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Inspection on 22/06/09 for Argyle House

Also see our care home review for Argyle House for more information

This inspection was carried out on 22nd June 2009.

CQC 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff recruitment procedures are robust. Two activity persons are employed at the home and there is a regular programme of activities in place. Three of the care plans we viewed had sufficient information available for staff to be informed of the persons nutritional needs, this included nutritional assessments, which were each supported with a care plan. People identified at high risk of not receiving sufficient food and fluids had their daily food and fluids intake monitored, and records were available of the close monitoring of weight gains and losses. We looked the needs of a person requiring pressure area care, within their care plan a pressure area assessment had been completed that identified the risk of skin tissue breakdown, the assessment identified the preventative care and treatment required and the pressure relieving equipment needed which was seen to be in use. The care plans are regularly reviewed Concerns and complaints are appropriately dealt with records available to evidence that full investigations are carried out.

What has improved since the last inspection?

Requirements set at the last inspection have in most cases been met some partially met. The `do not resuscitate` consent forms within the care plans have been reviewed with the people using the service and their representatives. This ensures that the person`s rights have been central in reaching a decision not to receive resuscitation and ensure their right to dignity and propriety, and their spiritual needs, rites and functions are observed. A member of the nursing staff employed at the home had recently attended a train the trainer course in dementia care through the Alzheimer`s Society with a view to rolling out this training within the whole of the staff team.Argyle HouseDS0000012599.V376222.R01.S.docVersion 5.2Two members of staff have trained as moving and handling instructors this will ensure that new staff receive this training swiftly and ensure that existing staff are provided with refresher training. The doors within the laundry environment have been fitted with self-closing devices. This will further protect people using the service from the spread of fire.

What the care home could do better:

The statement of purpose needs to show in greater detail how the home aims to meet the diverse needs of people this information will assist people considering using the service to decide if their needs can be met. Newly admitted service users need to have a care plan (a draft plan) put into place at the point of entry into the home. This care plan needs to provide the basis for the care to be delivered, and generated from information within the pre admission assessment. Areas identified at risk to the person need to be given priority when drawing up the care plan. Information on the health and safety needs of service users need to be detailed within the risk assessments and associated care plan documentation. The food and beverage likes and dislikes of people using the service should be sought upon admission. To ensure people are provided with a varied, appealing, wholesome and nutritious diet, which is suited to their individual, assessed and recorded requirements. Staff need to ensure they follow the homes policy and procedures for the recording, storage, handling and administration of medicines. As during this inspection we found medication with two peoples rooms that were unaccounted for. The ratio of care staff needs to be determined according to the current assessed needs of people using the service. This will ensure that there is sufficient staff on duty to continually meet their needs. Mandatory and vocational training needs to be rolled out for all staff to ensure that staff are fully competent to do their jobs and ensure so far as reasonably practicable the health, safety and welfare of people using the service. The staff attendance for mandatory training should be closely monitored and addressed through individual supervision and appraisal systems.Argyle HouseDS0000012599.V376222.R01.S.docVersion 5.2The financial interests of people using the service would be better safeguarded if two signatures are obtained to verify financial transaction made on behalf of people who use the service.

Key inspection report CARE HOMES FOR OLDER PEOPLE Argyle House The Avenue Dallington Northampton Northants NN5 7AJ Lead Inspector Irene Miller Key Unannounced Inspection 22nd June 2009 09:30 DS0000012599.V376222.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Argyle House DS0000012599.V376222.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 argylehouse@schealthcare.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 Manager post 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.V376222.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. 1st August 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. Inspection Reports from formerly the Commission for Social Care Inspection are displayed in the entrance foyer of the home. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 5 Argyle House DS0000012599.V376222.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. Inspections undertaken by the Care Quality Commission (CQC) are based upon seeking the outcomes for Service Users and their views of the service provided. This visit was unannounced and took place over two days; our focus was on the home meet 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. Records in relation to recruitment and training, concerns and complaints and general policies and procedures were viewed. Prior to the visit taking place CQC 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. Within this report there is reference to a random unannounced inspection which took place on 13th August 2008. The reason for this inspection was following the receipt of concerns raised by Northampton County Council on standards of care at the home. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 7 What the service does well: The staff recruitment procedures are robust. Two activity persons are employed at the home and there is a regular programme of activities in place. Three of the care plans we viewed had sufficient information available for staff to be informed of the persons nutritional needs, this included nutritional assessments, which were each supported with a care plan. People identified at high risk of not receiving sufficient food and fluids had their daily food and fluids intake monitored, and records were available of the close monitoring of weight gains and losses. We looked the needs of a person requiring pressure area care, within their care plan a pressure area assessment had been completed that identified the risk of skin tissue breakdown, the assessment identified the preventative care and treatment required and the pressure relieving equipment needed which was seen to be in use. The care plans are regularly reviewed Concerns and complaints are appropriately dealt with records available to evidence that full investigations are carried out. What has improved since the last inspection? Requirements set at the last inspection have in most cases been met some partially met. The ‘do not resuscitate’ consent forms within the care plans have been reviewed with the people using the service and their representatives. This ensures that the person’s rights have been central in reaching a decision not to receive resuscitation and ensure their right to dignity and propriety, and their spiritual needs, rites and functions are observed. A member of the nursing staff employed at the home had recently attended a train the trainer course in dementia care through the Alzheimer’s Society with a view to rolling out this training within the whole of the staff team. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 8 Two members of staff have trained as moving and handling instructors this will ensure that new staff receive this training swiftly and ensure that existing staff are provided with refresher training. The doors within the laundry environment have been fitted with self-closing devices. This will further protect people using the service from the spread of fire. What they could do better: The statement of purpose needs to show in greater detail how the home aims to meet the diverse needs of people this information will assist people considering using the service to decide if their needs can be met. Newly admitted service users need to have a care plan (a draft plan) put into place at the point of entry into the home. This care plan needs to provide the basis for the care to be delivered, and generated from information within the pre admission assessment. Areas identified at risk to the person need to be given priority when drawing up the care plan. Information on the health and safety needs of service users need to be detailed within the risk assessments and associated care plan documentation. The food and beverage likes and dislikes of people using the service should be sought upon admission. To ensure people are provided with a varied, appealing, wholesome and nutritious diet, which is suited to their individual, assessed and recorded requirements. Staff need to ensure they follow the homes policy and procedures for the recording, storage, handling and administration of medicines. As during this inspection we found medication with two peoples rooms that were unaccounted for. The ratio of care staff needs to be determined according to the current assessed needs of people using the service. This will ensure that there is sufficient staff on duty to continually meet their needs. Mandatory and vocational training needs to be rolled out for all staff to ensure that staff are fully competent to do their jobs and ensure so far as reasonably practicable the health, safety and welfare of people using the service. The staff attendance for mandatory training should be closely monitored and addressed through individual supervision and appraisal systems. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 9 The financial interests of people using the service would be better safeguarded if two signatures are obtained to verify financial transaction made on behalf of people who use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 is not applicable to this service) People using the service experience good quality outcomes in this area. The needs of people are assessed prior to moving in, this enables the home to needs and whether the home is right for the person moving in. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information was available to people considering using the service and their families in the form of the statement of purpose and service user guide these documents provide current information on the staffing and management structure of the home and the range of services available, these documents are also available in cd/braille format if required. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 12 Copies of the statement of purpose, service user guide and the most recent CSCI inspection report were available within the entrance foyer, in addition a copy of the service user guide was available within each bedroom. The statement of purpose and service user guide, are corporate documents And contained information about registration categories which give a fairly broad indication i.e. older people, dementia, physical disability, however does not give information about the range of needs that can be met within each category at Argyle House. It is important that there is information about the range of needs that can be met, taking account of the environment and staff knowledge and skills. For example, Argyle House provides nursing care for people who require nursing care because of peoples physical care needs and employs registered general nurses who are trained to meet these needs. The manager advised that dementia nursing care is limited to people whose physical nursing needs outweigh their mental health needs. It would be helpful to people who are choosing or helping someone choose a home to have this information available to help them to make informed choices about their care. The manager advised that one of the floors at Argyle House accommodates a mix of people who fall within the nursing care and residential care categories. In discussion with the staff they were unclear as to what type of care people had been admitted for, however did confirm that where people had nursing needs these were being met by the registered nurses. We advised the manager at the time of inspection that this information needs to be clearly set out within the individual care plans to ensure that the care provided is in accordance with their admission / contracts criteria. Initially we found that information about the range of fees within the service user guide was not available. However this was discussed with the manager and a supplementary sheet was added before the end of the inspection. It is important that people have information about the full range of fees and of any differences in charges between people who have their care paid for, and those who fund their own. This helps them to plan their finances and also to understand the fee structure. 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 been fully assessed, prior to them moving into the home. 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.V376222.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 & 10 People using the service experience adequate quality outcomes in this area. The pre admission assessments identify the health and personal care needs of people however not in all instances was the information transferred into a draft care plan upon admission. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A random inspection by the Commission for Social Care Inspection took place on 13th August 2008 during which it was identified that the home needed to improve their systems on meeting the needs of people at risk of pressure sores and poor nutrition. At this inspection we chose four people to ‘case track’ this involved looking at care plans and associated health records of people using the service, we chose one person from each unit, we spent time speaking with them where possible and with the staff involved in their day to day care. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 14 Three of the care plans we viewed had sufficient information available for staff to be informed of the persons nutritional needs, this included nutritional assessments, which were each supported with a care plan. People identified at high risk of not receiving sufficient food and fluids had their daily food and fluids intake monitored, and records were available of the close monitoring of weight gains and losses. One person required all of their nutrition to be given via a Percutanious Endoscopic Gastrostomy (PEG) feed system. There was detailed information within their care plan on the feeding regime, and the care of the tube feed system, however there was also information on the person’s previous dietary needs which was no longer current. It is advisable that only the current dietary needs are available within the care plan to avoid any confusion and reduce the risk of the person being given foods orally. The pre admission assessment of one person recently admitted to the home identified them as being at risk of not receiving sufficient food and fluids. The instruction within the assessment was that a nutritional care plan must be put into place. However this was yet to be implemented, we spoke with the staff on duty who were able to confirm verbally the needs of the person in this area of their care. The pre admission assessment of a person recently admitted to the home identified them at high risk of falls the assessment stated that the person walks using a walking frame and required the assistance of one to two staff. A draft mobility care plan had been put into place, which stated that the person walked with the aid of a walking stick and needed to be assessed by the district nurse for a walking frame. This information was not in line with the information in the pre admission assessment. The person was observed moving about their room without the use of a walking stick and at times walking with the assistance of one member of staff. It is important that clear information is available within the assessments and associated care plan documentation so that staff can deliver the care that is appropriate for the individual, to ensure safety is maintained. On day two of the inspection it was confirmed that staff had put into place an eating and drinking and falls care plan for the person. We looked the needs of a person requiring pressure area care, within their care plan a pressure area assessment had been completed that identified the risk of skin tissue breakdown, the assessment identified the preventative care and treatment required and the pressure relieving equipment needed which was seen to be in use. Records were available of people being seen by healthcare professionals such as the district nurse (for people living at the home under the residential care Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 15 category), the Tissue Viability Nurse, Dietician, Optician, Chiropodist, Physiotherapist, Psychiatric Specialists and General Practitioners. We sample checked the storage and administration records of medications; we were concerned to find within two individual bedrooms medication which was not stored securely, one person had Paracetamol tablets in a medicine pot on their bedside table. We checked their medication record sheet (MAR) these tablets had been signed by staff as being given the previous evening when in fact it appeared that they had not been taken by the person. Another person had antihistamine tablets beside their bed. Both persons required their medications to be administered by staff, it is important that all medications are stored safely and that staff only sign the MAR sheet once it is witnessed that the medication has been taken by the person for whom it is prescribed. Argyle House DS0000012599.V376222.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 & 15 People using the service experience good quality outcomes in this area. The lifestyle in the home in general matches the expectations of the people using the service, although this could be improved by staff being more available to socialise with people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home employs two activity coordinators, in discussion with one of the activity persons they confirmed that they had just recently taken up post and where in the process of reading care plans in an effort to gain a greater insight into how people’s social and emotional needs can be met. During the inspection we observed a small group of people participating in a game of ‘countdown’ the people said that they enjoyed the activities provided by the home. Throughout the home there were notice boards on display were planned activities for the week were posted. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 17 The hobbies and interests of people were recorded within their care plans and records of involvement in activities provided at the home such as bingo sessions, attending in house entertainment, and outings. The religious, spiritual and cultural beliefs of people were recorded within their care plans to inform staff on the support needed to ensure that peoples continue to follow practice their beliefs. A member of staff told us that Argyle House has a minibus which helps people to access community facilities. For example staff have taken three or four people at a time for lunch at a local church centre. We were told that at present the bus is awaiting repair so this hasnt happened recently. We were told that authorisation for the repairs had been given. An area of the home has been made into a complementary therapy room and the manager advised that she is seeking to find a suitably qualified therapist to provide people living at the home with therapies to aid relaxation. On speaking with people using the service they confirmed they choose their meals a day in advance when asked if they could recall what they had ordered for their meal on the day of the inspection they were unable to confirm what they had ordered saying they ‘often forget what they have ordered’. The daily menus were available within each of the dining rooms, on the serving counter, however on checking the menus it appeared that all did not reflect the actual meal on the day. In discussion with staff they too were unable to confirm what meal was to be served on the day. Consideration should be given to having the menus up to date, and more accessible for people using the service, such as having them available on the dining tables. Within the pre admission assessment of one of the care plans viewed the persons food dislikes had been recorded, however it was noted that their food likes had not been sought. In discussion with the person, they confirmed that they did not like salads or rice pudding, as stated in the pre admission assessment and went on to say they really enjoy vanilla ice cream, cheese and biscuits and a glass of milk. It is important that staff also seek to establish the dietary preferences of people as well as their dislikes, in an effort to meet their individual needs, make meals more enjoyable, and encourage a good nutritional intake. One person using the service required a special diet to meet their religious and cultural needs in discussion with the catering staff they were able to confirm how they meet the dietary needs of the person, there was documentation within the care plan that demonstrated that the home work closely with the persons family who also bring in culturally appropriate foods. A risk assessment had been completed to identify any possible difficulties with this arrangement such as foods needing to be covered and dated, the person had the use of their own personal fridge within their room for storing their meals. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 18 Records were available within the persons care plan on how their fluid intake was to be maintained during religious festivals of fasting. Argyle House DS0000012599.V376222.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience adequate quality outcomes in this area. Concerns and complaints are acted upon, although all staff should to be aware of safeguarding procedures in the absence of the manager. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information was provided by the home through the Annual Quality Assurance Assessment (AQAA) in relation to the number of complaints and safeguarding were that 8 complaints received within the last 12 months and that 100 had been resolved within 28 days and 4 complaints had been upheld, and no safeguarding adults referrals had been made. Since the last key inspection two complaints had been received by the Care Quality Commission CQC (formerly CSCI), these involved concerns about a lack of training of staff in moving and handling procedures, reporting and recording of accidents and incidents, general housekeeping, the quality and choice of food, and medication management. We brought all of these concerns to the attention of the provider and investigations have taken place involving the home and the safeguarding authorities. We received safeguarding information which required the input of the Northants safeguarding team and Northants Commissioning Units involvement. These were staff working excessive hours, and the employment of illegal Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 20 immigrants. Argyle House has worked closely with CQC the safeguarding team the commissioning unit, and the home office in dismissing staff from their employ who were found to be working illegally. Training statistics provided on the day of the inspection identify that out of the whole staff team only 32 had received training on safeguarding vulnerable adults. Given the vulnerability of people who use the service, it is particularly important that staff are vigilant in how to recognise signs of abuse and of their responsibilities for reporting any concerns. The manager advised that further training for staff has been arranged. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 People using the service experience good quality outcomes in this area. People using the service are provided with a clean warm environment. We have made this judgement using a range of 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 appeared clean and there were no offensive odours Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 22 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, and call bells were seen to be within reach of the people using their 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. At the last key inspection it was identified that door hold open devices needed to be fitted to the laundry doors to ensure that they close in the event of the fire alarm being activated, during this inspection this work was seen to have been completed. On checking the staff training records it was established that 54 of the staff team are trained in infection control. 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. However we were concerned to note in minutes of staff meetings that staff were being told it was not necessary to use protective gloves as routine when providing personal care for people. The manager advised that this was as a result of some recent infection control training that she had attended. Discussion indicated to inspectors that there may have been some misunderstanding and the need to make a distinction between assisting someone to wash their face and assisting with a full body wash. We advised the manager to contact the infection control training provider to clarify this with staff. Advice was also given to use the Department of Health infection control risk assessment to identify any areas for improvement. Argyle House DS0000012599.V376222.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 & 30 People using the service experience adequate quality outcomes in this area. Staff training needs to be as robust as the company’s recruitment practices. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the first day of inspection the staffing levels throughout the home during the morning were: Ground floor (nursing unit) 1 qualified nurse and 3 care workers First floor (nursing unit) 1 qualified nurse and 2 care workers Second floor (dementia care unit) 3 carers (we were told that due to a staff shortage on the day that the nurse from the ground floor was covering to do medications on this unit) Third Floor 1 senior care and 1 care worker. The staffing levels in the afternoon were: Ground floor 1 nurse and 2 care workers First floor 1 nurse and 2 care workers Second floor 3 care workers Third floor 1 senior care and 1 care worker Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 24 At the last random inspection in August 2008, it was noted that staff were very limited in the time they could spend with individuals, due to short staffing levels. However also at the random inspections we noted that the interactions witnessed between staff and residents despite being short staffed showed that they endeavoured to provide empathy and an individualised approach, which indicated that the staff knew the people they cared for well. At the random inspection we were concerned that people were not being fully supported on the dementia care unit and again at this inspection this concern remained. We observed interactions between people on this unit whilst staff were out of the room for approximately 20 minutes, we observed one person repeatedly calling for help ‘nurse please someone’, ‘get me up’, ‘help nurse please’, ‘is there somebody out there’, another person sitting beside this person reached out and held their hand to try and provide some comfort. Another person became agitated at the person calling out and abruptly told them to ‘shut up, be quite, you’re waking everybody up’. On the first day of inspection we observed that staff were under a great deal of pressure trying to meet peoples needs and displaying signs of stress. A nurse was responsible for administering medication to people on the ground floor and the second floor of the home, in addition to meeting the other nursing needs and supervising the floors. One person on the second floor (dementia care unit) required dressings to be renewed on their legs; the person was saying their legs were painful. The nurse on the ground floor was busy administering medications on this unit and said that she was doing medications on two floors and would attend to the person’s dressings as soon as she could. The person who was worried about their legs and required time spent with them to provide reassurance, the dressings were attended to, and the nurse tried to reassure the person however it was obvious that she was much overstretched. The additional pressure on care staff resulting in poor outcomes for people who use the service. For example one person who likes to be washed and dressed by 10am was not attended to until 12-00. Observations indicated that this was not a reflection on staff who were working hard to meet peoples needs and were distressed at not being able to, it was simply that there were not enough staff to meet needs. We spoke with staff and identified that many of the people at Argyle House require a high level of assistance to meet their needs. An example was given of one person who requires one and a half hours of staff time to assist them with showering and dressing and this didnt appear to be accounted for in the number of staff available. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 25 We spoke with the manager about systems in place to determine how many staff are required to meet peoples needs. A dependency tool is completed for each person using the service, however the manager advised that the hours are set in the budget for Argyle House rather than being linked to this dependency tool. Staff rotas showed shortfalls in the number of staff on duty, particularly nursing staff. We identified that there is a system whereby a notice is put up informing staff of extra shifts that are available and staff sign up for those they are able to cover. We noticed that where staff had not volunteered for additional shifts these had not been covered, leaving a shortfall in the number of nurses on duty. The manager advised the deputy manager is responsible for the rota and was on annual leave. She confirmed that arrangements will be made to ensure that making sure that there are enough staff is not reliant on one person. A requirement was made in the last report relating to staffing levels, which was very specific about the number of staff that needed to be on duty. Due to the changing dependency levels of people using the service, we have altered the wording of the requirement to reflect the need to review the number of staff regularly and the need to consider the actual outcomes for people. We looked at a sample of staff files to check the adequacy of the recruitment process in protecting people who use the service. We found evidence to confirm that criminal record bureau clearances and references had been obtained prior to people starting work. We did however find information on one persons file which indicated that necessary documents were either not available on file or had not been obtained from the Home Office. The manager took advice about this during the inspection and was following this up with the member of staff concerned. One of the staff files that we looked at during the inspection was for a new member of staff who had no previous experience of care work and had been employed as a night care assistant. We were unable to find evidence of the member of staff having been provided with induction training even though they had worked one night. This was raised with the manager who immediately arranged for this member of staff to have induction training before they returned to night duty. It was evident that the arrangements for the induction of new staff were not satisfactory in helping to ensure that staff had the necessary information and knowledge to meet people’s needs and safeguard them. We spoke with another relatively new member of staff, who explained they had been given written information about fire safety by the home, however they were unclear about their responsibilities should the fire alarm be activated this was of some concerns as they were the only member of staff on the floor whilst their colleague was on their break. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 26 Southern Cross Healthcare have a system in place which enables them to monitor the percentage of staff who have attended mandatory training for all staff to undertake to enable them to fully meet the needs of all people using the service, and to ensure that peoples health safety and welfare is promoted and protected. The training statistics showed that in all areas apart from fire drills (95 ) and customer care (76 ) the overall percentage of staff who had attended core training was very low. The manager acknowledged this and advised that training courses had been scheduled. Notices were seen to be on display on the staff board of forthcoming training events to include safeguarding of vulnerable adults (SOVA), nutrition, moving and handling, medication administration and mental health and mental illness. The manager said that it is an expectation that staff put their names forward to nominate themselves to attend training sessions, and that there had been problems with staff either not turning up for training or not putting their names forward in the first instance. We discussed the importance of all staff keeping up to date with current care practice and of all staff being accountable for their personal and professional development. We discussed the need for attendance for mandatory training to be closely monitored and addressed through individual supervision and appraisal systems. We viewed the recruitment files of three staff which all evidenced 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 from previous employers. With the exception of the one staff memebr who has not been provided with induction training, there was records of other new staff having received induction training some which were still in the process of completion. The staff training plan was available that provided statistics on the number of staff that had attended training and dates of planned training. The plan included mandatory health and safety training such as fire awareness, moving and handling, food hygiene and medication administration as well as vocational training such as courses on the end of life pallative care (the Liverpool Care Pathway), tissue viability and training on Percutanious Endoscopic Gastrostomy (PEG) feed systems. 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. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 27 Two staff had attended a train the trainer course on moving and handling to enable in house training to be provided for all new staff and all existing staff to be provided with refresher training on the correct procedures for moving people safely. The manager confirmed verbally that staff are provided with National Vocation Qualification (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 training and that 1 member of staff had recently achieved their NVQ award. Information provided through the Annual Quality Assurance Assessment (AQAA) which was submitted to the CQC in April 2009 within the AQAA we asked what the home thought they didi well they stated that robust recruitment practices were followed, that the training plan / matrix was up to date and that there was good training opportunities for staff. We asked what they felt they could do better they indicated to have 100 of staff fully trained, improvements planned for the next twelve months were to ensure all staff have performance appraisals and supervisions to identify individual training needs. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 & 38 People using the service experience adequate quality outcomes in this area. The promotion of 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. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There have been several management changes at Argyle House over recent years. The current manager advised that she started work at Argyle House in January 2009 she advised that she is a registered general nurse and has previous experience of managing a nursing home. She confirmed that she had Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 29 submitted an application for registration to the Care Quality Commission and this was being processed. Standard 31 relates specifically to the role of registered manager therefore this standard has not been fully assessed. The management arrangements are considered critical in the quality of care and in safeguarding the health and welfare of people who use the service and are therefore reported on in that context. We spent time with the manager assessing compliance with the requirements issued following the last key inspection. All of the requirements were either met or partially met. We looked at the information provided within the AQAA within the area of management and administration the home had stated that what we do well is to have policies and procedures in place. That regular supervision takes place for staff and that head of department meetings take place. The manager had introduced drop in surgeries for relatives. They felt that they managed enquiries and assessments well and managed staff recruitment well. Areas where they felt they could do better were to make sure that all staff work in compliance with the policies and procedures as set out by the company. Areas identified as being improved were that more staff had gained NVQ awards and that more staff had signed up to embark on NVQ training. They felt that the home continued to work well as a team. Plans for future improvement were to ensure that the team leaders get regular day to day support and that regular meetings cintinue to take place. Southern Cross Healthcare has a range of quality assurance tools and audit to measure the quality of care; for example monthly unannounced visits to look at the quality of care provided are carried out, usually by the operations manager who supervises the home manager. These unannounced visits are a requirement of the Care Homes Regulations 2001 as it is considered important that organisations are overseeing the quality of care provided to people using the service. There have been several changes of operations manager and review of the reports identifies that these have not been carried out on a monthly basis. A visit was carried out by the Operations Director on 17th June 2009 and a report made, however prior to that the last visit was made on 6th January 2009 by a temporary manager from another home. The manager advised that there had been a recent internal audit which had resulted in an action plan to address the issues raised during the audit. These included some of the issues that we have raised during this inspection, such as the need to check all staff files, increase staff training and ensure that all new Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 30 members of staff receive a full induction. It is important that these systems are in place to identify and address any shortfalls, though disappointing to see that these issues have occurred. For example the shortfalls in staff training. This is of particular concern as Southern Cross have a very good system in place to identify these problems quickly. Surveys had been sent out by staff at Argyle House to relatives of people who use the service prior to the inspection. The manager advised that the responses had been collated, however an action plan not yet drafted. The responses were displayed in the foyer for people to see the results. Obtaining the views of people who use the service and those involved with it is an important part of reviewing the quality of care. Some people leave small amounts of money for safekeeping to assist with paying for services such as hairdressing and chiropody. This is kept in a central bank account, which accrues interest and is added to each individual account. During our inspection we looked at a sample of records for two people and cross checked a sample with purchase receipts. We found that staff shop weekly and buy toiletries for people who want and need them. A single receipt is obtained and then the charges are transferred to the individuals record and deducted from their account. We have advised that to improve safeguards for people that there are in all cases two signatures to verify each transaction, for example the person paying the money and the person receiving the money. As identified in the staffing section there are shortfalls in staff training. This includes training in safe working practices such as movement and handling, health and safety, fire safety and food hygiene. It is important that staff receive training in safe working practices to protect themselves and people who use the service. The manager was co-operative with the inspection process and acted on areas of concern raised during the inspection. Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 32 No Are there any outstanding requirements from the last inspection? 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 15 Requirement Newly admitted service users must have a care plan put into place at the point of entry into the home. The care plan must provide the basis for the care to be delivered, generated from information within the pre admission assessment. This is to ensure continuity of care and health, safety and welfare is promoted and protected. Information on the health and safety needs of service users must be detailed within risk assessments and associated care plan documentation. This is so that staff can deliver the care that is appropriate for the individual, to ensure their health, safety and welfare is maintained. 3 OP9 13 (2) Staff must adhere to the homes medication procedures for the recording, storage, handling and administration of medicines. DS0000012599.V376222.R01.S.doc Timescale for action 31/08/09 2 OP8 13 (4) (c) 31/08/09 31/08/09 Argyle House Version 5.2 Page 33 This will ensure that service users received their medications safely and are protected by the homes policies and procedures for dealing with medications. 4 OP27 18 The ratio of care staff to service users must be determined according to the current assessed needs of the service users. This will ensure that there is sufficient staff on duty to continually meet the needs of service users. All staff must be provided with training appropriate to their role to enable them to meet the changing needs of service users. This is to ensure that all staff are trained and competent to do their jobs. The policies and procedures as set out in this standard must be followed. This will ensure so far as reasonably practicable the health, safety and welfare of people using the service. 31/08/09 5 OP30 18 30/09/09 6 OP38 13 (2) (3) (5) 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations Greater detail in the information in the statement of purpose on how the home aims to meet the diverse needs of people should assist people considering using the service to decide if their needs can be met. DS0000012599.V376222.R01.S.doc Version 5.2 Page 34 Argyle House 2 OP15 The food and beverage likes and dislikes of people using the service should be sought as a matter of urgency upon admission. To ensure people are provided with a varied, appealing, wholesome and nutritious diet, which is suited to their individual, assessed and recorded requirements. Staff attendance for mandatory training should be closely monitored and addressed through individual supervision and appraisal systems. There should be two signatures to verify any financial transaction made on behalf of people who use the service 3 OP30 4 OP35 Argyle House DS0000012599.V376222.R01.S.doc Version 5.2 Page 35 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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