Inspection on 29/11/06 for Arden House Nursing Home

This inspection was carried out on 29th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arden House Nursing Home 19/11/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Arden House Nursing Home 31 Upper Highway Hunton Bridge Kings Langley Hertfordshire WD4 8PP Lead Inspector Hazel Wynn Key Unannounced Inspection 29th November 2006 10:00 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 Nursing Home DS0000067713.V321945.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 Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arden House Nursing Home Address 31 Upper Highway Hunton Bridge Kings Langley Hertfordshire WD4 8PP 01923 262157 01923 267137 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) Lower Green Limited Alexander Lancelot Banson-Idun Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22), Terminally ill (2) of places Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Arden House is an extended Edwardian House in a residential area of Hunton Bridge and provides accommodation. The home is slightly set back from the road. A small forecourt provides access to the home with limited off road parking. There is a bus service that stops directly outside the home. Residents are accommodated on the ground and first floor. Lift access is provided to the first floor. There is a single storey extension to the rear of the building. Residents are accommodated in 14 single rooms, two of which have en-suite provision and 4 double rooms. The L-shaped day area is used as a lounge and dining area. Assisted bathing and toilet facilities are provided. Arden House has been a Nursing home for many years but does not fully meet the current enhanced requirements for communal space for homes registered from 1 April 2002; the home changed proprietorship in 2006 and the new proprietor is looking at providing additional communal space via a conservatory. The statement of purpose, service user guide and previous CSCI inspection reports are available at the mangers office at Arden House (a copy of the service users guide will be provided to prospective service users by the home) CSCI inspection reports are also available on the CSCI web site. The fee range is £475 - £700. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 29th November 2006 over one day. One inspector from the CSCI conducted the inspection process and visited the home. Time was spent prior to the inspection in reviewing all information received about Arden House since the last inspection to support an inspection plan for the actual site visit. The majority of the inspectors visit time, to the home, was spent observing and talking to residents and staff. Some time was also spent looking at records and care plans, and the results of the inspection were discussed with the proprietor. Six service users, three members of care staff and a relative were met and spoken with; the service users and the relative provided good feedback during the visit. This was generally a positive inspection, and the majority of the standards were met or partially met. Recommendations were made to review the frequency of formal supervision sessions, and to complete all paperwork supporting the care plans. What the service does well: What has improved since the last inspection? Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 6 The home was re-registered under new proprietorship earlier this year and this was the first inspection following this registration. What they could do better: 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 Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3: (Standard 6 is not applicable to Arden House.) An up to date statement of purpose and service user guide is in place. The home carries out a comprehensive assessment of the needs of the service users prior to an offer of placement. The home does not provide intermediate care. The quality in this outcome group is excellent; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: The service was registered in 2006 following a change in the proprietor. As part of the registration process a Statement of Purpose and Service User Guide was produced and the information within these documents remain current. Service users or a relative on their behalf are encouraged to visit the home prior to accepting placement. Prospective service users are fully encouraged Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 9 to ensure the home is right for them through the assessment process, discussions about their needs and how these can be met. A full initial assessment is completed prior to the offer of a placement to ensure that the home is able to meet the needs of the service user; the assessment information is used to compile the initial care plan. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 10 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): Standards 7 – 10: The care plans contained health, personal and social care needs of the individual service user and health care needs appeared to be fully met. Medication was being appropriately managed. Service users were being treated with dignity and respect and their right to privacy was observed as intact. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were closely examined and these contained the assessed health, personal and social care needs of the individuals the plans related to. The care plans were clear and provided guidance for staff to consistently to meet care needs. One of the care plans had been reviewed with regard to minimising the risk of the bed rail protector being worked loose by a resident and leaving the hard rail exposed and able to cause injury. A recommendation was made that progress notes should contain only positive comments and highlighted a training need. Also a ‘tick sheet’ used as a front index needed to be completed if it was to serve a positive purpose. The GP monitors the Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 11 service users health progress, calling weekly as a routine visit and individually on referral. A positive approach was being implemented to support the service user with a swallowing reflex problem. Service users spoken with said, “I am well cared for, it’s a good home and I feel my dignity is intact, staff are respectful”. One of the service users said “the staff are very kind and the food is good” another service user said “ the staff are so very good and they keep it all very clean, oh yes, they show us respect. I would love to be more independent but the staff have to help me but they always communicate well with me, that’s about protecting my dignity, I think – don’t you?” (the service user’s first language was not English but the staff use their communication skills to ensure good communication). A relative met briefly with the inspector and stated that he was happy with the service and care and had no issues at all to raise and liked the way that the service user’s choice to remain in their own room is honoured if they preferred to keep to themselves. Medication was observed to be well managed and stored. Medication had been dated on opening and controlled medication was also well managed and securely stored; this was audited as part of inspection process and was easily reconciled; records were transparent and accurate. Medication records were well maintained, clear and with no gaps in recording. The medications received and returned files were observed to be well maintained. Relevant information relating to medication in use was readily available to provide information for staff dealing with medicines. Policies and procedures are in place for service users who could self medicate. Service users spoken with stated that they were happy with their care, and they were treated with dignity and respect by staff and that they felt that their right to privacy was upheld. During the inspection, staff were observed to be supporting service users in a meaningful, friendly and professional manner. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 12 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): Standards 12 – 15: Service users are satisfied with plans to improve activities and improvements already made to the social setting; their religious and cultural needs are catered for. Contact with family/friends/representatives and the local community is maintained and encouragement and support is given to help service users maintain choice and control over their lives. Service users enjoy a wholesome and balanced diet and dining arrangements have flexibility. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector met with the proprietor who stated that he is currently looking at resources to further improve efforts to support people who have dementia care needs. The manager is looking to extend the part-time activities co-ordinator’s hours to five days a week; this was in response to a review of the activities provision alongside service users and relatives and the outcome of that review identified that there was a need to increase the provision. The inclusion of service users and relatives in looking at how things could be better is an excellent demonstration of the home being run in the best interests of the service users. It is envisaged that the current activities provision will be greatly increased in the short term with action already taken. Service users said that local clergy visit to provide for their religious needs. Family/friends Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 13 and representatives are free to visit in accordance with the service users individual wishes and a group of relatives arrived for a relatives meeting during this inspection. Several service users confirmed that their relatives and friends visit frequently at varying times and the visitors’ book shows a constant flow of visitors. Since the last inspection, a dining area has been provided for those who prefer to dine with others at the dining table and this has proved to be a great benefit to some service users. Menus and dining times have also been reviewed to provide greater choice, service users said this is in response to their wishes and has improved mealtimes and choice. The mealtime arrangements and menu were reviewed with service users and their relatives. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18: Complaints would be listened to, taken seriously and would be acted upon. Service users legal rights are protected and service users are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users stated they would be comfortable in lodging a complaint if they needed to complain. There had been no official complaints from serviced users or relatives since the home became registered under new proprietor earlier this year. Staff complained about the behaviour of another member of staff and an investigation was conducted; the member of staff has since resigned and the staff stated that the team is now very cohesive and supportive of one another. A review had taken place regarding the risk assessment for a bed rail, which had caused bruising to the face of a service user. The reviewed risk assessment ensures that the risk of the bed rail cover becoming loose is minimised. The registered manager is a trained trainer and has provided training for staff in abuse awareness. An abuse awareness policy, procedure and guidelines is in place at the home. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 15 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): Standards 19 and 26 The service users are assured of a safe well-maintained environment. The home is clean, fresh and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Various improvements have been made to the home since registration earlier this year, these include: general maintenance, the provision of a dining area, door plates to personalise rooms and to support service users to more readily recognise their own room, renewal of some soft furnishings and the entrance hall had been upgraded. Some new over bed/chair tables have been purchased for service users who would benefit from these. Three of the service users rooms have been redecorated since registration this year. Wall fans have been added to help keep service users comfortable in hot weather. A choice of bedding has been made available and new bathroom cabinets have been purchased. New bedding and towels have been purchased. All service users rooms have paper towel dispensers. The kitchen has a monthly deep Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 16 clean programme. All rooms have ‘Dorguards’ to assist the safety of service users in the event of a fire. A rolling programme has been put in place for the update of equipment, e.g. commodes and bed rail bumpers. Future plans have been drawn up to provide further improvements to the environment. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 17 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): Standards 27 – 30: There are adequate staff to meet the health and personal care needs of service users. Staff are trained to provide a safe and competent service to service users. The home’s policies, procedures and practices regarding recruitment provide for the support and protection of service users. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection there were adequate staff on duty and the month’s rota reflected that adequate cover is maintained. Evidence was gained from talking to staff and looking at training records that training has been provided to staff; Registered Nurses were updating their training with an intense medication-training programme. National Vocational training progress had been made, Dementia care training had been provided with one staff completing a course and others had undertaken this. All mandatory training updates had been provided, e.g., fire safety, food hygiene, moving and handling training. The home’s policies and procedures are up to date, having been produced at the point of the registration process earlier this year; the policies and procedures in place provide safeguards for service users. During this inspection staff were observed to be skilled and competent in managing their duties and providing support to service users. On several Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 18 occasions staff were observed to reposition service users to maintain their safety and comfort and they appeared to be very vigilant throughout the inspection. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 19 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): Standards 31, 33, 35, 36 and 38 The manager of the home is a fit person who is experienced and competent. Every endeavour is made to run the home in the best interests of the service users. The financial interests of service users are safeguarded. The formal supervision of staff needs to be increased to meet national minimum standard. Service users and staff are protected by the home’s health, safety and welfare policies, procedures and practices. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home was registered by the Commission for Social Care Inspection earlier this year and as part of this process was deemed fit to be in charge of the home. The registered manager has several years experience of management in care. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 20 Service users and relatives meetings are held very regularly and are geared to the service users being at the centre of decision-making. Earlier in this report we have documented that the activity coordinator’s hours have been increased to provide more activities as a result of service users and their relatives taking part in reviews of the service. The inclusion of service users and relatives in looking at how things could be better is an excellent demonstration of the how the home is being run in the best interests of the service users. The proprietor explained that service users relatives provide support to service users regarding financial matters; the home does not have any involvement other than invoicing the service users for fees and costs; generally, the invoices are settled by a family member of the individual service user. Formal supervision is provided for staff, the frequency of this should to be improved to provide a minimum of 6 one to one sessions per year. Formal supervision provides an opportunity to support staff and identify any gaps in training or other needs. The staff training programme and records together with the policies, procedures and practices of the home, provide safeguards for the health safety and welfare of the service users and staff. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 21 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 OP36 Good Practice Recommendations All paperwork contained in the care plan should be completed; this refers to the index sheet at the front of the care plan. Review supervision arrangements so that all staff receive formal supervision at a minimum frequency during a 12 month period. Arden House Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Nursing Home DS0000067713.V321945.R01.S.doc Version 5.2 Page 24 - 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. 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