Inspection on 07/01/08 for Argyle House

This inspection was carried out on 7th January 2008.

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

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

Other inspections for this house

Argyle House 08/02/10

Argyle House 22/06/09

Argyle House 01/08/08

Argyle House 15/03/07

Argyle House 07/06/06

Argyle House 28/09/05

Argyle House 09/05/05

Argyle House 07/09/04

Argyle House 20/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Argyle House The Avenue Dallington Northampton Northants NN5 7AJ Lead Inspector Linda Clarke Unannounced Inspection 09:30 7 & 8th January 2008 th 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.V354483.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.V354483.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 Mrs Isobel Jane Martha Scott 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.V354483.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. 15th March 2007 2. Date of last inspection Brief Description of the Service: Argyle House provides personal and nursing care for up to 87 persons, who may have additional needs, which may include Dementia or a Physical Disability. Argyle House accommodation is located over four floors, the ground and first floor providing nursing care, the second floor providing residential and nursing care to individuals with Dementia and the third floor providing residential care. All floors have a communal lounge and dining room, a majority of bedrooms being single, with some shared bedrooms available. All bedrooms have an ensuite facility consisting of a wash hand basin, toilet and bath or shower. Argyle House has outdoor space for service users to relax, and is surrounded by mature shrubs and plants, with outdoor seating provided. Argyle House benefits from good access to public transport into the town centre. The current weekly fees for the home, which were provided by the Manager on the day of the site, visit range from £331.00 - £650.00 for residential care and £477.00 - £950.00 for Nursing care. Commission for Social Care Inspection Reports are displayed in the entrance foyer of the home. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection process consisted of pre-planning the inspection, which included reviewing the Previous Inspection Report, reviewing the Annual Quality Assurance Assessment (AQAA), which is a self-audit tool completed by the Manager. We (Commission for Social Care Inspection) sent surveys to twenty five service users of which eleven were completed and returned, twenty five service user relatives of which eleven were returned, fifteen were sent to care staff of which five were returned, in addition fourteen surveys were sent to health care professionals, which included General Practitioners, District Nurses and Specialist Nurses of which four were completed and returned. The unannounced site visit commenced on the 7th January 2008, which took place over two days. The focus of the inspection is based upon the outcomes for the service users. The method of inspection was ‘case tracking’. This involved identifying service users with varying levels of care needs and looking at how these are being met by the staff at Argyle House. Six service users were selected, with a range of individual needs, including residential and nursing care and those with Dementia. Discussions were held with two service users and the relatives of one service user case tracked, in addition discussions were held with four service users and two visiting relatives of service users not case tracked. Discussions were also held with Nursing and care staff. What the service does well: Prospective services are fully assessed to ensure that the nursing and care staff of Argyle House can meet their needs, and a draft care plan is put into place for their admission to the home. Care plans are comprehensive and are regularly reviewed detailing all aspects of the social and health care of service users. Monitoring forms are used effectively to review the progress of service users health. Complaints are recorded and investigated with the complainant being advised as to the outcome. The home is decorated to a good standard throughout. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 6 Nursing staff provide practical supervision and instruction to care staff where service users require specialist support and care. What has improved since the last inspection? What they could do better: Service users, particularly those service users with Dementia or who are unable to express their views and opinions would benefit from the introduction of Person Centred Plans, which outline the service users preferred daily routines, likes and dislikes and information as to how they wish to be cared for. Service users would benefit by the Manager reviewing how staff respond to the call bell system, and the implementation of a system, which ensures that service users upon activating the call bell can be confident that it will be answered promptly. Significant improvements need to be made with regards to consultation and communication. A significant number of comments expressed by service users, relatives, staff and health care professionals relate to this issue. Areas for improvement expressed included the quality and variety of meals, the attitude of some staff, sufficient staffing levels to ensure that the care needs of service users are always met, response times to service user call bells and the sharing and passing on of information. Service users and relatives need to be provided with opportunities to comment on the care and services they receive, there comments should be collated, and a report produced with the findings, which incorporates an action plan as to how the service will make changes to improve the service is offers. Staff need to have the opportunity to develop their skills and training, by attaining National Vocation Qualifications in Care and by receiving training relevant to the specialist needs of service users. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 7 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.V354483.R01.S.doc Version 5.2 Page 8 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.V354483.R01.S.doc Version 5.2 Page 9 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 and 3. Standard 6 is not applicable, as the service does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with information about the service and can be confident that their needs will be assessed. EVIDENCE: Prospective service users and their relatives are provided with information as to the services provided by Argyle House documentation includes the Statement of Purpose and Service User Guide, which detail the aims, objectives and philosophy of care of the home, and the terms and conditions of occupancy. Service users retain a copy of the Service User Guide, which is kept in a file in their bedroom. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 10 The records of six service users were viewed which evidenced that a comprehensive assessment of an individual needs are carried out prior to their admission, the assessment focuses on all aspects of an individuals social, personal and health care needs. A draft care plan is then produced prior to the person moving into the home, which details the support and care the individual needs, and provides additional historical information about a service users family, work, hobbies and interests. The draft care plan enables staff to have an understanding of an individuals needs, and their role in offering care and support. The care plan additionally provides information about their lifestyle enabling care staff to have a greater understanding of the support the individual may require to help them to settle in to the home environment. The CSCI sent out surveys to service users as part of the Key Inspection process, surveys confirmed that a majority of service users were provided with sufficient information about the home before moving in. Information obtained from service users through conversations, identified that some service users had visited the home prior to moving in, whilst some service users had a family member visit on their behalf, the visits being to establish whether the home was appropriate to them and whether they liked the home. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users care needs whilst mainly met, do not happen in all instances in a timely manner, and in a way in which the service user finds acceptable. EVIDENCE: The care plans of six service users were viewed, two of which were in receipt of residential care, and four receiving nursing care of which two had a diagnosis of Dementia. Care plans were comprehensive and for service users in receipt of nursing care were written and monitored by Registered General Nurses. Care plans were in place for all aspects of service user care including personal care, including continence, sleeping, social interaction, pain management, pressure area care and specialist support such as wound care or specialist eating requirements. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 12 Care plans are regularly reviewed, and daily notes record information about the care a service user receives. Of the service users and relatives spoken with, only one service user was aware of their care plan and its contents, saying it was reviewed with them. Care plans could further be improved through a person centred approach, which details how the service user wishes to be cared for in all aspects of their daily lives, and information as to service users preferred daily routines; this is particularly relevant where service users due to their health are unable to express their views. Care plans include information as to the medication service users are prescribed, and the medication and medication records for two service users case tracked were viewed and found to be in good order. Medication is administered by Nursing staff or a Senior Support Worker. Observations took place in communal areas on all floors within the home during the two day site visit. Staff spoke and interacted with service users in a manner, which maintained their privacy and dignity and showed respect for service user individual wishes. Conversations with service users identified that service users in the main felt that staff respected their privacy and dignity, some service users said that some day and night staff could be abrupt, which resulted in service users feeling as though they were an inconvenience, and that staff were very busy, which made the service user feel rushed. Conversations with service users and service user relatives, identified in general satisfaction with the care, however their were consistent areas amongst all which reflected areas that could be improved, this included the time it took for staff to respond to call bells. Service users stated that the wait being between 5 to 10 minutes, but had in some instances been longer, all service users and visitors felt that insufficient staffing levels were responsible for the delay. Service users comments included: “I get the impression that the night staff can’t be bothered.” “The night staff have more time for you that the day staff.” “The care is very good, when I ring the bell you can wait for up to 5 – 10 minutes for staff to respond.” “Staff response to the buzzer is pretty good, short staffed at times.” “On the whole staff are friendly, but they’re rushing about as they’re short staffed.” Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 13 “My Physiotherapist recommended mobilisation, however staff who have been shown how to support me have little time to act on this, it usually happens at the weekend with one particular member of staff.” “I’m supposed to exercise my hands and legs regularly, but I haven’t done able this since the previous Activity Organiser left.” “Majority of staff are good, polite and courteous. Feels that we have to be careful about what we say sometimes.” Comments from service user relatives included: “The care is improving. I have raised concerns in the past, which have been acted upon, however I feel aspects of care still warrant improvement, i.e. small issues – attention to detail. Staff don’t have time to read care plans, I have spoken to the Manager about the necessity of continuity of care staff when caring for service users who are not able to communicate or express their views.” The Manager advised that a new call bell system has recently been fitted, however when a service user uses the call bell, the bell sounds at all nursing stations on all floors within the home, systems need to be put in to place which provides staff with clear guidance and timescales with regards to the answering of call bells. Service users need to be confident that their call will be answered promptly. Health care professional surveys provided a range of comments with regards to the care service users receive, and the role of staff in promoting the health of service users. Surveys completed by General Practitioners expressed concern that information about service users health and the involvement of General Practitioners is not always communicated effectively amongst the nursing and care staff. One survey identified that the a General Practitioner was not confident that service users privacy and dignity is always maintained, stating that in some instances they are asked to see a service user within a communal area of the home. A survey completed by a specialist nurse praised the care service users with pressure area care needs are cared for, stating that staff always follow advice and ensure that service users health care needs are met. The survey incorporates information, which states that staff are caring and there is always a warm welcome when you visit the home. Surveys completed by service users and relatives gave mixed views with regards to the care service users receive, and whether the home meets service user needs. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 14 Risk assessments are in place, supporting care plans, which identify risks to service users, and how the risk is to be managed. The risk assessments are regularly reviewed. Staff were observed moving and handling service users, in all instances this was done appropriately with the use of the appropriate equipment. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities and meals provided by Argyle House do not in many instances meet the needs of service users. EVIDENCE: Argyle House employs an Activity Organiser who is responsible for the organising and delivery of activities for service users. A programme of events for the week of the site visit was viewed, which included bingo, a visiting singer and board games. On the days of the site visit no activities were observed as taking place. In some instances service users choosing to spend time in their bedrooms watching television or listening to music, whilst other service users sat in communal lounges, where in most instances the television was switched, but not always watched. Service users were asked their views at to the activities provided by Argyle House. The following comments were made: “Since the new activity organiser started, we don’t get to go out on the bus.” Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 16 “Church Services are held in the home and I attend. I’m not interested in the other activities, I do occasionally watch a film and participate in the singing.” “I’m not interested in joining in with the activities.” “I don’t enjoy the activities, nothing to my taste. The mini-bus is never used now, and we don’t go out.” “All activities are held on another floor, and I don’t wish to leave the floor I live on.” “I believe one to one stimulation for some service users is required, I have supplied a range of music and films for my partner, however staff don’t always change the music CD, or turn the television to an angle my partner can see.” Service user and relative surveys incorporated comments as to activities provided for service users by Argyle House. • • The activity co-ordinator is excellent and produces a good range of interesting activities and is very good with residents. My friend relies totally on me for outings and stimulation. I have asked for short one to one sessions of activity for them but without response. Overall the activities are very poor and unvaried. To appoint a new member of the staff to support the residents with personal needs of just a friendly pop in service for a talk on a one to one once a week, a great comfort for those who do no have any visitors. • Observations identified flexibility with regards to routines within the home, service users being able to eat their meals in their bedrooms or in the dining room. A majority of service users stated they preferred to eat their breakfast in their bedroom. Service users on the second floor who have Dementia are supported to get up and go to bed, and eat meals at a time, which suits them promoting their well being. Time was spent with service user during the lunchtime meal on both days of the site visit. Service users who require support with meals were supported with sensitivity. Service users who require a specialist diet were catered for. Discussions with service users provided varied information as to the views of the meals provided. Service users in some instances expressed general satisfaction, however a majority commented that there was little variety and the quality was not very good. Service users emphasised that the quality and variety of the meals in their view was as a result the budget that the Chef has to work with. Comments included: Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 17 “The meals are nice, there are choices available.” “The meals are alright.” “The food isn’t bad, and it’s plentiful.” “Food is alright, satisfactory there are choices.” “I dislike the food, the Chef does their best with the money they have. Meat is always tough, fresh fruit is available, but I think the vegetables are frozen. The chips are dry, and there is no variety. The staff are suppose to ask us what our choices are for the following day, this only happens if there is enough staff, we were not asked yesterday, but it’s Tuesday therefore it will be on the menu as Lamb Steak, but in reality it will be mince which is shaped and then covered in bread crumbs.” “They revised the menu a short while ago and things were suppose to improve, but I know what is going to be on the menu by the day of the week.” “The food could be cooked better, vegetables are undercooked and the meat is tough.” “The budget is very low for meals, I believe it to be £15.50 per week per service user.” Service user and relative surveys highlighted that whilst some service users are happy with the activities and meals provided by the home, a majority expressed some dissatisfaction. Surveys revealed that service users who require additional support with activities due to their health and care needs do not benefit from activities, and many commented on that outings into the community have stopped. Surveys reflect that service users are dissatisfied with the variety and quality of meals provided. The Manager was apprised as to comments service users and visitors had made, the Manager stated it was their intention to recruit an additional Activity Organiser, who will as part of their role focus on activities for service users on a one to one basis, and those service users with Dementia. The Manager said that the budget set for the home with regards to meals was in the region of £2.70 a day. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and visitors benefit from an accessible complaints procedure, and service users are supported by staff that have received training in safe guarding adult processes. EVIDENCE: Discussions with service users and relatives during the site visit evidenced that service users and relatives are aware of the complaints procedure for the home; some service users and relatives said they have not met the new Manager and therefore wouldn’t be able to raise a concern directly. One relative confirmed they had raised concerns, which had been addressed but felt that there were some areas, which could still improve. No concerns have been made directly to the home or to the Commission for Social Care Inspection, since the appointment of the new Manager. The home has received 28 complaints/concerns in the previous twelve months. The most recent concerns and complaints received by the home were viewed; all had been investigated, with the outcome of the investigation being communicated to the complainant. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 19 Service user and relative surveys in the main confirm that they are aware of how to raise a concern, however in some instances some feel that concerns and complaints are not responded to appropriately. There have not been any adult protection referrals since the recently appointed Manager took up their post. A majority of staff have received training in identifying the signs of abuse, and the forms abuse may take, and includes their responsibilities for reporting their suspicions. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a warm, safe, clean, comfortable and wellmaintained environment suitable for their needs. EVIDENCE: Information supplied within the AQAA completed by the Manager prior to the site visit details that the environment is regularly maintained, with regards to fire detection and fire fighting equipment, emergency call equipment, heating system and electrical equipment and systems. Service users have access to a communal lounge and dining room on each floor, all were viewed during the two day site visit and were found to be clean and have a good standard of décor. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 21 Argyle House provides grab rails within corridors and bathing and toilet areas, and in addition has specialist equipment for the moving and handling of service users and the delivery of personal care. The bedrooms of some service users were viewed during conversations with service users to ascertain their views, bedrooms were decorated to a good standard, and had been personalised by furniture and personal items of the service user. Service users were happy with the environment and its cleanliness in a majority of instances. A majority of staff have undertaken training in food hygiene, and some staff have received training in Infection Control. Service users confirmed that staff do wear gloves and aprons, but one service user commented that they believed staff did not always change their gloves for each service user. Laundry facilities are provided in the basement of the home, with laundry being undertaken by a specific team of staff. Surveys completed by service users and their relatives expressed satisfaction with the cleanliness of the home. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A robust recruitment process protects service users; staffing levels and training in some instances do not ensure service users needs are always met. EVIDENCE: Discussions were held with two Nurses and three care staff, working over different floors. Nurses felt that there were sufficient nursing staff on duty, but commented that in some instances there is not enough care staff. There was a shortage of care staff on one of the floors, on the day of the site visit. All care staff spoken with confirmed that staffing levels have improved, but identified that sickness continues to impact on day-to-day staffing levels. Whilst it is acknowledged that staffing levels have improved, comments from service users, visiting relatives and staff identify that improvements need to be made to the quality and timely delivery of care, reflects additional staffing needs to be provided. Observations noted that care staff were busy, and that the response time to answer call bells was approximately 5 minutes. Current practices need to be reviewed, and systems put into place to ensure that service users receive a prompt response. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 23 Service users and visitors commented that in there view there are not always sufficient staffing, which in some instances makes service users feel rushed and left them with a sense that they are being a nuisance. Whilst two service users commented that physiotherapy exercises they should be doing are not always done, the reason they gave being insufficient staff. Information supplied by the Manager prior to the site visit identified that ten members of care staff, out of the thirty five employed have attained a National Vocational Qualification in Care, this being 29 of care staff team, with an additional ten members of staff working towards an NVQ. This is significantly below the target set within the National Minimum Standards that 50 of staff attain an NVQ by 2005. In addition to care staff Argyle House employs fourteen Registered General Nurses. Care staff spoken with identified that the Nursing staff, provided instruction with regards to the specific care of individual service users, and felt that there knowledge was extended by working alongside the Nurses. Staff surveys expressed general satisfaction with their induction, but many felt that training was not readily accessible. Staff commented on staffing levels not always being sufficient. Staff views were mixed as to the accessibility of Managerial staff. The records of two members of staff were viewed, both were found to contain the necessary pre-employment checks which included two written references, a Criminal Record Bureau disclosure, and in the case of a Nurse confirmation that they are registered with the Nursing Midwifery Council. A training matrix was provided by the Manager, which identified topics relating to service user health and safety, including medication and abuse training. Staff spoken with confirmed that some had attended training in Dementia Care, it was a concern to Nursing and care staff that on occasions staff from other floors within the home support service users with Dementia, and that their lack of training does not equip them to provide the care service users with Dementia require. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 24 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, 32, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Management of the home does not encourage service users and other interested parties to influence the day-to-day running of the home and the services received by service users. EVIDENCE: The Registered Manager has resigned her position with the company for which Argyle House is part of; the Commission for Social Care Inspection is awaiting confirmation from the Registered Manager before removing their details from the Certificate of Registration for the home. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 25 The Manager now employed at Argyle House, has been in post since September 2007. Prior to this the Manager was a Registered Manager at another home within the company. The Manager is a Registered General Nurse, and has a Diploma in Management and has attained the Registered Managers Award. Conversations with service users and visitors were mixed, in that some said they had met the Manager, whilst others said they had not. One visitor said they only new the name of the Manager, as a result of their conversation with us. The Manager said they had organised a service user and relative meeting in December 2007, for which there were minutes available. The Manager confirmed that information is put onto notice boards throughout the home. Discussions with staff highlighted that there have been no recent staff meetings, and staff indicated that they do not receive one to one supervisions, but are supervised by nursing staff with regards to the delivery of personal care. Nursing and care staff meetings have not been held for a considerable period of time, the lack of consultation and communication between the Manager, staff, visitors and service users has had a significant impact on the outcome of the Key Inspection, with a number of issues raised being due to a lack of awareness and communication. The Manager confirmed that Argyle House has a quality assurance system, which involves sending out surveys to service users and their relatives to ascertain their views, however the quality assurance system has not be implemented. Surveys sent to service users, relatives and staff, identified concerns with the number of Managers the home has recently employed, and that there have been areas of improvement since the commencement of the Manager, however majority believe that the Manager needs to be seen more amongst the service users and staff Service users, relatives and others who contribute to the care of service users need to have the opportunity to comment on the care and day to day management of the home, there views need to be collated within a report which is shared with all participants and includes an action plan as to how the service will continue to improve its service. Information supplied by the Manager in the AQAA confirms that the home regularly maintains systems through out the home, including meets the requirements of all regulatory departments, which include fire, central heating and emergency calls systems, are regularly checked. Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 26 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 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 1 1 X X 1 X 3 Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP10 Regulation 12(4) Requirement The Registered Person to ensure that the care service users require and receive is delivered by staff in a timely and sensitive manner that promotes the service users privacy, dignity and welfare. The Registered Person to ensure that service users are consulted about their social interests, and the programme of activities arranged by the home, and put into place activities and events of interest to service users. The Registered Person to ensure service users are consulted about the meals provided by the home, to ensure that service users needs in relation to choice and variety are met. The Registered Person to ensure that staff receive training relevant to the needs of service users, including health conditions and Dementia Care. The Registered Person to ensure that systems are set up which provide staff with the DS0000012599.V354483.R01.S.doc Timescale for action 09/03/08 2 OP12 16(2) 09/03/08 3 OP15 16(2) 09/03/08 4 OP30 18(1) 09/05/08 5 OP32 18(4) 09/03/08 Argyle House Version 5.2 Page 28 6 OP33 24(1) opportunity to discuss and influence work practices and the day to day running of the home, for example through staff meetings and supervisions. The Registered Person to ensure 09/03/08 that the quality assurance system is implemented for service users, relatives and other stakeholders who contribute to the care, safety and welfare of service user, and that their views are collated and used to continually develop the service for the benefit of service users. 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 OP7 Good Practice Recommendations Care plans should be discussed and reviewed with the service user, to ensure that the care being delivered is as agreed by the service user or their representative. Service users should have a person centred approach care plan, which details their views and preferences, preferred daily routines, and information as to their hobbies, interests, this is particularly relevant to service users with Dementia and those who cannot express their views and opinions. Systems to be introduced to promote information sharing and communication to ensure that health care guidance is implemented and followed through. All nursing and care staff to be supplied with a pager, which identifies the location of the service user requesting assistance when ringing a call bell. All care staff attains a National Vocational Qualification in Care. 2 OP7 3 4 5 OP8 OP27 OP28 Argyle House DS0000012599.V354483.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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.V354483.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!