Inspection on 01/08/08 for Argyle House

This inspection was carried out on 1st August 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

Argyle House 08/02/10

Argyle House 22/06/09

Argyle House 07/01/08

Argyle House 15/03/07

Argyle House 07/06/06

Argyle House 28/09/05

Argyle House 09/05/05

Argyle House 07/09/04

Argyle House 20/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Argyle House The Avenue Dallington Northampton Northants NN5 7AJ Lead Inspector Irene Miller Unannounced Inspection 31st July 2008 09:45 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 Argyle House DS0000012599.V369393.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. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Argyle House Address The Avenue Dallington Northampton Northants NN5 7AJ 01604 589089 01604 589423 argyle.house@ashbourne-homes.co.uk 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) Ashbourne Homes Ltd Vacant Care Home 87 Category(ies) of Dementia (87), Old age, not falling within any registration, with number other category (87), Physical disability (20), of places Physical disability over 65 years of age (20) Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling in any other category - Code OP. Dementia - Code DE and DE(E). Physical disability - Code PD and PD(E) (Maximum number 20) The maximum number of service users who can be accommodated is 87. 7th January 2008 2. Date of last inspection Brief Description of the Service: Argyle House provides personal and nursing care for up to 87 persons, who may have additional needs, which may include Dementia or a Physical Disability. Argyle House accommodation is located over four floors, the ground and first floor providing nursing care, the second floor providing residential and nursing care to individuals with Dementia and the third floor providing residential care. All floors have a communal lounge and dining room, a majority of bedrooms being single, with some shared bedrooms available. All bedrooms have an ensuite facility consisting of a wash hand basin, toilet and bath or shower. Argyle House has outdoor space for service users to relax, and is surrounded by mature shrubs and plants, with outdoor seating provided. Argyle House benefits from good access to public transport into the town centre. The current weekly fees for the home, which were provided by the Manager on the day of the site, visit range from £331.00 - £650.00 for residential care and £477.00 - £950.00 for Nursing care. Commission for Social Care Inspection Reports are displayed in the entrance foyer of the home. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 5 Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. The focus of all inspections undertaken by the Commission for Social Care Inspection (CSCI) are based upon seeking the outcomes for Service Users and their views of the service provided. This visit was unannounced and focused on the ‘key standards’ under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of four people using the service were sample checked this involved looking through written information available on their care, such as their care plans (a care plan sets out how the home aims to meet the personal, healthcare, social and spiritual needs of the person using the service.). Discussions took place with people using the service, staff and visitors and observations of the staff interactions with the people using the service were made, to establish if the needs of people were being met and to establish how people were with the care and services provided by the home. Because people with dementia are not always able to tell us about their experience of the service, we used a formal method of observation called the Short Observational Framework for Inspection (SOFI). This involved spending a period of two hours within one of the communal lounge/diners observing the care of three people. This observation period gave an indication as to how the service supports the needs of people using the service and how the individuality of people living with dementia is maintained. During the visit records in relation to staff recruitment and training, how the home responds to concerns and complaints, the management of medication and the homes general policies and procedures were viewed. Prior to the visit taking place the Commission for Social Care Inspection had sent to the home an Annual Quality Assurance Assessment (AQAA) for completion by the registered provider. This was returned prior to the visit and provided information on how the service self assesses its own performance. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Further work is needed to provide staff with the opportunity to discuss and influence work practices and the day to day running of the home, for example through staff meetings and one to one supervisions sessions. Staff caring for people with dementia must follow the instruction provided within the care plans to ensure that the health, personal, emotional and spiritual needs of people living with dementia are met. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 8 The resuscitation policy needs to be reviewed, as there was no evidence available to demonstrate how a decision has been reached to ‘not resuscitate’. There must be evidence to demonstrate that the person rights had been central in reaching this decision. The set of doors leading into the laundry must have self-closing devises fitted. All flammable substances stored within the maintenance workers room must be stored safely in line with the homes fire risk assessment. The manager needs to ensure that her application to register with the Commission for Social Care Inspection is submitted without further delay. 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. Argyle House DS0000012599.V369393.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 Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 is not applicable to this service) Quality in this outcome area is good. People choosing to use the service are provided with the opportunity to visit the home and their care needs are fully assessed prior to moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users spoken with confirmed that they had been given the opportunity to visit the home prior to moving in, one person said that due to their ill health they had been unable to visit the home personally but their wife had done this for them. One service user said that they had visited several homes in the area and had chose Argyle House because ‘it was clean and had no smells’. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 11 Within the care plans viewed there was pre admission documentation available to evidence that the care needs and dependency levels of people applying to live at the home having being fully assessed, prior to moving into the home. A representative from the home and the local authority care management team had conducted the assessments. Within the pre admission assessment documentation there was records on the individuals medical history having been obtained, and this information had established whether the home could meet the individuals care needs. The homes Statement of Purpose and service User Guides were available within the front entrance of the home; these documents gave current information on the staffing and management structure of the home and the range of services available. In addition a copy of the service user guide was available within each bedroom, and is also available in cd/braille format. Information provided within the Annual Quality Assurance Assessment (AQAA) on how the home aims to give greater choice of home is to provide more information on their website and the production of a home information booklet. Argyle House DS0000012599.V369393.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 7,8,9,10 & 11 Quality in this outcome area is adequate. The care plans identify the health and personal care of people using the service however not in all instances were the instructions contained within them followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people using the service were case tracked this involved looked in depth, at the care provided for these individuals, viewing the written care plans and speaking with them where possible, and staff. The care plans had current information available on the health, personal care, social and emotional needs, there was information on the medical history of each individual and this had formulated the care required. Nutritional assessments were available which had identified special dietary needs, the care plan for a person who had a wheat allergy was viewed in discussion with the person they confirmed that they had use of a separate Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 13 toaster and sandwich maker, they said ‘the staff are very careful that my diet is followed to the letter’ and went on to say that if they had any foods with flour in it ‘they would end up in hospital’. Within this person’s individual care plan there was records of Gluten free foods having been obtained on prescription and within the main kitchen there was information for the staff to follow on providing a Gluten free diet. The weekly menu was on display on notice boards throughout the home, there were two choices of meal and a vegetarian option daily. The vegetarian option on the day of the visit consisted of a veggie burger at lunchtime, however this option was again repeated at the evening meal, in discussion with the chef they confirmed that this was a printing error and this would be attended to immediately. The care of one person who required a vegetarian diet was looked at and within their care plan there was records of their food preferences, likes and dislikes having been established. In discussion with the person they were unable to confirm what they had eaten for their lunch and this was due to short-term memory loss, although they did say ‘whatever it was, it was very nice’, the staff confirmed that this person had been provided with the veggie burger for lunch. Within the care plans there was records of peoples weight gains and losses being monitored on a monthly basis. Risk assessments were in place for people identified at risk due to poor diet and fluid intake, and those on special diets. Risk assessments were in place for people identified at risk of falls, and for one person with a diagnosis of epilepsy there was a risk assessment that identified the action to be taken should the person have an epileptic seizure out in the community. This person had recently suffered an epileptic seizure that resulted in a hospital admission, there was records of their care plan having been reviewed and updated upon their return to the home. Within the care plans there was a monitoring sheet for staff to complete on a daily basis a ‘record of personal care’ monitoring sheet, the aim of this record is to quickly identify the frequency of when a person has been bathed, hair washed etc. in some instances there was gaps between entries in the case of one person there was 11 days between entries being made. One person who was bed bound said that the care they received was good that ‘the staff regularly call in to see them an check they are ok’ they confirmed that the staff check their pressure areas, that they were comfortable and in no pain. Pressure relieving equipment was seen to be in use such as necessary for the care of this person, and within the care plans a pressure area assessment was available (waterlow score) that identified the individual risk of skin tissue breakdown for this person, and the preventative care and treatment required. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 14 Within the care plans there was records of people having visits by their general practitioner, and other healthcare professionals such as optician, chiropodist, physiotherapist and psychiatric specialists. People spoken with during the visit confirmed verbally that ‘if they needed to see the doctor the staff would arrange for this’. Within the care plans viewed all had ‘do not resuscitate’ consent forms contained within, these forms had been signed by relatives and in one instance a friend, however there was no other records available to evidence that the person rights had been central in reaching this decision, or evidence to show that the person lacked the capacity to give their informed consent. One person with a diagnosis of dementia presented some problematic behaviour such as making their skin bleed, there was an entry within the daily notes that the staff had noticed a skin tear on the persons arm, that the staff had dressing the area and alerted the district nurse, there were records of the person having been seen by the district nurse and a dressing being applied to the arm. In discussion with the staff they said that this behaviour was common with this person, on checking the care plan there was no record of this behaviour and no risk assessment to identify the risks associated with the continual trauma to the skin. This person frequently changed their clothing several times a day the aim of the personal care plan was “to support and assist the person to dress more appropriate and correct any mistakes”. Staff need to be reminded of the effort it takes for a person with dementia to choose what to wear and to successfully dress themselves, this should be celebrated and not ‘corrected’ by staff unless the persons safety or dignity is at risk as continually ‘correcting’ this behaviour could ultimately impact on this persons sense of well being and self esteem. The care of three people was observed for a period of two hours which encompassed the lunchtime period and records were made using an observational inspection tool called ‘the short observational framework for inspection’ (SOFI) the aim of this observation period was to get a feel of what life is like for people using the service who have limited communication and therefore may have difficulty in expressing their needs and feelings to staff and others. Over the two-hour period records were made at five-minute intervals on the persons state of being, their level of engagement with people and the environment and the frequency and quality of staff interactions. The care plan for one person observed had instructions that staff should: • • ‘Promote and maintain the persons ability to communicate effectively’ ‘To give the person time to express their thoughts and feelings’ DS0000012599.V369393.R01.S.doc Version 5.2 Page 15 Argyle House • • ‘To explain any intervention through the use of body language’, as ‘the approach will determine the persons behaviour’ ‘To give the person time to enjoy their food’. During the observation period one member of staff was observed to follow the instructions in the care plan, and when attended to by this member of staff the interactions were good. Over the two-hour period this person had two good, eleven neutral and five poor interactions with staff. Good interaction are when the staff seek to engage with the person, to gain eye contact and response from the person, Neutral interactions are when there is merely an exchange of information, nothing more and nothing less, poor interactions are when no effort is made by staff to engage or interact with the person. In all but two instance there was little meaningful interaction-taking place to make the mealtime a pleasant experience for this person, on a few instances a member of staff was observed to tap the persons bottom lip with the spoon, this action appeared to rush the person into opening their mouth for the next spoonful. There was very little verbal interaction or eye contact established. There were a few instances when a member of staff approached the person to attend to a blanket that was covering their knee. At these times the person was observed to attempt to communicate with the member of staff, however this opportunity was abandoned, as the member of staff did not respond to their efforts. In general the staff did not follow the instruction within this persons individual care plan. In contrast another person observed over the two-hour period spent time chatting with staff and other people, in some instances having the attention of four staff all at once. This person was in a positive state of being for the whole of the time spent observing. An area identified for improvement within the information provided within the AQAA is for all staff to have a thorough understanding of person centred care through the dementia care training programme ‘Yesterday, Today, Tomorrow’ and implementation of customer service training. A member of the nursing staff has attended a train the trainer course in dementia care and it is hoped that as more staff receive the training they will be more aware of the importance of meeting the emotional needs of people living with dementia in line with the physical needs. The medication administration records were sample checked and records within the medication administration records and the controlled drugs register were in good order with the balance matching the stocks. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 16 The temperature within the medication room was high at approximately 34 degrees; efforts had been made to reduce the temperatures by the use of an electrically operated fan. Daily records were available of the temperature readings of the medication fridge Argyle House DS0000012599.V369393.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): Standards 12,13,14 & 15 Quality in this outcome area is good. The lifestyle in the home in general matches the expectations of the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs two activity coordinators, in discussion with one of the activity persons they spoke of their enjoyment of providing activities for the people using the service. When asked if care staff participate in providing activities at the home they confirmed that in the main the actual activities are carried out by themselves as the ‘care staff are often too busy, doing their caring tasks’. Within the care plans there was records of the hobbies and interests of people using the service having been obtained and there were records of the involvement of individuals in activities provided at the home. In discussion with a small group of people using the service they spoke of damage that had been caused to the homes mini bus due to vandalism, and Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 18 how this had prevented them from going on a planned trip to Skegness in discussion with the manager she confirmed that the damage to the minibus was in the process of being repaired. The people spoken with talked of the home providing regular outings to include trips to a local garden centre and a canal trip on a barge. One person said that the activity person used to take them out in the wheelchair and that this no longer took place All of the people using the service spoken with were complimentary of the care provided at the home; they talked of their enjoyment of attending in house entertainment provided at the home. That they had recently enjoyed listening to an outside entertainer who had visited the home to sing for them, they said that this entertainment had taken place within the ground floor lounge, and that ‘often the activities take place on the first floor lounge saying there’s not much room in there and it gets very warm’. Whilst talking with a small group of people one member of staff came into the room to offer people drinks of tea, coffee and fruit juice one of the people within the group was observed laughing and joking with the staff member and said that “he plays her up something terrible” The relations between the staff and people using the service appeared light hearted and friendly. One person who follows a gluten free diet was offered gluten free biscuits with their drink. There were records within the care plans of when people had participated in activities such as bingo sessions, attending in house entertainment, and outings. Throughout the home there was notices on display of planned activities. On the day of the visit one of the planned activities was a film afternoon this was seen to take place within one of the floors, the lights were dimmed and the curtains closed to give a feel of being in a cinema. The minutes of relatives meetings were available within the front lobby of the home, in a recent meeting there had been a guest speaker from the local Alzheimer’s Society. A relative spoken with said that “ They were happy with the home and the care provided”. Comments received from people using the service were all positive: • • • • • ‘I like it here’, ‘I look forward to coming on holiday here’ ‘I have met some good friends’ ‘The food is good’ ‘Its very clean, the bed and sheets that very important’. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. People using the service can be assured that any concerns of complaints they may have will be taken seriously and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home keeps records of all concerns, complaints and safeguarding referrals. Since the last inspection there ha been five complaints raised with the provider there was records available on the nature of the complaints, investigation and outcome the manager confirmed verbally that all the complaints were now closed. The staff training plan identified which staff had been provided with safeguarding adults training, in discussion with the staff they confirmed that they had received safeguarding training and that they were aware of the importance of reporting any suspected or actual incidents of abuse. Argyle House DS0000012599.V369393.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, 25 & 26 Quality in this outcome area is adequate. People using the service are provided with a clean warm environment, however safe systems of working need to be followed when using cleaning chemicals and solvents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A limited tour of the building was carried out to include sample viewing the bedrooms, bathrooms and WC’s, kitchen, laundry and communal areas within the home. On the day of the visit the home looked clean and there was no offensive odours Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 21 Redecoration work was taking place within the main kitchen, the chef confirmed verbally that one of the freezers was out of order and the home was awaiting quotes to purchase a replacement freezer. The bedrooms viewed were pleasantly decorated, clean and personalised with the occupant’s personal items such as small items of furniture, pictures, photographs and ornaments. There was TV’s and telephones available within the bedrooms. People spoken with said that they were pleased with their bedrooms. The communal areas looked homely although some of the decoration was beginning to look worn such as tears to the wallpaper in high traffic areas due to wheelchairs, hoists and the heated kitchen trolleys passing through. The laundry had sufficient equipment washing machines, tumble dryers and ironing equipment, rotary iron and trouser press the staff confirmed verbally that all the equipment was functioning correctly. Within the laundry area one set of doors did not have self closing devises fitted it was pointed out that this needs to be addressed due to the high fire risk within this area of the home. There were records available of risk assessments for the use of the equipment and safety data leaflets being available on the chemicals in use (Control of Substances Hazardous to Health (Coshh) leaflets which were available within the immediate working environment for quick reference in the event of an emergency. It was noted that within the dementia care floor a cleaning trolley was left unattended in the corridor whilst the member of staff was cleaning within one of the bedrooms. There were chemicals such as liquid toilet cleaner on the trolley and there was an unlabelled container with a powder substance, which the member of staff later confirmed was powder sanitizer. Safe working systems need to be in place to ensure that all chemicals are not left unattended. Five domestic assistants and one housekeeper are responsible for the cleaning of the home, the staff confirmed that each domestic assistant is responsible for cleaning two floors daily to include deep cleaning three bedrooms each day. The staff confirmed that there was shortage of vacuum cleaners and only one carpet cleaner that is used on a daily basis. When asked whether the domestic staff have the opportunity to meet with the manager of the home to look at the cleaning schedules, workloads, use of equipment etc. they said that they had not had a meeting for a number of years. In discussion with the manager she confirmed that she meets with the heads of departments on a regular basis but was unaware of the shortage of equipment. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 22 The nurse call system has been in place since the home was built and is now antiquated in comparison with modern call systems now in use, when the alarm is activated it creates a continual buzzer sound around the whole of the home, in discussion with the manager she confirmed that the company are at present testing a new call system, which prints out the time when it has been answered and also identifies the member of staff who attended and plans are in place to replace the nurse call system. There was evidence of staff using personal protective equipment (PPE) and there was evidence of cross infection procedures being followed within the laundry, kitchen and within personal bedrooms. The storeroom that is used by the homes maintenance worker was left open and on checking this environment there was pots of paints stored within this area that on checking were water based and therefore presented a low risk, however there was some flammable items such as lubricants and solvents contained within that need to be stored outside of the home. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is good. People using the service are protected through robust recruitment practices being followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three recruitment files were viewed all of which had evidence to show that pre employment checks had been carried out to include police checks through the criminal records bureau (CRB) and checks on the protection of vulnerable adults register (POVA first), there were records of the home having obtained at least two references . There was records of new staff having received induction training some which were still in the process of completion. The homes staff training plan was available that provided the dates of when staff had attended training and dates of planned training. The training plan included mandatory health and safety training such as fire awareness, moving and handling, food hygiene, medication administartion. The vocational training included courses in end of life pallative care (the Liverpool Care Pathway), Peg feed training and tissue viability training. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 24 A member of the nursing staff had recently attended a train the trainer course in dementia care through the Alzheimer’s Society entitled ‘yesterday, today, tomorrow’ with a view to rolling out this training within the staff team and raising awareness of good dementia care practice. The manager confirmed verbally that staff are provided with NVQ training levels 2 & 3 that an NVQ assessor comes into the home to mentor staff who are undertaking the training. The manager confirmed that four staff had recently signed up to embark on NVQ trainingand and that 1 member of staff had recently achieved their NVQ award. Argyle House DS0000012599.V369393.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 31,33,35,36 & 38 Quality in this outcome area is adequate. The introduction of staff team meetings, supervision and support will provide the forum for staff to develop their skills further to ensure the needs of the people using the service are fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service user guide has been updated with the information on the qualifications of the current manager who holds a Diploma in Management, the Registered Managers Award, and is a Registered General Nurse with twenty years experience in the care of the elderly. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 26 The manager has been in post since October 2007 and has yet to submit her application to register with CSCI this was discussed with the manager who confirmed that her application is soon to be submitted, this should now be done without further delay. Time was spent with the manager assessing compliance with the requirements issued following the last key inspection. All of the requirements were either met or partially met. Information provided through the AQAA indicated that regular supervsion takes place for staff, in discussion with the staff it was confirmed that regular team meetings do not take place, in discussion with the manager she confirmed that steps are in place to focus on providing greater staff support, she confirmed that she now undertakes supervision with the heads of department, such as the housekeper, maintenance worker, nursing staff, and the administartion assistant. There is now a need for supervision to be cascaded through all of the staff team to ensure that all staff employed at the home receive regular one to one supervision, to provide the opportunity to assess their skills and build upon areas of self development. Action has been taken place to improve on how the home consults with people to gain their views on how the service can be continually developed. There was evidence of resident’s satisfaction surveys having been carried out; the findings of the latest survey were on display in the front lobby entrance of the home. Relatives meetings take place and minutes of these meetings are made available within the entrance lobby of the home. The minutes of the latest relatives meeting were viewed which confirmed that • A guest speaker from the local Alzheimer’s Society had attended the meeting • The provision of hoists was discussed • The provision of outdoor seating and the unsuitability of the footpaths for people using wheelchairs • The provision of activities of which one to one activities had been introduced those present at the meeting felt that this was working well. • There was some concern over cleanliness of the home in particular a dirty commode. The manager confirmed that at present residents meetings do not take place however plans are in hand to hold residents meetings on the last Friday of each month. In discussion with people using the service some confirmed that they had been given satisfaction surveys to complete since moving into the home, one person Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 27 said that their wife had helped them to complete the survey, and said that ‘they had no concerns or worries about the care provided at the home at all, that if they did they would speak out’. There was information available throughout the building on notice boards of planned activities, and within the care plans there was evidence of people having been consulted on what specific interests they have. Risk assessments were seen to be in place, however there was some areas as outlined within the environmental section of this report that need addressing to ensure that people using the service are not placed at undue risk. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 28 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 2 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 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 29 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 OP10 Regulation 12(4) Requirement The registered person must ensure that the staff follow the instructions as outlined within the individual care plans. This will ensure that the identified needs of the people using the service are met. Timescale for action 31/08/08 2 OP11 12 (3) (4) 3. OP25 23 (4) (c) (i) 4. OP36 18 The registered person must be 30/09/08 able to evidence that the person’s rights have been central in reaching a decision not to receive resuscitation. This is to ensure the persons right to dignity and propriety, and their spiritual needs, rites and functions observed. The registered person must 30/09/08 ensure that all doors within the laundry environment are fitted with self-closing devices. This is to protect people using the service from the spread of fire. The registered person must 30/09/08 ensure that all staff receives individual supervision. This will ensure that staff have the opportunity to influence work practices and to develop their skills and competencies. DS0000012599.V369393.R01.S.doc Version 5.2 Page 30 Argyle House 5 OP38 16 (2) (k) The registered person must ensure that staff follow safe systems of work when using cleaning chemicals and solvents. This will ensure so far as is reasonably practicable the health, safety and welfare of service users and staff is promoted and protected. 30/09/08 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 Refer to Standard OP31 Good Practice Recommendations The registered provider should ensure a registered managers application for the current manager be submitted to the Commission for Social Care Inspection without any further delay. This is to ensure that the manager is registered with CSCI and can discharge her responsibilities fully. Argyle House DS0000012599.V369393.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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