Inspection on 24/04/07 for Arden Valley Christian Nursing Home

This inspection was carried out on 24th April 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arden Valley Christian Nursing... 27/11/08

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

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

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

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 Jean Thomas Unannounced Inspection 24th April 2007 09:15 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.V336402.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.V336402.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) Trinity Care Homes Limited Vacant 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.V336402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 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. 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. Fees are in the range of £466.00 - £752.00 per week. The fees do not include newspapers, toiletries, hairdressing or private telephones. Arden Valley Christian Nursing Home DS0000004385.V336402.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 residents 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 was a key unannounced inspection visit, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The visit to the care home took place on Tuesday April 24th 2007, commencing at 9:15am and concluding at 6:55pm. A regulation manager accompanied the inspector for part of the visit. Since the last key inspection, a new manager was appointed in November 2006 but the organisation has not submitted an application for registration. The organisation must take action to ensure an application is submitted to the Commission for Social Care Inspection (CSCI) so that they can be sure an experienced and qualified person is managing the care home. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. Two people living at the home were 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’ and where evidence of the care provided is matched to outcomes for residents. A tour of the building and several bedrooms was made and observations at a mealtime. Since the last key inspection visit, two separate random inspection visits to the home have been made. The first of these took place on Thursday 18th January 2007 and focused on areas identified for improvement at the last key inspection and showed compliance and improvements in a number of key areas that affect outcomes for the people living at the home. One shortfall was identified and a requirement issued to bring about the improvements needed to ensure the continued health, safety and welfare of the residents. The second visit on Wednesday 21st March 2007 was made by a pharmacist inspector to look at the medicine management within the home due to poor practices found at the previous random inspection. The inspection found there had been considerable improvement in the overall control and management of medication within the home with good practice evident in many areas. Details of the outcome of both inspection visits are included within this report. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 6 This report uses information and evidence gathered during the random and key inspection process, which involved three visits to the home and looking at a range of other 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. Since the last key inspection visit, there have been two allegations of abuse made to the commission and two complaints made to the home. The first was an allegation about the physical abuse of two residents by a staff member who was suspended from their employment pending an investigation and who later resigned. The Police and Adult Health and Community Services were involved in the investigation and no further action was taken. The second allegation was about the poor physical state of a resident and the outcome of an investigation carried out by health and social care agencies raised a number of concerns about the care provision within the home and a placement stop was put in place. The placement stop has now been replaced with a cautionary note. The first complaint made to the home was about the way staff had responded to the behaviour of a resident and is now resolved. The second was about poor care practices the outcome of the investigation by the manager showed that the complaint was upheld. At the time of writing the report, we received a number of concerns from a relative. The issues raised included, aggressive behaviour displayed by a male resident, staff who do not speak English, poor state of residents on admission to hospital and poor staffing levels. Some of these issues have already been looked at by other agencies involved in safeguarding adults and others have been looked at during the inspection process and are included in the report. The inspector had the opportunity to meet a number of the residents by visiting them in their rooms and spending time in communal lounges and dining areas and talked to several of them about their experience of the home. Due to cognitive impairment or general frailty, most residents found it difficult to engage in conversation. General observations of working practices and staff interaction with the people living at the home were included in the inspection process. We talked to three visiting relatives, five staff members, the organisation’s acting operations manager and the new care home manager. At the end of the inspection, feedback was given to both managers. 24 comment cards were sent to residents and 24 to relatives or visitors to the home. At the time of writing the report, 14 residents and eight relatives had responded. An audit of residents’ comment cards shows that most residents had the support they needed from relatives or representatives when completing the surveys. The information held on the surveys show they receive a contract and enough information about the home before they moved in so they could decide if it was the right place for them. Residents’ felt they do not always get the support they need but feel the staff listen and act on Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 7 what they say and are generally available when they need them. Comments noted include: “I appreciate that staff have to care for other residents not just me.” “If not available immediately, it is because they are caring for other residents and are available as soon as possible. Therefore this is not a criticism.” “Staff shortage evident at mealtimes.” “My demands are quite high so I do get impatient but in an emergency they are usually available.” An audit of relatives and visitors comment cards show that the care home gives the support or care expected or agreed and staff listen and act on what they say. Other comments made include: “The staff are very kind. Most appear to be trained. The only problem with a few of the carers is that their English is limited which can cause problems sometimes.” “Certain staff members have dealt with my father well, however the language barrier has been the difficulty.“ “Because foreign staff are employed whose main language isn’t English sometimes difficult for me to understand, let alone mentally ill residents.” “We always see staff notes displayed regarding staff training, so although new/agency staff come in, we feel there is a training structure in place.” The inspector would like to thank residents, staff and visitors to the home for their cooperation and hospitality during the inspection visit. What the service does well: What has improved since the last inspection? The systems for the management of medicines in the home have improved to reduce the risk of harm to residents. A new duty rota has been devised to include the role of each staff member and the hours worked by the manager, so that the home can be sure sufficient numbers of experienced staff are available. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 8 Residents have access to a call alarm, which can be used to get the help and support they need. Residents’ life stories and histories are being developed and the information used for the benefit of residents, for example, reminiscence therapy. Staff are trained on how to safeguard residents and aware of reporting procedures. Records of any accidents or incidents that affect the health safety or welfare of residents are held. What they could do better: Residents who require support to meet their intimate personal care needs should be consulted about whether they prefer a male or female carer to support them with the task and any preferences expressed acknowledged, respected and recorded. The number of male and female staff on duty should reflect the needs of residents. Make sure staff recruitment policies and procedures take into account the cultural, language and communication needs of residents so that the home can be sure that the people appointed accurately reflect the cultural needs and diversity of the residents Staff employed at the home should have sufficient understanding of the English language to be able to interact with and engage residents so that the home can be sure residents’ needs are being met. Make sure the duty rota includes the start and finish times of staff so that the home can be sure there are sufficient numbers of experienced staff available to meet the needs of residents. Action must be taken to increase the number of staff qualified to National Vocational Qualification (NVQ) level two or equivalent so that residents benefit from having their needs met by staff who are appropriately qualified and experienced. The activity programme requires revising so that all people in the home irrespective of their needs have equal opportunities for stimulation through leisure and recreational activities and which match their cultural preference. Make sure staff understand the needs of people requiring specialist dementia care and make suitable provision for social and therapeutic activities for those individuals with specialist care needs so that the home can be sure individual needs are met. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 9 Action must be taken to raise the standards of health and safety management within the home including: effective measures to prevent infection and cross contamination, sufficient resources and an effective cleaning schedule necessary to ensure all areas of the home are kept clean and well maintained. Make sure there is sufficient specialist equipment available to meet the needs of residents and that the equipment used is properly maintained so that residents are not placed at risk of harm or injury. Make sure that we are advised of any accident or incident that adversely affects the health, safety or welfare of residents. 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.V336402.R01.S.doc Version 5.2 Page 10 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.V336402.R01.S.doc Version 5.2 Page 11 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): 1,2 and 3 Quality in this outcome area is adequate. People who are considering moving into the home have their care needs assessed and have access to information necessary to make informed choices 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. Standard 6 is not included in this judgement, as the home does not provide intermediate care. EVIDENCE: The home has developed a Statement of Purpose, which sets out the aims and objectives of the home, and includes a Resident Guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. Both documents Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 12 should be updated to reflect the changes in the organisations management structure and to show that the home does not have a registered manager. Admissions are not made to the home until a full needs assessment has been undertaken. Those who are self funding and without a Care Management Assessment have their needs assessed by the manager. The assessment involves the individual, and their family or representative, where appropriate. When the assessment has been undertaken through care management arrangements the home insists on receiving a summary of the assessment and a copy of the care plan. Prospective residents are given the opportunity to spend time in the home but due to cognitive impairments or physical frailty, very few people choose this option, preferring instead to rely on the views and opinions of relatives or representatives. Comments included on a relatives comment card include, Visited to see whether it is suited on behalf of my mother. Then the information requested was provided. Two care needs assessments were read and showed that the manager obtained some information about the individual’s needs before they moved into the home. However the format used to record the assessment is made up of tick boxes and does not provide sufficient additional space needed to record further information that may be needed to form a view as to whether the individual’s needs can be met by the home. Both residents had a Care Management Assessment, which was detailed and informative The assessments carried out by the home include a dementia care assessment and covered all the areas expected in the standards but did not always provide sufficient information to form the basis of the care plan. For example information included on the Care Management Assessment includes responds better to deadlines usually retires around 22:00hrs, would stay in bed all day.” The homes assessment has not included this information and the recorded response to the question what time does the client usually go to bed is No The random inspection showed that staff do not always have the information they need to make sure new residents have their needs met. For example, a prospective resident had been discharged from hospital a day earlier than had been agreed. The unexpected arrival of the resident at 11:45pm meant that as the office was locked overnight and the assessment information was stored in the office the staff did not have the information needed to ensure the resident’s needs were met. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 13 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): 7,8,9 and 10 Quality in this outcome area is adequate. Residents have a plan of care, but do not have access to health care services. Residents are treated respectfully and the control and handling of medication has improved in order to maintain residents’ health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents were identified for case tracking purposes, this involved looking at their care plans, reviewing their living accommodation, talking to staff and where possible the residents. Care plans contained a range of information to enable staff to meet health and social care needs. Standardised documentation is used in the care planning process. Care needs are noted but the type and level of support required is not always recorded in detail. Strengths and weaknesses are not noted and Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 14 staff are not generally asked to encourage independence but they are asked to encourage residents to choose their own clothes. Staff need to be aware of the residents’ capacity for independence before independence can be safely promoted and maintained. Information held shows appropriate intervention. For example, a review of a nutritional risk assessment shows the resident has lost weight and the staff responded by introducing a dietary monitoring chart and following a visit by a GP a food supplement was prescribed. Weight monitoring records now show the resident’s weight has increased. The information held on daily records is limited and fails to confirm in detail whether the care provided is as agreed on the care plan for instance entries noted include “all needs met.” The records belonging to a resident assessed as requiring regular repositioning during the night to reduce the risk of developing pressure sores fails to show whether this occurs. Photographs are held of pressure wounds and records show improvements therefore wounds are being well managed. Body mapping records are used to show any tissue wounds. Evidence is available in care files to demonstrate that residents have access to external professionals such as consultant psychiatrist, dentists, chiropodists, GPs, optician and staff from Adult Health and Community Services carry out regular care reviews. Involving these professionals ensures that residents’ health care needs are being met. However not everyone feels that their relatives’ health care needs are being met. For example comments included on relatives’ surveys includes: “There are numerous occasions when Ive requested services i.e. a hearing test or his feet looked at. This still hasnt been attended to but I dont know if this has been the fault of the service requested rather than the home.” “Medical support is usually good during the week. The support at the weekends is there, but usually means a call to the emergency services and often a visit to hospital, which is distressing and not always necessary. This is not the fault of the home; in fact, it makes things even more difficult for them as staff are required to accompany residents if no relative is available.” There was documentary evidence of regular management reviews of care plan information taking place. The manager is auditing the documentation to ensure it is up to date and contains sufficient detail. Comments made include: Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 15 “My mother is well looked after, is physically fit and her weight is constant.” Examination of documentation and discussion with the manager shows that work to develop resident’s life stories and histories has commenced. The manager talked about some of the difficulties around obtaining the information needed to develop life stories and histories and demonstrated a commitment to making sure the information made available to staff includes cultural diversity and lifestyles. Residents seen looked well presented and their hair groomed and nails clean. Two residents spoken to said they are satisfied with the service comments made include, ”we are looked after” and “nurses are very good.” Residents do not always get to wear their own clothes. For example, one resident spoken to showed the inspector the socks they were wearing which they said did not belong to them. Observations in the laundry room show that not all items of clothing can be easily identified therefore residents are at risk of not having their clothes returned. Observations in one resident’s room found a welcoming notice displayed on the inside of the wardrobe door. The information on the notice includes resident’s name, named nurse and key worker but was not the name of the current resident in the room. The absence of accurate information is unwelcoming and can heighten any confused state and does not make the resident feel valued as an individual The staff induction process used with new workers includes how to promote and maintain residents’ privacy and dignity. Observations during the key inspection visit show staff promoting residents’ privacy and dignity. For example making sure personal care is provided in private. Observations during the inspection visit and consultation with two relatives show that residents are not offered a key to their room. Residents should be offered a key to their room unless their risk assessment suggests otherwise, and doors to residents’ private rooms should be closed unless the resident chooses otherwise. In which case it should be recorded on the care plan. During the random pharmacist inspection visit on March 21 2007, the home manager and two unit managers on duty were spoken with. All the medicine charts were seen. Six residents medication charts were audited together with their accompanying care plans and the outcome is as follows: The medicine management had improved since the last inspection on 18 January 2007. There has been considerable improvement in the overall control and management of medication within the home with good practice evident in many areas. The medicine charts documented the residents current medicine Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 16 requirements. This means that there is a record to show that medicine prescribed by a General Practitioner (GP) for a resident is recorded. In addition, there were good procedures and some double checks in place to make sure that all residents received the correct medicine at the right time. This can be confirmed by an audit trail that the care service maintains. This means that the health and welfare of residents are safeguarded with improved medication systems All medicine storage was secure and locked. The person in charge held the medicine keys at all times. Temperature records of the refrigerator were recorded and documented on a daily basis to ensure that residents’ medicines were stored at the correct temperature. Medicines were dispensed in a Monitored Dosage System (MDS) (each medicine dispensed in a 28-day blister pack for ease of administration) in addition to traditional containers. Records indicated that all of the medicines dispensed in the MDS were administered as the doctor prescribed. A comprehensive medication audit is undertaken on a daily basis for each resident. The audit includes detailed information about each resident’s medicine and any nutritional supplements, which include the date of receipt of medication, total quantities available with a running stock balance and disposal records. This was good practice. All the medicine charts were seen. It was observed that staff recorded for the administration of medication or documented a reason if medication was not administered. When a medicine was stopped or changed by a GP then the medicine charts were correctly documented and where possible the GP signed and amended that medicine charts. This was good practice. Two nurses were interviewed during the inspection. They had a good understanding of the clinical condition of the residents and what the medicines were for. One resident was prescribed a medicine for behaviour management ‘when required’, however the medicine chart was being signed for the administration every evening. The medication was also available in the MDS as a daily administration. There was no detailed written procedure or assessment available in the care plan to inform staff under what circumstances the medicine should be given ‘when required’. This means that residents’ healthcare needs could be at risk. There was a record in the care plan indicating that the GP had reviewed medication for the resident in February 2007 but it did not appear that any specific changes had been made. This was discussed with the care home manager who agreed that the use of the medicine at night would need to be further reviewed by the GP. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 17 Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Food is nutritious and plentiful but nutritional needs are at risk of not being met. Open visiting arrangements encourage regular contact with relatives and friends. Social, and recreational activities do not meet the specialist needs of residents with dementia or other cognitive impairments. 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. Detailed records are held of what activities have been arranged and who has participated. Information held includes pictures of residents’ involved in events and includes daily activities such as family visits, hairdressing and attendance at a church service. Planned activities arranged in the home include physical exercise, softball games, Pat a pet, board games and flower arranging. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 19 Details regarding preference of religious needs, family contacts are all noted in care files. Information held on relatives and residents comment cards show appreciation for the work carried out by the activities organiser, but gaps identified in service provision during the last key inspection have not been addressed. For example, there is no evidence to suggest that the needs of people with dementia are being considered when planning activities; this is because apart from ‘hand massage’ most of the activities available require a level of concentration and memory recall that people with dementia do not always not have. A number of tactile boards are displayed in corridors but there is no evidence to suggest that these are ever used for the benefit of residents. The environment lacks stimulation and fails to engage residents with dementia, and who spend significant amounts of time with nothing to do. Two residents spoken with said they enjoy the activities and praise the activity worker for their kindness and consideration. Comments included relatives surveys include: “I cant really comment as my mother can no longer communicate. However, she used to really like sitting out in her garden. The upstairs residents very rarely if at all are taken down to the garden area.” “Relatives faith is catered for with regular visits from the local church.” “I do not always feel like joining in all the activities but I know they are arranged and available. Ive enjoyed the occasional trip out.” The home has a flexible visiting policy that takes into account the express needs of residents. Two visiting relatives spoken to said they could visit at any time and were made to feel welcome. Observations show residents receiving visitors either in communal areas of the home or in the privacy of their own room. We took the opportunity to visit the kitchen, which appeared to be well managed. Store cupboards, fridges and freezers held a range of provisions including fresh fruit. Although staff were busy preparing the main meal the kitchen was generally clean and appeared well managed. A chocolate cake stored in the fridge was not covered and dirty knives had been left on the plate. The home must make sure that food stored in the fridge is covered and if appropriate dated so that staff can make sure, residents are not offered food that may place them at risk of harm. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 20 The manager talked about the catering arrangements and informed inspectors that on January 30th 2007 the home was awarded a Food Hygiene inspection rating ‘ Silver Award’ certificate by the Public Protection manager Stratford on Avon. A certificate displayed in the home confirms this occurred. A four-week menu is used to plan meals and provides food that is varied and nutritious. On the day of the key inspection visit residents were offered chicken casserole or macaroni cheese. Soft and pureed diets are supplied to those residents assessed as needing them. Food is transported from the kitchen to the dining rooms in hot trolleys where it is served to the residents. Improvements in the way meals are managed were noted for example residents are assisted to the dining table just before the meal is served and staff attend to the needs of residents in a more sensitive caring and manner. Staff are observed engaging residents and offering alternatives. Food served was nutritious but was not always attractive as some of the ingredients were mixed together in such a way that you could not identify what was on the plate. It is recommended that food moulds be used so that food is presented in a more attractive and appetising manner. A significant number of residents require help and encouragement to eat their food. Residents who have their meals in the dining rooms have their meals before those residents who are being cared for in their rooms. Although the main meal is at 12:30pm some residents who are being cared for in their rooms do not get their meal until 1:45pm this is due to the amount of help and encouragement needed by residents in the dining rooms and to the limited number of staff available to provide the support needed. A number of visitors regularly visit at mealtimes specifically to feed their relative. Observations show that nutritional needs are not always met. For example: a meal was served to a resident in their room and the staff were not available to provide the support the resident needed to eat their food. 40 minutes later, the meal was taken away without the resident having eaten any of it. Observations during the random inspection visit also showed that an inexperienced staff member was asked to feed a resident and was then left unsupervised (details included in the Staffing outcome group of the report). Staff in one of the dining rooms were observed feeding two residents at the same time such practices are considered institutional and do not promote the residents’ or dignity or sense of self worth and may place residents at risk. Comments on residents’ surveys include: Staff shortage evident at mealtimes” Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 21 “25 residents approximately 20 - 22 require help with feeding and encouragement to eat. Physical incapacity coupled with dementia, need to staff and some sort of system in place to check if and how much residents have eaten at times one member of staff feeding two residents at the same time, query cross infection.” Action must be taken to make sure that there are sufficient numbers of experienced staff available to meet the needs of the residents and that the meals served are fresh and have not been stored in a hot trolley for excessive amounts of time in some instances up to two hours. So that the home can be sure, nutritional needs are met and residents’ health safety and welfare not placed at risk. Residents spoken to who were able to express a view said they were generally satisfied with the food provided. Comments noted on residents’ surveys include: “I do not always feel like eating every meal, but that is my choice not that the meals are nice.” “I enjoy my food but have problems with swallowing and much of the food produced for soft diets is unappetising and lacks taste.” Comments from relatives include: “Food always smells good. Sunday roast usually looks very good. Not able to see lunches in workday due to working. Teatime food seems plenty of good choice.” “Teatime sandwich filling poor at times also bread can be stale. Frozen process cakes/gateau often at teatime.” Residents who have capacity are able to exercise personal autonomy and choice. Comments from relatives include: “Particularly on the dementia floor, where residents are allowed the freedom to do as they want (so long as they do not endanger themselves or other residents).” Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 22 Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 23 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. The home has a complaints and safeguarding adult’s policy and procedure and have staff that know how to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear written complaints procedure and all complaints are responded to within 28 days. The complaints procedure is included in the Resident Guide and is displayed within the home. Records of complaints are held and show that since the last key inspection the home has received two complaints. The first complaint was about the way staff respond to the behaviour of a resident and following management intervention is now resolved. The second was about poor care practices and following investigation by the manager the complaint was upheld. Information held shows that complaints are acknowledged in writing and responses sent to the organisations head office before being sent to the complainant. At the time of writing the report, we received a concern from a relative. This involved the aggressive behaviour of a male resident, staff who do not speak English, poor state of residents on admission to hospital and poor staffing levels. Some of these concerns have been looked at by other agencies Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 24 involved in safeguarding adults and others have been looked at during the inspection process and have been included in the report. One resident spoken to was not aware of the complaints procedure but said they would talk to their relative if they were concerned. An audit of relatives’ surveys shows that people know how to raise any concerns. Comments include: “I would write to the manager.” “Within the home yes, but not sure of the structure above the manager.” “My mother cannot communicate and so I have to decide if something requires attention.” An audit of residents’ comment cards also shows that residents know who to talk to if they are unhappy. Comments include: “I would usually tell a carer first but I can tell my son who would raise any concerns for me.” “There is a comments book outside the managers office, which is useful.” “Complaints procedure is prominently displayed in the entrance.” Since the last key inspection visit, we have received two allegations of abuse. The first was an allegation about the physical abuse of two residents by a staff member who was suspended pending an investigation and who later resigned. The Police and Adult Health and Community Services were involved in the investigation and no further action was taken. The second allegation was about the poor physical state of a resident admitted to hospital and the outcome of an investigation carried out by health and social care agencies raised a number of concerns about the care provision within the home and a placement stop was put in place. The placement stop has now been replaced with a cautionary note. In response to shortfalls identified at the last key inspection 32 of the 40 staff employed at the home attended training on ‘safeguarding adults’ in January 2007. Three staff spoken to confirmed this occurred and gave examples of what action may constitute abuse. Staff are aware of the ‘ Whistle blowing’ policy and procedure and said that if they were concerned they would talk to the person in charge. Staff spoken to said residents are well cared for. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 25 Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 and 26 Quality in this outcome area is poor. The home is not clean or well maintained and the absence of effective infection control measures place residents at risk of infection or cross contamination. Residents do not have the equipment they need and their health, safety and welfare is at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of the furnishings and fittings in residents’ rooms was generally good. One room was personalised with photographs and ornaments making the room feel warm and homely. Some rooms were sparse and held very few personal possessions. A number of residents were visited in their rooms but were frail and unable to hold a conversation. A number of residents were being cared for in bed and observations in the rooms visited show residents have safe and easy access to a call alarm. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 27 Areas of the home looked at during the random inspection were found to be clean, warm, bright and comfortable. Observations during the key inspection found that areas looked at were not being properly cleaned. For example, the floors in the dining areas were sticky and were attracting ants. Skirting boards in a number of bedrooms were also dirty. Carpets in residents’ rooms looked like they were not being regularly cleaned and required vacuuming and a number were stained and required shampooing. Wheelchairs had particles of food and other debris around the footplates. An audit of relatives and visitors comment cards show concerns about the environment. When asked what the home could do better, comments noted include: The laundry service is very poor. Cleaning staff with no laundry experienced are used on a rotation basis. Clothes are frequently lost and damaged. The standard of cleaning at times is rather poor. There seems to be a problem keeping appropriate staff. I have concerns about the cleanliness of the home. Several times, I have witnessed filthy cutlery, the kitchen is appalling and the door handles and walls are disgusting. There is a dirty smell in the home. One relative spoken with said they often found faeces on their relative’s chair. The laundry room is equipped with sufficient commercial equipment to manage the soiled laundry for the home but the laundry is poorly managed and the absence of robust systems to control the spread of infection is unsafe. For example, • A significant amount of linen was waiting to be laundered. • There was no identifiable dirty to clean flow of laundry. • Soiled linen is held in a number of red alginate bags and placed in the sink therefore preventing staff access to hand washing facilities. • Soiled and clean linen is not being held separately. • Baskets of linen are not marked to identify whether the laundry is soiled or clean. • The floor was dirty and had a significant amount of debris on it. • Pillows and a duvet were on the floor at the back of the washing machines. • Gloves and aprons are not placed in areas where the control of infection is necessary and this includes bathrooms and the laundry area. Staff members talked about infection control measures and said that an alcohol based hand scrub is used to make sure their hands are thoroughly cleaned after each activity. Staff training records show that staff attend regular infection control training. The staff spoken with confirm this occurs. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 28 The absence of effective management systems necessary for preventing infection or cross contamination is unsafe and places residents at risk. Staff spoken to told us that the domestic staff are responsible for the laundry service and are expected to make regular visits to the laundry while carrying out other cleaning tasks. There is no system in place to identify the time spent in the laundry or on cleaning the home. Action must be taken to make sure the laundry is properly managed and the home is a clean and a safe place for people to live. Staff rotas seen show there is usually a housekeeper and two domestic staff available 8am – 4pm on Mondays, Wednesdays and Thursdays, this number reduces to the housekeeper and one domestic assistant on Tuesdays and to just having the housekeeper on Fridays. At weekends, two domestic assistants usually work Saturday 8am – 12pm and on Sunday one domestic assistant 8am – 12pm. Staff spoken to said that staff absence is not always covered and therefore tasks are not completed. Observations in one resident’s room found that their clothes were not being properly looked after as dresses, blouses and cardigans were piled up on the floor of the wardrobe. The home provides a range of equipment that is used to promote independence, including grab rails, hoists and assisted toilets and baths. Observations on the first floor of the home show residents’ needs are not being met. For instance, the home has one hoist which is shared between the two units therefore staff spend significant time transferring the hoist between the two units and residents often have to wait for long periods before they receive the support they need. Staff spoken with said they were aware this was causing problems and that residents have to wait while the hoist is being transferred. One visiting relative spoken with said they had requested that their relative be supplied with a suitable chair, as there were concerns that following a change in needs the chair currently used was no longer safe and the resident was at risk. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. Residents are protected by the home’s recruitment procedures but do not benefit from having their needs met by appropriate numbers of suitably trained or qualified staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In response to shortfalls identified during the last inspection the duty rota has been revised, to include the time spent in the home by the manager. A new format to include the role of each staff member has been introduced but information on the rota does not include the staff members start and finish times which is necessary for making sure sufficient numbers of experienced staff are available to meet the needs of residents. The staff rota shows there are four carers including a senior carer and a qualified nurse on each floor who are supported by a unit manager, deputy manager and manager. The home also employs an administrator, maintenance person, cook and two kitchen assistants. (Details of the arrangements for cleaning and laundry tasks can be found in the Management and Administration outcome group of the report). There are 10 male carers, 12 female carers, 13 overseas staff and nine staff whose first language is English. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 30 The inspection identified a number of concerns that the organisation must address if residents are to have positive outcomes. Observations made by the inspector and comments from relatives and residents show that there are not always sufficient numbers of staff available to meet residents’ needs especially at meal times when a number of residents need support and encouragement to eat their food (Further information is included in the Daily Life and Social Activity outcome group in the report). Discussion with staff members, residents and an audit of relatives and residents’ surveys shows that the composition of male and female staff is not considered when rotas are devised. For example, there are occasions including nights when only male carers are on duty and when a significant number of residents require intimate personal care. Comments on relatives’ surveys include: “Some elderly women might be embarrassed being tended to by a man.” “At times all the carers male all seven between both floors query reference to chaperoning needed when carrying out intimate tasks.” “We feel her gender is respected also although we have to presume this when we are not there. But she always seems content, and doesn’t seem afraid of any of the carers.” A number of staff, relatives and residents expressed concern about the high numbers of overseas staff working at the home who do not have good enough English speaking skills. This does not encourage interaction between staff and residents and prevents the staff from engaging with residents. An audit of relatives’ surveys includes the following Comments: “They try to commit to the residents needs, however I feel the turnover is staffed is the difficulty and also as previously mentioned they are recruiting other nationalities and there are language barriers, which I feel in the past has frustrated my mother.” “Certain staff members have dealt with my father well, however the language barrier has been the difficulty.” “The staff are very kind. Most appear to be trained. The only problem with a few of the carers is that their English is limited which can cause problems sometimes.” “Southern Cross/Ashbourne tend to recruit from overseas which results in use staff having poor English communication skills. If it doesnt Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 31 already Southern Cross should pay for English lessons or insist on reasonable English as part of the recruitment process.” “Because foreign staff are employed whose main language isn’t English sometimes difficult for me to understand, let alone mentally ill residents.” Two residents spoken to said, “the carers are very good, but I can’t always understand what they say” and “When I ask for help they don’t know what I’m saying and have to fetch someone”. Two staff spoken to said they often experience difficulties when explaining tasks to some of the overseas workers who they described as being “kind and caring” and could empathise as it must be equally frustrating for them when they do not fully understand what is expected of them. One staff member said they “spend such a lot of time trying to communicate and I feel the time could be better spent looking after the residents”. One staff member said the home was unable to influence the number of overseas staff working at the care home as staff recruitment was carried out by the organisation and the home instructed to take whoever has been appointed without first considering residents’ cultural back grounds and needs. The manager talked about the difficulties in recruiting staff locally and attributed this to the location of the care home and to the close proximity of another care home. The manager said he is advertising locally and has vacancies displayed on a notice board outside the home. During the last random inspection, the manager talked about the staff induction procedure and showed the inspector the worker’s induction records. Information held showed the worker had been made aware of residents’ right to have their privacy and dignity respected at all times. The worker had been at the home for two days with no previous experience of care work it was therefore of concern to see that the staff member was left unsupervised when feeding a resident. The staff member was unaware of the resident’s name or their needs including whether the resident was assessed as being at risk of choking. The manager said he would take immediate action to make sure residents are protected and have their needs met by experienced staff who are aware of their needs. Allowing inexperienced or trained staff to work unsupervised indicates that insufficient numbers of skilled staff are available to meet the needs of residents. Information supplied by the home before the key inspection visit shows that only 22 of the care staff are trained to National Vocational Qualification (NVQ) level two or equivalent. This falls well belong the standard that expects Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 32 50 of care staff to be qualified to NVQ level two or equivalent by 2005. The manager talked about learning and development and said that the recruitment of high numbers of overseas staff has left shortfalls, as staff have to be resident for three years before they are able to register for the NVQ. Some of these staff have been awarded care or nursing qualifications in their country of origin but the qualifications are not always easily transferable. A training matrix is held and used to record staff training and to identify any gaps in learning. Records show that staff attend a wide range of training that includes, Dementia Awareness, Challenging Behaviours, Customer Care, Pressure Care and Bedrail Safety. Nurses also attend training courses in Care Planning and Wound Care. On the day of the key inspection visit, a number of additional staff were present at the home to attend a learning module devised by the Alzheimers Society to increase knowledge and understanding of dementia care. The training was to be facilitated by the manager. Two relatives spoken with said there is not always sufficient staff available to meet residents needs. Staff members are described as “dedicated and caring” and “are often rushed off their feet.” Other comments noted on relatives’ surveys include: “I do feel that they have limited staff and training to deal with my fathers dementia and behavioural difficulties.” Staff recruitment practices were looked at involved reading the recruitment files of the most recent appointment and a worker who was waiting for the outcome of a Criminal Record Bureau (CRB) disclosure before being confirmed in post. Information held for the most recent appointment shows evidence of identification, health declaration, job description and checks made against the Protection of Vulnerable Adult (PoVA) register. Information held also shows that the person did not start working at the care home until after the outcome of the PoVA first check was known. The inspector was told that the second worker was waiting for the out come of a CRB and PoVA check before commencing employment at the home. Examination of documentation shows that other information and documentation needed to determine fitness has not been secured and includes, identification, recent photograph, name and address of GP. The application form requires the person to disclose whether they have any criminal convictions and has not been completed. Gaps in employment history while living in the Philippines from 1997 – 2003 have not been explored with the applicant. The manager says he is aware of the need to make sure all the information is secured before the person is confirmed in post. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 33 Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 34 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): Quality in this outcome area is poor. The home is not well managed and does not have quality assurance and monitoring systems developed by a qualified, competent manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of writing the report, the commission had not received an application from the owners for the person employed as manager to be registered. The owners must take action to ensure an application is submitted so that we can be sure an experienced and qualified person is managing the care home. Secure facilities are in place for safekeeping monies held on residents’ behalf. Records and receipts for financial transactions are held and in response to Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 35 shortfalls identified during the last key inspection visit; individual receipts for hairdressing are now being held. Information supplied by the home shows that 24 residents are subject to Power of Attorney orders, one resident handles their own financial affairs and the manager does not act as appointee for handling any residents’ financial affairs The inspection shows that since the last key inspection there has been little progress made on developing an effective quality monitoring tool. For example, regular relatives meetings and questionnaires are in place but not used in any meaningful way to bring about any improvements identified as necessary. The manager talked about the quality questionnaires that are displayed in the reception area of the home and said none had been returned. Residents’ meetings have been introduced with the first meeting having taken place in April 2007. We obtain information before inspections. This information includes confirmation that all necessary policies and procedures are in place and are upto-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Information about staff training received from the home before the key inspection shows that staff training in 2006 included, First Aid Awareness, Manual Handling, Medication, Fire Awareness and Infection Control. Training already carried out this year includes Fire Drills and Fire Safety, Control of Substances Hazardous to Health (COSHH), Health and Safety and Nutrition. Further training planned for this year includes Medication. Regular updates will be carried out throughout the forthcoming year. Staff use moving and handling equipment safely but not all equipment used is safe. For example, disposable gloves were being used to hold fittings in place on the footplates of a wheelchair. Such practices are unsafe and place residents at risk. The inspector raised immediate concerns about safety with staff and the wheelchair was taken away to await repair. The Care Homes Regulations (2001) requires that the home advise the commission of any accidents or incidents that affect the health, safety and welfare of residents. The inspection found that the home has not complied. For example, for a number of days over Christmas, problems with the boiler left half the home without hot water provision. The manager talked about the arrangements for making sure residents’ personal care needs were being met and said that staff transported hot water from one side of the building to the other in buckets. Management do not have contingency plans in place for events such as this. Risk assessments were not carried out therefore practices may have been unsafe. The home did not have a clear strategy for making sure residents’ personal hygiene needs were met and the risk of infection or cross contamination was increased. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 36 A number of relatives and residents have expressed concerns about the high temperatures on the first floor, especially during the summer months. There are concerns that the high temperatures may affect the health, safety and welfare of residents. Comments noted include: “Dementia floor (last summer) Temperature in the home before current window restrictions was 38°C at times. (Home’s corridor thermometer) airconditioning in lounge helps a little but there is urgent need to review and plan for forecast hot/warm summer. Heat on dementia floor in the summer is unpleasant for staff and residents. Also effect of 38°C on tablets and other medication, combustible material for example oxygen cylinders, pads aerosols etc.” The manager must carryout a risk assessment and make sure the air temperature in the home is regularly monitored and recorded and any action deemed as necessary taken to ensure the continued health, safety and welfare of residents. Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 37 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 1 X X X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 38 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must ensure that there is a documented protocol available for medication, which has been prescribed for behaviour management on a when required basis so that the home can be sure residents needs are met. Timescale for compliance 30/04/07 not met. Effective procedures must be in place to reduce the risk of infection or cross contamination so that residents are not placed at risk. For example: Effective cleaning schedules necessary to ensure all areas of the home are kept clean. Hand washing facilities especially in high-risk areas such as the laundry room. Action must be taken to increase the number of staff qualified to National Vocational Qualification (NVQ) level two or equivalent so that residents benefit from having their needs met by staff who are appropriately DS0000004385.V336402.R01.S.doc Timescale for action 26/05/07 2. OP26 13(3) 26/05/07 3. OP28 18 31/07/07 Arden Valley Christian Nursing Home Version 5.2 Page 39 4. OP31 5. OP33 6. OP38 7. OP38 8. OP38 experienced and qualified. An application from a suitable person to register as manager of the care home must be submitted to the commission so that residents can be confident that the home is being managed by a person who is appropriately qualified and experienced. 24 A system for evaluating the quality of the service provided must be introduced and maintained and include consultation with residents their representatives and other stakeholders so that management are aware of and can respond to any shortfalls identified in the service provision. 37 Make sure that we are consistently advised of any accident or incident that adversely affects the health, safety or welfare of residents. This will ensure that residents can live safely in the home and are not at risk in their environment. 13(4)(a) Raise the standards of health and safety management within the home. So that residents can be sure that the home is being managed in their best interests and can be confident that their health, safety and welfare is given the highest priority. Regulation Make sure the room 23(2)(p) temperatures on the first floor of the accommodation are regularly monitored. A record of the room temperatures must be held and if necessary appropriate action taken to prevent temperatures rising to levels that may be detrimental to residents. So that the environment is safe and comfortable for residents and 8 DS0000004385.V336402.R01.S.doc 26/05/07 26/08/07 26/05/07 26/05/07 26/05/07 Arden Valley Christian Nursing Home Version 5.2 Page 40 9. OP38 their health, safety and welfare is promoted and maintained. Regulation Make sure there is sufficient 23(2)(n moving and handling equipment available to meet the individual needs of residents and that the equipment used is properly maintained so that residents are not placed at risk of harm or injury. 26/05/07 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 OP1 Good Practice Recommendations The Statement of Purpose and Resident Guide should be updated to reflect the changes in the organisations management structure and to show that the home does not have a registered manager. Risk assessments should take into account the residents capacity for independence to make sure staff are aware of the actions needed to reduce risk and to promote independence and self care so that residents are not placed at risk. Residents who require support to meet their intimate personal care needs should be consulted about whether they prefer a male or female carer to support them with the task and any preference expressed acknowledged, respected and recorded. Staff should be aware of the residents’ capacity for independence before independence can be safely promoted and maintained. Information held on daily records should confirm in more detail whether the care provided is as agreed on the care plan. 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 DS0000004385.V336402.R01.S.doc Version 5.2 Page 41 2. OP7 3. OP10 Arden Valley Christian Nursing Home resident’s private rooms should be closed unless the resident chooses otherwise. In which case it should be recorded on the care plan. Make suitable arrangements to make sure residents have their clothes returned to them and do not wear clothes that belong to someone else. Make sure that any welcoming notices displayed in residents rooms is accurate so that residents feel valued as an individual and is treated respectfully 4. OP12 Staff with responsibility for planning activities should be trained in the provision of specialist dementia care so that they are aware of how to identify residents’ needs and can provide appropriate social and mental stimulation. A planned programme of person centred activities for people with dementia or other cognitive impairments should be introduced so that residents have opportunity to maintain life skills and benefit form having quality care that reflects their individual needs. Residents should be consulted about a programme of activities that takes into account individual and group needs. Details of planned activities should be displayed in the home so that residents are aware of what is planned for the day and can plan their time accordingly. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. The work already started on developing life stories and histories should continue so that staff are aware of cultural diversity and lifestyles and can make sure residents needs are met. Residents should be given the opportunity to go out into the garden or make visits to the local community. Residents should not have to wait for staff to be available to give them the help they need to eat their food. Experienced staff should provide support and encouragement for residents to eat their food. Staff should not feed two residents at the same time as such practices are institutional and do not promote the Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 42 5. OP15 residents’ or dignity or sense of self worth and residents may be placed at risk. Food moulds should be used for soft or pureed diets so that food is presented in a more attractive and appetising manner. Staff should be aware of the name and needs of the resident they are supporting and familiar with any potential risks. Make sure staff recruitment policies and procedures take into account the cultural, language and communication needs of residents so that the home can be sure that the people appointed more accurately reflect the cultural needs and diversity of the residents Staff employed at the home should have good enough English speaking skills to be able to interact and engage residents so that the home can be sure residents’ needs are being met. Make sure the duty rota includes the start and finish times of staff so that the home can be sure there are sufficient numbers of experienced staff available to meet the needs of residents. The home must make sure that food stored in the fridge is covered and if appropriate dated so that staff can make sure, residents are not offered food that places them at risk of harm. To reduce the risk of infection or contamination dirty cutlery should not be left in the fridge. 6. OP29 7. OP38 Arden Valley Christian Nursing Home DS0000004385.V336402.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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