Inspection on 28/09/05 for Argyle House

This inspection was carried out on 28th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 15/03/07

Argyle House 07/06/06

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 Stephanie Vaughan Unannounced Inspection 28th September 2005 10:30 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.V255050.R01.S.doc Version 5.0 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.V255050.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Argyle House Address The Avenue Dallington Northampton Northants NN5 7AJ 01604 589089 01604 589423 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 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 (87), Terminally ill over 65 years of age (87) Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users with Physical Disability may be aged 18 and over. 20 Service Users receiving Personal Care will do so by virtue of old age and will not fall under any other category 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 on 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. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 10.30 and 15.45. Preparation for the inspection included, and took approximately one and a half hours. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, staff supervision, previous requirements made, and staff and service user interviews. Four service users were case tracked. Two staff members, plus the acting manager, were interviewed at length, and several others briefly, whilst six service users were spoken to in detail. What the service does well: What has improved since the last inspection? Several requirements made at the previous inspection had been met. Improvements were made in the legibility of care plans. Risk assessments in relation to falls, pressure sores and nutrition had been completed. There were no fire doors wedged open inappropriately during the inspection. The acting manager outlined the training which had been undertaken, and that planned for the coming weeks. The home now have an acting manager and a care manager in post. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 6 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. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 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.V255050.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Assessments were satisfactory, however service users needs were not being met. EVIDENCE: Assessments were viewed for all of the service users case tracked. These were informative documents. There was also a social history, which was completed by the next of kin in some instances, outlining service users hobbies and careers. In one instance the assessment information did not reflect the care being given, or the instruction to staff in the care plan. In some instances the care practices documented and observed during the inspection did not demonstrate that the service users needs are always met. For example, turn charts were not adequately completed for service users at risk of pressure sores. This will be addressed in further standards. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Service users health and personal care needs were not met. EVIDENCE: Care plans were not specific in their instruction to staff, and in one instance gave incorrect instruction. This was particularly the case in relation to PEG feeds. The reviews of the care plans were overdue by at least 2 weeks in almost all cases. In two instances, the daily summary indicated further needs of the service users, for which care plans had not been written. One service users care plan in relation to pressure area care was written to a high standard, clearly stating the service users turning regime, however turn charts demonstrated that this is not being carried out. A moving and handling assessment for one service user stated that she had bed rails in situ, however this was not observed to be the case. Care plans did not contain evidence of service users involvement in their writing. One service users records indicated that she had lost 1kg in weight in three days, however her nutritional assessment had not been reviewed following this. At least one healthcare score had not been scored correctly, when calculated according to other information recorded in the service users file. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 10 Service users dressings appeared to be changed erratically, i.e. not for 9 days, and then every other day, but then not for 6. One service users care plan stated that his blood sugar levels should be recorded weekly, however the assessment stated daily. His records indicated that it is recorded very erratically, with recordings documented for 27.4.05, 3.6.05, 27.6.05, 21.7.05, 4.9.05, 5.9.05, 7.9.05, 8.9.05, 14.9.05, and 15.9.05. Service users records in relation to PEG feeds records were not fully completed in every instance. Fluid balance charts were not completed accurately, and were not totalled. There was no evidence of the type of tube in situ, or the type of pump used. Service users output was also not recorded accurately. None of the service users who were nil by mouth had care plans in place for mouth care. The daily report, and elimination records for one service user indicated that he had a catheter in situ, however this was not the case. One service user had a urinary catheter in situ, which was 2 weeks overdue for changing. Some medication administration record sheets had gaps in the recording of administration. The treatment rooms where the medication is stored remained very hot in temperature. Medication was found for one service user for whom it was no longer supplied, and other medication past its shelf life was also in use. In one service users room a tub of cream was found, belonging to another service user, and in a second instance a name label had been removed. The acting manager stated that she is currently reviewing the supply and management of medication. Management of controlled drugs was satisfactory. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 Service users social needs are not met fully. The home make every effort to provide food of an acceptable nature to all service users. EVIDENCE: Two service users spoken to by the inspectors stated that there are not sufficient activities within the home. There were no activities at the time of the inspection. The acting manager stated that there is not currently an activities organiser working at the home, and that efforts are being made to arrange cover for this post. She added that some activities are continuing to be arranged. One service user stated to the inspector that she wished to have bed rails fitted to her bed, as she felt safer when asleep. The Care Manager stated that a recent assessment had indicated that this service user did not need them for safety reasons, and that they had been removed as they may create a hazard by having them in place. The inspector expressed that this service user should be enabled to exercise her right to have the bed rails fitted, and with correct documentation this should be supported, without compromising the homes responsibility to the service users safety. Two of the five service users spoken to stated that they were not satisfied with the quality of the food provided, and they were not offered a choice. They stated that if they left the food, they were not offered an alternative. One Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 12 added that she has her own food brought in by family. Lunch was observed at the time of the inspection. The presentation was satisfactory, as was the quantity. Staff were heard to offer service users a choice of several dishes, including a vegetarian option. The acting manager and deputy stated that every effort has been made to accommodate the service users particular preferences in relation to the food, and the chef visits the service users regularly to obtain feedback. A carer was observed assisting a service user to eat his lunch. The carer had a very pleasant and caring manner with the service user, affording him choices, and conducting meaningful conversation with him. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: These standards were not assessed on this occasion. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21,22,26 The premises is adequately maintained. The provision of equipment is on an as required basis, and service users are initially asked to purchase their own equipment. EVIDENCE: Several bathrooms and ensuite were visited. Numerous ensuite rooms were being used as storage areas, containing several and a variety of objects, some of which were relevant to the service users occupying that room, and some which were not. These items created a tripping hazard to anyone trying to use the rooms, and may cause cross infection as it would be difficult to clean the room adequately. The hot water in one wash hand basin was very hot, and a bath water temperature was recorded as 45 degrees. The acting manager stated that there was currently a problem with the heating system, and an engineer was in the building at that time. A toilet seat in one communal toilet was broken, and laying on the floor. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 15 A previous requirement had been made in relation to the practice of wedging open service users bedroom door with various items. This had also initiated a visit from the fire officer. The acting manager stated that automatic door closures connected to the fire alarm system had been fitted to some of the service users bedroom doors in order to overcome this issue. Two service users spoken to by the inspector stated that they had been asked to pay for these pieces of equipment themselves. The acting manager stated that this was correct. Service users are denied choice by being expected to purchase door stops at a cost of £120 if they wish to have their bedroom door open. In addition to this one service user had purchased her own hoist. The reason given for this was having to wait too long for the homes hoist to be available. The acting manager and deputy strongly denied this and stated that it was the service users families choice. A second had purchased a wheelchair, again stated to be her choice. One of the hoists belonging to the home was out of use at the time of the inspection, meaning that hoists had to be shared between different floors. The acting manager stated that this had happened on the day of inspection, although staff said it had been broken since the previous day. Two service users stated that they have to wait an unacceptable length of time for their call bells to be answered. The inspectors were not aware of any call bells sounding during the inspection. A service user stated that she had purchased her own paint for her room to be redecorated, however the redecoration had never taken place. One ensuite had an overnight catheter bag in the bath, which did not have a protective cap on the end to prevent infection. This room also had a soiled urinary bottle, and two soiled bowls in it. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Staffing within the home is being appropriately addressed. EVIDENCE: The acting manager stated that she is currently recruiting nursing and care staff, and that agency usage is now at a minimum. On the day of the inspection two staff did not arrive to work on the late shift, however these shifts were quickly covered by other staff. The acting manager stated that service users dependency is considered when deciding upon staffing levels, but within the staffing levels set by the company. She stated that dependency levels are not recorded, however she was aware of the Department of Health guidelines. One service user stated that she has difficulty in understanding staff whose first language is not English. Others said that they could understand adequately. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,36 The management of the home is now being adequately addressed. EVIDENCE: The acting manager has been in post for approximately 10 weeks. She is due to undergo her fit person interview in the coming weeks. Service users money was checked. The records and the money held corresponded. Service users money is held in a communal account which does not accrue interest. Although this is not recognised as best practice, the records demonstrated that the system is managed adequately. The administrator stated that the money held is insured, but stated that the service users do not have access to their money at weekends. The acting manager should ensure that service users are made aware of this. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 18 The acting manager stated that although she has attended training on providing staff with supervision, this has not yet commenced within the home. She added that it will be in place before the new year. The acting manager stated that various training has been arranged for staff, and staff spoken to verified this. Notices to staff were also seen about study days. The acting manager advised that staff, service user and relative meetings have been held regularly. All service users had risk assessments recorded in relation to falls. Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X 2 2 X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 2 X x Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes 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 8 Regulation 12 Requirement Further improvements must be made to the content, consistency and accuracy of the instruction to staff regarding the management of Percutaneous Endoscopic Gastrostomy Feeding. This was a previous requirement made with a timescale of 1/9/05 which remains unmet. Records must be developed to ensure that the required actions for the management of Percutaneous Endoscopic Gastrostomy Feeding are recorded, once they have been undertaken. This was a previous requirement with a timescale of 1/9/05, which remains unmet. Assessments, care plans and actual care given must all correspond. Care plans must be written for all of the service users needs, contain accurate instruction, evidence the service users involvement in their writing, and be reviewed timely. Healthcare assessments must be DS0000012599.V255050.R01.S.doc Timescale for action 15/10/05 2 8 17 15/10/05 3 4 3 7 14 15(1) 20/10/05 20/10/05 5 8 12(1) 20/10/05 Page 21 Argyle House Version 5.0 6 7 8 9 10 7 8 8 9 9 15 12 12 13(2) 13(2) 11 12 9 12 13(2) 16(2) 13 14 16(2) 14 15 16 17 18 19 19 21 22 26 27 36 23 23 23 13(3) 18 18 recorded timely, as the service users needs indicate, scored correctly. Care practices must reflect that prescribed in the care plan. Dressings must be changed timely, and associated records completed. Catheters must be changed at the correct timescales. Medication administration record sheets must not contain gaps in the recording. The temperature of the medication stores must be recorded daily. Steps must be taken to reduce the temperature of these rooms to below 25 degrees. Medication must not be used communally, and must not be used past its expiry date. The provision of activities must be addressed. A copy of the activities programme must be forwarded to the Commission for Social Care Inspection with information as to how this will be achieved. Service users must not be denied their choice in relation to the use of bedrails, and documentation must reflect this. Ensuites must not be used as storage areas creating a hazard to service users. The broken toilet seat must be repaired or replaced. Service users must not be expected to purchase equipment for the use of the home. Infection control issues must be addressed. Service users dependency must be recorded and reviewed timely. Staff supervision must DS0000012599.V255050.R01.S.doc 20/10/05 20/10/05 15/10/05 15/10/05 15/10/05 15/10/05 25/10/05 20/10/05 25/10/05 20/10/05 20/10/05 25/10/05 25/10/05 31/12/05 Page 22 Argyle House Version 5.0 20 8 12 commence. Service users pressure area care needs must be met. 15/10/05 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 15 Good Practice Recommendations The acting manager should monitor the satisfaction of all service users of the food, ensuring that they are offered a choice, and sufficient quantity of food, if they do not like the meal provided. The acting manager should monitor call bell answering times, and take identified necessary action. The acting manager should monitor the standard of English spoken by staff. 2 3 19 28 Argyle House DS0000012599.V255050.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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.V255050.R01.S.doc Version 5.0 Page 24 - 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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