Inspection on 12/12/07 for Argyll House

This inspection was carried out on 12th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Argyll House 07/03/07

Similar services:

Chesham House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

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

CARE HOME ADULTS 18-65 Argyll House 201 Holt Road Cromer Norfolk NR27 9JN Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 12th December 2007 09:30 Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 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 Argyll House DS0000067522.V356547.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 Adults 18-65. 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. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Argyll House Address 201 Holt Road Cromer Norfolk NR27 9JN 01263 515130 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) info@argyllhouse.org K T Health Limited Mr Ian Claybourn Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2007 Brief Description of the Service: Argyll House is situated in a suburban location on the outskirts of Cromer. It is a house that was built at the turn of the century and has been designed to accommodate people with mental health problems who need to develop a more independent lifestyle. The house itself comprises of eight flats and or studio flats and four rooms that have en suite facilities. The train and bus stations are within walking distance. Service users are encouraged to promote as much independence as possible and are facilitated to engage in work experience, further education and activities provided by the home. They are also encouraged to take part in the running of the home. The fees range from £500 to £900. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key Inspection that took place over one day and lasted six hours. We spent some time with the manager, the proprietor, staff and service users. Written comments were received from five service users and one relative. This report gives an overview of the service and how it has developed since the initial Key Inspection in March 2007. What the service does well: What has improved since the last inspection? Spot auditing of medicines has improved the system for handling medication. Although the home had a satisfactory system in place for managing complaints they felt that they needed to improve their system, this now allows service users to see how their complaints are dealt with and action taken in response. Records are now kept of the amount of Clozapine that is taken out on ‘home leave’. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Individual needs and aspirations are assessed, all residents are appropriately placed and all admissions to the home are planned. This means that the people who use this service can be confident that their highly specialised needs can be met. EVIDENCE: The home works closely with other agencies to ascertain knowledge about prospective service users. Case files that were sampled during the inspection evidenced a comprehensive needs assessment. The manager advised that service users who are moving into the home have the opportunity to visit the home over an extended period of time, this assessment process allows the home to ensure that it can meet all the needs of the individuals and that they are also happy with the placement and have enough information to make an informed decision about entry to the home. Once a decision is made the other professional agencies, the home and the service users work closely together to plan the care. A current service user described their experience of the admission process and how their support workers worked with the staff to ensure that the process was good and advantageous to them. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to lead independent lives and are fully involved in the day-to-day running of the home. EVIDENCE: As evidenced during the previous Key Inspection, the case files that were examined on this occasion contained therapeutic interventions that detailed specific targets and goals associated with achieving paths to independence. These plans included aspects of social inclusion, budgeting and catering and all other aspects of care relating to the service users changing needs and aspirations. Those service users whom we spoke with indicated that they were very much involved in their care and there was evidence in the care plans of regular reviews and updating as needs change. They also acknowledged that they are encouraged to take reasonable risks in relation to their moves towards more independence. This can also mean learning to live independently in one Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 10 of the flats attached to the house. The case files also held risk assessments in relation to known behaviour and these also had evidence of regular review. The care plans also had evidence of other professional agencies that are involved in the overall care of the people living in the home. A number of the service users discussed with us how they are all involved in the running of the home, some who wish are involved with the interview process for new staff and in menu planning. Some of the service users also work on a one to one basis in the kitchen with the cook as part of their plan in moving on. The daily notes were very detailed and entries were made with regard to some of the notes in the care plans when needed and if care needed to be changed. Comments made by relatives were very favourable and evidenced that the staff as far as possible involve the family if so desired and appropriate in the care and that they are always happy to talk with relatives and address any concerns. Those service users spoken with felt that they had certainly gained a lot since being at the home and one commented that it was the best that they had felt and been in twenty years and also felt that they had really developed some coping skills with a view to becoming more independent. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are actively supported and encouraged to integrate with the local community and are given every opportunity to access a variety of social situations. EVIDENCE: Discussion with the manager, staff, service users and records on care plans and daily notes evidenced that the home continues to support the service users in relation to opportunities for education and socialisation both within the home and the wider community. One service user writes in the comment card, that “the support they receive extends to all areas of our life, catering, time management, budgeting, family, voluntary employment, moving on and preparation to leave the home”. The staff are clearly aware of the need to promote the service users confidence and self-esteem to ensure that they do not become dependent on the service that is offered by the home. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 12 The routine of the home is organised to promote the inclusion of all the service users, which we witnessed during the inspection process; it also recognises their need for privacy and freedom of choice within their lifestyle. The staff continue to provide a sensitive but focused approach to the service user’s mental health needs. We witnessed the social interaction between the staff and some of the service users at lunch- time, there was a lot of laughter and banter from all sides and appeared to be an enjoyable time. The lunch itself appeared appetising and nutritious with a number of choices on the table; fresh fruit is always available and the buffet style lunch works well as it allows a flexible approach for those service users who are undertaking some form of activity and might be at risk of missing lunch. All the service users have a fridge in their rooms so that cold food can be saved for them and we noted weekly fridge checks were undertaken. A number of the service users who help prepare food in the kitchen as part of their move towards independence have got food hygiene certificates. The cook works very closely with these residents and also joins them for lunch. One resident commented that they can eat lunch at any time and are not restricted to times and said that they felt the food was good and healthy. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a high level of personal support from a dedicated and motivated staff team that promotes their emotional and physical welfare at all times. Attention to records in relation to p.r.n. (as required) medication will ensure that justification can be given for continued use. EVIDENCE: Discussion with service users confirmed that staff are always available to support them in how they manage their lives and their specific mental health needs. This was also reflected in written comments received from relatives and residents. The home works very closely with other agencies involved in the overall care of their residents thus ensuring a holistic approach to their care in the way that they prefer. All the residents self-medicate and risk assessments are in place for this purpose; it is recommended that for those residents who arrive with risk Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 14 assessments for self-medicating have another risk assessment completed by the home and reviewed as necessary. Examination of medication records and triangulation of care notes revealed that the residents who have p.r.n. (as required) medication do not have care plans in place for this activity: it is a requirement that these are put in place in order to be able to justify why medication being given and also a way of monitoring care. A random audit of medication was undertaken and all medication checked tallied with the medication records that were in place. Records were in place regarding how often staff monitor stock levels. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are listened to and are safeguarded from abuse, neglect and self-harm. EVIDENCE: The home has an appropriate, updated and much improved Complaints Procedure in place that clearly demonstrates how complaints are handled, action taken and feedback forms given to the complainant so that they can see that they have indeed been listened to. We reviewed one of these completed forms and spoke to the resident who had made the complaint; they were happy in the way that it had been managed and said that they felt “it had been sorted properly”. The manager has meetings with all the residents once every two weeks and in between times the manager and proprietor are always available to the service users: this was observed to be so during the inspection. Written and verbal comments made by the residents’ evidence their continued confidence that the manager and provider would resolve any issues and they would always be listened to. The home has appropriate procedures in place for safeguarding adults and all staff have had training related to this and an up date is booked for January. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a homely and safe environment for its residents. EVIDENCE: As part of the inspection a complete tour of the premises was undertaken, with the exception of those rooms where permission was not able to be obtained. The home continues to provide suitable accommodation for all the people living in the home. The independent living accommodation remains well kept and safe. The home continues to be homely and clean and those residents we spoke with were more than happy with their surroundings. The facilities are sufficient in number to satisfactorily meet the needs of every one in the home. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are cared for by an appropriately recruited, supportive and trained staff team. EVIDENCE: Records for newly appointed staff were inspected and were seen to reflect a robust system for recruitment and indicated that all appropriate checks were in place before employment had commenced. One new member of staff confirmed that she had had an induction to the home and its practices that also included mandatory training. Records for induction confirmed this. Frequent formal supervision is continued and records for this activity were seen. The training record within the home continues to evidence that staff undertake relevant and comprehensive training in relation to the specific needs of the service users in the home. Those staff members we spoke with confirmed this. Comments made by those service users we spoke with evidenced that they felt that they were supported fully by all staff members. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has an efficient and competent manager and provider from whom both staff and service users benefit from. EVIDENCE: The manager of the home has worked with people with specific mental health needs for a number of years. We noted a most inclusive atmosphere within the home and it would appear that the manager and the proprietor still exude passion and enthusiasm for their roles that benefits not only the staff but also the service users. As evidenced at the last inspection staff, residents continue to make numerous positive comments regarding the managers’, proprietors’ and members of staff skills and care practice. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 19 Service records for equipment were well maintained, easy to comprehend and all up to date. The Health and Safety records maintained by the home evidence that all appropriate tests and drills are carried out at regular intervals; the home and the responsible person need to be commended for this. It was noted that the manager and proproetor have a very good working relationship that obviously cascades down to all members of staff. One new member of staff said that it was the best managed home that they had ever worked in and felt well supported by the management from the very beginning. Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 4 3 4 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 4 32 4 33 4 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 x LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 4 4 3 4 4 4 Argyll House DS0000067522.V356547.R01.S.doc Version 5.2 Page 21 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 YA20 Regulation 13.2 13.4 Requirement People who use the service must have medicines prescribed on a p.r.n. (as required) basis given to them by staff only when clinically justified and this can be demonstrated by record keeping practices i.e. care plans. Timescale for action 12/02/08 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 YA20 Good Practice Recommendations It is recommended that service users who enter the home with risk assessments in place for self-medication be subject to the home’s own risk assessment. 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