Inspection on 08/06/06 for Arden House

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 16/04/09

Arden House 16/04/07

Arden House 16/02/06

Arden House 25/08/05

Arden House 24/11/04

Arden House 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT Lead Inspector Sandra Wade Key Unannounced Inspection 8th June 2006 07:50 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 DS0000004200.V290759.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 DS0000004200.V290759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arden House Address 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT 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) 01926 423695 01926 315769 Greensleeves Homes Trust Mrs Charlotte Schram Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2006 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 assessible 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. A small conservatory leading from it is located on the ground floor. Bedrooms are provided on the ground, first and second floors. 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 Spas 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. The manager advised that from 10 April 2006 the social services fee rate had increased from £338.18 by an additional 2 . Private fees range from £375.00 to £545.00. Extra charges are made for hairdressing, chiropody, toiletries, newspapers, activities and trips. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Arden House for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff and residents. This inspection took place between 7.50am and 8.30pm. Records examined included care plan files for residents, recruitment records, staff files, training records, social activity records, staffing records and medication records. Records relating to the care and services provided by the home were also viewed. Before the inspection, service users and their relatives were sent questionnaires, to seek their independent views about the home. Comments received are included within this report. A pre-inspection questionnaire was received from the home on 20 April 2006, some of the information contained within this document has also been used in assessing actions taken by the home to meet the care standards. On arrival to the home, staff were in the process of assisting residents to get up and dressed so they could go to the dining room for breakfast, which is situated, on the lower ground floor of the home. One resident came into the lounge area and said they had already had their breakfast. What the service does well: The manager is committed to raising standards within the home and has been actively reviewing the care and services provided so that residents receive effective care. Staff were observed throughout the visit to interact well with residents and had a sensitive and caring approach when offering them support. Resident choices are being respected and the majority of residents spoken to on the day of inspection said they felt well cared for. Seven comments cards returned to the Commission from residents confirmed that they all felt the staff treated them well. A visitor stated that staff welcomed them to the home and that staff were very approachable, friendly and created “a good working atmosphere”. Another visitor stated that staff are “always helpful”. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 6 The Registered Provider visits the home on a monthly basis to talk to staff, residents and undertake an inspection of the records and premises to identify any concerns or matters requiring attention. Detailed reports are made of these visits, which are made available to the manager, and Commission and these include any actions arising from the visits to be carried out. The home is clean and pleasantly decorated and residents have been able to personalise their rooms to their liking. Staff training is being provided on an ongoing basis and the manager is always looking ahead to ensure training is being arranged for those staff who will need to complete this. What has improved since the last inspection? What they could do better: Following the assessment of a resident, letters need to be written to residents to confirm the home can meet their needs. Care plan files do not always contain care plans for each identified need with instructions to staff on how to meet these. This could result in residents care needs not being fully met. The management of Medication needs to be improved in particular in relation to controlled drugs to ensure errors are not made, which could impact on resident health. It is not evident that residents are being consulted about activities provided so that activities in the home are in accordance with their wishes. Not all staff are clear on actions that need to be taken in the event of abuse to ensure residents are protected. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 7 Access to the front of the home has not been fully addressed in regard to independent wheelchair access (it is accepted this delay has been due to having to seek planning permission). The management of infection control within the home needs to be improved to ensure staff practice good hygiene. The manager needs to ensure staff recruitment policies for the home are followed consistently in particular in regard to obtaining ‘Protection of Vulnerable Adult’ (POVA) checks before staff work in the home. Quality monitoring has not been addressed on an ongoing basis to ensure the views of residents and their representatives are considered when making management decisions affecting the home. The management of resident’s pocket monies has not being undertaken effectively to ensure residents financial interests are protected. The way food is stored in the fridge plus the food store needs to be improved to ensure safe practices are being followed. 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 DS0000004200.V290759.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 DS0000004200.V290759.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is adequate. Information about the home is available to prospective residents to enable them to make an informed choice about whether to stay at the home. Residents are assessed prior to their admission but they do not receive written confirmation that the home can meet their needs. EVIDENCE: A Service User Guide and a Statement of Purpose, which both give details about the care and services provided by the home are available. The manager also has various brochures giving details about the home, which are given to prospective service users to help them decide whether to stay at the home. Some minor adjustments to the Statement of Purpose were suggested and it was advised that the manager ensures there is evidence that the Service User Guide has been issued to residents. All residents are assessed prior to their admission to the home and this information is then used to develop care plans to meet the needs identified. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 10 Assessment records were available on care plan profiles viewed. It was not evident that the manager writes to residents following their assessment to confirm the home can meet their needs. The manager agreed to address this. Arden House DS0000004200.V290759.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. Improvements are ongoing to ensure that resident’s health personal and social care needs are suitably recorded to support and protect residents and ensure that all care needs are met. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Care plan profiles have been developed for each resident. A random selection of resident files were reviewed. One care plan file contained a personal profile detailing information such as medical history, interests and hobbies, daily routines etc, this was not dated so that is was clear when this information was recorded. The daily routine included information on times the resident liked to get up and go to bed and that they liked to choose their own clothes. Risk assessments had been completed in regard to risks associated with the residents care such as deafness and falls. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 12 Records of district nurse visits had been made and it was noted that the district nurse had visited to apply a dressing to a pressure sore. There was no care plan record in place to show that the resident had a pressure sore and no body map had been completed showing the location and size of this to ensure staff were aware of it. The manager said that a Waterlow Assessment should have been completed regarding the risk to the resident of developing pressure damage to the skin but this was not available in the file. This resident also had swollen ankles and there was no care plan completed stating how staff should manage this. A GP sheet in the care plan stated that this resident’s feet should be elevated. During discussions with the resident they said that they did occasionally elevate their legs and they normally asked staff to move the chair across the room so that they could do this. It was not evident from viewing this residents room that a footstool was available and the manager said that four foot stools had been on order for a while and should arrive at any time. A mobility care plan viewed did not state that the resident used a walking frame. This should be indicated so that staff providing care know the resident will need this to mobilise safely. The risk assessment for mobility did state a frame was to be used. Care plan records stated a resident liked to have a bath twice a week. The resident said that they could have a bath at any time and staff were “always very good” at meeting their request for a bath. A member of staff spoken to said that this resident normally preferred a bath before breakfast. One resident said that they had found it difficult to settle into the home after being in their own home but said staff were kind and “cant do too much” to help. The resident said that staff were very good at respecting their privacy and dignity and they knocked the door before entering their room. This was observed during the inspection. This resident stated they “could not find a better home than here” and went on to tell the inspector of their medical problems which were confirmed in the medical history notes in the care plan. The resident confirmed that staff came in each morning to give them tablets for a medical condition and said that they kept a spray in their room if this condition got too bad. It was not evident from the care plan records that the arrangement in regard to the resident keeping and using the spray had been agreed and was in place. This is important to record so that staff know how to manage this aspect of their care safely. Daily records had been completed within those residents files viewed. Records completed were not always specific to the care plans in place so that it was clear the needs of the residents were being met. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 13 For example there were comments such as “fine no concerns” or “fine all care given” which does not demonstrate the staff interactions carried to address their care. In one care file viewed, the medical history, social interests and preferred daily routine had been recorded including the times they wished to get up and go to bed. It is also identified that this resident had hearing and sight problems. Risk assessments had been completed for behaviour, falls and confusion. The original assessment which would have been completed when the resident was admitted was not available as staff review the assessments on a monthly basis and the original had been archived. This assessment should be retained on file to demonstrate an assessment of the residents needs was completed as part of the admission process. This assessment also assists staff in identifying any progress or deterioration in the resident’s health care needs. A care plan had been devised for this resident’s partial sight but staff actions detailed were insufficient to show this resident’s needs were being met. For example, there were no instructions to provide written material in large print or to provide information on tapes or to advise how meals should be presented to allow the resident to eat independently. This resident acknowledged that staff did not always consider the difficulties associated with their sight and sometimes they didn’t know what food had been put in front of them. It was evident however from viewing this residents room that actions had been taken to ensure some of this residents needs were being met. This resident had musical tapes, a talking clock and a pull light very close to the bed. Notices on the door however were not in large print. The personal profile for this resident stated that they suffered from dry skin on their feet and legs. It was observed that this resident also had dry skin to the face. No care plan had been devised stating how this should be addressed. During discussions with one resident it was observed they looked very frail and thin. Weight charts showed that the resident was of a low weight but that this was “stable”. Staff said that this resident eats well. During discussions with this resident they said that the food ranges from “pretty good” to “not so good”. Staff had not been monitoring this person’s food intake as they considered the resident was eating well. It was established that this resident is active in the home and as food intake records had not been completed, it could not be confirmed that the calorie intake for this resident was sufficient to maintain their health. It was not evident that a nutritional assessment had been completed. The manager agreed to pursue this matter with the dietician. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 14 This resident said that staff were “very anxious” to help them but sometimes staff did not always manage their care the way they wanted. Some aspects of the conversation with this resident seemed to be appropriate to previous times before they were in the home and the manager was asked if this resident suffered with periods of confusion. The manager said that she had noticed some behaviour issues and was monitoring this. This resident had been seen by a chiropodist and optician and the GP had been contacted to prescribe cream for a medical condition. This resident was not on any prescribed medication at the time of inspection. A review of medications was undertaken. Photographs had been placed on the medication administration records (MARs) to help staff identify the correct person, which is good practice. Some of the medications received had not been recorded on the MAR chart so it was not possible to confirm the amount given and remaining were correct. The management of controlled drugs (CD) was found not to be in keeping with the correct procedures. This relates to both storage and the recording of tablets used within the ‘controlled drug register’. Any controlled drugs kept in the home must be stored within a locked CD cabinet that conforms with the Misuse of Drugs (safe custody) regulations 1973 to ensure they are managed safely. Creams which had been prescribed to be applied twice a day such as Aqueous cream and Hydrocortisone cream had not been applied. A risk assessment had been carried out for a resident who was self medicating staff were signing weekly reviews to confirm this practice could continue. It was not clear what was being checked when the weekly review is being carried out and advice was given in regard to this matter. A medication, which a resident had purchased, had been written onto the MAR for staff to administer. Staff must only administer medications prescribed by the GP to safeguard the resident. Alternative medication can be given if it has been agreed with the GP within a homely remedies policy to ensure there are no unwanted drug interactions. It was observed during the inspection that resident’s privacy and dignity was being respected. Staff knocked doors before entering bedrooms and one service user confirmed that staff always knocked before entering. This resident said that they had chosen to have their mail redirected to their family who would bring it in to them. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 15 One resident said they chose to stay in their room for long periods as opposed to going into the communal lounge area and confirmed that staff respected this choice. This resident was wearing two hearing aids and batteries were working so the resident could hear clearly. The manager said that spare batteries are kept in the office in case they should need replacing. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. Residents are offered and supported to take part in social and leisure activities and to maintain contact with their families and friends. Residents receive wholesome and appealing meals to maintain their health and are afforded choices in how their care is delivered. EVIDENCE: Activities are provided within the home and an activities schedule is in place, which shows there is an activity being provided each day. The manager said that there is no Activities Organiser for the home but this was something she was hoping to review. The manager advised that activities are provided by rostering an extra carer on duty or by volunteers who visit the home. The manager said that when a new activity is provided she will ask the residents if they enjoyed it and if they say yes, she will make further arrangements for this to continue. Some records had been completed to confirm which residents had been on outside trips such as a pub lunch, butterfly farm and Cadbury’s World but records had not been completed consistently for those residents who had participated in activities provided in the home. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 17 This is important so that the home can demonstrate these are taking place and that residents are being given the opportunity to participate. The social care plan for one resident said that they liked to visit church and that they would indicate to staff when they wanted to go. Daily records completed by staff confirmed this request was being respected. The resident said that they had been “too ill” lately to go to church. Records also stated that this resident liked to read and it was observed that reading material was available on their side table close to where they were sitting. It was not evident that the home has a hearing loop to support those residents with hearing aids. One resident commented on the difficulties they experienced when in a room with lots of people and the television on which made it difficult for them to hear properly. One resident said that they belonged to several societies, which helped to support their social interests. One resident said that they missed visiting the local town and the shops but acknowledged that they had chosen not to go on the outside visits arranged by the home. One resident said that liked the garden but they were too anxious to go into the garden because if there were no staff around and they needed to go to the toilet there is no call bell to alert them. Seven comment cards had been returned to the Commission from residents. Five of the residents commented that there were suitable social activities being provided and one person commented they were provided “sometimes”, one declined to answer. Relatives were visiting residents during the day and comments forwarded to the Commission from relatives confirmed that they knew they could visit the home at any time and that staff in the home make them feel welcome when they do. In regard to resident being given choices in how their care and services are delivered. One person said that the choice of food was “very good” and they were able to have their meals in their room if they wanted to. This person did however say that if they had breakfast in their room they sometimes had to wait a long time for it to arrive. Residents said they were given choices when they could have a bath and one person said that they made sure staff respected their choices in how care and services were received. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 18 One person said that they were “a little disappointed” with the food and they were finding it difficult to have “tasty” meals. This resident said that sometimes they were given “too much” and they could not face it. Another resident said that they were happy with the food. A member of staff confirmed that breakfast is usually provided between 8 – 9.30am, dinner 12.30pm and supper 5.30pm. Menus are in place, which show the choices of food made available. These show that there are two choices of main meal being provided and there is always a hot choice of breakfast in addition to the cereals, fruit and juice provided. Menus did not show all drinks being made available or that snacks and a snack meal in the evening are being provided. The manager said that all residents had notices on their doors indicating that they can have a snack at any time upon request. These notices were seen on the day of inspection. On viewing the dining room, all tables had been laid with table clothes, cutlery, condiments and napkins. Residents who chose to have tea were provided with this in a small tea pot, milk jug, sugar and a cup and saucer so that they could help themselves. Residents were seen to independently put their own marmalade on the toast provided. Some of the tables had already been prepared for the resident in that cereals had been placed in bowls with cling film on the top and side plates contained buttered bread. This practice could be considered as removing the choice from the resident. A member of staff confirmed that semi-skimmed milk is being used as opposed to whole milk. Whole milk is recommended for older people to maintain sufficient calorie intake and health. As soon as residents arrived in the dining room they were asked if they would like tea and a member of staff went to do this straight away. At 8.15am there were seven residents in the dining room and it was observed that residents came and left at times of their choosing. Residents were talking amongst one another and there was good interaction between the residents and staff. The dining room is situated in the middle of two kitchens, the far kitchen is where the food is prepared and is referred to as the “Clean” kitchen and the second kitchen is mainly used to wash up dirty items. The dining room is pleasantly decorated and spacious so that residents can easily move around. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 19 At lunchtime residents had the choice of braising steak or vegetarian sausages with vegetables. The vegetables were prepared and served in dishes in the middle of the tables so that residents could help themselves. The meal looked appetising and staff were on hand to assist any residents with cutting food etc. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome group is adequate. A complaints procedure is in place and most residents know who to complain to. Procedures in regard to abuse are in place but not all staff are fully familiar with these to ensure residents are fully protected. EVIDENCE: A complaints procedure is in place, which is confirmed in the Statement of Purpose and Service User Guide for the home. These give contact names and addresses if a resident, visitor of relative wishes to make a complaint. No complaints have been received by the Commission for this home but the home had received two complaints. One of these was linked to the menus and the other in regard to the attitude of a member of staff. The manager advised this complaint was still in the process of being addressed. It was not clear from the complaints register what actions had been taken since the complaint had been received. The manager was able to show computer records of actions taken. The manager acknowledged that complaints must be responded to within 28 days in line with the homes procedures. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 21 One resident said that they “never like complaining” but named a senior member of staff as a person they would approach if they had a complaint. This person said they were not clear of the staffing structure of the home and who had “authority” over who although they did know who the manager was. Another resident said that they “were not sure” who they would need to speak to if they wanted to make a complaint, as the home is “very understaffed”. All comment cards received by the Commission from residents stated that the residents knew who to speak to if they were unhappy with their care. The manager said that all staff who commence at the home are required to read the Department of Health Guidance “No Secrets” in regard to how abuse is identified and managed. Training records provided to the Commission by the manager show that staff have completed training in regard to abuse. A member of staff who was questioned about this was not fully clear on the processes that must be followed if abuse is identified. The manager advised it was planned to organise additional training for staff in regard to this process. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 22 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, 21, 22, 26 Quality in this outcome area is adequate. The home is clean and comfortable and well maintained but service user independence is not maximised for wheelchair users accessing the home. Infection control practices need to be addressed to ensure hygiene can be maintained effectively. EVIDENCE: This home has four floors and all of which can be accessed by a passenger lift. The first and second floor also have a stair lift. All rooms have an en-suite toilet with the exception of four single rooms. There are also four communal bathrooms and each of these has a bath hoist to assist those residents who are less mobile. In addition to the bathrooms there are two “wet rooms” where residents can have a shower. One of these is based on the top floor and the other is on the second floor. Hot taps tested randomly in bedrooms and bathrooms were found to be at safe levels to prevent scalding residents. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 23 The home is pleasantly decorated and the three lounges and a dining room, which were clean, tidy and well maintained. A maintenance person is available to attend to any maintenance and decorating required. Bedrooms viewed were pleasantly decorated and furnished with personal items to make them homely. The manager advised there are plans to decorate further areas of the home. At the time of the inspection the hairdressing salon was in the process of being redecorated. One resident when asked if they had everything they needed in their room said “I think so”. One resident with poor sight said that staff did not always leave things in the same place that they had left them. One resident said that they did not have anywhere to lock their personal things. The manager said that lockable boxes are available in all rooms and some rooms also had cabinets. Cabinets were seen in some of the bedrooms viewed. No unpleasant odours were identified during the tour of the home. Since the last inspection actions have been ongoing in regard to addressing a ramp for disabled access to the home. Due to the home being a listed building, planning permissions had to be sought which have now been given and the manager advised she is awaiting the organisation to now authorise works to go ahead. A sluice room is available to deal with the cleaning of any commodes pans or incontinence pads. Gloves were available for staff but no aprons were available in the sluice room itself. Staff said that they use the gloves and aprons, which are available on the cleaning trolley. The sluice room did not have any liquid soap or paper towels for staff to wash their hands and maintain good infection control practices. The laundry area was viewed at around 8am, this was clean and organised with all laundered clothes being in named boxes. Laundry baskets were colour co-ordinated but it was not clear which ones were for clean or dirty laundry. Aprons were available for staff in the laundry but no disposable gloves, the trolley outside of the laundry did contain gloves. A sink unit is available for hand washing items but a specific sink for staff to wash their hands is not available. No paper towels or soap were available. Staff said that they wash their hands in the staff toilet, which is next to the laundry. To maintain effective infection control practices hand-washing facilities should be available in the laundry. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is adequate. The numbers and skill mix of staff being provided are sufficient to meet the needs of residents accommodated in the home. Robust recruitment procedures are in place but not always followed to fully safeguard residents. Staff complete training on an ongoing basis to ensure residents are managed safely and effectively. EVIDENCE: Since the last inspection a new deputy manager has been employed for the home and the manager has undertaken the registration process with the Commission. At the time of the inspection there were 29 residents in the home including one in hospital. The manager advised that they aim to have one senior carer and three carers on each day in addition to the deputy manager and manager of the home, which is in accordance with, agreed staffing levels for the home. Due to there being several different duty rotas which have been devised in different formats it was difficult to get an accurate picture of staffing for the home on an ongoing basis. The duty rotas seen showed there are four carers rostered to work each day from 7.15am till 9.15pm and two waking carers to work during the night. The domestic rota showed there are dedicated domestics who clean the home seven days a week. It was not clear from rotas who does the laundry for the home and when. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 25 The kitchen and maintenance rota did not detail staff designations so that it was clear which duties they were completing. It was established that a Head Cook, Cook, Assistant Cook and a Kitchen Assistant provide catering services to the home. A cook or assistant cook is available each day from 7.30am to 1.30pm (some days 2pm) and a supper cook is then available from 4pm to 6pm each day, which is good practice. The manager said that there were 25 carers in post and three new carers were due to start in the home once the recruitment process had been completed. Through discussions with the manager it was evident that staffing of the home is being reviewed on an ongoing basis to ensure staffing arrangements are effective for the residents. The manager confirmed that she has been authorised to bring in additional staff if required but they try not to use agency staff unless it is absolutely necessary. The manager advised that any agency staff who work in the home complete an induction. An induction record was seen showing that these staff are advised on key matters to ensure they can care for the residents safely and appropriately. One resident said that staff “were most helpful” and said that “staff are on demand all of the time”. One resident said that sometimes staff say they will be “two minutes” but then do not come back. The resident said if it was urgent they just keep pressing the call bell. One resident acknowledged that staff were helpful but said “certain staff are not very good”. One comment was made that a member of staff who had not been in the home long “was very good”. One resident said there were two staff who had not been in the home for long which were “very nice”. This person went on to say that staffing is an issue for the home and they are “always busy”. They said the night staff were “good”. A member of staff said that staff work well together as a team and the ongoing training provided by the home was helping them to be more efficient and productive in their work. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 26 The manager advised that all new staff complete induction training to the required standards and once this is completed they are then enrolled onto an appropriate training course to complete the National Vocational Qualification II in Care (NVQ). This training is to support staff in providing more effective care to the residents. Of the 25 carers employed, five carers have completed this training to enable them to provide more effective care to the residents. The manager said that eight carers were in the process of completing this and six carers were almost at the end of their training. Once this training has been completed the home will exceed the standard for 50 of care staff to undertake this. Statutory training is being addressed by the home on an ongoing basis and includes, moving and handling of residents, first aid, basic food hygiene, and fire. Training records provided show that other training being provided includes infection control, health and safety, abuse, risk assessments and medication as well as training linked to the care needs of the residents. A review of staff files was undertaken to establish recruitment procedures carried out by the home. Staff files contained criminal record checks, two written references and completed application forms. Contracts had been issued to staff and protection of vulnerable adult checks (POVA) had been carried out. For one member of staff their start date was recorded as 7 March but the POVA check was dated 8 March the following day. Staff must not start employment in the home until this check has been received to ensure residents are safeguarded. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. Service users live in a home, which is run and managed by a person who is of good character and able to discharge her duties fully. Systems are not fully developed to ensure the home is run in the best interests of the residents – this includes financial interests. Some matters relating to health and safety are to be addressed to ensure the welfare of service uses is protected. EVIDENCE: Registration records confirm that the manager is a qualified nurse and has also attained the Registered Managers Award, which was completed in January 2006. She has completed various training courses to ensure her knowledge is kept updated and is about to undertake Diploma in Management Studies. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 28 Throughout the inspection it was evident that the manager is committed to raising standards within the home. The manager was very aware of those areas in the home which needed to be improved and described proposed actions to address these. Satisfaction surveys had been developed for family and friends, Stakeholders and residents. The manager advised that some of these had already been sent out and some had already been returned. The manager is aware that once all of these have been returned responses should be reviewed and a report of the outcomes devised. This report should then be made available to the residents along with any proposed actions to address any issues raised. The manager said that she proposes to hold resident/relative meetings on a three monthly basis to allow for consultation to take place on matters relating to the management of the home. The deputy manager advised that a meeting had already taken place just with residents and notes of this meeting had been kept. Most of the residents were positive about the home. One said they “couldn’t find a better home than here”. One resident felt staff did not always do what they wanted them to do but said that given the amount of time they had been in the home is was “very good”. One resident said they were happy with the home and one resident said that they had accepted they needed to be in the home but could not say they were content. Of the seven comment cards received from residents by the Commission, four residents said they liked living in the home and three said they liked it “sometimes”. A review of the systems to manage resident’s pocket monies was undertaken. A random selection of records were reviewed which are managed by a member of administration staff. Records checked against monies available did not tally. The differences ranged from 10p to £11.00 short against the records. There were lots of receipts available but these were not in any date order and it was therefore difficult to tie up the right receipt with the transactions as detailed on the records. Where receipts had been provided by the home, the residents name had not been written onto the receipt so that receipts could be clearly identified. Records are not being countersigned by a second member of staff to enable records to be double checked as accurate. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 29 It was not evident that the pocket money records had been audited to check records and money as being correct. The manager agreed to take prompt action to address these matters. The manager had forwarded documentation to the inspector prior to the inspection visit to confirm health and safety checks carried out. This confirmed that gas safety checks had been carried out in November 2006 and the electrical wiring had been checked in February 2004. Other safety checks recently carried out included the lift; call bells, fire equipment, fire alarms and a legionella check. The kitchen area was viewed and this was found to be organised clean and tidy. Some sandwiches were found in the fridge which were not labelled or dated so that it was clear what was in them and when they needed to be used by. Eggs had been stored in a fridge but neither the eggs or trays had been dated so that the cook would know how long they had been there and when they needed to be used by. Breaded nuggets were in the fridge but it was not clear what these were. A dinner had been plated and put in the fridge but the individual items stacked on top of one another had not been labelled or dated. On one of the shelves in the kitchen there were packets of soup and bread sauce, these had not been stored in sealed containers to ensure they were pest proof and kept fresh. The food store was viewed and it was noted this felt very warm. The window was slightly ajar and it was a sunny day outside. One of the cupboards in the store room contained numerous dried foods. The packets had been opened but “sealed” with a tie. Some of the ties were loose and inadequate to seal the foods appropriately. Dried spaghetti in a box had been opened, a “silverfish” was seen to run across the shelf. All dried foods once opened should be kept in sealed air tight containers. In the laundry, a plastic jug was noted on top of one of the washing machines with a green substance in it. It was not clear what chemical this was. Staff should ensure chemicals are not decanted into other implements unless they are clearly labelled and the procedures linked to Control of Substances Hazardous to Health (COSHH) are followed. Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 2 X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 X 2 2 Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 31 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 OP4 Regulation 14 (1) (d) Requirement The manager must write to residents to confirm that following their assessment the home can meet their needs. Care plans must be developed in accordance with identified needs with staff actions required to meet these needs. Equipment being used to support a resident is to be detailed within care plans as appropriate. Records must demonstrate that the care needs identified are being met consistently. The manager must ensure that instructions detailed in care plans are carried out such as elevating a resident’s leg. Timescale for action 31/07/06 2. OP7 12 31/07/06 Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 32 3. OP9 13, 17 The manager is to review medication management to ensure all medications received, and administered are clearly recorded. 31/07/06 4. OP12 23 (2) (n) Controlled drugs must be appropriately documented on the MAR and CD register and must be stored in an appropriate cabinet. The manager is to address the 30/09/06 provision of a hearing loop to assist those residents with hearing aids to ensure compliance with the Disability Discrimination Act. The manager must ensure there is evidence that residents have been consulted on social activities and that records demonstrate these are being provided to residents. The manager must ensure that all staff are fully clear on actions that must be taken following the identification or an allegation of abuse in the home. The responsible individual must 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 Disability Discrimination Act. (Outstanding from previous inspections) The manager is to advise a date for the above to be addressed. The manager must ensure that arrangements are in place to prevent infection, toxic conditions and the spread of infection at the care home. 5. OP18 13 31/08/06 6. OP22 23(2)(n) 31/08/06 7. OP26 13, 16 31/07/06 Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 33 Action is to be taken to ensure gloves and aprons are available at all times in the sluice room and laundry. To maintain effective infection control practices, hand-washing facilities need to be available in the laundry, a date to action this is required. Soap and hand drying facilities must be available in both the laundry and sluice room. The manager is to confirm that the home is operating in compliance with the Water Supply (Water Fittings) Regulations 1999. A copy of the certificate is to be forwarded to the Commission or alternatively, a date is to be confirmed for this inspection to take place. The manager is to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. To demonstrate the above, the manager is to advise when care staff have completed their NVQ II training. The manager must ensure that staff recruitment records include a completed POVA check before the person is employed to work in the home. 8. OP28 18 (1) 30/09/06 9. OP29 19 31/07/06 Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 34 10. OP33 24 11. OP35 17 Sch 4 The manager is to confirm that 30/09/06 following the receipt of quality satisfaction surveys, a report is compiled of the outcomes, which is made available to the residents. Any actions taken following comments made must be clearly demonstrated. The manager must ensure that 31/07/06 robust procedures are in place for the management of resident’s monies. 12. OP37 13. OP38 All resident pocket monies and records are to be audited and actions taken to rectify any discrepancies. 17,14, 13, The manager must take actions 24 to address record keeping in the home in areas identified. This includes records relating to staff, medication, assessments, care plans and quality monitoring. 16,13 The manager is to undertake a review of the storage of dried food in the kitchen and store room. Dried foods once opened, must be stored in appropriate containers that are pest proof. Items stored in the fridge must be appropriately labelled and dated. Any chemicals in the home must be managed in accordance with COSHH guidelines. 31/08/06 31/07/06 Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1. OP1 It is advised an organisation structure (chart) is incorporated into the Statement of Purpose so that this is fully clear to the reader. It is suggested that a sample activities programme is detailed in the Statement of Purpose to show the type of activities being provided. The frequency of resident meetings and implementation of quality questionnaires should be detailed. The fire precautions and emergency procedures should be included in the Statement of Purpose. In regard to resident reviews, this should also contain the arrangements for reviews with Social Workers and families as appropriate. The privacy and dignity policy should be contained in the Statement of Purpose. The manager should consider options available for residents to alert staff if they need them when they are using the garden. The manager is advised to ensure menus show all snacks and drinks provided and also show that a snack meal is being provided in the evening. The manager is advised to ensure that any actions taken when complaints are received are clearly documented in the complaints register as well as any computerised records that are in place so that it is clear action is being taken. The manager is advised to review duty rotas so that they are in one uniform format and show all staff designations, shifts worked and any staff completing the laundry for the home. 2. 3. 4. OP12 OP15 OP16 5. OP27 Arden House DS0000004200.V290759.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. 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