Inspection on 01/11/07 for Arden Valley Christian Nursing Home

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Valley Christian Nursing... 27/11/08

Arden Valley Christian Nursing... 03/06/08

Arden Valley Christian Nursing... 16/01/08

Arden Valley Christian Nursing... 24/04/07

Arden Valley Christian Nursing... 23/06/06

Arden Valley Christian Nursing... 13/12/05

Arden Valley Christian Nursing... 26/04/05

Arden Valley Christian Nursing... 08/09/04

Arden Valley Christian Nursing... 13/04/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

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

CARE HOMES FOR OLDER PEOPLE Arden Valley Christian Nursing Home Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR Lead Inspector Michelle McCarthy Unannounced Inspection 1st November 2007 09:30 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 Valley Christian Nursing Home DS0000004385.V346437.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 Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arden Valley Christian Nursing Home Address Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR 01789 731168 01789 731883 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) www.southerncrosshealthcare.co.uk Trinity Care Limited vacant post Care Home 48 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2007 Brief Description of the Service: Arden Valley is a purpose built home providing accommodation for 24 people with dementia and 24 people who are frail elderly. Accommodation is provided on the ground and first floor of the property. Residents from both units have access to a secluded garden at the rear of the building. Each unit provides a variety of communal living space with a light and airy conservatory area. The home is located in a rural area, which is not easily accessible without a car. There was no written information available about the cost of living in this home. The manager said it is assessed on an individual basis and the fee is agreed before people move into the home. The fees do not include newspapers, toiletries, hairdressing or private telephones. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The visit to the home was made on 1st November 2007. The lead inspector visited the home between 9.30am and 9.45pm and was joined by a second inspector between 4pm and 9.45pm. 48 people were living in the home on the day of the visit. It was the assessment of the home manager the majority of people living in the home had medium or high dependency nursing care needs. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. Care plans and monitoring records of other residents were examined randomly. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. Inspectors had the opportunity to meet most of the residents by visiting them in their rooms and spending time in the communal areas. Some of the residents found it difficult to engage in conversation due to their dementia or physical condition but were able to express their feelings with verbal and nonverbal communication, such as a simple ‘yes’ or ‘no’ answer, a nod or shake of their head or a smile or frown. There were opportunities to observe working practices and staff interaction with the people living in the home. The home manager and Southern Cross’ Operations Manager were present throughout the inspection visit. Inspectors also spoke to several nursing and care staff, the administrator, laundry assistant and activities co-ordinator. Feedback was given to the manager, deputy manager and Operations Manager at the end of the inspection visit. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Arrangements must be made to ensure prospective residents have a full assessment of their needs and abilities recorded before they move into the home. This is to make sure that prospective residents can be confident that the home can meet their needs. Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be developed and implemented when new or changed needs or risks are identified. This is to make sure people get the care they need. Records must be available to demonstrate that any form of potential restraint (such as ‘bedrails’) is used in the best interests of people living in the home and the risk of entrapment must be assessed and minimised. This is to protect people living in the home from the risk of harm from potential restraint or entrapment. Arrangements must be made to make sure that medicines are stored within the recommended temperature limit. This is to make sure medicines remain stable and effective. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 7 The home must be conducted in a manner that upholds the privacy and dignity of people living in the home. This is to promote the well being of people living in the home and give them person centred care. The personal hygiene care needs of people living in the home must be met. This is to uphold the dignity of people living in the home and maintain their well-being. Arrangements must be made to maximise the opportunities for people living in the home to engage in meaningful activity that suits their preferences and abilities. This is to promote the psychological well-being of people, prevent social isolation and enhance peoples’ quality of life. Arrangements must be made for people living in the home to be assisted to eat their meals in a sensitive and timely way that is acceptable to them. This is to ensure that people living in the home benefit from a nutritious diet and can enjoy each meal in a dignified way. Staff must be able to recognise signs of potential abuse and know the procedure to follow if an allegation or suspicion of abuse is suspected or reported. This is to protect the people living in the home from potential harm. Effective procedures must be in place to reduce the risk of infection or cross contamination so that residents are not placed at risk. This should include the way the home manages soiled laundry, the cleanliness of the sluice rooms and procedures for cleaning equipment for shared use among people living in the home. The numbers and skill mix of staff must be appropriate at all times to meet the health, welfare and social needs of people living in the home. Systems must be in place to ensure that staff do not start working in the home until satisfactory pre employment checks, including references, have been obtained. This is to ensure that the home is sure that the person employed is suitable to care for vulnerable people. Arrangements must be made for all staff to have up to date mandatory training in Manual Handling. This is to ensure that people in the home are protected from the risk of harm. A qualified and competent person must manage the home. This is so that people living in the home can be confident the home is managed efficiently and in a way that maintains their well being. Systems must be implemented to raise the standards of health and safety management within the home. This includes the prevention of infection and protection from abuse. So that people living in the home can be sure that the home is being managed in their best interests and can be confident that their health, safety and welfare is given the highest priority. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed Quality in this outcome area is adequate. The home has a procedure for assessing the needs of people before they move into the home. The procedure is not always followed so prospective residents cannot be confident that the home will be able to meet their needs. Standard 6 was not assessed because the home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that it was usual practice for a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 11 The case files of two people admitted to the home since the last key inspection was examined to assess the pre-admission assessment process. The home uses assessment booklets to record the needs and abilities of residents. One case file contained details of a pre-admission assessment that identified the needs and abilities of the individual. The information was recorded in enough detail for staff to develop preliminary care plans and allow the service to confirm they could meet this person’s needs. The pre-admission assessment booklet in the case file of another resident with dementia care needs was incomplete, containing only details of the person’s dependency level. A separate dementia care assessment booklet recorded no detail. A care plan from the person’s social worker and information from the previous care home was available but was dated on the day of this resident’s admission. This means there was not enough information for staff to develop preliminary care plans and allow the service to confirm they could meet the person’s needs before they moved into the home. Southern Cross have an organisational procedure for assessing the needs of prospective residents but the evidence illustrated that that the home does not robustly follow these procedures. This means the home cannot confirm they have the resources to met the needs of prospective residents and leaves staff without the information necessary to develop care plans. This puts people at risk of not having their needs met. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 12 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, 8, 9 and 10 were assessed. Quality in this outcome area is poor. Residents each have a plan of care and are protected from harm by the safe management of medicines. The service is failing to meet all the care needs of people living in the home. Working practices and the attitude of some staff do not uphold the dignity and privacy of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager identified that the majority of people living in the home have medium or high dependency nursing care needs; this was confirmed by observation and meeting with residents. Up to one third of people living in the home are nursed in bed. In the dementia care house in particular there are many people who have high physical needs alongside their dementia care needs. Three people living in the home were identified for case tracking. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 13 Each person had a care plan, daily records and monitoring records. Care plans were available for each of the identified needs of residents; these did not contain all of the information required to ensure that good and consistent care was given, and new needs were not always recorded. For example, one person developed a chest infection. A care plan was not developed to address this. Another person was observed to have a special textured diet at mealtimes but this need was not included in the care plan. There was evidence of monthly reviews of each care plan. The service uses risk assessments for falls, nutrition and pressure sores. Care plans are developed and implemented to reduce identified risks; for example, staff identified a high risk of developing pressure sores for a person living in the home so a care plan was developed to reduce this risk and included the use of specialist equipment and frequent repositioning of the person. Records confirm that risk assessments are reviewed monthly. Risk assessments for the safe use of bedrails are available and were seen in some case files but they are not consistently used. One person had bedrails in use and this decision was recorded in a care plan to maintain their safety. However, there was no risk assessment for the possibility of entrapment or potential for restraint. The home is therefore unable to demonstrate the safe use of bedrails for this person. Weight monitoring charts are maintained. The three examined showed that residents had maintained their weight. One person with Type 2 diabetes (non-insulin dependent) had records of weekly blood sugar checks within normal limits demonstrating that the service monitored this person’s health. The manager said that four residents currently had pressure sores. Body mapping records are used to show any tissue wounds. Photographs are held of pressure wounds and records are maintained therefore wounds are being well managed. Body mapping records for one resident recorded the person was admitted in August with some bruising. On the day following admission more bruising was recorded to the person’s wrist. One week after admission new bruising was noted to the person’s nose and forehead. Two further incidents of a skin laceration and bruising to the person’s arm are recorded in the following month. The body mapping records include no detail or cross references as to Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 14 how these injuries were sustained by this resident who has severely impaired mobility and is nursed in bed with bedrails in place. This was discussed with the manager who was not aware of these injuries. There is no evidence of referral under Adult Safeguarding Procedures to establish the cause of these injuries. The failure to respond appropriately to unexplained injuries does not safeguard people from the risk of abuse. This information is used to support the outcome judgement in the ‘Complaints and Protection’ section of this report. Evidence is available in case files to demonstrate that residents have access to external health professionals such as consultant psychiatrist, dentists, chiropodists, GPs and optician. This ensures that residents’ health care needs are met. The appearance of people living in the home during this inspection was variable. It was observed that the personal care needs of most people were met; most people looked clean, well groomed and dressed appropriately in well-laundered clothing suitable for the time of year. However, some omissions of care were evident. A resident held out their hand in greeting to the inspector at 11am during a tour of the home. The person’s fingernails and fingers were very soiled. The manager accompanying the inspector made no comment on this. The inspector returned to the dining room at 5.15pm and observed the resident at the dining table eating their evening meal. Their hand was still soiled. This means that staff had not attended to the personal hygiene needs of this person throughout the day; the person had been assisted to the dining room for two meals without having assistance to wash their hands. During a discussion with one person who was nursed in bed, the person said they were thirsty and would ‘love a cup of tea’. A beaker of orange squash was available in the room but was not within reach of the resident. Fluid intake monitoring records for this person were examined at 4.30pm and documented: • • • 8.30am tea juice fortisip 200mls 10.20am squash 200mls 12.30 squash 200mls This means this person had not had a drink for 4 hours. Information shared with us since the last key inspection raised concerns about moving and handling practice within the home. Inspectors made the following observations during this inspection visit. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 15 Staff were observed transferring residents from a chair to a wheelchair without applying the brakes on the wheelchair. This increases the risk of falls during transfer. Other moving and handling practices observed on the day of the inspection visit were safe and appropriate; for example, safe practise was observed when two care staff used a hoist to transfer a person from a wheelchair into an armchair. Staff offered the person explanation and gentle reassurance throughout the procedure. Case files contained moving and handling risk assessments and care plans for each resident to give staff direction for safe moving and handling of the person. Another hoist has been purchased in response to a requirement made at the last key inspection; staff spoken to confirmed that this has improved outcomes for residents because they do not have to wait so long to use the hoist. Moving and handling equipment (such as slide sheets, handling belts and hoist slings) for use in assisting residents on the first floor are stored at the top of a stairwell at the end of one corridor. This does not make equipment easily or quickly accessible for staff to use. The manager explained that the equipment had been moved to this location in response a suggestion made during a Social Services’ Contracts monitoring visit due to the risk of people living in the home touching the equipment and increasing the risk of cross infection. If slide sheets are for ‘shared use’ between people living in the home, this potentially increases the risk of cross infection. The systems for the management of medicines in the home were examined. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in locked treatment rooms (one upstairs and one downstairs). Treatment rooms were tidy and organised. Daily treatment room temperature recordings demonstrate that temperatures often exceed 25°C, which means we cannot be sure of the stability of the medicine. No action had been taken to reduce the room temperature. A medicines fridge is available in each treatment room with daily recordings of the temperature, which was within recommended limits. The facility for storing controlled drugs (CD) is satisfactory. There is one CD cupboard to store CDs for both floors. A controlled drug register is accurately maintained but there are two registers in use, which has the potential to cause confusion. The contents of the controlled drug cabinet were audited and were correct. Controlled drugs that were no longer in use for one resident were Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 16 stored. The home has a DOOM kit for safe disposal of these drugs but it had not been implemented. The medication of people involved in case tracking were audited and demonstrated that medicines had been accurately administered as prescribed. Medicine administration records were accurately maintained. The home has developed a daily audit of all medicines administered in their original packaging to check that they have been administered as prescribed. This good practice reduces the risk of harm from medication errors. There was no evidence that a documented protocol has been developed for the administration of medication which has been prescribed for behaviour management on a ‘when required’ basis. However, individual case files contain detailed care plans for any ‘when required’ medication prescribed for residents so that staff have clear direction about how the medicine should be given. The way the service upholds the dignity of residents was variable. Most of the staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, residents were spoken to respectfully by most staff, and addressed by their preferred names. One carer was overheard saying to a resident, ‘You are very naughty! You’re supposed to sit still!’ It is not appropriate to speak to an adult as if they were a small child. During a tour of the dementia care unit all the bedroom doors of people nursed in bed were open. It is not clear whether this was the preference of the residents or for ease of staff for monitoring. There were no records of decisions made. This compromises the privacy of people living in the home. During a tour conducted by the manager, the bedroom door of one resident nursed in bed was open and the inspector observed another resident standing by the bed fiddling with the bedclothes. It was not clear whether this visit from another resident was acceptable to the person nursed in bed. The manager did not comment on this. The inspector greeted a resident and introduced themselves. It was evident that the person had dementia care needs and did not communicate verbally with the inspector but took her hand and led her along the corridor. When the inspector asked the manager the person’s name, he said, ‘This is [name]. She doesn’t know who she is or where she is.’ This response does not demonstrate an attitude that upholds the personhood of an individual and does not uphold the dignity of the person to be described in this way, particularly within their hearing. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 17 Previous inspections dating back to 2005 report failures to understand the needs of people with dementia. This demonstrates the failure of the service to sustain any improvements implemented. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 18 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, 13, 14 and 15 were assessed. Quality in this outcome area is poor. There are limited opportunities for people living in the home to participate in meaningful and stimulating activities so their social and recreational needs are not met. This reduces the quality of life of people living in the home and increases social isolation. A varied and nourishing diet is available but there are not sufficient staff to sensitively assist people to eat their meals in a timely manner and in a way that is acceptable to them so mealtimes are not enjoyable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a full-time activities organiser who is responsible for arranging a range of activities for the benefit of residents. Planned activities arranged in the home include physical exercise, aromatherapy, hand massage, gardening, cooking and flower arranging. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 19 Detailed records are held of what activities have been arranged and who has participated. There is no evidence to suggest that the needs of people with dementia are being considered when planning activities; this is because most of the activities available require a level of concentration and memory recall that people with dementia do not always have. The activities co-ordinator said she plans ‘one to one’ sessions for around 26 residents two or three times each week. The sessions last 10-15 minutes. Evidence from observation showed that the majority of staff interaction took place during an intervention to meet a personal care need rather than a social or recreational need. With the exception of the activities co-ordinator, staff were not observed spending time with residents to support their social or recreational needs. There are not enough staff available to support people with their social, psychological or recreational needs; people living in the home spend long periods of time isolated in their rooms. Poor management in this area was referred to in our inspection report of 23rd June 2006. There is no evidence of improvement or sustaining improvement. A high proportion of residents are nursed in bed. The manager said that the home did not have sufficient specialist seating to facilitate these people getting out of bed but the organisation was reviewing the equipment and plans were in progress to order more specialist seating. Being nursed in bed restricts residents to their rooms and limits their choice and opportunities to socialise or be stimulated by a varying environment and can impact on their general health. Records showed that not all residents participate in meaningful or engaging activities. The records of one resident involved in case tracking documented the person’s participation in a daily activity on 7 occasions during the month of September and 11 occasions during the month of October. Staff have begun to compile ‘Memory Albums’ for residents, which include life histories and interests. This should assist staff in delivering ‘person-centred’ care for people living in the home. A number of tactile boards are displayed in corridors but there is no evidence to suggest that these are ever used for the benefit of residents. The environment lacks stimulation and fails to engage residents with dementia, who spend significant amounts of time with nothing to do. Most of the residents on the dementia care unit were observed to remain in their room. During this inspection visit there were a maximum of three residents observed using the lounge at any one time during the day. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 20 The home has no restrictions on visiting. The visitors’ book recorded visiting times throughout the day and evening. The inspector undertook a period of observation in the dementia care unit during the lunchtime meal service. Staff started to assist residents into the dining room for their midday meal at 12.30pm. The first resident assisted to the dining room was using a wheelchair. The carer who brought the resident to the dining room commented to her colleague that the resident needed to sit a distance from the table because ‘she’ll throw things’. The two staff made a decision to remove the tablecloth from the table to avoid this potentially challenging behaviour and allow the resident to sit at the table rather than a distance from it. It is unclear why the person was assisted to the dining room to sit at the table 20 minutes before the meal was served, particularly as staff were aware that the person could become agitated. The dining room tables were sparsely set. Tables were covered with linen tablecloths but there was no cutlery, condiments, napkins or table decoration. Food was brought to this first floor dining room from the kitchen in a heated trolley. Meals were ‘plated’ for residents when they were ready for them, so meals are hot when they are served. The choice of meal on the day of this inspection visit was beef casserole or macaroni cheese accompanied by mashed potato, swede and broccoli. The food served to each resident is the choice they have made on the day before. This is not a realistic choice for people with dementia who have a limited capacity to remember. People who required special textured diets due to swallowing problems had each part of their meal liquidised separately to make sure they could enjoy the taste of each part of their meal. However, this was then served together in a bowl or plate so the components of the meal mixed together and looked unappetising. The service has not responded to recommendations at the last key inspection to use food moulds or sectioned plates so that food is presented in a more attractive and appetising manner. Staff began to serve meals to residents at 12.50pm. The inspector walked around the dementia care unit between 1.20pm and 1.40pm and made the following observations, • Nine residents attended the dining room for their meal. Some of these people required physical assistance to eat and the remainder required monitoring and supervision. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 21 • • • Two people remained in the lounge to eat their meal. One of these people required full assistance from staff to eat. Seven residents remained in bed and needed full assistance from care staff to eat their meal. Five residents sat in their rooms to eat their meals. It was not clear from the inspector’s observation the level of assistance these people required. Four care staff and one nurse were on duty to assist residents to eat their meals. Observation of practice confirmed that there is insufficient staff on duty to sensitively assist people to eat their meals. Staff were observed standing up while feeding residents who were in bed with bedrails in place. This could give the impression of having to rush the meal rather than sitting at the bedside of a person and lowering the bedrail when assisting with eating. One carer stood up in the dining room while assisting a resident, seated at the table, to eat. Another carer offered a person seated at the dining table a spoonful of food as they walked by, and, when they declined, said ‘Don’t you want any more?’ as they removed the plate. At 1.45pm the inspector commented to a member of care staff that it’s very busy at lunchtime because lots of people need help. The carer replied, ‘It’s ok. Just four more to feed now’. The activities co-ordinator came to the dining room to offer assistance with meals at 1.50pm. One bedroom door was open and the inspector observed the resident that occupied the room sitting with their eyes closed and their head in their hands while another resident sat in a chair opposite them in the room eating a meal placed on an ‘over chair / bed’ type table. It was unclear whether the resident occupying the room had exercised any choice in inviting another resident to dine in their room or whether the other resident (previously observed to have good mobility) had removed the table and meal from the other person. These practices do not reflect the individual needs of people living in the home; it limits the ability of people to enjoy eating a meal as a pleasurable and social experience. The service must be able to demonstrate that it meets the needs of each person in a way that is acceptable to them. The operations manager said that the home has recently implemented a system to ‘stagger’ the times of meals so that more staff were available to assist people to eat their meals. There was no evidence observed during this inspection to indicate that this was successful. One staff member was observed sit at the dining table with one resident and offered sensitive assistance with their meal for 20 minutes. Another staff member sat for a similar period of time with another resident. The experience of eating a meal was pleasurable for these residents and offered them the Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 22 opportunity to engage in a one to one relationship with that staff member during their meal. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 23 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 were assessed. Quality in this outcome area is poor. Residents and their representatives can be confident that the service will respond in a timely and objective manner to written complaints but we cannot be sure that verbal or everyday complaints are listened to and acted upon. The service is failing to recognise and respond appropriately to incidents of potential abuse, which leaves people living in the home at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear written complaints procedure and all complaints are responded to within 28 days. The complaints procedure is included in the Resident Guide and is displayed within the home. Records of complaints are held and show that since the last key inspection the home has received two complaints. One relative complained that they were not informed when a resident’s named nurse left their employment. Another relative complained that a resident’s hand was soiled with faeces. Evidence was available that the manager and provider make a timely and objective response to concerns raised and the outcome is recorded. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 24 In the week before this key inspection Southern Cross were told that an ‘undercover’ journalist had been employed as a care assistant in Arden Valley during October 2007. The journalist raised concerns about poor moving and handling practice, staffing levels, inadequate assistance to help people eat, poor attention to personal care need, the cleanliness of the environment and infection control measures. The newspaper also shared the information with us. These areas of concern have been considered during this key inspection under the appropriate outcome groups. Our findings have been reflected in these sections and requirements for improvement have been made where required. Southern Cross acted appropriately by sharing information with us, Social Services Commissioning Units and Primary Care Trusts. Southern Cross have told us that they informed relatives of people living in the home and held a meeting with them, interviewed staff and offered the organisation’s Whistle Blowing policy, the organisations’ manual handling trainer has assessed training and equipment and the Infection Control Nurse Specialist came in to the home to give advice. On the day of this inspection there were no written records of the action taken in response to the allegations or outcomes of any investigation. The Operations Manager gave the inspector a verbal summary of the meeting with relatives held the day before this inspection visit. Written minutes of the meeting had not yet been prepared. The service does not record verbal complaints or concerns so we cannot be certain that anything other than a written complaint is listened to or acted upon. The service has recently implemented a communication sheet for each room where relatives or can write their concerns or comments and staff can record a written response. This could assist residents who have difficulty communicating their needs because of their physical or dementia care needs. Information shared with us by a member of the public in September 2007 raised concerns that there were not enough staff on duty to care for the high number of ‘severely poorly’ residents, difficulties communicating with staff who have poor spoken English and an incident of a person left inappropriately clothed. This information was considered during this key inspection under the appropriate outcome groups. The manager said that there have been no referrals for investigation under Adult Safeguarding procedures since the last key inspection. During discussion with the manager it was evident that he did not fully understand the procedure for referring allegations of abuse for investigation under Adult Safeguarding Procedures. The Operations Manager confirmed that Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 25 Southern Cross has an ‘On Call’ system so that the manager would have 24hour access to advice from an Operations Manager. However, there is an expectation that the manager of a service should be aware of the correct procedure to be followed. The failure to understand how to refer an allegation of abuse puts people living in the home at risk of not being protected from potential harm. There is evidence in the ‘Health and Personal Care’ section of this report that the service failed to recognise that incidents of unexplained injuries are evidence of potential abuse. The manager was unaware of the unexplained injuries, which means nursing staff had not reported them. Consequently, there was no referral under adult protection or safeguarding procedures to investigate the cause of the injuries. This leaves residents at risk of harm from abuse. Training records show that 98 of staff have attended abuse awareness training in the last 12 months. Staff had not reported unexplained injuries despite having this training, which suggests they did not recognise potential abuse. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 26 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 were assessed. Quality in this outcome area is poor. People living in the home benefit from recent redecoration and refurbishment of the home so they have comfortable surroundings to live in and enjoy, but some working practices do not protect them from the risk of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation over two floors, referred to by the manager as ‘houses’. People who have general nursing needs live on the ground floor and people with dementia care needs live on the first floor. Each floor has 24 single occupancy bedrooms with en-suite facilities. There is a dining room in the centre of each ‘house’ and a lounge at either end. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 27 A programme of refurbishment of the communal areas is in progress. The corridors in the dementia house were being redecorated in the day of this visit. The ground floor dining room has recently been redecorated and provides a bright and airy environment. The ground floor lounges were cosy and homely. Armchairs and the carpet in one of the first floor lounges were stained. On the day of this visit the corridor on the first floor was being redecorated. This created some noise and disruption for residents. It is not clear why a decision was made to decorate both ends of the corridor at once. In view of the small numbers of people seen using the lounges it may have demonstrated better insight and planning to decorate one end at a time to reduce the disruption to residents. The quality of the furnishings and fittings in residents’ rooms varied but were generally good. Call systems in rooms are accessible to residents. In one of the rooms viewed hard vinyl flooring is used as an alternative to fitted carpet; this gives the room an institutionalised, clinical feel. Some residents had taken the opportunity to personalise their room with some of their own belongings, such as quilt covers, cushions, ornaments and photographs. This identified these rooms as ‘belonging’ to that person. Room temperature records were maintained in response to a requirement made at the last key inspection to make sure temperatures did not rise to levels that might be detrimental to residents. This helps to makes sure people living in the home have a comfortable environment to live in. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, profiling beds, accessible showers and moving and handling equipment including hoists. A range of pressure relieving equipment, including specialised ‘air’ mattresses are available. Evidence in the ‘Daily Life and Social Activities’ section of this report demonstrates that the home has insufficient specialist seating for residents, which limits their opportunities to socialise or experience a varying environment. The manager said that domestic cleaning staff have been reorganised so that there is a member of cleaning staff on duty daily on each floor and an identified laundry assistant. Cleaning staff sign records to document when an area has been cleaned but there was no information or schedule to determine what level of cleaning was involved. For example, whether a room is vacuumed, damp dusted, showerheads de-scaled or floors mopped. On the day of this inspection visit the deputy manager was working supernumerary but was vacuuming one of the corridors. When asked why, she said that she was ‘helping out the domestic’. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 28 Communal areas and bedrooms viewed looked clean. There were no unpleasant odours in the home. The inspector visited the laundry room before lunch. A member of care staff was working an overtime shift as the laundry assistant. It was established that one of the two commercial washing machines had broken down two weeks ago, it had been removed and was due to be replaced today. Despite being without one of the washing machines the laundry room was fairly organised with people’s belongings in clearly marked boxes. The assistant said she had ‘helped get it organised in here, it’s much better organised than it was but it’s starting to get bad again because we haven’t got the second machine.’ Hand washing facilities and protective clothing was available. Alginate bags were in use for soiled laundry to minimise handling and reduce the risk of infection. When the inspector returned to the laundry room just after 8pm there were five overflowing buckets of unsorted laundry. The manager explained that ‘the night staff will do it, they’ve been having to help out with the backlog of laundry since the washing machine broke down’. The inspector asked if staffing levels had been reviewed to reflect this increased workload of non-caring duties but was told it had not. Two sluice rooms are available on each floor and have macerators installed (these break up and dispose of cardboard bed pans). There is no sluicing disinfector available in the home. The manager said that paper products were used for bedpans, lining commodes or male urinals. However, plastic urinals were available in one of the sluice rooms. It could not be determined why these were available, whether they had been used or how they were sterilised between use. The inspector asked the manager how the plastic urinals, plastic bases for the cardboard bedpans and commode chairs were cleaned; the manager said he did not know which indicates there is no clear strategy for the cleaning and disinfecting of these items. Sluice rooms were untidy. A soiled seat cushion from an armchair was stored in one of the sluice rooms. Alcohol hand rub is available in communal areas throughout the home to minimise cross infection. However, it is also accessible to people living in the home and could present a risk of harm from inappropriate use by people with impaired understanding. This had not been considered using a risk assessment strategy. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 29 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, 28, 29 and 30 were assessed. Quality in this outcome area is poor. The home does not have sufficient staff on duty to meet the needs of the people living in the home in a way that is acceptable to them. Recruitment procedures do not protect residents from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that the usual staffing complement for the home is Ground Floor (General Nursing) Registered Nurse Care Staff Registered Nurse Care Staff First Floor (Dementia Care) Registered Nurse Care staff Registered Nurse Care Staff 8am – 8pm 8pm – 8am 1 4 1 1 1 4 1 2 The manager said that the number of care staff on duty between 8am – 8pm on the ground floor had recently been increased from three to four. Staff Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 30 confirmed that this had assisted them in meeting the needs of residents. Examination of the staff duty rota confirmed the staff complement. The manager’s full time hours are supernumerary. The manager said he works ‘on the floor’ if there is unplanned absence such as sickness but this has been necessary on only five occasions in the last 12 months. There are ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. The inspector was told • • • • • • The home employs an administrator for 30 hours each week The kitchen is staffed between 7am and 6.30pm every day of the week. The laundry is staffed by a laundry assistant for 8 hours each weekday and 5 hours a day over the weekend There is one member of domestic (cleaning) staff on each floor for 8 hours each day. There are two domestic cleaning staff on duty 7-day of the week, working 5 hours each. A maintenance person is employed for 24 hours each week. The manager said that the staffing levels ‘were in line with the Commission’s (our) recommendations’. It was discussed that we do not ‘set’ staffing levels, but it is the responsibility of the provider to make sure there are sufficient competent staff on duty to meet the needs of residents. In the ‘Environment’ section of this report there is evidence that night care staff had undertaken laundry duties over the past two weeks. The manager did not review the staffing complement to reflect how this increased workload impacted on the ability of staff to meet the needs of residents. It is difficult to determine whether the examples of failing to meet the needs of people living in the home included in the ‘Health and Personal Care’ section of this report are due to insufficient number of staff, a lack of training and/or a lack of direction and supervision of staff. Evidence in the ‘Daily Life and Social Activities’ section of this report indicates that there are not always enough staff on duty to meet the needs of people in a way that is acceptable to them, particularly during mealtimes. There are not enough staff available to support people with their social, psychological or recreational needs; people living in the home spend long periods of time isolated in their rooms. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 31 Most staff interaction with residents takes place during a task to meet a physical need. With the exception of the activities co-ordinator, staff were not observed spending time with residents to support their social or recreational needs. This was discussed with the manager and Operations Manager who expressed the opinion that staff may feel that it was more important that they were ‘seen to be doing things’ because an inspector was present. It is the responsibility of the manager and provider to make sure staff are aware of the importance of meeting the social and psychological needs of people living in the home to enhance their quality of life. The needs of people living in the home are met in a task orientated rather than person centred manner. Two nursing staff discussed the staffing levels and felt ‘there are enough staff to make sure everything gets done.’ Training records show that seven out of twenty three care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. This includes • Four care staff with NVQ level two • Three staff with overseas healthcare qualifications, which have been verified as comparable to a UK qualification at NVQ level two or above. There was evidence of this verification in staff files. 30 of care staff in the home are qualified at NVQ level two or above which falls below the National Minimum Standard for 50 of care staff to have this qualification. A further four care staff have completed the course and are awaiting verification of their award and five staff are scheduled to be enrolled in the coming week. The service has complied with the requirement to increase the number of staff qualified to NVQ level two or equivalent so that residents benefit from having their needs met by staff who are appropriately experienced and qualified. The personnel files of two recently recruited staff were examined. One file contained evidence that a satisfactory Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) checks were obtained before the person started work in the home. The references for this person were not from the referees named on their application form, were addressed ‘To Whom it may Concern’ and were not verified as authentic. The second file contained evidence that CRB check had been applied for and a satisfactory PoVA check was obtained before the person started working in the home. No evidence was available to confirm the person had been supervised for the eight-day period before receipt of a satisfactory CRB. This file contained one written reference and one unconfirmed telephone reference. The failure to maintain robust pre employment checks does not safeguard the people living in the home from the risk of abuse. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 32 A training matrix is held and used to record staff training and to identify any gaps in learning. Records demonstrate that staff have access to mandatory training in food hygiene, fire safety, abuse awareness, infection control, nutrition and moving and handling. Records show that 74 of staff have had manual handling training, which means that 26 of staff do not have up to date training. This puts people at risk of harm from incorrect manual handling. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 33 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, 32, 33, 35, and 38 were assessed. Quality in this outcome area is poor. The home is not well managed and this has resulted in the failure to sustain improved outcomes for the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home manager is a Registered Mental Nurse (RMN). He has been in post for a year. He is awaiting the outcome of his application for registration with us. The decision to register him was deferred until after the inspection. The organisation’s Operations Manager for this service spends two days each week in the home to support and supervise the manager. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 34 The provider returned a satisfactory Improvement Plan in response to the requirements made at the last key inspection. Six of the nine requirements made at the last inspection have been met. Although this shows the provider has taken action to make improvement, it is evident from the information contained in this report that the service has failed to sustain improvement to other outcomes for the people living in the home. A ‘Satisfaction Survey’ was used to seek the opinion of the people who live at this service and their relatives. 30 returned the survey forms. Evidence was available that the responses were analysed, published and action plans developed for points raised. Monthly relatives meetings have been implemented. Minutes of the 3rd October meeting were available. The home manager completes an organisational audit system for monitoring working practices and the quality of care delivered to people living in the home on a bi-monthly basis and is checked for compliance by the Operational Manager. The outcome of the manager’s most recent audit was 91 which would indicate a ‘Good’ service indicating that the organisation’s own audit system failed to identify the poor outcomes for people living in the home that are evidenced in this report. We took enforcement action against the provider for their failure to return an Annual Quality Assurance Audit to us. A statutory Notice was issued on 14th September and was complied with in the timescale set. The service has a system for managing residents’ personal monies. Their money is deposited into a bank account and a ‘float’ and chequebook is held in the home so that residents can access their money when they want it. Account sheets are held electronically to record income and expenditure. On the evening of this inspection visit the manager was unable to access the account sheets. This means that although people could have access to their money, the service would be unable to provide an individual statement to determine the amount of money available for a person to ‘withdraw’ or demonstrate income and expenditure activity. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, labels on hoists indicate they were checked in May 2007, labels on portable electrical appliances indicate they were checked in July 2007. Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 2 X X 1 Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 36 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 OP3 Regulation 14 Requirement Arrangements must be made to ensure prospective residents have a full assessment of their needs and abilities recorded before they move into the home. This is to make sure that prospective residents can be confident that the home can meet their needs. 2 OP7 15 Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be developed and implemented when new or changed needs or risks are identified. This is to make sure people get the care they need. 3 OP8 13 Records must be available to demonstrate that any form of potential restraint (such as ‘bedrails’) are used in the best interests of people living in the DS0000004385.V346437.R01.S.doc Timescale for action 31/12/07 31/12/07 04/12/07 Arden Valley Christian Nursing Home Version 5.2 Page 37 home and the risk of entrapment must be assessed and minimised This is to protect people living in the home from the risk of harm from potential restraint or entrapment. 4 OP9 13 Arrangements must be made to make sure that medicines are stored within the recommended temperature limit. This is to make sure medicines remain stable and effective. 5 OP10 12 The home must be conducted in a manner that upholds the privacy and dignity of people living in the home. This is to promote the well being of people living in the home and give them person centred care. 6 OP10 12 The personal hygiene care needs of people living in the home must be met. This is to uphold the dignity of people living in the home and maintain their well-being. 7 OP12 12 Arrangements must be made to maximise the opportunities for people to interact socially, reducing isolation and behaviours associated with this. This is to promote the psychological well-being of people, prevent social isolation and enhance peoples’ quality of life. Arrangements must be made for people living in the home to be assisted to eat their meals in a sensitive and timely way that is DS0000004385.V346437.R01.S.doc 31/12/07 31/12/07 31/12/07 31/12/07 8 OP15 12 31/12/07 Arden Valley Christian Nursing Home Version 5.2 Page 38 acceptable to them. This is to ensure that people living in the home benefit from a nutritious diet and can enjoy each meal in a dignified way. 9 OP18 13 Staff must be able to recognise signs of potential abuse and know the procedure to follow if an allegation or suspicion of abuse is suspected or reported. This is to protect the people living in the home from potential harm. 10 OP26 13 Effective procedures must be in place to reduce the risk of infection or cross contamination so that residents are not placed at risk. This should include the way the home manages soiled laundry, the cleanliness of the sluice rooms and procedures for cleaning equipment for shared use among people living in the home. This is outstanding from the last inspection and has not been complied with in the timescale of 26/05/07. 11 OP27 18 The numbers and skill mix of 31/12/07 staff must be appropriate at all times to meet the health, welfare and social needs of people living in the home. This is to make sure there are sufficient competent staff on duty to meet the needs of people living in the home. 12 OP29 19 Procedures related to employment, such as satisfactory references and DS0000004385.V346437.R01.S.doc 04/12/07 02/11/07 31/12/07 Arden Valley Christian Nursing Home Version 5.2 Page 39 supervision on employment, must be followed. This is to ensure that people living in the home are protected from the risk of abuse. 13 OP30 18 Systems must be in place to ensure staff follow the correct procedures for manual handling. This is to ensure that people in the home are protected from the risk of harm. The home must be conducted in a manner, which promotes the health, welfare and social needs of people living in the home in a way that is acceptable to them. This is to promote positive outcomes and enhance the quality of life of people living in the home. 15 OP38 13 Systems must be implemented to raise the standards of health and safety management within the home. This includes the prevention of infection and protection from abuse. So that people living in the home can be sure that the home is being managed in their best interests and can be confident that their health, safety and welfare is given the highest priority. This is outstanding from the last inspection and has not been complied with in the timescale of 26/05/07. 04/12/07 31/12/07 14 OP32 12 31/12/07 Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Information held on daily records should confirm in more detail whether the care provided is as agreed on the care plan. Monitoring records should be accurately maintained to demonstrate the needs of people living in the home are met. 2 OP12 A planned programme of person centred activities for people with dementia or other cognitive impairments should be introduced so that residents have opportunity to maintain life skills and benefit form having quality care that reflects their individual needs. Residents should be consulted about a programme of activities that takes into account individual and group needs. Details of planned activities should be displayed in the home so that residents are aware of what is planned for the day and can plan their time accordingly. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. 3 OP16 The home should be able to demonstrate that they respond to verbal complaints or concerns so that people can be confident their concerns are listened to and acted upon. The provision of specialist seating should be improved to give people more choice and opportunity about how they spend their day. Systems for monitoring the quality of service delivered by the home should be reviewed so people living in the home can be sure it accurately identifies where improvement is necessary. Accurate accounts of personal monies held for safekeeping should be available for people. DS0000004385.V346437.R01.S.doc Version 5.2 Page 41 4 OP19 5 OP33 6 OP35 Arden Valley Christian Nursing Home Arden Valley Christian Nursing Home DS0000004385.V346437.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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