Inspection on 15/03/07 for Argyle House

This inspection was carried out on 15th March 2007.

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

The inspector 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 01/08/08

Argyle House 07/01/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Argyle House The Avenue Dallington Northampton Northants NN5 7AJ Lead Inspector Judith Roan & Linda Preen Key Unannounced Inspection 15th March 2007 08:30 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 Argyle House DS0000012599.V331756.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.V331756.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 Limited Post Vacant Care Home 87 Category(ies) of Old age, not falling within any other category registration, with number (87), Physical disability over 65 years of age of places (20), Terminally ill over 65 years of age (20) Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 20 Service Users receiving Personal Care will do so by virtue of old age and will not fall under any other category Service Users with Physical Disability may be aged 18 and over. A Total number of 87 Service Users of either sex may be accommodated in the home. No one falling within the category of TI(E) may be admitted to the home when there are already 20 persons of category TI (E) already in the home. No one falling within the category of PD(E) may be admitted to the home where there are already 20 persons under the category of PD(E) already accommodated within the home 9th November 2006 Date of last inspection Brief Description of the Service: Argyle House is a purpose built facility, providing accommodation for up to 87 service users in both single and double rooms. Nursing care is provided at the facility. Accommodation is provided on four floors. The facility is located off the Harlestone Road in Northampton, partially secluded by trees. The building is set in well-maintained grounds. There is good access to public transport via a bus route into the town centre. The current weekly fees for the home are: Residential - private: single room - £500, shared room £400 and use of a double room as a single - £600 Nursing bed fees - private: £650 for a single room, £550 for a double and £750 for use of a double room as single occupancy. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Service Users and their views of the service provided. Prior to the inspection 4 hours were spent reviewing information received and planning the inspection. The primary method of inspection used was ‘case tracking’ which involved selecting 7 service users and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The inspection took place during the morning and afternoon with two inspectors over a period of 8 hours (16) as part of the statuary inspection programme, and also as part of an ongoing monitoring of the home following Protection of Vulnerable Adult incidents and complaints received about the home. The inspection was carried out on an unannounced basis. This report also contains summaries of two random inspections undertaken on 25th August 2006 & 9th November 2006 to monitor compliance with requirements made at the previous Key Unannounced inspection on 7th June 2006 What the service does well: What has improved since the last inspection? Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 6 Two immediate requirements relating to health care needs of residents have been met within the timescales. Care plans now give clear instruction on how carers are to meet their needs. Care plans have all been reviewed and there is evidence that this is ongoing. Healthcare risk assessments such as those for pressure ulcers are undertaken to ensure appropriate care and treatment is identified and provided. Cooling fans ensure temperature control in the treatment room so there is safe storage of medication. Training has been completed on basic care, tissue viability and manual handling. Sufficient manual handling equipment is available within the home. Demand however needs to be kept under review. Staff are receiving regular supervision. Complaints were now recorded and there is evidence that outcomes are notified to complainants. The homes atmosphere has become calmer and there is evidence that organisation has improved. 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. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 7 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.V331756.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s can be assured that their needs will be assessed prior to admission into the home. EVIDENCE: Resident’s are provided with clear information about the service prior to making a decision about moving into the home. The inspector found that all resident’s seen had copies of a service user guide located on the wall in their bedroom. Resident’s are assessed prior to admission to the home to gains details on there, physical, emotional and social care needs. All residents are encouraged to visit the home prior to admission. National Minimum Standard (NMS) 6 was not assessed, as intermediate care is not provided in this home. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 9 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 adequate. This judgement has been made using available evidence including a visit to this service. Health care needs remains a concern with not all needs being met as stated in individual resident’s care plans. EVIDENCE: Two immediate requirements relating to health care needs of residents made at the last key inspection were met within timescales. Care plans were found to be improved and to contain the required information to meet resident’s needs. There were minor anomalies, but these were explained and addressed during the inspection. One resident expressed that they were in severe discomfort after receiving personal care and provision of support aids. The resident expressed that some carers can be heavy handed in their support and often had little time to adjust the aid. This was reported and immediate action was taken to ensure the residents comfort. In discussion with the acting manager a review of the residents needs was agreed. Care of resident’s on other floors was good and needs were generally well met. Issues arise more at night when staffing levels were lower. One resident said Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 10 that they had often waited for long periods for support with personal care at night, as there was only one carer, with one nurse between two floors on occasions. Healthcare assessments for pressure ulcers, nutrition, fluid intakes, catheter care, Peg feeds, pain management and specialist care are completed on the three nursing floors. Healthcare assessments were evident as required for residents on the residential care floor. All residents had risk assessment completed for manual handling, falls and specific activities related to the individual. The ongoing safeguarding issues still remain a concern as they all relate to poor care practices and omissions. A recent complaint in relation to medication resulted in a resident not receiving their prescribed medication for two days prior to admission to hospital. A series of errors and omissions on the medication ordering system have been identified and will now be reviewed. A requirement is made. Medication errors were also evident on one floor where staff are consistently short. This requirement is made again following requirements made in July & September 2006. Residents spoken to during the inspection all stated that their needs for privacy and dignity were maintained. In observation staff demonstrated that they had good communication with residents and that every effort was made to protect dignity and maintain privacy, for example knocking on doors and closing them when personal care was provided. However it was noted that at handover time staff stood around the nursing stations and relayed personal information about residents to the next staff team on shift. Consideration needs to be taken as to the appropriateness of this area for the task being carried out. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Activities were not always available throughout the home due to staffing restraints on the two upper floors. Meals were well presented and met resident’s dietary and cultural needs. EVIDENCE: Copies of the activity programme within the home were available on the notice board on all floors. (Bingo, quizzes, scrabble, darts, film afternoon, painting) Trips on a canal boat and to Althorp were advertised. An activity co-ordinator was observed undertaking an activity with residents on the third floor. Service users preferences were noted on files and there were good social histories available on residents to assist staff in supporting residents with activities they enjoyed. A film being enjoyed by a large group of residents was on during the afternoon of the inspection. Residents all stated that contact with family and friends are supported and visitors are always made welcome in the home. In discussion with one family member over the telephone to aid interpretation they confirmed that the family met their mothers socialisation in the main. They were happy with the support their mother received and that any issues regarding communication were easily resolved through them. In discussion with the acting manager it was Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 12 agreed that a communication book in the resident’s preferred language could be explored. Some resident spoken to stated that daily activities were sometimes restricted due to staffing availability. One resident who was nursed in bed for most of the time had few visitors and did feel isolated at times. Most residents were happy with the choices that were available and most spoken to have the care they needed at their preferred time. The meal that was served at lunchtime was attractively presented with a soup a choice of three main meals and a dessert. Special diets were provided that included diabetic, vegetarian and added supplements. One resident commented that the chef used too much spice, but on investigation it was found that no spices were added or available in the kitchen and salt was left for residents to add as much as they preferred. Drinks were available throughout the day and jugs of cold drinks were to be found in all the lounges. The residents spoken to in the dining rooms all said the food was good and they were able to make a choice from the menu. Care staff helped residents who needed assistance and specific requests were catered for. Records were completed for those who were being monitored for dietary intake. One resident said the food was no so good as it required to be pureed. The meal was however served attractively and in separate potions. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 13 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): 16,18, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although complaints and safeguarding incidents are investigated there continues to be further concerns raised. EVIDENCE: Since the last key inspection there have been a further two random unannounced inspections to monitor compliance. A recommendation made at the key inspection in June 2006 for complaints to be fully documented has been fully implemented. In addition the CSCI have received three complaints that have been referred to social services for investigation and a fourth regarding serious errors in the administration of medication that was investigated as part of this inspection. Two of these have been referred under safeguarding adults. Information raised in the complaints raises serious concerns about standards of care and suggests no improvements have been made. CSCI are also aware through a safeguarding meeting that social services have received at least one other complaint, which falls under safeguarding. All of the complaints and concerns have now been fully investigated by the organisation, social service and CSCI. The recommendations below have in the main been implemented to improve care practices within the home. The Service Users Guide and Statement of Purpose are to be re-issued to all residents and their relatives. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 14 Staff’s competency in the understanding of the care planning process needs to be reviewed. A full review of all existing residents individual needs. Accurate recording of fluid balance and turn charts and the transfer of information at handovers between staff shifts. Further Moving and Handling instruction to be provided for all care staff, especially in the use of equipment. Training in communication, recognition of medical emergencies, specifically in the clinical indications of fractured neck of femur and required action, the importance of customer care. Training to also include support in mental health issues, and basic care giving and infection control routines for all staff. The needs of resident’s that have less opportunity to socialise need to be reflected within the activity programme. The practices in regard to the call bells will be monitored through unannounced visits from senior staff. Staff practices to be investigated as appropriate using internal disciplinary procedures. A review of how medication is managed within the home is required so errors are not repeated. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 15 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): 19,20,21,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported in a clean and well maintained home. EVIDENCE: In touring the building all communal areas were seen to be clean and well maintained. Bedrooms were personalised, with many resident’s bringing treasured items from home. As one resident said it’s ‘like home from home. I am very satisfied with the support I receive. At a recent review of their care needs, additional handrails were agreed to maintain the resident’s independence. The manager had kept the resident informed of progress. The premises were clean and well maintained, with satisfactory reports from the fire and environmental health departments’ available. A hoist is available on each floor and a number of different slings were also seen. An additional stand aid is now available in the home and another resident has purchased one privately. This resident stated that she had hurt their leg recently as the night staff had failed to put her slippers on and this Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 16 had caused her to slip. It is important that all staff follow the correct safety procedures to minimise accidents. See requirement 2. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing shortfalls continue to place residents at risk. EVIDENCE: On the day of the inspection the staffing levels were deficient in meeting the needs of resident’s on two floors of the home. It was evident from observation that these staff were very busy. However despite this call bells were answered within ten minutes. Some staff commented that they were stretched and that when two staff were needed in supporting personal care needs this left no one on the floor to respond. In discussion with the acting manager she informed the inspectors that the organisation is reviewing levels of staff and are working towards a 1-5 ratio for residents on nursing floors. Assurances were given that the shortfall identified during the inspection would be rectified so that there would be three staff member on each floor. Residents spoken with on floor two and three supported the carers’ views of shortage of staff. Residents also commented that at night carers are often left to work alone as the RGN worked across several floors. It is of concern to the inspector that the assurance given by the manager regarding staffing levels has not been maintained. Standard 27 had been met on the two previous random inspections. A requirement made at the key inspection in June 2006 is therefore restated. The recruitment policies and procedures ensure that resident’s are protected. Files viewed demonstrated that full checks are undertaken. Training records Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 18 showed that staff have undertaken all statutory training and have opportunities to develop their skills. Nurses maintain the appropriate level of training required as part of their registration with the Nursing and Midwifery council. In discussion with carers they had recently completed tissue viability training and a review of basic care skills. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the home is managed in their best interests. EVIDENCE: The deputy manager was on duty at the home on arrival. An experienced manager from another home within the organisation supports the deputy in the interim until a newly appointed manager commences work. Systems to maintain health & safety are being reviewed to ensure that residents are safe, listened to and that the service is managed in their best interests. Supervision of staff at the home is undertaken on a regular basis. Staff commented that they work well together. Daily records seen were well maintained and monitoring was notable. Day staff however, picked up an oversight by night staff to record the accident identified on page 13/14 of this report when they noticed bruising. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 20 Regular audits are undertaken as part of the organisations monitoring to confirm that NMS are attained. A new area manager has recently been recruited and will commence their role shortly. Investigations carried out by senior managers in relation to safeguarding concerns were well documented and responsive. Appropriate action has been taken for any shortfalls identified. Manual Handling assessments were evident on resident’s files and satisfactory. Resident’s spoken with maintained their own finances or were supported by relatives. In a few situations the home maintains finances, which have always been managed appropriately. A maintenance person is employed to oversee the routine maintenance and upkeep of the premises. On the day of the inspection the fire system was fully tested which is part of the regular safety checks. The last fire drill was undertaken on the 1st march 2007. Maintenance records were seen and monthly checks were completed for water temperatures, call bells, window restrictors, door closures, emergency lighting and wheelchairs. The only health and safety issue that was identified on this inspection was the storage of supplies in the stairwell that is also a fire exit. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 2 3 3 3 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 3 X 3 X 3 X X 2 Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement A clear and accurate record must be maintained of the totals of medication kept in the home as part of an effective audit trail. (A similar requirement with a timescale for compliance of 09/07/06 and 30/09/06 has not been fully met) Management practices on the ordering of medication need to be reviewed to ensure that residents are protected. Safe working practices must be maintained within the home. Staffing levels must be improved to meet the identified needs of residents. Timescale for action 30/04/07 2. OP9 13 30/04/07 3. 4. OP18 OP27 13 (5) 18 30/04/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Healthcare practices need to be continually monitored to DS0000012599.V331756.R01.S.doc Version 5.2 Page 23 Argyle House 2. 3. 4. 5. OP10 OP12 OP22 OP38 minimise the risks to residents. Personal information that is essential to be communicated to other staff should respect the privacy of residents. The needs of socially isolated residents need to continually monitored. Staff need to use specialist equipment safely. All staff should be diligent in ensuring that exit are kept clear at all times. Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leicester Area Office The Pavilions 5 Smith way Grove Park Enderby Leicestershire LE19 1SX 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 Argyle House DS0000012599.V331756.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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