CARE HOMES FOR OLDER PEOPLE
ARGYLES NURSING HOME Pound Street Newbury Berkshire RG14 6AE Lead Inspector
Rhian Williams-Flew Unannounced 26 July 2005, 9.30 am 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 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. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Argyles Nursing Home Address Pound Street, Newbury, Berkshire, RG14 6AE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01635 551166 BUPA Care Homes Limited Miss Susan Jayne Smith Care Home (CRH) 57 Category(ies) of Care home with nursing (N) registration, with number of places ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of persons for whom accommodation is provided at any one time shall now exceed 57. 2. The category of persons for whom accommodation is provided shall be that of general nursing and medical care of the elderly. 3. Chronically disabled persons under the age of 60 years will not be received except for convalescent or respite care for periods not exceeding 3 weeks. Date of last inspection 8 March 2005 Brief Description of the Service: The Argyles is a care home with nursing run by BUPA care homes. The home can accommodate 57 residents over the age of 65 years of age. It is not registered to provide care for people who were suffering from dementia as the primary diagnosis. The accommodation in the home is provided over two floors. Each floor has access to two lounge areas. There is a passenger lift between the two floors of the home. The home is very close to the centre of Newbury and is easily accessible by road and rail, as well as pedestrian access. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection occurring between 9.30 – 17.00 hours on a weekday. The Registered Manager was on leave. The focus of the inspection was to review the delivery of care by speaking with the residents, reviewing care plan records and viewing all areas of the home that residents have access to. At least 15 residents were spoken with during the inspection. An immediate requirement was issued for the home to investigate an issue of serious concern. This was satisfactorily concluded within the timescale set of 7 days. What the service does well: What has improved since the last inspection?
The care plans are more comprehensive in their detail and the residents and/or their representatives are now included in the process of developing their care plan. Members of staff have received specific training in the protection of vulnerable adults, infection control and moving and handling. Residents commented that the food quality had improved in recent times.
ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 This home does ensure that they have either assessed the persons needs or they have care management information about the persons needs prior to admission. EVIDENCE: The care records of a resident who had been admitted in recent months were reviewed and were found to contain all the relevant pre-admission information required. The present care plan also indicated that the care home was able to meet the specific needs of the resident. In conversation with this resident they confirmed that they felt their needs were being met. In conversation with a resident who had been admitted within the past two weeks they felt that their care needs were being addressed properly and they were adjusting to their changed circumstances. The care records for this resident did not contain particular information about how to meet their care needs. In discussion with the registered nurse she advised that they were still fully assessing the persons needs before formulating a care plan. Discussions were held with this nurse to ensure that a skeleton care plan is in place from admission. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. Care plans are detailed and are reviewed regularly however, the use of task orientated lists to record the weights of residents and bathing requirements etc does not embrace the principles of individual care needs being recorded in individual care plans. EVIDENCE: The care plans for 6 residents were reviewed in detail and reflected the care needs of the residents concerned. They were being reviewed regularly, at least once a month, and any changing needs were being noted and actioned. The health care needs of residents are being addressed. Records of visits by the GP and other healthcare professionals were noted and any actions required by these people have been followed through. Pressure area care was being reviewed regularly as well as nutritional screening. The weight records of some of the residents had not been recorded since May 2005 in their care plans however, a separate weight record list was seen and it was noted that they were all up-to-date. The more appropriate place to record a residents weight is in their individual records and this should occur. It was also noted that there was a “bath list”. A better place to record a residents choice as to when they prefer their bath would be their care plan. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 10 The administration of medication was observed and was conducted appropriately. Examination of the storage of the control drugs was not examined on this occasion. The majority of residents confirmed that their privacy and dignity was upheld. Observations of the interactions between staff and residents demonstrated that the majority of the members of staff were respectful of peoples dignity and privacy. There were exceptions to this reported to the Inspector. The expressed concerns of the residents were referred to the management of BUPA for immediate action. The Commission for Social Care Inspection (CSCI) have required that any findings be reported to them on these matters, initially within seven days of the inspection. A report has been submitted to CSCI within this timescale and we are satisfied with the conduct of the investigation and the findings and actions that will be put in place for the future. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15. Ensuring that residents are enabled to maintain their independence and preferences must be a fundamental principle when addressing the needs of residents. This is an area of care delivery that needs to be readdressed in this home. EVIDENCE: In conversation with some of the residents it was apparent that they had regrets that they could no longer pursue the lifestyles and choices they had had in the past. However, some of them recognised that they were no longer able to pursue these lifestyles because of their physical limitations. Some of the residents spoke of their continuing contact with previous community activities, which they look forward to and enjoy. The activities coordinator works for four days a week. The programme of activities was displayed in the home and in conversation with the activities coordinator she said that most of her contact with the residents was on an individual basis as this was their preference and she found them more responsive to this style. Several of the residents were complimentary about their contact with the activities coordinator in the ideas and suggestions she offers them. Some comments from residents indicated that they were accepting of the choices presented to them rather than actively participating in the choices. It was also observed during the inspection that some care staff offered no choice
ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 12 to residents when drinks were being offered (preferring to issue drinks from a preference list). It was also noted that there was little engagement or interaction by some of the care staff when offering drinks or when attending to their needs. This is very poor practice. Interactions by other members of staff with residents were noted to be more appropriate. Bearing in mind the expressed regrets of residents as to the loss of lifestyle choices and independence it should be paramount that any choices they can make are facilitated and provided. This should be done on an individual basis and not provided because a specific list directs it or it has become part of a routine for the care staff. Residents were asked about the food offered to them and whether it met with their preferences. The majority of service users were content with the food offered to them some saying it has improved. One resident expressed a preference for not having a soft diet as they found it boring and bland. The registered nurse was asked to address this matter with the resident and the other professionals involved in their care. It was noted that residents are asked the previous day as to which menu they would prefer for the following day. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Members of staff need to understand what constitutes a complaint, which should then be brought to the attention of the Registered Manager. EVIDENCE: It was concerning that a resident commented to the Inspector that they had complained about the care they had previously received but no evidence could be found that the complaint had been recorded or investigated. The management of BUPA have been asked to investigate how this had occurred and report to the CSCI within seven days of their findings. A report has been submitted to CSCI within this timescale and we are satisfied with the findings. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 & 24. The public areas of the home are in poor decorative condition. The fire safety requirements of the home are being compromised, thus placing all who use and live in the building at increased risk. EVIDENCE: The fabric and decoration of the home are showing signs of considerable wear, particularly in the public areas of the home such as corridors. Wallpaper has been torn and paintwork damaged (the likely cause being the movement of hoists and equipment around the home). The carpeting in these areas is also very stained. The resident’s private rooms are in better decorative order. It was noted that members of staff are contravening the requirements of the local fire service by propping open the fire doors into resident’s rooms. The door props were noted to be a variety of ornaments, bean bags and wastepaper bins. At least 10 rooms were found to be in this state. This should not occur. If it is a residents preference that their door is not closed then appropriate door mechanisms should be used that are compatible with the fire safety regulations.
ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 15 It was noted that at least four residents had high nursing dependency levels that required them to be using height adjustable beds. This is not only for the safety of the residents but also members of staff attending to them. The hoisting equipment has damaged the enamel on one of the baths in the home. This can present an infection control risk. Repairs and refurbishment will need to take place. It would also be advisable that the hoisting equipment be examined to ensure that it is appropriate for the design of bath as clearly the damage has occurred over a period of time. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None inspected. EVIDENCE: These standards were not inspected on this occasion. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None inspected. EVIDENCE: These standards were not inspected on this occasion. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2
COMPLAINTS AND PROTECTION 1 x 2 x x 2 x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x x x x x x x x x ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 10 Regulation 13(6) Requirement An immediate requirement was made to investigate matters of serious concerns raised by residents. This has been concluded satisfactorily. Resident choice must be a paramount principle that the care staff should ensure is promoted at all times (subject to individual risk assessments). The delivery of care should include engaging and conversing with residents. Members of staff must understand what constitutes a complaint so that the Registered Manager can conduct a complaint investigation that is recorded. The public areas of the home should be redecorated and re carpeted. A plan of refurbishment, with timescales, should be submitted to CSCI by the date specified. The plan should also be shared with the residents and their representatives. Fire doors should not be propped open as this places all people within the home at greater risk. Timescale for action 7 days 2. 14 12(2) 31 August 2005 3. 16 22 31 August 2005 4. 19 23(2) (d) 19 September 2005 5. 19 23(4)(a) Immediate and ongoing.
Page 20 ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 6. 21 13(1)(c) 7. 24 23(2) (n) If residents prefer to have their doors held open that then this must be done with approved door closing fittings and in consultation with the fire authority. The enamel on the identified bath must be repaired/refurbished to limit the risks of cross infection. The provision of more height adjustable beds in the home is required. Particularly for residents with higher nursing dependency needs. A plan for the provision of such beds, with timescales, should be submitted to CSCI by the date specified. 19 September 2005 19 September 2005 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. 2. 3. 4. Refer to Standard 3 8 12 15 Good Practice Recommendations When new residents are admitted to the home a skeleton care plan needs to be developed whilst the evidence for the detailed care plan is being gathered. Weight records and individual bathing preferences need to be recorded in one reference point, preferably the individual care plans not in separate task orientated lists. If the residents previous lifestyles can be pursued this needs to be facilitated and recorded. Involvement of the chef/catering staff in offering residents alternative choices when they have specific dietary requirements could increase the variety of food available to residents. ARGYLES NURSING HOME H52-H01-S10969-Argyles-V2222694-260705Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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