplies and equipment including a current Gas Landlords certificate but could not locate an electrical supply certificate or PAT testing record. A lift insurance certificate has been obtained and lift repairs are carried out as needed. Regular walk around checks are carried out by the manager which includes completing a room check list with any action needed recorded. Environmental risk assessments are also carried out and recorded. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 26 Accidents and incidents are recorded in compliance with the principles of data protection. There was no obvious system to audit falls. Incidents are reported to the commission as required. The owners ensure that business planning is in place. The owners regularly visit the home and provide support for the manager. A current certificate of employers’ liability is on display. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 3 1 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 3 X 2 Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 28 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 Medication which requires storage at a cold temperature, i.e. refrigeration, must be stored in a manner which reduces the risk of fluctuations in temperature and contamination. The current use of a domestic fridge in the kitchen does not meet this requirement. Safe storage is most likely to be met by the purchase of a designated lockable medication fridge. This is repeated from the inspection of 17 May 2006, further non-compliance will result in enforcement action being taken. Medication practices must ensure 30/06/07 that there is evidence that medication is given as directed by the prescriber by staff who are properly trained to do so. The medication administration record must be an accurate record of the time and actual administration of the medication. This will include creams and Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 29 Timescale for action 31/07/07 2 OP9 13 (2) 3 OP9 13 (2) 4 OP15 16 (2) (i) 5 OP19.5 16 (2) (j) 13 (3) lotions. Medication training for staff must 30/09/07 equip them with the knowledge to ensure medication is administered as directed by the prescriber. On the majority of days of the 30/06/07 week residents have nutritious and well prepared meals however on a minority of days this is not the case. Residents must be able to have meals which are wholesome, suitable, nutritious, varied and properly prepared. The kitchen must be maintained 30/09/07 in a safe and clean manner. • The actions required as detailed in the Environmental Health Officer report must be implemented to include replacing the defective flooring, thorough cleaning of the kitchen and replacement or repair of the dishwasher. Food requiring refrigeration must be refrigerated. The kitchen must not be used as a through route by staff as this practice increases the risks of accident and cross infection. 31/07/07 • • 6 OP21 13 (4) Shower and bathing facilities must be safe for residents to use. • Where the water at outlet is recorded as above safe levels action must be taken in response to reduce the Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 30 temperature. • As bathrooms and shower rooms are accessible to residents, they must be kept clear of equipment which poses a risk of accident and allows for safe use by residents if they choose. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP3 Good Practice Recommendations The statement of purpose/service users guide should contain the standard form of contract. The person carrying out the pre admission assessments should ensure that sufficient information is obtained to ensure the person’s needs are accurately described and can be met in the home at the time of admission. There should be information available to staff about incoming residents to offer staff guidance to help the resident settle into the home and indicate how specific care and mental health needs are to be met in the transition stage. There should be a system other than by use of the daily record sheet and handovers to provide staff with updated information about changes to care and support needs for residents, especially at the time of admission and as more detailed information about the resident is obtained. Where there is a known physical or mental health risk, triggers to any relapse, and where appropriate contact details from support agencies, should be recorded. To aid the prevention or reduction in number of falls there should be a system to monitor falls as recorded in the accident and incident records and through daily records. DS0000062874.V339434.R01.S.doc Version 5.2 Page 31 3 OP3.4 4 OP7 5 6 OP8.7 OP8.8 Arden House 7 OP9 8 OP12 Where medication is recorded to be given ‘as required’ there should be written detail of when this medication should be administered, including the triggers for administration. Activities provided should be publicised in advance to ensure residents are aware of all that is available. This recommendation is repeated from the inspection 17 May 2006 9 10 OP15 OP15 China used for meal times should be discarded when it is chipped or cracked. A choice of menu should be publicised in advance to enable residents to make a choice about the meals they receive. This recommendation is repeated from the inspection 17 May 2006 The complaint record should be set up to meet the principles of data protection and to record details, including any supplementary paperwork, which shows how the complaint was dealt with and whether the complainant is satisfied with the outcome. In line with reviewed fire safety guidance, a person qualified to do so must carry out the fire risk assessment. It is strongly recommended that hand drying facilities which reduce the risks of cross infection are put in place as a priority in communal toilets and bathrooms. Small improvements to the interview and reference request system would offer better evidence that the employee was suitable including: • Identifying in writing that the address of the referee should be recorded on the application form. Checking that any person given as a referee as an employer is also recorded as part of the employment history. Questioning when only mobile phone numbers are provided for employer references. Recording interview questions to provide evidence that employment history is verified. 11 OP16 12 13 OP19.5 OP26 14 OP29 • • • 15 OP33 The quality assurance process could usefully include obtaining relatives and professionals views of the service and incorporating these, together with the resident DS0000062874.V339434.R01.S.doc Version 5.2 Page 32 Arden House surveys into a report on the standards in the home. 16 OP35 17 OP38.2 18 OP38.3 As a receipt of money isn’t routinely signed by the resident, it is recommended that where she chooses not to sign a witness initials that the transaction takes place In addition to carrying out regular fire evacuation procedures by drills and practices, it is also strongly recommended that all staff attend fire safety training provided by a person qualified to do at least annually. Evidence that the electrical services and facilities in the home are safe should be provided by means of an electrical supply certificate and records of PAT tests. Arden House DS0000062874.V339434.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V339434.R01.S.doc Version 5.2 Page 34 - 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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