Inspection on 30/07/08 for Ardenlea Court

This inspection was carried out on 30th July 2008.

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

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

Other inspections for this house

Ardenlea Court 05/06/07

Ardenlea Court 05/07/06

Ardenlea Court 01/02/06

Ardenlea Court 20/09/05

Ardenlea Court 15/02/05

Ardenlea Court 05/10/04

Ardenlea Court 20/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Ardenlea Court 39-41 Lode Lane Solihull West Midlands B91 2AF Lead Inspector Michelle McCarthy Unannounced Inspection 30th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ardenlea Court DS0000004566.V369549.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. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ardenlea Court Address 39-41 Lode Lane Solihull West Midlands B91 2AF 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) 0121 711 7773 0121 711 2235 www.bupa.com BUPA Care Homes (BNH) Ltd Mrs Kim Elizabeth Brown Care Home 63 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (34), of places Physical disability (34) Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May provide accommodation, nursing, and personal care for up to 5 people requiring palliative care over 65 years of age. May provide intermediate care for up to 18 people over 50 years of age, which may include care and nursing needs related to sickness, injury and infirmity. Intermediate care services must be provided from the dedicated accommodation identified for this purpose within the home and must be supported by equipment and staffing appropriate for its specific intermediate care function. Rehabilitation facilities and equipment must not impinge upon or reduce the communal space available to non-intermediate care service users. 5th June 2007 4. Date of last inspection Brief Description of the Service: Ardenlea Court is a purpose built Care Home that is owned and managed by BUPA Care Homes Ltd. The home provides personal care and nursing for up to fifty-five residents over the age of 65, who are frail elderly and/or physically disabled. Of the fifty five beds available eighteen of them are under contract with the Solihull Primary Care Trust to provide Intermediate care to patients following transfer from hospital. These beds are used for patients of 50 years and older falling within the following categories: sickness, injury, infirmity, surgical or investigative care and are situated on the ground floor. In addition, up to 5 beds are registered to provide care to residents requiring palliative care. All bedrooms have en-suite facilities and there are assisted bathing facilities situated around the home. The home is situated within walking distance of the centre of Solihull. The M42 is about two miles away and the bus and rail services are easily accessible. The property is adjacent to private housing accommodation. There is a paved garden to the rear of the property providing a seating area and there is adequate car parking space at the front of the building. Access for wheelchair users is good. There are no steps to the front door. The home has a passenger lift situated in the main corridor, which provides access to all areas inside the building. Information provided at the inspection confirmed the fees for living in the home to range between £780 and £850. Additional costs are payable for items such Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 5 as hairdressing, newspapers and some events. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the users experience the service. Before the inspection, we looked at all the information we have about this service, such as information about: • • • concerns, complaints or allegations incidents previous inspections and reports. We do this to see how well the service has performed in the past and how it has improved. The visit to the home was made on Wednesday 30th July 2008 between 10.35am and 7.15pm. 53 people were living in the home on the day of our visit. It was the assessment of the manager that the majority of people living in the home had high dependency nursing care needs but people using the intermediate care service had low to medium nursing care needs. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. This included talking to people who use the service and observing their interaction with staff where appropriate. We also looked at the environment and facilities provided and checked records such as care plans, risk assessments, staffing rotas and staff files. Three people using the service were identified for case tracking and we chose to look at the experience of one person with dementia care needs, one person with high nursing care needs and one person with intermediate care needs. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. At the end of the visit we discussed our preliminary findings with the manager and nursing care manager. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 7 The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? Medicine Administration Records (MAR) maintain an accurate record of medicines administered to residents. A training matrix has been developed and implemented since the last inspection and is used to record staff training and identify any gaps in learning. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 8 The grounds been improved since our last inspection providing a walkway around the home and seating areas among the attractive lawned and shrubbed gardens. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ardenlea Court DS0000004566.V369549.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 Ardenlea Court DS0000004566.V369549.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): Standards 3 and 6 were assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. People admitted for intermediate care are helped to maximise their independence and to facilitate their return home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of three residents admitted were examined to assess the pre admission assessment process. The manager said that it was usual practice for a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 11 Staff from the Primary Care Trust (PCT) are involved in assessing the rehabilitation needs of people admitted to the home for intermediate care. Social services and staff from the PCT complete assessments of individual care needs, which include assessing whether people require nursing care. Files examined contained a pre admission assessment of each person’s needs and abilities. This means that sufficient information was available so that the home could confirm they could meet each person’s needs and develop care plans. For example, one person was identified as having a high risk of developing pressure sores during the pre admission assessment. A care plan was developed on their admission to the home to minimise this risk and we observed a pressure relieving mattress in use for this person. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People are treated respectfully and are protected from harm by the safe management of medicines. Care plans are not consistently developed for identified needs, which may result in care needs not being met consistently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. It was evident from our observation that the personal care needs of people living in the home are met. The care files of three people identified for case tracking were examined. Each person had an individual care file. The service uses information gathered during the pre admission process to develop care plans to meet people’s identified needs. The care planning documentation used by BUPA (the Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 13 registered provider) is standardised and is divided into sections recording information about each activity of daily living, such as communication, maintaining a safe environment and personal cleansing and dressing. The quality of care plans developed to meet people’s identified needs was variable. Some care plans gave staff information about the actions they needed to take to meet people’s needs. For example, one person identified as having limited mobility had a care plan developed to give staff directions on how to move the person safely; ‘use a slide sheet to move XXXX up or down the bed and use the hoist for all transfers’. A care plan was available for another person with dementia care needs describing how they needed to be supported to maintain their personal hygiene using a combination of physical assistance and prompting to undertake the tasks they could do for themselves to promote their independence. Care plans for some people’s needs did not give staff sufficient information about the actions they needed to take to meet the needs. For example, the care plan for one person with insulin controlled diabetes described how frequently blood sugar should be monitored but did not record a range of blood sugar agreed with the medical practitioner outside of which action should be taken, such as omitting insulin. The medicine administration record for this person recorded occasions when insulin was not given as the person’s ‘blood sugar was too low’. A care plan was developed for one person with dementia care needs to record incidents of challenging behaviour, including what caused the behaviour and the consequence of it. The care plan did not include information for staff about the actions they should take to minimise the incidence of challenging behaviour. The care plan did not include strategies staff should use when an incident occurred so that anxiety and agitation could be reduced for this person. Care plans were not developed for some of the identified needs of one person with high dependency nursing care needs admitted to the home one month before our inspection. For example, the pre admission assessment identified, ‘XXXX is dependent on others for her dietary intake.’ There was no care plan in place to meet this need although we observed staff giving full physical assistance to this person at meal times. This resident was identified as having urinary and faecal incontinence but there were no care plans in place for these needs. There was no care plan developed to meet personal cleansing and dressing needs although it was evident from our observation and discussion with staff that this person was fully dependent on others to meet these needs. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 14 We asked care staff how they knew what they had to do to meet the person’s care needs. They told us, ‘The nurses tell us.’ The absence of care plans means staff do not have written information about the actions they need to take to meet people’s needs. This puts people at risk of not having appropriate care to meet their needs. The service uses risk assessment tools to identify whether residents are at risk of developing pressure sores or have an increased risk of falls. Care plans were available to minimise identified risks. A risk assessment tool was available for identifying people’s risk of poor nutrition but in all three of the case files examined the outcome failed to identify what action was to be taken. For example, the outcome for one person’s nutritional risk assessment referred to ‘MUST plan A’ but this was not available in the care file to describe any action that should be taken. Records for another person documented a progressive weight loss of 12Kg over a tenmonth period but there was no recorded evidence of action taken to investigate or resolve the person’s weight loss. We discussed with the manager that the way staff used the nutritional risk assessment tool indicated a poor understanding of it. This means people’s nutritional needs may not be monitored effectively. The care file of one person observed to have bedrails in place on their bed contained a risk assessment for their use and documented the decision to use the bedrails in the best interests of the person. This means that staff had given consideration to the best way of maintaining this person’s safety. Each person’s care file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have access to Health Care professionals such as the GP, optician, chiropodist and attending hospital out patient appointments. There is a close working relationship with health professionals, which include physiotherapists and occupational therapists from the PCT who provide a rehabilitation service for people admitted to the intermediate care unit. We examined systems for the management of medication. A monitored dosage (‘blister packed’) system is used. Medication was safely stored in locked trolleys, which are kept in locked clinical rooms. Medicine fridges were available with daily recordings of the temperature, which was within recommended limits. Daily room temperature recordings show that medicines are stored within recommended limits to maintain their stability. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 15 The facility for storing controlled drugs (CD) was satisfactory and complies with legislation. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. MAR sheets maintained an accurate record of medicines administered to residents. We audited the medicines of three people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). The audits indicated that the medicines had been administered correctly. Insulin prescribed for one person with diabetes was recorded as ‘omitted’ on one occasion on the MAR sheet. We discussed this with staff who told us the person’s blood sugar is monitored before insulin is administered. There is no record that an acceptable range for this person’s blood sugar level was agreed with a medical practitioner. It is recommended that a range of blood sugar level be agreed with the medical practitioner on an individual basis for each person who has diabetes along with the actions staff need to take if the blood sugar level falls outside the agreed range. This should promote the health and well being of residents. This person was prescribed ‘Hypostop’ and ‘Glucagon’ with instructions recorded on the MAR sheet to use ‘as directed’. These instructions should be clarified with the person’s medical practitioner and recorded on the MAR sheet and in a care plan so that staff know what medicine to give and when it needs to be given. Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, residents were spoken to respectfully by staff and addressed by their preferred names. For example, we observed staff giving sensitive explanation and reassurance to one resident when they were assisting him to move using a hoist. This should reduce anxiety for this person during intervention. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. People living in the home are supported to maintain their enduring relationships and participate in activities that enhance their quality of life. Residents benefit from a varied and nutritious choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs three activities co-ordinators to provide a total of 60 hours each week to support residents’ recreational activities. A high proportion of these hours are dedicated to the dementia care unit. ‘Life Maps’ were completed in the case files of the people we case tracked. These documented people’s life histories, their enduring relationships, family life, employment history and interests. This means staff have good access to information about people’s social, cultural and recreational preferences so they can meet their needs. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 17 There is an activity room on the second floor that provides the opportunity for activities to take place in small groups. A notice of planned activities was displayed and forthcoming events are advertised. Activities planned include sing-along, artwork, one-to-one sessions and music and movement. One of the activity co-ordinators told us of an on-going project taking residents on a ‘tour’ of other countries by providing a series of themed events in the home. Residents were supported to experience the culture of other countries by having themed menus and traditional entertainment from other European countries. The home has no restrictions on visiting. Residents were observed welcoming their visitors in their own rooms as well as in the lounges. The dining rooms in the home of well presented. Tables are laid at meal times and menus provided enable people living in the home to make choices in the food they eat. Menus examined demonstrated that meals offered are varied and appealing encouraging residents to eat nutritious and balanced diets. A cooked breakfast can be requested any morning. Lunch is the main meal of the day. The choice of meal on the day of our inspection visit was chicken in mushroom Sauce accompanied by seasonal vegetables or prawn salad with bread roll followed by pears and cream. Special diets are catered for, such as varying textures for people who have difficulty swallowing. We observed the evening meal service in the ground floor dining room. Vegetable soup, sandwiches, beef salad and cheese cake were served. Some people remained in their rooms for their meals and some physically frail people were assisted to eat their meals in bed. Care staff were observed to provide discreet assistance to residents as and when required at mealtime to meet the needs of individual people. Planned menus were available and accurately reflected the meal served on the day of our inspection. Residents made positive comments about the food provided in the home. Their comments included, ‘the food is great. There’s so much choice’ and ‘it’s a great improvement on the meals they gave me when I was in hospital!’ The most recent Environmental Health Officer’s report in October 2007 recorded compliance with Food Safety regulations. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 17 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager. Information shared with us in January 2008 raised concerns about various care practices in the home. We referred this to the provider to investigate. A record of complaints and concerns received by the home is maintained along with the action taken by the home regarding each issue raised. The service has recorded two complaints since the last key inspection including the information shared with us (above). The home’s complaint register and action file demonstrates that concerns are listened to and acted upon and timely and objective responses are made. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 19 The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff receive abuse awareness training during their induction, which should mean that they can recognise signs of abuse and are aware of their responsibilities for reporting to senior staff. It was evident through discussions with the manager that she is aware of local Social Services and Police procedures and her responsibilities for responding to allegations of abuse. This was further evidenced by her appropriate referral of an incident involving two residents in the home potentially putting each other at risk of harm due to their behaviour. This practice safeguards people living in the home. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. The home is well maintained providing a safe, attractive, homely and clean place for people to live in and enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation over two floors. There is a dining room and communal lounges on each floor. The communal areas in the home were attractively decorated to a good standard; easy chairs were grouped socially so that residents are encouraged to interact with each other. Residents were observed making use of all the communal spaces, although people who prefer to remain in their own rooms are accommodated. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 21 Several bedrooms, including those belonging to the people involved in case tracking, were viewed. Rooms were comfortable, well decorated and had good quality furniture and co-ordinating soft furnishings. All the rooms have ensuite facilities. Rooms viewed were personalised with people’s own belongings and looked as though it belonged to the person. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The smaller lounge on the dementia care unit has been redecorated with a music theme and has memorabilia of artistes from previous decades. Several residents used this room on the afternoon of our inspection to enjoy watching an old film on DVD. The day of our visit was sunny and warm; several residents and their visitors enjoyed the accessible garden and patio area. The grounds been improved since our last inspection providing a walkway around the home and seating areas among the attractive lawned and shrubbed gardens. All areas we viewed were clean, bright and airy. Systems are in place for the management of dirty laundry. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Recruitment practices are not sufficiently robust to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is divided into three units, each of which provides care for three client groups. The first floor of the home provides accommodation for twenty-nine people with varying stages of dementia. The ground floor provides a service for eight long-term residents with general nursing care needs and up to eighteen people requiring intermediate care. The intermediate care service involves helping residents to maintain their independence through supported rehabilitation, with the intention of resuming their day-to-day life in the community. The manager told us that the usual staffing complement for the home is: Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 23 Ground Floor Nursing and Intermediate care 7.45am till 2.15pm 2.15am till 8.45pm 2 Registered Nurses and 5 Care staff First Floor Dementia Care 1 or 2* Registered Nurses and 6 Care staff 2 Registered Nurses and 5 Care staff 1 or 2* Registered Nurses and 5 Care staff *Between 7.30am and 9pm there are additional nursing hours allocated to the dementia care unit. The manager decides when these hours are worked depending on the needs of residents. This means there are 2 registered nurses on duty in the dementia care unit for seven hours between 7.30am and 9pm every day of the week. 8.45pm till 7.45am 1 Registered Nurse and 2 Care staff 1 Registered Nurse and 2 Care staff In addition the manager is supernumerary and there are sufficient ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. For example, • • • • • • The kitchen is staffed between 6am and 7pm every day of the week. The home employs 22 hours of housekeeping staff each day to undertake cleaning and laundry duties. The home employs a full time maintenance person A gardener is employed for 10 hours each week The manager is supported by an administrator for 40 hours each week and a receptionist for 35 hours each week. The home employs three activities co-ordinators in a total of 60 hours each week. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 24 Three weeks of the home’s duty rota between 11th July and 1st August 2008 was examined and demonstrated that the staffing levels set by the home (in the table above) are consistently achieved. It was evident from our observations and the outcomes achieved for residents that there are sufficient staff on duty to meet their needs. Training records demonstrate that 12 out of 40 care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level 2 or above, which, at 30 , falls well below the National Minimum Standard for 50 of staff to be qualified. Several care staff have an overseas nursing qualification that, although the qualification is not recognised in the UK, means that these staff are experienced in care. The service should consider validating the comparable qualifications of overseas staff to demonstrate their competency. This should increase the numbers of qualified care staff. The personnel files of two recently recruited staff were examined. One file contained evidence of satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references. However, the second file evidenced that the staff member had a satisfactory PoVA First check but started working in the home before a satisfactory CRB was obtained. The manager confirmed that the CRB for the staff member had not yet been received by the home. There was no evidence of supervision for this staff member. This practice does not protect people living in the home from the risk of abuse. Staff who have received a clear POVAFirst check can only be employed subject to the induction and supervisory arrangements stipulated in the Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. The employee can only work with vulnerable adults in accordance with these prescribed supervisory arrangements until a full satisfactory CRB and POVA check is received. We discussed this with the manager who made immediate arrangements for the supervision of the staff member until the CRB was received in the home. A training matrix has been developed and implemented since the last inspection and is used to record staff training and identify any gaps in learning. Records demonstrate that staff complete an induction programme and receive mandatory training in moving and handling, infection control, first aid, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is good. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked at the home for several years and is registered with us. She is experienced in the care of older people. She is a Registered General Nurse and has completed the Registered Manager’s Award (NVQ Level 4). Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 26 There are clear lines of accountability within the home with two nursing care managers reporting to the manager who in turn is supported by her organisational line manager. There is a quality assurance and monitoring process which is based on ensuring the home is meeting the needs of the people living in the home. This involves an internal audit against identified standards. Quality monitoring covers all areas of the service and includes, infection control, training and development of staff, food provision, staffing levels and complaints. The views of residents and relatives were surveyed in December 2007. Their opinions on all aspects of the service were collated and are published in the home. However, there was no evidence that any of the information from the surveys has been used to assist in the development of action plans. The opinion of people using the service should be considered during the development of action plans so people know the home is run in their best interest. Residents’ personal monies held by the service for safekeeping are pooled in one bank account. Individual account sheets are maintained along with receipts for income and expenditure and are available for residents or their appointee to see. Incidents and accidents that happen in the home are recorded and were available for examination. The home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. A sample of service and maintenance records were examined and found to be up to date; for example, hoists (for lifting people) were serviced in July 2008 and portable electrical appliances were tested in October 2007. Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 27 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 12 Requirement A care plan must be available for each of the identified needs of residents describing the action staff have to take to meet the need. This is to make sure people get the care they need to promote their health and well-being. 2. OP8 12 Systems must be in place to identify residents at risk of poor nutrition. Where risk assessment tools are implemented, arrangements must be made to make sure staff can interpret the outcome effectively and implement strategies to reduce the risk. This is to promote the health and well being of people using the service. 3. OP29 19 Systems must be in place to ensure that staff who have received a clear POVAFirst check are employed subject to the induction and supervisory DS0000004566.V369549.R01.S.doc Timescale for action 30/09/08 30/09/08 30/09/08 Ardenlea Court Version 5.2 Page 29 arrangements until a full satisfactory Criminal Records Bureau check is received. This is to ensure that people living in the home are protected from the risk of abuse. 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 OP8 Good Practice Recommendations A range of blood sugar level should be agreed with the medical practitioner on an individual basis for each person who has diabetes along with the actions staff need to take if the blood sugar level falls outside the agreed range. This should promote the health and well being of residents. Staff should seek clarification from a medical practitioner when a medicine is prescribed ‘as directed’. Clear instructions should be recorded on MAR sheets so that staff have clear instructions about when they need to administer prescribed medicines. The service should be able to demonstrate that 50 of care staff have a National Vocational Qualification in Care at level 2 or equivalent. The service should consider validating the comparable qualifications of overseas staff to demonstrate their competency. This should increase the numbers of qualified care staff. This should make sure that the service can demonstrate people living in the home are cared for by competent staff. 2. OP9 3. OP28 Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands Office 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. Extracts may not be used or reproduced without the express permission of CSCI Ardenlea Court DS0000004566.V369549.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!