Inspection on 03/06/08 for Arden Valley Christian Nursing Home

This inspection was carried out on 3rd June 2008.

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

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

Other inspections for this house

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

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

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

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

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

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

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

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

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

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Arden Valley Christian Nursing Home Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR Lead Inspector Jo Johnson Unannounced Inspection 08:45 3 and 6th June 2008 rd 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.V365964.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.V365964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arden Valley Christian Nursing Home Address Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR 01789 731168 01789 731883 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.southerncrosshealthcare.co.uk Trinity Care Limited Mrs Petra Thompson 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.V365964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2008 Brief Description of the Service: Arden Valley is a purpose built home providing accommodation for 24 people with dementia and 24 people who are frail elderly. Accommodation is provided on the ground and first floor of the property. Residents from both units have access to a secluded garden at the rear of the building. Each unit provides a variety of communal living space with a light and airy conservatory area. The home is located in a rural area, which is not easily accessible without a car. There was no written information available about the cost of living in this home. The manager said it is assessed on an individual basis and the fee is agreed before people move into the home. The fees do not include newspapers, toiletries, hairdressing or private telephones. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience Poor quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The manager supplied the commission with an AQAA (Annual Quality Assurance Assessment) in November 2007. Information from this has been used to make judgements about the service, and have been included in this report. Surveys were sent to ten people who live at the home and ten staff. Four surveys from people and their relatives and five staff surveys were returned. The findings of these surveys have been included in the report. This was the home’s first key inspection of 2008/2009. The inspection visits were unannounced (we did not let the home know that we were coming) and took place on 3rd June 2008 by a pharmacist inspector and on 6th June between 8.45am and 4.45pm by two inspectors. The inspection involved; • • • A pharmacist inspection looking at the medication systems and the medication and care records of six people. Observations of and talking with the people who live at the home, relatives and the staff on duty and the manager. Four people were identified for close examination by reading their care plan, 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 people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. • Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 6 We would like to thank the people who live at the home, the manager and staff for their hospitality and cooperation during the inspection visit. What the service does well: What has improved since the last inspection? Additional support has been provided at lunchtime during the week so that people are supported to eat and drink in a dignified and sensitive way. Medicines are now stored in the labelled packaging in which they were originally dispensed so that staff can be certain what they are and whom they are prescribed for. There are now relatives meetings so that they can discuss issues directly with the manager. People have contributed to the activities programme through the monthly resident’s meeting. The ongoing mural decoration in the dementia care house means that people are benefiting from a more stimulating environment. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 7 What they could do better: Since the last inspection there has been deterioration in the quality of the service provided by the home and the outcomes for the people who live there. Accurate assessments must be completed for people. This is to make sure that peoples’ needs are identified and staff know how to care for them. People’s care plans must be reviewed, kept up to date, and include all the individual’s clinical and behavioural assessments. This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. Any areas of risk identified for individuals must be assessed and these assessments must include any behaviour that may challenge others. This is so that any risks are minimised and staff know what action to take to keep people safe. The staff at the home must ensure that a General Practitioner physically sees people for new conditions before accepting newly prescribed medications. This is to make sure that people receive the correct medical treatment. The recording, administration and medication management systems need to improve. This is to make sure that people receive their medication as prescribed and that there are systems in place to make sure medication is administered safely. Staffing levels provided at the home must be based upon the individual needs of the people who live there, and not based upon ratios of staff to residents. This is to make sure that there are sufficient staff to meet the personal, physical, social and psychological care and support needs of the people at the home. Staff must not be accommodated in the care home’s registered bedrooms. This is because it is the resident’s home and staff have not been assessed for nursing care. The management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Quality in this outcome area is poor. People who are moving into the home cannot be sure that all of their needs will be assessed so they cannot be confident that the home can meet all of their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessments for three of the four people admitted since the last inspection were looked at. The manager is undertaking all of the assessments for people to see whether the home can meet their needs. The manager told us that the physical Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 11 dependency and frailty of people living at the home is high and she is trying to balance this out with admitting people who are less physically dependent. The people whose assessments we looked at had some complex mental health issues and or a diagnosis of dementia and two of them had a history of behaviours that could challenge others including people who live at the home. One person is epileptic and another has manic depression. The assessments completed by the manager did not accurately reflect people’s needs. For example, the assessments completed by the health and social care professionals identified that one person had dementia, was epileptic, and had complex behaviours including faecal smearing, inappropriate urinating and sexually disinhibited behaviours. These needs were only briefly referred to in the initial assessment. This meant that they were then not identified in sufficient detail in the subsequent care plan so staff were not fully aware of the individual’s needs. Another person had a long history of aggression and sexually disinhibited behaviour to other residents at their previous care home. Again, the initial assessment did not reflect these past behaviours even though the social services assessment identified these areas as ‘high risk’. One of the assessments seen was not dated so it was not clear when it was completed. It is not clear based on the assessments seen whether the home can be sure that they can meet peoples’ needs before they are admitted to the home. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. People living at the home are treated respectfully. The shortfalls in medication management put people at risk of harm from non-administration or misadministration of medication. Care plans and risk assessments do not identify and or consistently describe the actions necessary to meet the identified needs of people living in the home, which puts them at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager identified that the majority of people living in the home have medium or high dependency nursing care needs; this was confirmed by observation and meeting with people. In the dementia care house there are Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 13 many people who have high physical needs alongside their dementia care needs. A number of people are cared for at all times in bed. Four people’s care records were looked at. The organisation has a standard assessment, care planning, risk assessment and daily record system. The information gained from the initial assessments should identify needs that must be risk assessed and planned for. Some of the shortfalls identified in the assessment section of the report mean that elements of people’s lives are not risk assessed or planned for. For example: • One person’s plan did not include any information or description about their epilepsy, there was not any epilepsy management plan nor was their behaviours risk assessed or planned for. This means that staff were not aware of how to safely care for this person or were they aware of the risks and how to minimise these. • Another person’s plan did have a care plan for managing any incidents of challenging or aggressive behaviour. There was no plan for the sexually disinhibited behaviour that social services had assessed. There were no risk assessments for this person’s behaviour and how staff were to minimise these risks. One person who was identified by both a speech and language therapist, dietician and deputy manager at high risk of choking did not have an up to date plan in place that specified the correct types of drink supplements or thickness of any fluids. The deputy manager had reviewed the nutritional risk assessment the day before the inspection. She had identified further risks and specified that only a qualified nurse or senior carers were to assist the individual with eating and drinking. She also identified that although there were two suction machines in the home, neither were in working order nor were there sterile suction catheters. We advised the deputy manager that if she had identified that a suction machine was needed she must take immediate action to ensure that one was sought for the home. A new suction machine with sterile suction catheters was delivered to the home by the end of the inspection. • The care plans lacked some detail regarding peoples’ underlying medical conditions and it was not possible to identify all their needs from the care plans alone. For example, one person was at risk of choking but was still prescribed tablets and capsules. No information was given how to ensure that he took his Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 14 medicines safely. Other examples were found where one person with diabetes had no information recorded to support their condition. Care plans seen did include clear records about people’s pressure areas and body maps of any marks. Risk assessments were completed for nutrition, moving and handling and falls. People had been weighed on a monthly basis to monitor whether they were losing or gaining any weight. The manager told us that five people at the home have pressure sores. She told us that the advice of the tissue viability nurse has been sought when needed and the pressure relieving equipment is available for those people at risk. There were records of the amount of fluids people had drunk in their bedrooms. Daily records seen reflected the personal care they had been provided with and what they had eaten. The personal profile section in the care plans seen had very little or no information about the individual. As two of the new people have dementia and one of them does not communicate verbally, the staff knew very little about the new people as individuals. One staff member said that they had asked one person’s family to provide them with some information about the individual so they could start a life history. There was no information compiled by the home for the person who does not communicate verbally. For one person who has lived at the home for over a year their family had made a ‘life history’ book. Staff were knowledgeable about this individual. Discussion with the manager, staff, surveys from relatives, observation of care plans and daily records showed that people living in the home have access to other health professionals such as GP, dietician, dentist and specialist consultants and chiropodist. One survey included the comment ‘sometimes it is necessary to apply pressure to obtain the doctor outside normal visiting days’. For one of the people admitted two weeks before the inspection, their daily record referred to them having a sore face. The next day’s entry stated that the General Practitioner had prescribed a cream ‘without visiting him’. The staff at the home must ensure that people are physically seen by a General Practitioner to make sure that people receive the correct medical treatment. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 15 A section on the care planning document relates to DNR (Do Not Resuscitate) directives. In two of the plans seen, this section had been completed with the consent of people’s next of kin. Any decisions as to end of life care and directives should be agreed by a multidisciplinary team including the individual’s doctor. People’s next of kin must not make these decisions alone if the individual does not have the capacity to do so. This is to make sure that people’s best interests are taken into account. The home has two medication rooms, one on each floor. Both had a portable air conditioning systems but neither machine was switched on. The temperatures in both rooms exceeded 26°C. The temperature should be below 25°C at all times to ensure that the medicines are stored within recommended temperature limits to maintain their stability. Both medication rooms had a refrigerator, which were at the recommended temperature, clean and tidy. The home used a good system to check the prescriptions prior to dispensing and to check the medicines and charts into the home. This ensured that they were able to action any discrepancies found before administering the medication to the residents. Staff had failed to check all the medicines received into the home for one new resident. This had resulted in this resident not having an emergency medication available to treat an epileptic fit, as documented in the pre-assessment records. The manager immediately tried to contact the resident’s doctor to address this issue. By the second day of inspection, three days later, this medication was still not in the home. This was chased up during the inspection and the manager confirmed that the medication was to be delivered the same day. Clarification of the use of the medication was established following the inspection through discussion with the consultant psychiatrist. However, this information should have been clarified when the person was admitted, not after we identified it. One medicine had been purchased by the resident and was found in the medication trolley. It had not been recorded on the medicine chart so it could not be demonstrated whether it had been administered or not as a homely remedy. No record was found that the doctor had been informed of this and it was safe to administer with her other prescribed medication. A similar issue surrounding homely remedies was raised at the last inspection. The majority of medicines had been administered as prescribed. A few errors were seen. Some medicines had been recorded as administered when they had not been. Other medicines were unaccounted for without any explanation. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 16 The manager had installed a quality assurance system to check the medicines administered on a daily basis that have been dispensed in traditional boxes and bottles. This was not robust enough to identify individual staff responsible for the mal-administration of some medicines. The manager was keen to address this issue. Two nurses were spoken with during the pharmacy inspection. They both had a good understanding about the clinical conditions of the residents they care for and were very knowledgeable about the medicines they administered to them. One resident’s constant refusal to take her medicines had prompted a medication review and convert administration had been discussed. The home was adhering to the Mental Capacity Act before this method of administering medicines to the resident without her informed consent was undertaken. All parties involved in her care were in the process of being consulted. All controlled drug balances were correct and they were correctly stored in a dedicated controlled drug cabinet that complied with the current regulations. All controlled drug entries were accurately recorded. People were generally well groomed and cared for. Relatives and people spoken with said that staff always take care to make sure people are well dressed and their appearance is cared for. Staff spoken with had a good understanding of recognising people as individuals and respecting their privacy and dignity. Staff surveys told us that they ‘always’ or ‘ usually’ have the right support, experience and skills to meet the diverse needs of people who live at the home. Comments included, ‘I feel we need more time to spend with our service users’ and ‘Because it is a must to know or have knowledge about each resident’ Staff observed had good relationships with the people living at the home and were patient and encouraging. People with dementia approached staff and staff gave them reassurance when needed. Staff respected people’s privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. Peoples and relatives’ surveys told us that staff treat them well and that carers listen and act on what they say. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 17 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): 12, 13, 14, 15 Quality in this outcome area is good. People who use this service are able to participate in social activities and are given choices including choice of meals provided to maintain their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a full time activities co-ordinator who is responsible for arranging individual or group activities for the benefit of the people who live there. The coordinator is employed to work 37.5 hours per week, Monday to Friday from 10am to approximately six pm. The hours are flexible to meet the needs of the people who use the service. An activities schedule is in place, which shows that there is an activity being provided each weekday. On the day of the inspection, the activities co-ordinator spent the morning with individual residents in their rooms. People who live there were able to have one to one Aromatherapy sessions or take time to sit and chat with the coArden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 18 coordinator. Arts and Craft activities were available in the afternoon for those who wished to join in. The inspector observed part of the Arts and Craft session in the afternoon. People were asked what they wanted to do and were spoken to and treated with respect. Staff were seen to remind and invite people to the arts and crafts session to ensure all those who wished to join in, could. A bulletin is produced to inform the people who use the service what activities are happening each week. People spoken to confirmed that activities take place regularly in the home. Staff maintain records of what activities have been arranged and who has participated. Staff also record any positive outcomes from the activities for the people who join in, and any comments that would improve the variety of activities based on individuals preferences. The home has recently bought a mini bus that accommodates wheelchair users. This will enable staff to support people who live at the home to go on various outings and maintain links with the community. Staff spoken to were not aware if any outings that have been arranged for the coming summer months. However, staff stated that there have previously been trips to The Stables Garden Centre and to the local pub situated next to the home. Some of the people are able to tell staff what activities they would like in the monthly residents meetings. Information in the minutes of the monthly meetings included requests to start growing vegetables in the garden area and to have broad beans served at some of the meals. People also expressed their pleasure at the ‘Pet a Pet’ activity on Thursday mornings. On the day of the inspection, people who live at the home were supported to get up at different times through the morning. They were given the option of having breakfast in their own rooms or the dining room. Breakfast was served up to 11am. At breakfast, a choice of a cooked meal is offered as well as cereals, toast, and drinks. Menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared nutritious. Tables were well presented in preparation for lunch, which was served at 12:45. People said that they were able to have their meal in the dining or their own room if they wish. The home has a kitchenette on each floor in addition to the main kitchen. Residents and families can use the kitchenette to make themselves a hot drink or have a snack. Evening tea is served at approximately 4:45pm. As this can Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 19 be a long time until breakfast, staff need to ensure that the kitchenettes are well stocked with food and drinks to ensure people are able to have food and drinks in the evening. At lunchtime, one inspector observed lunch being served in the dementia unit, the second inspector observed lunch on the ground floor. On the ground floor, people were provided with a choice of hot meal from the menu – lamb casserole or fish pie, served with potatoes and a choice of vegetables. One person having lunch commented ‘I enjoyed my lunch and had plenty to eat’. Another person agreed saying ‘the lunch was nice’. Staff were observed offering assistance to those who required it in a sensitive and discrete manner. There are choices offered for each meal each day, with the addition of a pureed diet alternative when necessary. The menu however does not always offer a soft diet alternative, staff need to ensure that those who need a soft diet are provided with a soft diet and not given a pureed diet. This would promote the self esteem and dignity of those who use this service. The home now has the foot rests to accompany the specialist seating bought at the time of the last inspection. People who require this seating are now able to use this. People at the home are encouraged to maintain links with their family and friends who are made welcome on their visits. One relative spoken with stated that she is able to visit her mother when she wishes, and they can spend time together in privacy. Another person felt that her links with her family would be improved if she was able to have her own phone in her bedroom, as there is no public phone in the home. The people who live at Arden Valley were seen to interact well with each other and staff and were treated in a positive and dignified manner. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 20 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): 16,17,18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people and their families. People are encouraged to raise their concerns with the manager. All four surveys from people and their relatives show that they know who to speak to if they are not happy and know how to complain. One visitor spoken with knew how to complain and who to speak to if they had any concerns. Staff spoken with and five surveys show that they know what to do if a service user or relative or friend has concerns about the home. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 21 We have received one concern from a family member who also complained directly to the home. The complaint related to staffing levels at the home. The complainant was satisfied with the manager’s response. We reviewed the record of complaints kept at the home by the manager. There have been five complaints made directly to the home since the last inspection. Four of the five complaints relate to staffing levels at the home, the other complaint related to the attitude of a staff member towards an individual’s relative. The record shows that complaints have been investigated and responded to within the home’s 28-day response time. A ‘Communication Sheet’ is available in each person’s room to improve communication between staff and relatives. The manager discussed that this was particularly useful where residents were unable to communicate their needs effectively because of their dementia care needs or physical disability. Two relatives spoken with told us that the sheets work, they said, “we put that XXX needed her nails cut on her hand as they were digging in and the staff sorted it out”. A comments book is available in reception inviting visitors to make comments or suggestions. It was evident that the comments are considered because a written response from the management team was recorded alongside each comment. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. A majority of staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. Staff spoken with had an understanding of how to recognise and report any allegations of abuse. There have been no adult protection referrals made to us since the last inspection. The manager told us that there had been no allegations of abuse made directly to the home either. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 22 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): 19,26 Quality in this outcome area is adequate. In the main, the home is maintained and furnished so that people live in a clean and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation over two floors, referred to by staff as ‘houses’. People who have general nursing needs live on the ground floor and people with dementia care needs live on the first floor. Each floor has 24 single occupancy bedrooms with en-suite facilities. There is a dining room in the centre of each ‘house’ and a lounge at either end. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 23 Decorating work is ongoing throughout the home and in the dementia care house an artist has created scenes on the walls of some of the corridors to provide a more stimulating environment for people living there. For example, one scene appears to be market stalls and another depicts ‘washday’. A number of tactile objects related to each scene are displayed; such as fruits on the market stalls and a clothes line with washing pegged to it on ‘washday’. There are plans to involve the people at the home in the next mural on the dementia care house. The quality of the furnishings and fittings in people’s rooms varied but were generally good. Call systems in rooms are accessible to people. We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. People in the dementia care house who have lived at the home for more than a few months have their ‘life history’ book in their rooms. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, profiling beds, accessible showers and moving and handling equipment including hoists. A range of pressure relieving equipment, including specialised ‘air’ mattresses are available. The home felt very warm throughout the inspection. The heat and adequate ventilation is a particular problem on the dementia care house. There is a large air conditioning unit in the corridor outside one of the lounges. This unit is very noisy and was constantly on during the inspection. It was difficult to hear the music playing in the lounge and or any conversation with people due to the constant drone of the unit. This could have a negative impact on the well being of people living at the home. Either a quieter air conditioning unit or other alternative ways of reducing the temperature should be sought for the dementia care house. This is so that the constant noise does not have a negative effect on people’s well being. Most of the home was fresh and clean. There was an unpleasant odour in the lounge in the dementia care house. We told the manager about the smell and she took immediate action and asked a member of domestic staff to check and clean the area. The four surveys from people and their relatives told us that the home is ‘usually’ fresh and clean. The surveys included the comments: ‘my carpet is filthy’ and ‘every time I visit father the home is fresh and clean’. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 24 The manager told us that the domestic staff have been reorganised so that there is a member of cleaning staff on duty on each floor and an identified person working in the laundry for each day of the week, including weekends. The laundry room was clean, tidy and well organised. All of the washing machines were in working order. Hand washing facilities and protective clothing was available. Alginate bags were in use for soiled laundry to minimise handling and reduce the risk of infection. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub were available and were used by staff when handling soiled linen and when supporting people with personal care. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 25 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): 27,28,29,30 Quality in this outcome area is poor. There are insufficient staff on duty to fully meet the needs of the people living there. Staff present as competent and caring, however due to the high dependency levels of some people who live there, people are not receiving the best possible care and this is also impacting upon staff morale. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection visits, there were 39 people living at the home. Records maintained at the home show that on the 6th June 2008, the home employees 22 care assistants, 10 registered nurses, 4 kitchen staff, 4 laundry / domestic staff, 1 maintenance staff, 1 activities co-ordinator, and 1 administrator. Since the last inspection, the home has admitted four people who have high levels of dependency upon staff support. One registered nurse is available on Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 26 each floor throughout the day and night time. Further support is provided from four care staff upstairs on the Dementia Care Unit and three care staff downstairs on the General Nursing Unit during the day. This is reduction of one member of staff on each floor in comparison to the last inspection, despite an increase in the number of people who live at the home and an increase in dependency upon staff support. Ground Floor General Nursing One Registered Nurse Three care Staff One Registered Nurse Three care Staff One Registered Nurse One care Staff First Floor Dementia Care One Registered Nurse Four care Staff One Registered Nurse Four care Staff One Registered Nurse one care Staff 8am – 2pm 2pm – 8am 8pm- 8am This was confirmed by examination of two weeks duty rota between 26/5/08 to 08/06/08. This staffing levels impact on the amount of time staff can spend with people, resulting in only basic care needs being met. The quality of care observed was good and staff interactions were not rushed. However, there were long periods throughout the inspection where people were alone in their bedrooms or alone in lounges without staff being present. The four surveys from people and their relatives show that staff are ‘usually’ or ‘sometimes’ available when they need them. The surveys included the comment, ‘ Could do with extra staff, the staff on duty do their best’. One member of staff spoken to stated that she felt ‘yes, more staff are needed in the dementia care unit’. Another commented that ‘more flexibility from staff is needed to move between the units to ensure that staff support is available to those with higher dependency levels’. Surveys from staff also told us that there are ‘sometimes’ or ‘never’ enough staff to meet the individual needs of the people at the home. Comments included: • ‘I feel we really need more carers to help with duties. This would help greatly with busy work load and lift staffs mood and moral creating a nicer environment for our residents to live in’, • ‘Staffing levels should be based on personal needs for each resident’ • ‘Most of our residents are very dependent and we sometimes do not have the time we would want to talk to them and engage them socially Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 27 as well as give the care they need. We give high standards of care and respect to our residents’. The inspector was informed that due to the home’s remote location and transport difficulties, staff ‘prefer’ to work from 8am – 8pm. The manager’s hours are supernumerary. The manager said that she would work ‘on the floor’ should there be any unplanned absence. Alternatively, the home should look to use agency staff to ensure the required numbers of staff are on duty to meet the needs of the people who live there. Staffing levels provided at the home must be based upon the individual needs of the people who live there, and not based upon ratios of staff to residents. The operations manager is no longer present at the home in a full time capacity, and no records of any quality assessment visits were evident on the day of the inspection. Out of 22 care staff employed at the home, 11 have a National Vocational Qualification in Care (NVQ) at level two, which is at the National Minimum Standard for 50 of staff to be qualified. Staff training records demonstrate that staff complete an induction programme. The training matrix demonstrates that staff are able to attend a range of training programs and nursing staff are able to attend training specific to their roles. The home needs to ensure that all staff have training in safeguarding and whistle blowing procedures. The personnel files of the three most recently recruited staff were examined and all contained evidence that satisfactory pre-employment checks were carried out by the Chinese Police Authority before staff started working at the home. All files examined also contained two references. Personnel files of other staff members were also viewed on the day of the inspection, and contained the satisfactory pre-employment checks. There is a dining room assistant to provide sensitive support and assist people to eat their meals, and this arrangement is working well. The deputy manger has recently developed a recording system, which enables staff with the dining room assistant to monitor the quality of the meals. The head cook is currently on sick leave. short-term arrangements in her absence. Arden Valley Christian Nursing Home The home has made alternative DS0000004385.V365964.R01.S.doc Version 5.2 Page 28 • • The home employs an administrator who works 30 hours per week. Laundry and domestic assistants work between 8am and 4pm each day. This means that care staff no longer need to carry out these duties. The Kitchen is staffed between 7am and 6:30pm everyday of the week. • The home has recently employed three new members of staff. The staff are from overseas, and the home is currently supporting them with accommodation arrangements by using unoccupied rooms in the home that should be used for people who require nursing care. It is the responsibility of the manager to ensure that staff do not use rooms allocated for people who have been appropriately assessed as needing nursing care and ensure that alternative living accommodation is sought within the coming days. The manager confirmed with us following the inspection that the staff were no longer staying in the home or working at the home. People living in the home told the inspector that they felt they were ‘well looked after’ and the care staff were ‘very nice’ and ‘very kind’. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 29 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): 31, 32, 33, 35, 38 Quality in this outcome area is poor. People who live at the home do not benefit from or live in a well managed home that is run in their best interests or that has effective monitoring systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the manager has been registered with us. She is a registered nurse and has a Post Graduate Diploma in Management Studies and a master’s degree in Business Administration. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 30 The deputy manager who was in post at the last inspection in January 2008 has now left. A new deputy manager was appointed and had been in post for one month at the time of the inspection. The deputy manager was leaving the home on the Monday after the inspection. This means that the home will be without a full stable management team again. At the time of the last inspection the operations manager was based full time at the home. The plan was to reduce to the support to two days a week following the last inspection. Unfortunately, the operations manager has been off work for a number of months. A project manager for Southern Cross has been covering this role. There were no records in the home to demonstrate that any monitoring that had taken place or how often they had visited. The project manager informed us that he had been visiting the home. The manager told us that she is no longer working at weekends or undertaking monitoring visits out of hours. The manager told us that following the appointment of a deputy manager; she was focusing on the business side of the home and filling the empty beds to meet the organisation’s occupancy targets. There are a number of serious shortfalls in the assessment and care plans for new people who have been admitted to the home and the care plans of people already living at the home, the staffing levels and transparency of the management of the home. The management team of the home appears to be reactive rather than proactive as demonstrated throughout the report. The management team had every opportunity to inform us both before and during the inspection of the overseas staff that were staying at the home amongst the people who live there. This shows a lack of honesty and understanding that it is the residents’ home and that the rooms are registered with us for the provision of nursing care only. The management team had the opportunity to rectify the shortfalls identified by the pharmacist inspector who visited three days before the main inspection. However, although the manager took some initial action these shortfalls were still there when we visited. The staff morale is low, as identified under the staffing section, through discussion with staff and from staff surveys that were returned to us. The themes identified by staff were: staffing levels, low morale, working long hours and lack of supervision and support. The monitoring and quality assurance systems of the organisation and the manager have not identified these shortfalls and these must be improved. At the last inspection, it was acknowledged that the organisation and manager had made improvements to meet the shortfalls identified at previous Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 31 inspections. However, at that inspection we also stated that we were unable to fully assess the impact of the improvements made as no new people had been admitted to the home. We acknowledge that there is some improvement in the activities for people, the quality of the staff interactions and care and the levels of support available during the week at mealtimes. The manager has started to build relationships with families and regular relatives meeting are held. The views of residents and relatives were surveyed in January 2008 and this contributes to the home’s quality assurance system. This means that people’s views are considered when making any plans for the home. Peoples’ personal monies held by the service for safekeeping are pooled in one bank account. Individual account sheets are maintained along with receipts for income and expenditure and are available for people or their appointee to see. There is usually only a small ‘float’ allowing an individual to withdraw up to £10, if a larger sum was requested then the administrator would go to the bank and withdraw it. From discussion with the administrator, this system is still in place. No individual’s personal financial records were checked at this inspection. Information sent to us in the AQAA (Annual Quality Assurance Assessment) in November 2007 tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence of this was seen at the Key inspection in January 2008. No specific checks were made at this inspection. There are organisational systems in place for the routine servicing of equipment and fire, heating and electrical systems. Equipment seen during the inspection was in good order. Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x x 3 Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(2) Requirement Accurate assessments must be completed for people. This is to make sure that peoples’ needs are identified and staff know how to care for them. People’s care plans must be reviewed, kept up to date, and include all the individual’s clinical and behavioural assessments. Timescale for action 06/08/08 2 OP7 15 (1)(2)(b) 06/08/08 3 OP7 13 (4)(b)(c) This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. Any areas of risk identified for an 06/08/08 individual must assessed and these assessments must include any behaviour that may challenge others. This is so that any risks are minimised and staff know what action to take to keep people safe. The staff at the home must ensure that a General Practitioner physically sees DS0000004385.V365964.R01.S.doc 4 OP8 13(1)(b) 06/08/08 Arden Valley Christian Nursing Home Version 5.2 Page 34 people for new conditions and or new people admitted into the home before accepting newly prescribed medications. This is to make sure that people receive the correct medical treatment. 5 OP9 13(2) The right medicine must be administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice 06/08/08 6 OP9 13(2) This is to ensure that the clinical needs of the people are fully met A quality assurance system must 06/08/08 be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. This is to ensure that all nursing staff are responsible for their clinical practices All medicines must be stored in compliance with their product licences to ensure their stability 7 OP9 13(2) 06/08/08 8 OP27 18(1)(a) This is to ensure that the medicines are safe to administer. Staffing levels provided at the 06/08/08 home must be based upon the individual needs of the people who live there, and not based upon ratios of staff to residents. DS0000004385.V365964.R01.S.doc Version 5.2 Page 35 Arden Valley Christian Nursing Home 9 OP29 12 (1), (4) (a), 14(1) This is to make sure that there are sufficient staff to meet the personal, physical, social and psychological care and support needs of the people at the home. Staff must not be accommodated 24/06/08 in the care home’s registered bedrooms. This is because it is the resident’s home and staff have not been assessed for nursing care. The management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. 10 OP33 24 (1) 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP7 Good Practice Recommendations People’s assessment should be dated so it is clear when and by whom it was completed. Personal profiles in care plans and or ‘Life History’ books should be developed that include details and photographs of their ‘history’ such as family, friends, where they have lived, pets, work etc. These profiles or life history books will assist staff to have a greater understanding of them as an individual. All nursing and clinical equipment, that has been identified as being required, needs to be kept in good working order and be available to use. DS0000004385.V365964.R01.S.doc Version 5.2 Page 36 3 OP8 Arden Valley Christian Nursing Home 4 OP8 This is so that staff have access to working and safe equipment to be able to safely care for people Any decisions as to end of life care and directives should be agreed by a multidisciplinary team including the individual’s doctor. People’s next of kin should not make these decisions alone if the individual does not have the capacity to do so. This is to make sure that people’s best interests are taken into account. 5 OP9 Where unprescribed homely remedies are to be administered evidence of discussion and agreement of the GP should be documented and retained alongside MAR sheets. This is to show that medical advice has been sought, discussed and agreed. 6 OP15 The kitchenettes need to be kept well stocked with food and drinks. This is to make sure that people are able to have food and drinks in the evening. People who are assessed; as needing a soft diet should be given a soft diet not a purred diet. This would promote the self esteem and dignity of those people. Either a quieter air conditioning unit or other alternative ways of reducing the temperature should be sought for the dementia care house. This is so that the constant noise does not have a negative effect on people’s well being. Effective cleaning monitoring should be established so that unpleasant smells are eliminated before they become obvious. This is so that people live in a clean and fresh environment. All staff need to attend training in safeguarding and whistle blowing. This is so they know how to identify and report any allegations of abuse. 7 OP15 8 OP19 9 OP19 10 OP30 Arden Valley Christian Nursing Home DS0000004385.V365964.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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