Inspection on 08/02/10 for Argyle House

This inspection was carried out on 8th February 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 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 16/05/2010.

Key inspection report Care homes for older people Name: Address: Argyle House The Avenue Dallington Northampton Northants NN5 7AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Irene Miller     Date: 1 0 0 2 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 42 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 42 Information about the care home Name of care home: Address: Argyle House The Avenue Dallington Northampton Northants NN5 7AJ 01604589089 01604589423 argylehouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashbourne Homes Ltd care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 87. 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) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 42 Over 65 0 87 20 87 0 20 Brief description of the care home 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 en-suite 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 GBP 331.00 - GBP 650.00 for residential care and GBP 477.00 - GBP 950.00 for Nursing care. Inspection Reports from formerly the Commission for Social Care Inspection are displayed in the entrance foyer of the home. Care Homes for Older People Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of all inspections undertaken by the Care Quality Commission are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and carried out by two regulation inspectors and also included the involvement of an an expert by experience from Age Concern. The total time taken on this inspection was three days. We focused on the key standards under the National Minimum Standards and the Care Homes Regulations 2001, for homes providing care for older people. In November 2009 we carried out a Random Unannounced Inspection at Argyle House, during which we were concerned about the quality of care provided for people using the service. Following the Random inspection we issued an urgent action letter to the provider detailing requirements to be met within set timescales for compliance. The provider has submitted weekly action plans on how they are meeting the requirements, Care Homes for Older People Page 6 of 42 the most recent action plan received from the provider in January 2010. In addition to the Regulatory Activity of the Care Quality Commissions (CQC) there has also been a high level of involvement and monitoring of Argyle House from the Northamptonshire County Council Commissioning Unit, the Primary Care Trust and the Local Authority Safeguarding Team. Due to serious concerns about the quality of care for people at Argyle House a block on admissions was put in placed (an embargo) to enable the provider to make improvements. Continuing healthcare (CHC) reviews have be carried out at Argyle House with liaison with CQC, NCC, safeguarding and the Quality Monitoring Nurses and a Clinical Audit took place at Argyle House on 1st December 2009. In addition to the requirements issued by CQC, individual and institutional safeguarding concerns have been investigated through the safeguarding Authority and concerns have been shared with representatives from Southern Cross and Health and Social Care professionals. We sample checked care records of people using the service which involved looking through written information available on their care, such as, individual care plans (a care plan sets out how the home aims to meet the individual service users personal, health care, social and spiritual needs). During the visit we spoke with people about their experience of using the service, and staff to gain an insight into the staff support and training provided at the home. We carried out general observations of care practices to enable judgments to be made as to the quality of service provided at Argyle House. Records in relation to the homes management and administration systems, we looked at records of quality assurance, complaints, staff recruitment and other policies and procedures. Several weeks prior to this unannounced visit the Care Quality Commission sent out to the provider an Annual Quality Assurance Assessment (AQAA). This document allows the provider to reflect on the service they provide and supply us with written information on how they view their own performance. The AQAA was returned to the Care Quality Commission CQC within the timescale set, and gave an insight into how the home is managed and quality assessed. Over the three days of this inspection the Area Manager and the Deputy Manager where available at Argyle House. Throughout this report the term we is used to describe CQC as a collective body. Care Homes for Older People Page 7 of 42 Care Homes for Older People Page 8 of 42 What the care home does well: What has improved since the last inspection? Significant work has taken place on improving the staffing levels, the quality of the information within the care plans and the management of pressure area care, nutrition and special dietary needs. The atmosphere within the home is now much more positive the staff are being managed well and feel valued as team members. The provider has worked well with Health and Social Care professionals with the aim of improving the quality of care. It is now an expectation that continued improvement can be achieved through the providers own quality assurance monitoring systems. Care Homes for Older People Page 9 of 42 What they could do better: 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. Care Homes for Older People Page 10 of 42 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. Care Homes for Older People Page 11 of 42 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good planning of admissions into the home ensures that people are fully supported in their transition into the home. Evidence: Since the last inspection of this service there had been a significant increase in the number of safeguarding alerts being raised for people using the service. Based upon the concerns a decision was made between Southern Cross, Northampton County Council Commissioning Unit, Northampton Safeguarding Adults Team, The Primary Care Trust and the Care Quality Commission, to stop admitting people into the home. The purpose of stopping new admissions was to enable the provider to focus on improving the standard of care at Argyle House. National Minimum Standard (NMS) standard 3, looks at pre admission assessment and as no new admissions had recently taken place at Argyle House this standard was unable to be fully assessed. Care Homes for Older People Page 13 of 42 Evidence: Standard 6 is not applicable to this service. We looked at the information supplied from the provider within their Annual Quality Assurance Assessment (AQAA) which was submitted to The Care Quality Commission in March 2009. The AQAA had information that Argyle House planned to make improvements on the level of information supplied to potential new admissions, and to provide more information on their website and implement a home information booklet. At this inspection we used a person from the Help the Aged organisation known as an expert by experience this gave a greater opportunity to enable us to speak to more people face to face, to hear from them their experience of the care they receive at Argyle House. Several people were asked during the inspection about their experience of being admitted to the home, all of the people spoken with had moved into the home during 2009. One person said they had been brought into the home by her relative and had been met in reception by the person who had done their assessment and accompanied to her room, this person said that they had been given the opportunity of visiting the home prior to them moving in. A daughter of another person explained that she had been present at the initial assessment stage, and that when she had brought her mother into the home the admission seemed muddled and she was just told which room to go to. A couple spoken with said my nephew put us in here, they remembered having their assessment and their niece and nephew accompanying them but that did not think they had any say in the matter. One relative said that her mother was in hospital and the family had been looking round the homes in the area. they were surprised when one day, they turned up at the hospital to find the manager of Argyle House had arranged for their mother to be admitted into Argyle House. They had no knowledge of how the admission was conducted as it had been arranged whilst they were away. We talked with staff to gain an insight as to how they manage new admissions into the home, we asked whether on the day of admission extra staff are brought in, was the persons keyworker involved with the admission, the timing of the admission and the involvement of family/relatives etc. Care Homes for Older People Page 14 of 42 Evidence: The response from staff was vague, concerning how admissions are managed, staff told us they know when an admission is taking place, although not much thought is given as to how the person is to be supported on admission. Staff said they are told when a new admission arrives in reception , when they were called to fetch them. That whichever member of staff is free helps the new person to settle in their room. There was no indication that extra staff were brought in when a new admission is expected or that the staff knew the time of an arrival. Most people admitted into the home arrive with a relative and the staff helped with the unpacking and settling the resident into the room. Care Homes for Older People Page 15 of 42 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Close monitoring of the changing needs of people ensures that staff can continue to care for people in the right way. Evidence: Following a random unannounced inspection in November 2009 we identified that the provider needed to make improvements on the quality of the care plans, risk assessments and the management of medication. We issued an urgent action letter outlining detailing requirements which the provider must comply with under the Care Homes Regulations 2001. Due to a number of safeguarding concerns, Northants County Council, PCT and the Local Authority had also been heavily involved with monitoring the care of people at Argyle House. This had prompted Safeguarding Adults Protection Plans being imposed for individuals. The provider has submitted weekly updates on the actions taken to improve on the quality of service at Argyle House. An action plan submitted to CQC from the provider in January 2010 stated that fourty two care plans had been rewritten. That the Registered Nurses employed at the home Care Homes for Older People Page 16 of 42 Evidence: were to update and review all care plans on a monthly basis, and the Home Manager to audit four care plans on a daily basis. The provider stated that one care plan per floor to be audited per day and Home Manager to check this is carried out. We were told that staff were being allocated to individuals using the service on a daily basis and to take on the responsibility for daily recording the care provided for these individuals. Within the care plans and risk assessments viewed there was up to date information and records of regular review and monitoring of people identified at risk of their health and welfare needs not being met, due to problems with meeting nutritional and hydration needs, skin integrity, pressure area care, mobility and falls prevention. There was records of the involvement of other health care professionals in their care such as the Speech and Language Therapist (SALT), nutritionists and the Tissue Viability Nurse (TVN). Some people using the service are unable to take their foods orally and some require soft diets and thickened drinks to prevent the risk of choking. We looked at the care of a person requiring their nutrition to be provided through a tube feeding system, called a Percutaneous Endoscopic Gastrostomy (PEG) feed. The nutrition care plan had sufficient information on the persons individual feeding regime to enable staff to provide the right care. There was records available on the daily care of the tube feed equipment, although there was some gaps on the daily monitoring charts where staff had failed to sign to evidence that checks had been made and daily tasks completed. Due to person being unable to take foods orally we looked at the care plan for their oral health care, the information in this plan was basic such as needs mouth cleaned daily, there was evidence within the persons room that mouth swabs were in use. Although in discussion with staff we were informed that this person had some communication difficulties and sometimes resisted staff intervention in this area of their care. We advised that the care plan needs to reflect this element of need, with close monitoring and recording on a daily basis. We looked at the care of a person who was immobile and receiving treatment for a pressure ulcer. The care plan and risk assessments for this person had been regularly reviewed and there was details available on the specific pressure relieving equipment in use and the ongoing treatment for the pressure ulcer. We observed that the person was cared for on an air filled alternating pressure relieving mattress, there was records of daily monitoring of the pressure mattress to ensure its effectiveness in providing pressure relief. There was records of the frequency of when the person was turned in bed and records of the persons nutritional and fluid intake. Care Homes for Older People Page 17 of 42 Evidence: One person said they were an insulin dependent diabetic and confirmed that they have their blood sugar levels checked twice daily, this person said that they are aware when their blood sugar levels are dropping and had a supply of snacks within their bedroom. The person referred to an incident that had happened some time ago, when they said they had asked a care worker for their blood sugar level to be checked and that the care worker said that only the nurse on the unit could do this and the nurse was in a meeting. The person said that they offered to do the test them self (as they always had done before) but the carer said this was not allowed,the nurse arrived back onto the unit about two hours later to take the persons blood sugar reading. This information was shared with the project manager during the inspection, who said that now that Nurse and care staff are taking on greater accountability for allocated people on their units this is unlikely to happen again. We observed staff administering medications to people using the service. We observed a person receiving their medications through a PEG feed tube and the member of staff was observed to administer the medication in line with the instruction within the persons care plan. It was noted that the person had been prescribed a course of antibiotics and on the medication administration record (MAR Chart) that the course had been stopped and crossed off as course complete by an Agency nurse who had been working at the home. In discussion with the Nurse administering the medication they explained that they had quickly identified the error and resumed the person back onto the antibiotic the following morning, this swift action had resulted in the outcome that the person had continued to receive their prescribed medication. This error was brought to the attention of the area Manager at Argyle House who informing us that the care agency had been informed of the error their agency worker had made. Within one care plan viewed there was instruction, do not resuscitate (DNR) it was recorded that had been discussed with the individual back in May 2007. There was no evidence that this had been signed by the persons at this time. There was one signature obtained which was that of the registered nurse. The persons care plan stated that due to major brain surgery the person was unaware of risks. There was no evidence of any assessment having been carried out to determine whether the person had the capacity to understand the implications of this directive, and there was no evidence of a review of this decision since the first entry in 2007. The deputy manager confirmed that she had attended training on the Mental Capacity Act 2005 (MCA). We advised that the home seeks guidance from the Local Authority Safeguarding Deprivation of Liberty Lead (DoLS) to ensure that any DNR directives are made under the guidelines of the MCA 2005. Care Homes for Older People Page 18 of 42 Evidence: On speaking with one person they expressed dissatisfaction with the frequency of when they are provided with a bath/shower, the person said that they are only offered a shower once a month. This was brought to the attention of the Acting Manager who said that they would look into the persons concerns. The project manager explained that there had been shortfalls in this area and that since the introduction of the staff daily allocation to individual service users, that improvements have taken place with people receiving individualised personal care. The personal care plan for this individual was viewed which had been recently updated and stated that the person was to be offered a shower weekly. In discussion with one person they said that they managed to dress herself , her visitor who was in the room at the time was a little shocked and said the carers were supposed to do that. We observed an incident during the lunchtime meal when a person had finished their main meal and was standing up with their trousers in disarray. A care worker noticed this and went up and mentioned this to the person. The care worker attempted to maintain the persons dignity by helped to fastened the trousers as much as they could. We observed that the member of staff did try to encourage the person to leave the room to go and change their trouser but the person insisted they wanted to keep them on. The member of staff was heard to say but you know they do not fit you. Staff need to be mindful when assisting people to dress that clothing is appropriate for the person, as this could situation as well as causing some degree of embarrassment caused also have presented a potential tripping hazard. One visitor spoken with said when they arrived at the home they had found their mother to put her dentures in, although only managed to put one of the hearing aids in. During this time the visitor had been unable to communicate with their mother and had asked a care worker for help in putting the hearing aid in. The visitor said that they had been waiting twenty minutes for the care worker to return and no-one had come yet, saying they found this particularly annoying because they had traveled by bus and their visiting time was therefore limited. We observed the relative stop a care worker who then came into the room and with the relatives help managed to put the hearing aids in. The care worker stated we tried to put them in earlier but she would not co-operate, she fought us and my arms are all scratches. This was confirmed when the resident became agitated trying to stop the care worker from putting the hearing aid in. We observed the care worker to remain calm and act reasonably the whole time she was attempting to put in the Care Homes for Older People Page 19 of 42 Evidence: hearing aids. The daughter queried whether her mother had her tablets as they calmed her down. The carer said she did not know. We observed a member of staff enter a persons bedroom to provide treatment to the persons knee. This was in a double room shared between husband and wife. The staff member drew the curtain so that she could treat the person in private. All people spoken to stated that their call bells were answered quickly and that they were happy with the standard of care they received. people said they could go to bed or get up whenever wished and the staff knocked on their doors before entering. Care Homes for Older People Page 20 of 42 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people are satisfied with activities provided at the home, although not so satisfied with the quality of the meals provision. Evidence: The majority of people spoken with were satisfied with the service provided at Argyle House, the main area of dissatisfaction was around the quality of the meals provided. Some people said they enjoyed their trips out and hoped that now the minibus had been repaired they would be able to get out again. Most people were observed to spend time in their own rooms when asked if this was through their own preference they said they liked watching whichever they liked on their own television. Some said they like the piece and quite, one person said she likes to knit, another person who was registered blind said that they listened to their radio in their room. We asked if she ever listened to audio books and she said she was not really interested, that she had her CD player as well as the radio, this person said the staff are wonderful as I am utterly dependent on them. Within many of the bedrooms viewed people had use of a small fridge and tea and coffee making facilities. One person said that when she has visitors its nice for them to make a drink. Newspapers and magazines are delivered to the home for individuals Care Homes for Older People Page 21 of 42 Evidence: and we were told that a mobile library service used to visit but due to lack of demand they no longer came. We were told that presently the library was being used as a medication store due to the temperature in the designated medication store room being too high and having no air conditioning. We were told that once the medication store has the air conditioning installed that the suggestion is to turn the library into a small shop. The wife of a couple spoken with said that she would like to look around the shops. Church services are provided at the home and people said they were very pleased with these services. A monthly Songs of Praise takes place at which nuns from a local Convent visit. One person who is disabled said that they always brought her communion in her own room. Two activity staff employed by the home both covered other jobs when they were not doing activities. We were told that it is the responsibility of the activity staff to engage people in activities, that this is not seen as a role for the Nurses of care staff. Some activities are provided by outside entertainers, such as musical entertainment, we were told it is hoped to have an exercise motivator to the home twice a month. The hairdresser visits two days a week and at least once a month a pamper afternoon provided for ladies when they could have beauty treatment and their nails done. The programme of activities included, word puzzles, board games, scrabble, reminiscing, crafts such as making gift cards, baking and decorating Valentine cakes. We were told that the activity person collects shopping for people using the service. The programme for the months activities was displayed pinned on notice boards on each floor as individual programmes given to people using the service. Fund raising events takes place especially at the Christmas Fete and Summer Party, and we were told that the proceeds go half into the home and half given to an outside charity. Some of the activities that had taken place were visits to a sister home and fa local Christian Centre for coffee, out for meals and boat trips. On these outings we were told that the number of wheelchair users was limited not only by the availability of the minibus, but also the availability of helpers as it was normally only the two activity persons and if there is a driver of the minibus to help. It is not an expectation of care staff to participate in the outings. Staff said that although all people are asked if they wish to go out, we were told it is usually the same few who go. One of the activity persons said that much of his job was to visit people on a one on one basis. This included visiting people on all floors, to talk to them and find out any requirements. Care Homes for Older People Page 22 of 42 Evidence: One of the activity persons said they had completed their National Vocational Qualification (NVQ) level 2 in care. The other activity person, who had been employed in this capacity for six months,said they were not aware that they could do any qualifications and said they would be very interested in doing some. We asked if the activity staff had received any specific training in providing activities for people living with dementia, and was told that the Alzheimers Association had been approached more than once asking for help in this but there had as yet been no response from the Association. We were told by the activities staff that the next project was to make mobiles with people which can be hung in the rooms of people who are bedridden. We were told by care staff that every other Sunday is not covered by any of the activity staff. The carers said that on these days they put music on and dance with people and that they loved this. The quality and choice of food was really the only area of complaint which was usually followed by it has improved recently. A couple of people spoken to said that it had improved since about Christmas following an inspection. They stated that previously it was always the same stew but now there was more variety. One person was observed to have egg and chips for her lunchtime meal, we asked whether she had requested this alternative to the main meal, they said, I have this everyday, its the safest bet, they cant really do anything wrong with this. On all floors the dining tables were set out with serviettes. The food came up from the kitchen in a dumbwaiter. We were informed that people are asked what they would like from the menu the previous day, and their choice noted. Within all of the units. We observed that no menu was on display within any of the dining rooms or on the unit notice boards. The only menus that were on display were in the reception area on a notice board, it was noted that the print was very small and difficult to read. We did not observe any people using any aids, such as plate guards or specialist cutlery, we did staff were seen to a assist by cutting up food and to help people to eat their meal. On the second floor dementia unit it was noted that there was a long period between people receiving their main meal and their sweet. Staff were observed to ask people if they wanted a cup of tea in between the main course and the sweet. One person was observed to take a long time to eat her food, others in the dining room had finished their their meal well before this person had finished. If this is the normal eating pattern for this individual the use of a heated plate may be more Care Homes for Older People Page 23 of 42 Evidence: suitable. We observed that on each unit a snack tray of rolls, fruit, chocolate bars and crisps is made available, we were told by staff that the snacks are replenished three times a day. Staff said that people are free to take whatever they like from the tray, one person was observed to help herself to a chocolate bar, however when speaking with another person they said they did not know that they could help themselves to items on the tray. A small sign on display near the tray inviting people to help themselves may be useful, as some people may feel that they need to ask for items. It was also noted that the crisps were provided in one large bag, smaller individual packets of crisps may be more appropriate. One person did not want her meal and the staff offered her jam sandwiches instead, which she also did not eat. We were told that this would be noted but that she had been eating during the morning from the tray of snacks that was in the lounge. One person kept falling asleep at the dining table, they had eaten most of their meal. A member of staff knelt down beside to ask if she wanted to go to her room but they could not get an answer. The staff member then wrote the question clearly on some paper and the resident smiled and nodded her head. The impression was that staff do not go out of their way to spend time and talk to the people who spent most of the time in their rooms other than when a care task is required. One person said the staff did come in and chat to her. Many of those who had to stay in their rooms require to be fed by the staff so there is presumably dialog on this occasion. Friendly banter between staff and people using the service was observed, and on the whole they all seemed to get on well together. Staff said that recently they had been allocated their own individual floors more permanently and said this was much better as they found it much easier now to get to know and understand the residents especially those living with dementia. Generally there did not appear to be much interaction between staff and visitors, as mentioned earlier one visitor had asked for help and had to wait for twenty minutes. One visitor said they had been given a set of rules regarding bringing her dog into the home. Some people said that they attend the residents meetings and the main subject that is always brought up is the poor quality of food. A couple of the visitors said that they had attended the meetings one said that meetings were sometimes held in the Care Homes for Older People Page 24 of 42 Evidence: evening and she found that difficult to attend because there was no return bus and she also did not like going out at night. Care Homes for Older People Page 25 of 42 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices within the service have improved to protect people who use the service and ensure that they are safe. Evidence: In November 2009 we carried out a random inspection to monitor compliance with requirements issued at the last key inspection that took place in June 2009. Three safeguarding referrals have been made since the last inspection relating to medication errors and concerns raised by local commissioners, these are presently being investigated. The service has comprehensive policies and procedures in relation to handling concerns and complaints. A copy of the complaints procedure is available in the entrance hall at the home. People who use the service were all clear about how to make a complaint saying they would speak with the manager or a member of their family. Carers undertake abuse awareness training as part of their induction/foundation training. Several have completed this as part of their National Vocational Qualification. The inspector checked out their understanding during the inspection. Accidents are routinely recorded at the home. Since the last inspection in November there have been 31 accidents with three people requiring hospital Care Homes for Older People Page 26 of 42 Evidence: treatment/admission, 67 percent of which were falls. We found no evidence of management undertaking an analysis of the accidents so that measure could be taken to minimise these in the future. The open approach of the acting manager enables people who use the service to feel comfortable if there was a need to make a complaint or express a concern. In discussions during the inspection it was concluded that people using the service felt safe and that carers had a good understanding of their role and were aware of policies and procedures. Recruitment checks need to be more robust to ensure that people using the service are protected. Management need to ensure that all applicants have two references one being from their previous employer and a criminal bureau check before commencing work at the home. Care Homes for Older People Page 27 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people are provided with a home that is clean, pleasant and safe. Evidence: The communal areas were clean and nicely decorated nicely, although some areas were looking a little worn, such high traffic areas where wallpaper scuffs had occurred and some of the room doors and most of the handrails appeared in needed of re varnishing. In the corridor leading from the main reception area there was a notice board with photographs of the staff, this would be a useful addition to introduce onto the individual units to enable people using the service and visitors to link with staff who are allocated to individuals on a daily basis. On floor two Silverstone dementia care unit, themed wall collages had been placed along the corridors these included, board games, animals, locks, and toiletries, the purpose of these is to have some areas of interest within the environment for people to touch and look at. In discussion with the staff they said they would like to have some informal areas of seating such as a bench along the corridor, for people to stop and rest and promote a more relaxed feel. Some discussion took place about the hight of the plinth on the Care Homes for Older People Page 28 of 42 Evidence: nurse station, as it was observed that one person was unable to see above the top, when staff are sitting at the desk this could be perceived as a physical barrier to communication between staff and people using the service. Staff said that people often come and sit with them at the nurse station and would like to open up the area and make better use of this space. Within the open plan kitchen of the dementia care unit, it was identified through risk assessment that the use of the hot water boilers posed a significant risk for people residing on this unit. The boilers had been removed and replaced with a domestic kettle, which can be used by people with staff supervision, which is more familiar and reduces the risk of scalds. Risk assessments had been carried out on the hot holding ban Maries within the unit kitchens. It was warm in the home and one person said it is always a nice even temperature here. In one of the dining rooms two windows were slightly ajar a person sitting in the lounge next to the window requested this be close and staff responded immediately. Individual bedrooms viewed were nicely furnished and had been personalised. People spoken with all expressed satisfaction with their rooms. One person has a pet canary in their room. Within the bedrooms viewed we observed that call bells were available within reach. Specialist seating was available for some individuals within their own bedrooms and within the communal areas. We asked about the access to the lift on Silverstone dementia care unit, and whether this had posed a problem for any people that may have stepped into the lift unsupervised. We were told that occasionally some people had pressed the button but only a few were ever seen to go into it. It was noted that the car parking facilities was very limited, at 11:00am only three care parking spaces were left. At this time there were few visitors in the home and several visitors said they come by bus. Staff said that most visitors came in the afternoon. Protective equipment such as disposable gloves and aprons were available within the units for staff access and staff were observed to cover their uniforms with an apron at mealtimes to control any risks of cross infection. Care Homes for Older People Page 29 of 42 Evidence: Following a visit from the PCT Quality Monitoring Nurse to Argyle House concerns were raised regarding hoist slings being shared within the home person to person. This practice significantly increases the risks of cross infection, and was being followed up with the Quality Monitoring Nursing Team and the home. A dispenser is available at the entrance to the home, this is located to the right hand side just past the door in the main entrance, which contained a hand sterilising gel. The reception desk is to the left so when entering one would tend to automatically be looking to the left. The dispenser was white which blended in with the wall and no notice was on display near the dispenser or on the desk, to request that people use the hand sanitising gel on arrival and departure from the home. In general there was no offensive odours within the environment although, it was noted on Floor 2 there was a slight smell of urine within one bedroom. Care Homes for Older People Page 30 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are cared for by a team of staff that are generally aware of their needs, however shortfalls in training and recruitment practices has the potential to place people at risk. Evidence: At the last inspection of this service staff had said they felt unsupported, rushed and under pressure to meet the needs of people in their care, there was a clear lack of staff management observed throughout the home with staff being left to their own devises. At this unannounced inspection we found a significant improvement in staffing levels and the way that staff were being supported. With the introduction of a daily staff allocation system, each member of staff knows which unit and people within the unit they are assigned to. This has given a sense of responsibility and ownership to each individual member of staff to ensure the needs of people on each of the units are met. In discussion with staff they said they were very pleased with the new system and the increase in the staffing levels, saying they felt that they had more time to spend with people, less pressured and know what is expected of them. They spoke of the support they receive from the management and how the atmosphere within the home is much happier. Observations made over the three days of the inspection evidenced that the atmosphere within the home was much more relaxed and staff were seen to be more Care Homes for Older People Page 31 of 42 Evidence: available. Staff said that agency staff were sometimes used but not as often as previously. A couple of the staff said that an extra member of staff would be a great help and allow more time to interact with people. On the first day of the inspection we found that there were three nurses on duty one allocated to each of the nursing floors within the home. In support there were three carers on each floor with the residential floor having a senior carer to lead the shift and two carers. In addition they were supported by the housekeeping, catering and administration teams. At present there is a homes manager vacancy with the deputy manager acting up and being supported by the regional team. An appointment has been made for the homes manager and they are expected to join the service shortly. On the second day of the inspection staff sickness meant that the deputy manager was assisting the teams with direct care. We looked at the recruitment files of nine staff recently employed at the home. Within one of the files viewed we noted that the Criminal Records Bureau (CRB) clearance had been requested but not cleared for one staff member before they had taken up employment. It was confirmed that a check had been made on the Protection of Vulnerable Adults register (POVA). In discussion with the deputy manager, the new staff member and on observation it was evident that the staff member was working unsupervised. This was brought immediately to the acting managers attention, who took swift action and made arrangements for the staff member to work only under supervision alongside an experienced member of staff, and verbal assurance was given that this would continue until the CRB clearance had been achieved. We sample checked staff recruitment files and found that references on two files had been addressed To whom it may Concern there was no evidence available within the files or anywhere else within the recruitment records to show that these references had been verified. A further two recruitment records viewed did not evidence that the last employer had been approached to provide a written reference. The application form used by Southern Cross clearly states that applicants must give their present or last employer as a referee. Policies and procedures of the organisation also support the practice. Agency staff, nurses and carers are in regular use within the home and we were Care Homes for Older People Page 32 of 42 Evidence: informed that no system is in place to check with the care agencies, that staff have undergone CRB or POVA first checks and received the necessary training to ensure that meet the needs of the people using the service. We looked at records of staff induction training, one file contained evidence that the induction had been completed but the document had not been signed by the acting manager. Another contained no reference to an induction programme and in discussion with the staff member we established that they had received the programme but they were unsure as to how to complete it and had had no support from management since their appointment. The training records indicated that there was significant improvement in staff receiving training. However not all staff had completed updates in manual handling and other mandatory training. On further investigation this applies to only a few staff who persistently do not attend training. Management are addressing these issues in ongoing supervision. Some files reviewed were for overseas workers and there was evidence that all the information supplied within the application form had been verified. Records also confirm that medication training has been completed for staff responsible for this task and for carers prior to them taking on this part of their role. The Annual Quality Assurance Assessment (AQAA) document completed by the homes manager in March 2009 confirms that nine of the staffing team has achieved National Vocational Qualifications at level two or above. In reviewing records at the key inspection 16 carers now hold the qualification with a further three completing the training. This is an improving situation but the home has not yet achieved the 50 of staff trained at level two or above. All nurses hold a recognised professional quantification and with their registration with the Nursing & Midwifery Council (NMC) being checked and updated. Two staff spoken with said that although they had worked at Argyle House for four years they had done any NVQ training, the staff said they would like to do this qualification and had been told it might be possible shortly. Staff files mainly contained copies of required recruitment documentation and training certificates. Some files contained personal information that does not required to be stored and these would not meet the Data Protection guidelines and need to be reviewed. Care Homes for Older People Page 33 of 42 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the service has improved ensuring that the focus is on safety and quality outcomes for the people using the service. Evidence: The Deputy Manager has been taken off shift and is currently working supernumerary as the Acting Manager, supported by an Area Manager who is in daily contact with the home. This arrangement has been effective in ensuring that quality monitoring tasks have been carried out to ensure the health and welfare of people using the service continue to be met. During the inspection we received positive feedback from people using the service, visitors and staff in relation to how the home is currently being managed. The company has appointed a new manager who is due to commence their duties soon. We were told that the Deputy Manager will remain in a supernumerary position as this has had a positive impact on the ability to maintain quality and good management of the home. One noticeable change was improvement in the quality of the information Care Homes for Older People Page 34 of 42 Evidence: within care plans and the positive attitude of the staff in wanting to make further improvements. The service is reviewed by a regional manager who completes the required Regulation 26 reports on behalf on the organisation. Points raised at these visits are discussed and action taken by the deputy manager. Various meetings take place at the home which are recorded and demonstrate how the service is reviewed. The organisation undertakes an annual quality assurance process that involves consultation with people that use the service, families and other people that have a connection with the service. The results of the survey are displayed in the entrance hall of the home. The staff team have been through allot of management changes and despite this still remain dedicated They demonstrated that they had an adequate range of knowledge about the needs of people living at the home. The previous failings in the lack of guidance and support from management is being addressed. The implementation of formal one to one supervision for all staff is underway, although further work is still needed in this area. The acting manager confirmed she is drawing together a programme to ensure that all staff benefit from receiving regular one to one supervision. We tracked the supervision for one person where issues had been raised about their practice and there was good evidence that their performance and competency is closely monitored. Quality Assurance surveys are used by the company to assess their own performance. Comment cards are available within the front entrance to the home, and regular meetings take place with people using the service and visitors. The provider has undertaken most of the health and safety checks required, and records of checks are maintained. One area found in need of an update was the emergency procedure file, particularly information about new people moving into the home which had not been maintained. Health and Safety Policies and Procedures are in place and carers are aware of these. Induction training ensures that all employees have knowledge and understanding of these. Company Care Practices Policies are available at the home and are kept under review. In reviewing how service users monies were handled we were shown the electronic Care Homes for Older People Page 35 of 42 Evidence: record for service users at Argyle House. We did note that one person had a large sum of money held in an account and the staff could not confirm that interest was being paid on this amount. They thought that it may have ceased. There is some concern that the service may not be acting on the best financial interests if this is the position. If people using the service held their own savings account they would be receive a small percentage in interest. Care Homes for Older People Page 36 of 42 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 37 of 42 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People using the service must receive personal care according to their individual needs and wishes. This will ensure that people receive personal care according to their preference. 11/04/2010 2 11 15 Do not resuscitate directives 11/04/2010 must follow guidelines as set out under the Mental Capacity Act 2005 and kept under regular review. This will ensure that that best interest decisions made for people who lack capacity to make their own decision, follow the guidelines of the Mental Capacity Act 2005. 3 15 16 People using the service 11/04/2010 must be provided with meals that are varied, appealing and wholesome. Care Homes for Older People Page 38 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people receive a nutritious diet and mealtimes are an enjoyable experience. 4 28 18 Mandatory training for manual handling must be undertaken by all relevant staff at the home at the required frequency. This is to ensure that people who require moving and handling are safe. 5 28 18 Induction training must be 11/04/2010 fully completed for all new staff to ensure that they are equipped with the basic skills to meet the needs of the people using the service. This is to ensure that staff are fully aware of their roles and responsibilities. 6 29 19 Staff must have CRB clearance to work unsupervised with people using the service. This is to ensure that the provider has taken all reasonable measures to protect people using the service. 7 29 19 Managers at the home must ensure that agency staff working at the home supply 11/04/2010 11/04/2010 31/05/2010 Care Homes for Older People Page 39 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action evidence that all employment checks have been completed by their organisation. This is to ensure that people using the service are protected. 8 36 18 A programme of one to one staff supervison must be in place and implemented. This is to ensure that staff are supported and performance is managed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/05/2010 1 3 Admissions into the home should be planned and managed in such a way that people are fully supported to allow time to adjust to their new surroundings. 2 7 Where it is known that individuals can be resistive to personal care the care plan should give detailed instruction for staff to follow. This will ensure that the care delivered is consistent with the aim of reducing anxiety for the person receiving the care. 3 8 Health care monitoring records should be checked on a daily basis to ensure that staff record when tasks have been completed, this includes turn charts, food and fluid monitoring charts. This will ensure that people receive the care according to Care Homes for Older People Page 40 of 42 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations their care plan and monitoring records evidence the care provided. 4 15 Menus should be available in written or other formats to suit the capacities of all people using the service. This will inform people on a daily basis of the meals available. 5 29 Employment references requested by the provider should be addressed to named individuals and where this may not be possible To Whom It May Concern references are verified. This will ensure that robust pre employment checks are carried out. 6 35 The procedures for handling service users monies should be reviewed to ensure that they are managed effectively. This would ensure that peoples finances are managed in their best interests. 7 38 Regular review of the homes emergency procedures should take place. This would ensure the safety of people using the service and that information is current. Care Homes for Older People Page 41 of 42 Helpline: 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. 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