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Inspection on 23/06/06 for Arden Valley Christian Nursing Home

Also see our care home review for Arden Valley Christian Nursing Home for more information

This inspection was carried out on 23rd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A discussion took place with the operations manager and the registered manager and a commitment was made to address the issues raised by the inspection.

What has improved since the last inspection?

A number of health and safety issues have been responded to appropriately. For example: Fire doors are no longer wedged open and hazard signs clearly identify any wet floors. All residents have a plan of care, which provide staff guidance on how to meet individual needs. A review of staffing levels necessary to determine the number of staff needed to meet the care needs of residents has been completed and action taken to respond to the outcome. In order to ensure residents nutritional needs are being met, the management arrangements for the provision of meals has been extended to include a snack meal that is offered to residents in the evening. In order to make sure there is always a qualified first aider on duty, staff training in first aid, has been prioritised and a further 12 staff have completed their training. There was evidence that money was being spent to improve the home and make it more comfortable for residents.

What the care home could do better:

A number of requirements have been made as a result of this report Improvements to the management arrangements at mealtimes are necessary so that residents regularly receive the support they need to eat their food, and to make sure food presented is always attractive, appealing and appropriate. Residents would benefit from having their care needs met by staff who are appropriately supervised and whose care practices monitored. Residents requiring specialist dementia care should be afforded opportunity to participate in meaningful daily and life enhancing activities. Shortfalls in the management of medicines are unsafe and may place residents at risk.

CARE HOMES FOR OLDER PEOPLE Arden Valley Christian Nursing Home Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR Lead Inspector Jean Thomas Key Unannounced Inspection 23 June 2006 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.V290975.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.V290975.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) Southern Cross Healthcare Mrs Honor Morris 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.V290975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 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. Service users 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. Fees are in the range of £411.00 - £790.00 per week. The fees do not include newspapers, toiletries or hairdressing. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This key inspection visit was unannounced and took place over two days commencing Friday June 23rd 2006 and concluding Monday June 26 2006. Three residents were identified for close examination by reading their initial care needs assessments, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Other documentation maintained in the home was examined, and this included policies and procedures, staff personnel files and training records, records pertaining to safe working practices and the arrangements for managing medication. The inspector had the opportunity to meet most of the residents by spending time in communal areas of the home and talked to five of them about their experience of the home. Many of the residents require specialist dementia care and were unable to articulate or express an opinion of the service they receive. General conversation was held with other residents, along with observation of working practices and staff interaction with residents. The inspection also included observations at meal times and conversation with two health care professionals and three visitors to the home. The registered manager was present throughout the inspection and the operations manager present for most of the inspection. The inspector had the opportunity to talk to nursing staff, care workers, domestic staff and the cook. Since the last inspection on February 3rd 2006 we have received three complaints, one adult protection issue and two letters from staff that include grievances about their working arrangements. Two of the three complaints were in response to a reduction in staff levels and one was about the physical appearance of two residents. The inspection found that staff numbers had been reduced in line with a reduction in occupancy levels at the home. In response to the concerns raised, staff numbers have been now been restored to previous levels. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 6 The content of staff letters were discussed with the manager, who is to investigate the issues raised and notify us in writing of the outcome of her enquiries. The adult protection issue relates to the behaviour of a resident and was referred to Social Services in accordance with the local arrangements for the protection of vulnerable adults. The inspector would like to thank staff and residents for their co-operation and hospitality. What the service does well: What has improved since the last inspection? A number of health and safety issues have been responded to appropriately. For example: Fire doors are no longer wedged open and hazard signs clearly identify any wet floors. All residents have a plan of care, which provide staff guidance on how to meet individual needs. A review of staffing levels necessary to determine the number of staff needed to meet the care needs of residents has been completed and action taken to respond to the outcome. In order to ensure residents nutritional needs are being met, the management arrangements for the provision of meals has been extended to include a snack meal that is offered to residents in the evening. In order to make sure there is always a qualified first aider on duty, staff training in first aid, has been prioritised and a further 12 staff have completed their training. There was evidence that money was being spent to improve the home and make it more comfortable for residents. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 7 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. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the home Prospective residents and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: Discussion with two residents and documentation evidence the manager carries out pre admission assessments, providing a comprehensive understanding of the needs of the individual, which is then transferred into care plans. Two residents spoken with said they had been given the opportunity to visit the home prior to admission, but had chosen not to do so, preferring instead to have their relatives visit on their behalf. One resident said she moved into the home from hospital and hadnt felt well enough to visit prior to moving in. Four residents spoken with said the home was able to meet their individual care needs. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 10 Residents and their relatives have access to information about the home. The home’s Statement of Purpose advises prospective residents that someone from the home will formally write to them to confirm the home can meet their needs. Two residents spoken with said they hadnt received a letter from the home. The manager was aware confirmation letters have not been sent out and plans to ensure a letter is sent to each prospective resident as soon as the care needs assessment is completed and she is sure the home could meet their needs. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome group is poor. This judgment has been made using available evidence, including a visit to the home. Each resident has a plan of care, but the absence of accurate recording and monitoring is unsafe. Residents have access to healthcare services that meet their assessed needs. The principles of respect, dignity and privacy are not always put into practice. EVIDENCE: The personal profiles and care records of three residents identified for case tracking were examined. Care plans are detailed and informative, and generally provide staff with the information they need to meet individual care needs. Documentation evidence bed rails in situ for those residents assessed as being at risk of falling out of bed. Nutritional screening including weight checks are undertaken during the admission process and weight is then monitored weekly. Where there are concerns that nutritional needs are not being met, the outcome of a nutritional risk assessment informs care planning. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 12 Shortfalls identified include the absence of monitoring and recording of the dietary intake of residents whose nutritional needs are giving cause for concern. For example, the nutritional monitoring chart of a resident who is regularly losing weight, evidence that on three separate occasions information had not been recorded. Therefore we cannot be sure resident’s nutritional needs are responded to appropriately. A number of shortfalls in care planning were identified. For example: • Following a review of a resident’s dependency levels and when an increase in dependency from medium to high was identified, the care plan was not updated to reflect any change in needs or circumstances. Therefore, staff did not have access to the information needed to make sure the resident’s needs are met. The absence of a palliative care plan for a resident diagnosed as having a life limiting illness. • Although a number of gaps were identified, the range and quality of information recorded on care plans has improved since the last inspection. In response to shortfalls identified during the last inspection, oral hygiene needs are identified and included in the care planning process. Greater effort is required to further develop resident ‘life stories and histories’ so as to ensure staff have sufficient knowledge of the individual to be able to meet their needs. Documentation evidence regular reviews of care plans. Four residents spoken with said, they were not aware of the information held in their care plan and had not been involved in any review. Two visitors spoken with said they had been involved in devising the care plan for their relative, but were not aware of reviews. Residents have access to a range of healthcare professionals such as a GP, chiropodist, optician, etc. Information held on care plans evidence advice is sought from a range of healthcare professionals, including the continence adviser, speech therapist, community mental heath nurse and tissue viability nurse. Discussion with two visiting health care professionals evidence that care received by residents has improved and staff generally do a good job. Some concerns were also expressed about the lack of English speaking staff, which can make communication difficult. At the time of the visit two residents were being treated for pressure wounds. Both residents had been issued with a pressure relieving mattress. A number of residents assessed as being at risk of developing pressure sores also benefit from having a pressure-relieving mattress fitted. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 13 Observations and examination of documentation evidence one resident at risk of developing pressure sores did not have a pressure relieving cushion as identified in the care plan. This shortfall was discussed with the manager who is committed to ensuring residents always have access to the equipment needed to meet their care needs. Improvements were noted in the number and range of risk assessments carried out. For instance, falls, the use of bed rails and moving and handling techniques. Residents and visitors spoken with said they felt staff respect the privacy and dignity of residents. One resident said, theyre all lovely, nothing is too much trouble. Two visiting health care professionals spoken with said, “the care has improved”, and “staff generally do a good job”. A number of residents and family members spoken with said that a number of staff are unable to communicate effectively and there are insufficient numbers of English-speaking staff working at the home. In discussion, the operations manager and registered manager said they are aware of the need to strike a balance and hope to address this issue by trying to recruit suitable staff locally. Observations during the visit evidence an absence of regular or engaging social interactions between staff and residents. Observations evidence residents receiving personal care from staff in private, but a visiting chiropodist provided foot care for three residents in a communal lounge. Comments from visitors spoken with include: • • • The care is good, visiting is flexible, and we can bring the dog” “ The staff are very helpful and friendly” “ The food is good, and she is eating well” One resident, spoken with said, the food is good. I have a shower every Sunday and have just done some exercises, which I enjoyed. The staff are alright, but the language is sometimes difficult Observations and discussion with residents, visitors and staff evidence residents are able to spend time in the privacy of their own room. The doors to resident’s private rooms are often left open, and few residents hold a key to their room. All residents should be offered a key to their room unless their risk assessment suggests otherwise. When a key is not given the reasons for not doing so should be recorded in the care plan. The doors to residents rooms should be closed, unless the resident or their relative request otherwise, in which case this should also be recorded in the resident’s care plan. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 14 Inspection of the management, storage and administration of medication found a number of discrepancies. For example: • • • • On two occasions Madopare tablets had been signed for and not administered. Two Operazole tablets were missing and unaccounted for. On one occasion Raberprozole tablets had been signed for and not administered. 20 soluble Paracetamol tablets were missing and unaccounted for. Controlled medicine is stored separately and administered appropriately. A dedicated fridge is used to store eye drops, insulin, and any other preparations requiring low temperature storage. Only qualified nursing staff administer medication. Records are held, of medication returned to the pharmacist for safe disposal. There was no evidence of visits to the home by the administering pharmacist. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome group is poor. This judgment has been made using available evidence, including a visit to the home. Meals provided are varied and provide a balanced diet for residents, but the management of mealtimes is not well-organised and presents potential risks to the safety, well being and comfort of residents. The home has open visiting arrangements and residents know they can entertain their family and friends in their own room. Social, and recreational activities meet the expectations of some residents, but do not provide sufficient therapeutic stimulation for those residents requiring specialist dementia care. EVIDENCE: Sufficient staff resources are provided to allow time for activities and stimulation. The home employs a full-time activities organiser responsible for arranging activities for the benefit of residents. Activities recorded include physical exercise, softball games, and memory albums; pat a pet, board games and weekly flower arranging. Three residents spoken with said they enjoy the activities and praised the activity worker for her kindness and consideration. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 16 The inspection evidence positive outcomes for some residents, but for others notably those residents with dementia, there is an absence of evidence of positive outcomes. For example: • The care plan and daily records of a resident with dementia fail to include how and where she prefers to spend her time and how she spends her day. Records evidence the resident has a weekly hand massage and attends the church service held in the home each month. Daily records include negative comments about the residents behaviour, describing her as “noisy” therefore demonstrating a lack of understanding of the resident’s care needs. Although a number of tactile boards have been introduced greater effort is needed to make sure the social and therapeutic needs of residents with dementia are being met. Two carers spoken with were unsure of the needs of residents with dementia, and couldn’t say when it may be appropriate to use reality orientation methods. The environment lacks stimulation and fails to engage those residents with dementia, and who spend significant amounts of time with nothing to do. Staff training records evidence seventeen of the thirty three care staff have not undertaken training in specialist dementia care. In discussion, the manager said a number of staff are to increase their knowledge and understanding of dementia care by completing yesterday, today, tomorrow” a learning module devised by the Alzheimers Society Visiting is flexible and takes into account the individual needs of residents Three residents spoken with all said they could receive visitors at any time and could meet with their visitors, either in their private room or in a communal area in the home. Two visitors spoken with confirmed this occurred. A tour of the premises found the kitchen to be generally well managed. Store cupboards hold a range of provisions including fresh fruit. Four week’s menus held in the kitchen were examined and found to provide a varied and nutritious diet. Most residents have lunch in the dining area, while others remain in their rooms. On the first day of the inspection, poor staff management at lunchtime left in residents sitting at the dining table for long periods (45 minutes) before lunch was served. Meals are transported from the kitchen to the dining areas in a hot trolley, where meals are plated up by staff. Menus were not displayed in the home. Residents were served scampi or gammon, with broccoli, peas and swede followed by jam sponge and custard or rice pudding. Following shortfalls identified during the last inspection it was disappointing to note that the practice of serving gravy with fish continues. Observations evidence residents on the dementia care unit were not offered choices or made aware of what they had been given to eat. Two residents Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 17 spoken with said they thought they had been asked what they would like for lunch, but couldnt remember. Risk assessments for two residents at risk of choking identified the need for pureed foods. Observations evidence residents were given ‘soft diets’. The care plan of one of these residents includes “sandwiches for tea”. When asked, staff couldnt say whether gammon or scampi was included in the soft diet and were therefore unaware of what was being served to residents. In response to a request by the inspector to replace gravy with white sauce a carer poured white sauce on top of the gravy and placed the meal in front of a resident diagnosed as having dementia. Staff practice indicates a general lack of understanding of the nutritional needs of residents and an absence of cultural identity, necessary for ensuring residents care needs are being met appropriately. After lunch three residents with evidence of food on their hands and clothes were not given the opportunity to wash their hands or the assistance needed to change their clothes. On the second day of the inspection improvements in staff practices were noted. For instance: • • • • • Residents were assisted to the table when food was ready to be served. The menu board displayed alternatives available at lunchtime. More evidence of meaningful interaction between staff and residents. Staff more readily available to provide residents with the assistance they need to eat their food. Residents were offered choices. In response to requirements made during the last inspection. Residents on the dementia care unit are now offered snacks in the evenings and records held of the food provided. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the home. Residents have access to a robust, effective complaints procedure, but the absence of staff knowledge and understanding of adult protection procedures may be unsafe. EVIDENCE: The home has a clear written complaints procedure. All complaints are responded to within 28 days. Details of the complaints procedure is included in the Service User Guide and is displayed within the home. Since the last inspection one complaint has been received by the home, which was resolved to the satisfaction of the complainant. One visitor spoken with said she was unaware of the complaints procedure but would complain if dissatisfied with any aspect of the service. (Refer to the summary section at the front of this report for details of complaints or concerns received by the Commission). The home has an Adult Protection procedure, which ensures the safety and protection of residents. Training records indicate not all staff have had training in the protection of vulnerable adults. Three staff spoken with said they would report directly to a nurse or to the manager should they have any cause for concern. Staff were not aware of the ‘Whistle Blowing’ policy or procedure or aware of who else they could report any concerns to outside of the home. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 19 It is a requirement of this report that all staff receive adult protection training (to include the whistle blowing policy and procedure) as soon as possible, so as to ensure the continued protection of residents. It is also recommended that staff are made aware of the role of external agencies and the local arrangements for the protection of vulnerable adults. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the home. The home is generally clean and tidy and residents are given the opportunity to bring personal possessions and furniture. There has been an outbreak of infection. CSCI were informed and the home was able to control the spread of infection. EVIDENCE: Most areas of the home are clean, and generally well maintained, but not all are free of offensive odours. The home has a range of specialist equipment, including moving and handling and mobility aids, with adequate numbers of bathrooms. Due to refurbishment work, two shower rooms are currently out of use. It is envisaged that improvement work will be completed by the end of June 2006. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 21 In response to shortfalls identified during the last inspection designated space is used to store wheelchairs, and hazard signs displayed to make sure any wet floors are easily identified and avoided. Laundry facilities were inspected and assessed as being somewhat chaotic. The amount of bed linen, towels and garments in the laundry room was significant. None of the work surfaces were clear and clean laundry was left on the floor. The quality of the laundry varied, with some residents wearing clothes that were generally well cared for, and others that were creased and not generally well maintained. For instance two residents had buttons missing from their cardigans and one resident was wearing a dress with the hem falling down. The ironing board was old and the cover shabby. Disposable gloves were readily available and used by staff when handling soiled linen, but the absence of disposable aprons in the laundry room is unsafe and place residents at risk of infection or cross contamination. Following discussion with staff, immediate action was taken to make sure disposable aprons are available to staff in the laundry room. Discussions with the manager evidence concerns raised about the management of the laundry are to be addressed. In response to shortfalls identified during the last inspection soiled linen is laundered separately and washed at high temperatures so as to reduce any risk of infection. Labels attached to garments enable staff to identify the owner and reduce the risk of items going missing. Residents tell us they were not given opportunity to choose their rooms, but are encouraged to personalise their rooms. Most bedrooms were of a reasonable size and accessible for wheelchairs. Each contains a washbasin and a range of personal items belonging to the individual resident. Bedrooms inspected were all decorated and maintained to a satisfactory standard. Observations evidence residents do not always have easy access to a call alarm, necessary for ensuring residents are able to call for any assistance they may need. The home has a policy and procedure for the prevention and control of infection. Disposable gloves and aprons are worn by care staff when carrying out personal care tasks. Since the last inspection, the home has reported an outbreak of diarrhoea and vomiting, which has now been eliminated. Examination of documentation, evidence that in March 2006 thirty four staff attended training in infection control Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the home. Staff are employed in sufficient numbers, but residents’ needs are not always being met in an appropriate or timely manner. EVIDENCE: Records of the three most recent members of staff were viewed and found to contain all the relevant information. Criminal Record Bureau (CRB) disclosures are held centrally by Southern Cross Healthcare and were not available for inspection on the day of the visit. Documentation evidence CRB’s were sought in respect of those staff whose files were selected for examination. Staff spoke positively of the training they receive. Some certificates were seen and comprehensive training records were available, demonstrating that the manager has a co-ordinated program to ensure staff have the necessary skills for the work they are doing. All members of staff have completed training in moving and handling, other courses attended include care planning, challenging behaviours and wound care. 14 of the 28 nursing and care staff have been trained in dementia awareness. Examination of documentation and discussion with staff evidence new workers generally have induction training which involves working along side an experienced worker until they have the knowledge and confidence to work independently. Examination of senior staff files found that the recently appointed deputy manager had not had an induction. The manager said she was away from the Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 23 home for a period of time and plans to make sure the deputy has the support and guidance needed to fulfil her role and responsibilities. In response to requirements made during the last inspection of further 12 staff have completed first aid training. The home employ eight qualified nurses, and 19 care staff including five seniors, of which six hold a National Vocational Qualification (NVQ) Level 2 in care. In discussion the manager said she had difficulty accessing NVQ training for the overseas staff, but was pleased to report that a further six staff are now booked onto a course. Other staff employed includes: deputy manager, housekeeper, administrator, cook, two catering assistants, activities organiser, laundry assistant, six domestic assistants and a maintenance person. The staffing arrangements ensure there is a registered nurse on duty at all times throughout the day. On both days of the inspection there were four carers, and a registered nurse on duty on each of the two floors. The deputy manager and administrator supported the manager. The cook, laundry person, and two domestic assistants were also on duty during the inspection. Examination of staff rosters evidence staffing levels are generally maintained. There is a pool of relief staff used to fill any care staff gaps in the roster. The roster does not show the time spent by the manager in the home. A requirement has been made. Two letters were received from staff, expressing concern that a care worker is working excessive hours. Examination of staff rosters evidence, some staff work 60 hours each week. In discussion, the manager confirmed she had taken responsibility for devising rosters and will make sure all staff, have the opportunity to work additional hours should cover the required for absent colleagues, and will also make sure staff do not work ‘excessive hours’. Of the four residents spoken to three said they thought there were sufficient numbers of staff on duty, and one resident said she thought they were short staffed. Observations throughout the duration of the inspection found there were sufficient numbers of staff on duty, but the absence of effective staff supervision and delegation resulted in residents needs not always being met in an appropriate or timely manner. For example, one resident, calling out, had to wait several minutes for staff to respond even though they were close by. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the home. The range of health and safety policies and procedures in place protect residents EVIDENCE: The recently appointed manager is a qualified first level nurse, who has completed the Registered Manager Award. She has experience and skills in the management of a care home. She was able to demonstrate that she leads by example and has high expectations in respect of care standards. There are clear lines of accountability within the staff team. Secure facilities are in place for safe keeping money held on the residents behalf. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 25 Records and receipts for financial transactions are held but only one receipt is retained for all weekly hairdressing services purchased on behalf of residents. In response to shortfalls identified, the manager agreed to ensure individual receipts are requested, and retained on the residents personal file. Two residents handle their own financial affairs; five residents are subject to power of attorney and two residents subject to guardianship. Family members support the majority of residents to manage their finances. Documentation evidence, regular health and safety checks are carried out and include: fire equipment, central heating system temperature check, water heating check for compliance with legionella, emergency lighting, hoists, and the emergency call alarm system. Staff were observed using moving and handling equipment appropriately and staff have access to a range of health and safety training that includes moving and handling and fire prevention. Training on the Control Of Substances Hazardous to Health (COSHH) is due to take place in July 2006. Accident reports examined evidence records are not always held of injuries sustained by residents. For example, the care records of one resident report the resident sustained an injury while being transferred from the chair to a wheelchair. The information recorded in the care records does not include the location or type of injury sustained or provide evidence of any monitoring. This incident was not fully documented in the accident report book. The operations manager visits the home each month and completes a quality audit. Relatives meetings are held monthly and resident participation at regular meetings is to be actively encouraged. A comments book is to be introduced and quality questionnaires are being used for a trial period. The manager said she will respond positively to comments and will use the information to further develop the service. Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14, 15 Requirement Residents’ ‘Life Stories and histories’ must be produced to ensure that staff have sufficient knowledge of the individuals to be able to meet their needs. The Registered Manager must ensure daily records include evidence of monitoring and recording of how individual care needs have been met. The Registered Manager must make suitable arrangements for the recording, handling and safe administration of medication. (Timescales of 13.10.04, 15.06.05, 31.12.05, 28.02.06 not met). The Registered Manager must make suitable arrangements so as to ensure the care home is conducted in a manner, which respects the privacy and dignity of residents. (Timescale of 14.12.05 not met). Timescale for action 30/09/06 12 2. OP9 13 31/07/06 3. OP10 12(4) 31/07/06 Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 28 4 OP12 16 5. OP15 18(2) The Registered Manager must make arrangements to enable residents with dementia to engage in social and daily living activities suited to their needs. The Registered Manager must make sure staff are supervised and practices monitored. (Timescale of 28.02.06 not met) 31/07/06 31/07/06 12 (1) 6 OP18 18 (1) (c) 7 8 OP27 OP38 17 (2) Schedule 4 (7) 17 (1) (a) schedule 3 The Registered Manager must ensure residents nutritional needs are being met appropriately and their health and welfare not placed at risk. Timescale of 31.12.05, 28.02.06 not met. The Registered Manager must 30/09/06 ensure all staff attend up-to-date training in adult protection (to include ‘Whistle blowing’). The time spent in the home by 31/07/06 the Registered Manager must be recorded on the duty roster. The Registered Manager must 31/07/06 keep a record of any accident affecting the resident in the care home, which is detrimental to the health or welfare of the resident. The record shall include the nature, date and time of the accident, whether medical treatment was required and the name of the person who was respectively in charge of the care home and supervising the resident. The Registered Manager must ensure residents have easy access to a call alarm. 13 Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 29 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 OP10 Good Practice Recommendations In order to promote privacy, dignity and security, residents should be offered a key to their room unless their risk assessment suggests otherwise, and doors to resident’s private rooms should be closed unless the resident chooses otherwise. In which case it should be recorded on the care plan. Personal care should always be provided in private. It is recommended that staff are made aware of the role of external agencies and the local arrangements for the protection of vulnerable adults. Strongly recommend staff supervision include observational practice. 2 OP18 3 OP36 Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Arden Valley Christian Nursing Home DS0000004385.V290975.R01.S.doc Version 5.2 Page 31 - 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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