Inspection on 16/01/08 for Arden Valley Christian Nursing Home

This inspection was carried out on 16th January 2008.

CSCI found this care home to be providing an Adequate service.

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 Valley Christian Nursing... 27/11/08

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

Arden Valley Christian Nursing... 01/11/07

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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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 Key Unannounced Inspection 16th January 2008 09:00 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 Valley Christian Nursing Home DS0000004385.V358305.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.V358305.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.V358305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 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.V358305.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 that 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. Our inspection on 1st November 2007 raised concerns about the ability of the service to identify and minimise potential risks to the health and well being of people using the service. We issued a Statutory Notice on 21st November 2007 requiring the provider to • • • Investigate the cause of any injuries sustained by service users and hold a record of the outcome. Carry out a risk assessment where service users are considered to be at risk of harm or injury (to include choking) and use the outcome to inform care planning. Carry out risk assessments when bed rails are to be fitted. We looked for evidence of compliance with the Statutory Notice during this inspection. The inspection visit took place on 16th January 2008 between 10.30am and 7.30pm. 41 people were living in the home during the inspection visit. It was the assessment of the home manager that the majority of people living in the home had high dependency nursing care needs. Documentation maintained in the home was examined including staff files, training records and records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspector had the opportunity to meet several residents by visiting them in their rooms, spending time in the communal lounges and talking to some of them about their experience of living in the home. There were opportunities to observe working practices and staff interaction with the people living in the home. 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 Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 6 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. Feedback was given to the Regional Director, Operations Manager and Home Manager at the end of the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? Improvements are evident in each of the outcome groups. All the requirements made during the last inspection have been met. The service has complied with the Statutory Requirement Notice issued in November 2007. The pre-admission assessment procedure has been reviewed which should mean that people who are considering moving into the home will benefit from having their care needs assessed so that they can be sure the home can meet their needs. Care plans are 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 are developed and implemented when new or changed needs or risks are identified. This should make sure people get the care they need. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 7 Records are available to demonstrate that any form of potential restraint (such as ‘bedrails’) are used in the best interests of people living in the home and the risk of entrapment is assessed and minimised. This should protect people living in the home from the risk of harm from potential restraint or entrapment. Medicines are stored within the recommended temperature limit to ensure medicines remain stable and effective. The home is conducted in a manner that upholds the privacy and dignity of people living in the home. This should promote the well being of people living in the home. The personal hygiene care needs of people living in the home are met. This should uphold the dignity of people living in the home and maintain their wellbeing. The opportunities for people to interact socially and participate in meaningful activity has improved. This should promote the psychological well-being of people, prevent social isolation and enhance peoples’ quality of life. Arrangements have been 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 should ensure that people living in the home benefit from a nutritious diet and can enjoy each meal in a dignified way. Staff recognise signs of potential abuse and know the procedure to follow if an allegation or suspicion of abuse is suspected or reported. This should protect the people living in the home from potential harm. Effective procedures are in place to reduce the risk of infection or cross contamination so that residents are not placed at risk. This includes 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 of staff on duty have been reviewed and increased to meet the health, welfare and social needs of people living in the home. People living in the home are protected by robust recruitment procedures. Systems are in place to make sure staff follow the correct procedures for manual handling. This should make sure that people in the home are protected from the risk of harm. The home is 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 should promote positive outcomes and enhance the quality of life of people living in the home. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 8 Systems have been implemented to raise the standards of health and safety management within the home. This includes the prevention of infection and protection from abuse. This should mean that people living in the home can be sure that the home is being managed in their best interests. 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 Valley Christian Nursing Home DS0000004385.V358305.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.V358305.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 review of the pre-admission assessment procedure should mean that people who are considering moving into the home will benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no admissions to the home since the last inspection of the service so we were unable to see documentation relating to assessing peoples’ needs before they move into the home. The manager and operations manager discussed that the procedure for assessing the needs of prospective residents has been reviewed since the last inspection. Pre admission assessments will be undertaken by the manager Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 11 only, and documented to confirm that each person’s identified needs can be met in the home. This should ensure that people who are considering moving into the home will benefit from having their care needs assessed so that they can be sure the home can meet their needs. This will be further evidenced by future inspection. Arden Valley Christian Nursing Home DS0000004385.V358305.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 good. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Care plans are available for each of the identified needs of residents and staff recognise and respond to changes in the health and well being of people living in the home. This means that people living in the home can be confident their health and personal care needs will be met. 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. In the dementia care house in particular there are many people who have high physical needs alongside their dementia care needs. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 13 Evidence was available that requirements made at the last inspection relating to this outcome group were met. Observations found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met. The manager developed and implemented a ‘checklist’ to monitor at frequent intervals during the day that people’s personal care needs were met. The case files of three people identified for case tracking were examined. The manager and operations manager told the inspector that the case files of people living in the home had been reviewed since the last inspection. Case files were standardised, well organised and documented detailed information about each person. This should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were available for each of the identified needs of each person and supplied staff with the information needed to make sure the person’s needs were met safely and appropriately. For example, one person was identified as having diabetes and a care plan was developed to monitor this person’s blood sugar levels. Monitoring records were available to confirm that staff followed the instructions in the care plan. Two people identified as having swallowing difficulties and risk of choking had care plans developed to address their needs which included the provision of thickened fluids and special textured diets. This minimises the risk of harm for these individuals and is evidence of compliance with the Statutory Noticing requiring the provider to carry out a risk assessment where service users are considered to be at risk of harm/injury (to include choking) and use the outcome to inform care planning. The service uses risk assessments for falls, nutrition and pressure sores, which are reviewed at least monthly. When the outcome of the assessment identifies an increased risk, action is implemented to minimise the risk. For example, one person was identified as having a high risk of developing pressure sores and a care plan was developed to reduce the risk. This included the provision of a specialist pressure relieving mattress, which was observed in use for this person. The case file of one person observed to have bedrails in place on their bed contained a risk assessment for their use and documented the decision to use the bedrails in the best interests of the person. This means that staff had given Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 14 consideration to the best way of maintaining this person’s safety and is evidence of compliance with the Statutory Noticing requiring the provider to carry out risk assessments where bedrails are to be fitted. Each person’s case file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have appropriate referral and access to Health Care professionals such as the GP, Community Psychiatric Nurse and Tissue Viability Nurse Specialist. For example, staff observed that one person with very complex needs had developed pressure sores and made a referral to the tissue viability nurse specialist. The specialist advice was recorded in the case file along with wound assessment charts and photographs to monitor the progress of the wound. This means that staff took appropriate action to maintain this person’s health and prevent further deterioration. Safe practised was observed when two care staff used a hoist to transfer a person from an armchair into a wheelchair. 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. Staff have benefited from the organisation’s back care specialist working alongside them to review practice since the last inspection. A system has been implemented to make sure staff know the assistance each person needs to help them move; an information sheet is available in each person’s room with instructions for their safe moving and handling. 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 do not exceed 25°C which means that medicines are stored within recommended temperature limits to maintain their stability. A medicines fridge is available in each treatment room with daily recordings of the temperature, which was within recommended limits. Insulin for one person’s use was stored in the fridge without the original packaging and dispensing label so cannot be certain who it is prescribed for. It is recommended that medicines are stored in the labelled packaging in which they were dispensed so that staff can be certain who they are prescribed for. The facility for storing controlled drugs (CD) is satisfactory. There is one CD cupboard to store CDs for both floors. The contents of the controlled drug cabinet were audited against the controlled drug register and were correct. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 15 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. Staff were administering ‘Brewers Yeast’ (a vitamin type supplement) to one person; this had not been prescribed by the GP. Staff said it had been discussed and with the GP because it was the person’s preference to continue taking the supplement but there was no documented evidence of this available with the medicine administration records (MAR). The ‘Brewers Yeast’ tablets had been dispensed from their original packaging into another bottle with a handwritten label so staff administering these tablets cannot be certain what they are. It is recommended that evidence of discussion and agreement of the GP is documented and retained alongside MAR sheets and the tablets are administered from original packaging so staff can be clear of their suitability for administration. 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. 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. Staff were sensitive to the psychological well being of people with dementia care needs. For example, one person was tearful and agitated. Staff engaged this resident in conversation to try and establish the cause of the distress; when the person was unable to communicate any particular reason, staff offered gentle reassurance and sat with her to alleviate her anxiety. This means that staff took appropriate action to relieve the distress and anxiety this person was experiencing which should improve their quality of life. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. The home has a planned programme of activities led by an activities coordinator so that some of the people in the home can maintain their enduring interests. People benefit from a nutritious and varied diet and have sensitive assistance to eat their meals. 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. The activities programme has been reviewed since the last inspection to provide daily activity sessions in each unit of the home that reflects the interests of people living there and considers their ability to participate. For example, the programme for the dementia care unit included • Monday - A morning session of individual activities reflecting personal hobbies and interests and an afternoon session of exercise DS0000004385.V358305.R01.S.doc Version 5.2 Page 17 Arden Valley Christian Nursing Home • • • • Tuesday – Aromatherapy Wednesday – Individual activities and music Thursday – Church Service Friday – Individual activities or mini ‘Snozelen’ with a Residents meeting scheduled for 2pm Outside entertainers are regularly scheduled; January’s events included a Reminiscence session and a Magic Show. Other planned activities arranged in the home include physical exercise, aromatherapy, hand massage, gardening, cooking and flower arranging. The activities organiser attended a one day course in December 2007 around activities for older people and people with dementia care needs. One outcome of this is that she has started recording the level of engagement during her group sessions. This good practice should assist the activities co-ordinator to make judgements about whether residents find activities meaningful and stimulating. Detailed records are held of what activities have been arranged and who has participated. Specialist seating has been purchased since the last inspection and have been allocated to people identified as needing them. Staff are unable to use them at present as they are awaiting delivery of matching footstools. This provision should increase the opportunity for people with physical disability to sit out of bed and access other parts of the home which should improve their opportunities to socialise and be stimulated by a varying environment. Decorating work is ongoing throughout the home and on the dementia care unit an artist has created scenes on the walls of some of the corridors to provide a more stimulating environment for people living there. For example, one scene appears to be market stalls and another depicts ‘washday’. A number of tactile objects related to each scene are displayed; such as fruits on the market stalls and a clothes line with washing pegged to it on ‘washday’. The home has no restrictions on visiting. The visitors’ book recorded visiting times throughout the day and evening. The inspector spoke to one relative who confirmed she could visit when she wanted and was always made welcome. The inspector was present during the midday and evening meal service. Staff began to serve meals to residents at 12.45pm. The inspector undertook a period of observation in the dementia care unit during the lunchtime meal service and made the following observations; • Eight residents attended the dining room for their meal. Some of these people required physical assistance to eat and the remainder required monitoring and supervision. DS0000004385.V358305.R01.S.doc Version 5.2 Page 18 Arden Valley Christian Nursing Home • • • Four people remained in the lounge to eat their meal. One of these people required full assistance from staff to eat. Six residents remained in bed and needed full assistance from care staff to eat their meal. Three residents sat in their rooms to eat their meals. One staff member was observed sitting beside one resident and chatting while they helped the person eat their meal. Five care staff, one nurse and the activities co-ordinator were available to assist residents to eat their meals. A dining room assistant post has been created to make sure there is sufficient staff to assist people to eat their meals. The person appointed to this post has recently left the position and management are actively recruiting for a replacement. The number of staff available to help residents eat their meals has increased since the last inspection. The way people are assisted to eat their meals has improved since the last inspection to provide a more positive experience. Assistance is timely and unrushed; people have sensitive assistance at the pace they require. Care staff were observed sit at the dining table with residents to offer sensitive assistance and the opportunity to engage in a one to one relationship with that staff member during their meal. 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 gammon and parsley sauce or tuna and tomato pasta bake with boiled and mashed potatoes, cauliflower and sprouts followed by rhubarb crumble and custard or banana custard. A member of the care staff told the inspector that people are offered the choice of meal at the time it is served. Food was plentiful, appetising, well presented and nutritious. The inspector was present in the ground floor dining room for the evening meal. Staff began serving the meal at 4.30 pm which consisted of soup, macaroni cheese and a selection of sandwiches followed by a dessert of blancmange. One resident told the inspector they always had a choice of a hot, light meal in the evening. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 19 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 good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from 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 not received any complaints. Evidence was available that the manager and provider make a timely and objective response to concerns raised and the outcome is recorded. We have not received any complaints about this service since the last key inspection. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 20 Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. A ‘Communication Sheet’ is now available in each resident’s room to improve communication between staff and relatives. The manager discussed that this was particularly useful where residents were unable to communicate their needs effectively because of their dementia care needs or physical disability. The system has been well received by relatives. A comments book is available in reception inviting visitors to make comments or suggestions. It was evident that the comments are considered because a written response from the management team was recorded alongside each comment. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff have received abuse awareness training with recent updates in November and December 2007. Evidence was available in case files to demonstrate that staff record injuries sustained by people living in the home (such as cuts or bruises) on Body Mapping documents and the outcome of any investigation is recorded in the daily records. The service make timely notification to us about any event that adversely affects the well being of any person living in the home. This good practice should protect people living in the home from the risk of physical abuse and is evidence of compliance with the Statutory Noticing requiring the provider to investigate the cause of any injuries sustained by service users and hold a record of the outcome. Warwickshire Social Services implemented their Adult Safeguarding procedures and an investigation into concerns raised by an ‘undercover’ journalist, who was employed as a care assistant in the care home during October 2007, is ongoing. 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 provider has complied with all of the requirements we made when we considered the concerns at our key inspection of the service on 1st November 2007. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 21 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 adequate. People living in the home are provided with clean, comfortable surroundings to live in. 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 staff 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.V358305.R01.S.doc Version 5.2 Page 22 A programme of refurbishment of the communal areas is in progress. The ground floor dining room has recently been redecorated and provides a bright and airy environment. The lounges were cosy and homely. Decorating work is ongoing throughout the home and in the dementia care house an artist has created scenes on the walls of some of the corridors to provide a more stimulating environment for people living there. For example, one scene appears to be market stalls and another depicts ‘washday’. A number of tactile objects related to each scene are displayed; such as fruits on the market stalls and a clothes line with washing pegged to it on ‘washday’. The manager and operations manager discussed that redecoration of the dining room in the dementia is planned; they are considered an ‘al fresco’ theme with scenes painted by the artist. 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 soft vinyl flooring has been fitted as an alternative to carpet to help manage one person’s challenging levels of incontinence. This gives the appearance of a wood laminate and looks attractive and homely. It helps to maintain the person’s dignity as it is easy to clean and minimises the possibility of offensive odours. 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. 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. The provision of specialist seating has improved, which improves peoples’ opportunities to socialise or experience a varying environment. All parts of the home were clean and fresh. Domestic staff have been reorganised so that there is a member of cleaning staff on duty on each floor and an identified person working in the laundry for each day of the week, including weekends. Cleaning staff are now maintaining detailed records of their cleaning schedules. The inspector spoke with a member of the cleaning staff who said they felt ‘things are much better organised now’. One sluice room viewed was clean and tidy. Systems for providing an effective laundry service have greatly improved since the last inspection. The home has sufficient commercial equipment to manage soiled laundry; one of the washing machines that was broken at the last Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 23 inspection has now been replaced. The laundry room was clean, tidy and well organised. Hand washing facilities and protective clothing were available. Alginate bags were in use for soiled laundry to minimise handling and reduce the risk of infection. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. There are sufficient staff on duty to meet the needs of people living in the home. Residents benefit from being cared for by competent staff and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and operations manager discussed that the numbers of staff on duty have been reviewed since the last inspection to make sure there are sufficient staff to meet the needs of the people living in the home. This has resulted in an increase in the number of care staff in the dementia care unit between 8am and 2pm. A dining room assistant post has been created to make sure there is sufficient staff to sensitively assist people to eat their meals. The person appointed to this post has recently left the position and management are actively recruiting for a replacement. The manager’s full time hours are supernumerary. The manager said she would work ‘on the floor’ if there is unplanned absence such as sickness but this has not been necessary which means she is able to use her time in clinical supervision and monitoring working practices. The operations manager for the service has been present in the home in a full time capacity since the last Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 25 inspection to work with the new manager to make improvements to the service. The manager and operations manager have worked alternate weekends to provide a management presence in the home over a 7-day period. The manager said that the usual staffing complement for the home is: Ground Floor (General Nursing) Registered Nurse Care Staff Registered Nurse Care Staff Registered Nurse Care Staff First Floor (Dementia Care) Registered Nurse Care staff Registered Nurse Care Staff Registered Nurse Care Staff 8am – 2pm 8am -2pm 8pm – 8am 1 4 1 4 1 1 1 5 1 4 1 2 The operations manager said that the staffing complement is dependent on the number of people living in the home; the numbers in the table above are based on the home being fully occupied. There are ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. The way cleaning and laundry staffed are deployed has been reviewed since the last inspection to make sure the provision is consistent over 7 days a week. This has been successful in implementing improvements in the laundry service for residents. 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. A laundry assistant staffs the laundry for 8 hours every day of the week. There is one member of domestic (cleaning) staff on each floor for 8 every day of the week. A maintenance person is employed for 40 hours each week. Training records show that eleven out of eighteen care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. This includes three staff with overseas healthcare qualifications, which have been verified as comparable to a UK qualification at NVQ level two or above. 61 of care staff in the home are qualified at NVQ level two or above exceeds the National Minimum Standard for 50 of care staff to have this qualification. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 26 This should mean that residents benefit from having their needs met by staff that are appropriately experienced and qualified. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and satisfactory references were obtained before staff started working in the home. Robust recruitment practices safeguard people living in the home from the risk of abuse. A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records demonstrate that all staff complete an induction programme and have received mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 adequate. The registered provider has taken appropriate action to make improvements in outcomes for the people living in the home and the change in the management structure of the home should be effective in sustaining the improvements made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider responded appropriately to concerns raised at the last key inspection and has taken action to make improvements in the outcomes for people living in the home. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 28 The management structure of the home has been reviewed since the last inspection. A new manager has been appointed and has submitted an application to us for registration. She is an experienced manager with Southern Cross and has successfully developed and implemented improvements in their other care homes. She is a registered nurse and has a Post Graduate Diploma in Management Studies and a masters degree in Business Administration. The Deputy Manager of the home resigned the position and has been replaced by a new deputy manager from another Southern Cross Home; this inspection took place during his induction week in the home. The operations manager for this service has been working in the home full time but there are imminent plans to reduce this input to two days a week. The operations manager and manager have worked alternate weekends to make sure there is management support and a continuity of service across seven days of the week. The organisation deployed extra resources (for staff training and audit) and developed comprehensive action plans with evidence of review against the objectives set and improvements implemented. Improvements were evident in all of the outcomes for people living in the home during this inspection and all of the requirements made during the last inspection have been met. The home was not fully occupied; 41 out of 48 places were occupied at the time of this inspection. Further inspection will evidence whether the improved outcomes are sustained with the new management structure of the home when the extra resources are removed and the number of people living in the home increase. The regional director was present for feedback and told inspector that the organisation is reviewing its own Quality Audit system in view of the fact that its existing system identified Arden Valley as a ‘Good’ home. The views of residents and relatives were surveyed in January 2008. Their opinions on laundry, food, activities, visiting professionals and staff were collated and are published in the home. The provider used some of this information to assist in the development of action plans. This means that the opinion of people living in the home is considered so the home is run in their best interests. Residents’ personal monies held by the service for safekeeping are pooled in one bank account. Individual account sheets are maintained along with receipts for income and expenditure and are available for residents or their appointee to see. There is no limit on the amount that can be deposited or withdrawn although there is usually only a small ‘float’ allowing a resident to withdraw up to £10; if a larger sum was requested then the administrator would go to the bank and withdraw it. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 29 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 August 2007 and are due again in February 2008. Labels on portable electrical appliances indicate they were checked in July 2007. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 2 2 X 3 X X 3 Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. Refer to Standard OP9 Good Practice Recommendations Where unprescribed vitamin supplements are to be administered evidence of discussion and agreement of the GP should be documented and retained alongside MAR sheets. Tablets should be administered from their original packaging so staff can be clear of their suitability for administration. Medicines should stored in the labelled packaging in which they were originally dispensed so that staff can be certain what they are and who they are prescribed for. The programme of person centred activities for people with dementia or other cognitive impairments should be kept under review so that each resident has the opportunity to maintain life skills and benefit from having quality care that reflects their individual needs, regardless of their ability. The quality of the service provided to residents should be kept under review so people living in the home can be DS0000004385.V358305.R01.S.doc Version 5.2 Page 32 2. 3. OP9 OP12 4. OP33 Arden Valley Christian Nursing Home sure that the improvements implemented are sustained. Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Arden Valley Christian Nursing Home DS0000004385.V358305.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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