Inspection on 12/01/09 for Arkley Nursing Home, The

This inspection was carried out on 12th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arkley Nursing Home, The 31/01/08

Arkley Nursing Home, The 10/07/06

Arkley Nursing Home, The 04/01/06

Arkley Nursing Home, The 29/06/05

Arkley Nursing Home, The 28/10/04

Arkley Nursing Home, The 27/04/04

Arkley Nursing Home, The 24/02/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arkley Nursing Home, The Barnet Road Arkley Barnet Hertfordshire EN5 3LJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brian Bowie     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Arkley Nursing Home, The Barnet Road Arkley Barnet Hertfordshire EN5 3LJ 02084495454 02083648087 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: BUPA Care Homes (BNH) Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The number of service users under 65 years of age of with a physical disability must not exceed 10 (ten). Date of last inspection Brief description of the care home The Arkley Nursing Home is a purpose-built home, owned and managed by BUPA Care Homes Ltd. The home is registered to provide nursing care and support for 60 older people with up to ten places available for younger adults with a physical disability. Changes in room usage mean that the current capacity for the home is 51 places. At the time of the inspection The Arkley had 45 residents. The Arkley is located in a rural setting in Arkley near Barnet in Hertfordshire. The home is an attractive three-storey building, with a large car park, attractive shrubbery and landscaped gardens that are accessible to wheelchair users. There is a central atrium with a glass-domed roof. This provides a very attractive feature and a good source of natural light. Residents bedrooms are located in four corridors on each floor, which feed off the central area. There is a large dining room and lounge on the ground floor with a smaller dining room Care Homes for Older People Page 4 of 31 0 60 Over 65 60 0 Brief description of the care home and lounge on the first floor. The homes large kitchen is located on the ground floor. The first floor is serviced by a passenger lift. On the second floor, there are some offices and a large area dedicated to staff training. The homes stated aim is to provide high quality nursing care. BUPAs vision is to take care of the lives in their hands and provide as individual a service as possible to all residents. In January 2008 the fees charged by the home ranged from #850-#1,100 per week. BUPA makes available to residents, families and prospective residents inspection reports and information detailing the service provided by The Arkley. Care Homes for Older People Page 5 of 31 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: three star excellent 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 inspection took place over two days and involved two inspectors. An Expert by Experience also helped with the inspection. This is an individual who has had some experience of using services or has a relative who has received a care service. We were also helped throughout the inspection by the manager, Beatrice Godfrey, and a number of nursing and care staff. Throughout the inspection the way in which staff communicated with and supported residents was observed.. We spoke to 8 relatives and 15 residents. We were also able to speak to 6 members of staff individually, as well as the administrator, training coordinator, activities organiser and assistant chef. In addition we spoke with the GP who provides a regular surgery at the home. Many of the residents were very able to communicate how they felt about living at The Arkley. BUPA had completed the Annual Quality Assurance Assessment form (AQAA) that Care Homes for Older People Page 6 of 31 details BUPAs assessment of the service provided by the home. BUPA has put forward the manager for registration by CSCI. We would like to thank all residents, their relatives, the manager and staff for their assistance during this inspection. The overall impression from this inspection is that The Arkley is now providing an excellent standard of care to residents and has a relaxed and caring atmosphere. What the care home does well: What has improved since the last inspection? What they could do better: At the previous inspection there had been 4 areas the home had to improve. These areas had been improved. From this inspection 2 new areas to be improved have been identified. All nursing staff who have not had updated training on the care of residents with diabetes must be provided with such training. In addition the manager must ensure that all staff supervision meetings cover essential areas and are recorded in order to improve their care practice. These areas for improvement were discussed and agreed with the manager. 7 recommendations are made to highlight ways in which practice can be further Care Homes for Older People Page 8 of 31 improved at the home. A simpler, more user-friendly version of the statement of purpose should be produced to make it easier for people to see quickly what the home looks like and what it has to offer. It is also recommended that residents, especially those using wheelchairs, are helped to do simple exercises more regularly to help their general well-being. Both residents and relatives meeting should be held at least quarterly so that they can contribute more their ideas and suggestions on the running of the home. The manager should also identify how the cultural and ethnic needs of residents in relation to food and mealtimes can be further responded to. It is also recommended that refurbishment plans for the home take account of the changing and increasing needs of residents in relation to the accessibility of the building. The manager should reviiew weekend staffing arrangements to ensure residents needs are met at all times. Finally BUPA should review with the manager the existing management and staffing arrangements at The Arkley to ensure there is sufficient capacity to sustain the high standard of care. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 10 of 31 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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents, their families and professionals are given the information they need to make an informed choice about whether The Arkley is an appropriate placement. People moving into the home can be confident that their needs will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met. Evidence: BUPA had recently updated their format for the statement of purpose for their care homes. The statement of purpose provides detailed information about the home and how it is run so that people can make an informed choice about whether it is the right home for them. During the inspection the manager updated the statement of purpose Care Homes for Older People Page 11 of 31 Evidence: for The Arkley so that it now provides up to date information. It is recommended a simpler, more user-friendly version, making use of some pictorial information, is also produced to make it easier for people to see quickly what the home looks like and what it has to offer. We visited various homes before deciding on this one-this was the best one. This was the comment of one of the relatives. The relative of a resident who had recently moved in said they were very pleased with how their relative was getting on and that: Overall the care they are getting is very good. Records relating to a resident who had recently moved in were looked at. Specialists had carried out assessments before they had moved in. An assessment had then been made by the home. The assessments detail residents needs and abilities. New residents are seen by the GP for the home and specific issues followed up. As a result new residents get a thorough assessment of their needs. A detailed care plan is then drawn up that indicates how these needs are to be met. Consequently new residents benefit by having their needs and wishes responded to. The manager has improved assessment procedures to ensure no inappropriate admissions take place. Care Homes for Older People Page 12 of 31 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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home records well the health and personal care needs of residents. As a result residents benefit from receiving care in line with their needs and wishes. However staff training in the area of diabetes needs to be further improved to ensure residents needs are met at all times. Residents are protected by the effective, safe and thorough arrangements in place in relation to medication. The dignity of residents is promoted by staff treating them with respect and having regard to their need for privacy. Evidence: I find the staff very caring and hardworking. They listen to me. This was the comment of one resident and reflected the feedback from residents about their care. Care plans record clearly and in detail each individuals needs and how they are being met by staff. Each resident has a keyworker and named nurse who pay Care Homes for Older People Page 13 of 31 Evidence: special attention to how they are getting on at the home. Care plans now contain more information about the residents life history, interests and wishes, with relatives confirming they had been involved in drawing up care plans. As a result residents care is more tailored to meeting individual wishes, including cultural needs. In one case a resident whose first language is not English had been helped to communicate with the use of sign cards. There is also evidence in the care plans of residents being seen by a range of healthcare professionals, including physiotherapists, speech therapists, diabetic and palliative care nurses, as well as the homes GP. Care plans are detailed and reviewed regualarly. The home is in the process of checking and auditing care plans more rigorously to ensure they are up to date and comprehensive at all times. The manager and nurses interviewed were knowledgeable about the health needs of residents. The GP visits the home twice weekly and reviews medication and the medical care of residents. There is close contact with healthcare specialists, with monitoring charts in place for weight, nutrition and pressure care. Detailed risk assessments are in place to keep residents safe. Both residents and relatives were positive about healthcare in the home, with one relative saying: After my relative had a fall in the home the staff worked very hard so that they regained as much mobility as possible. In one case the care plan of a resident with a pressure sore was insufficiently specific or clear regarding changes of position. The manager followed this up during the inspection and arranged for the care plan to be reviewed and revised to indicate frequency of turning. In another case the care plan was insufficiently clear concerning urine and blood sugar testing for a resident with a diabetes. The manager ensured the care plan was revised to indicate frequency levels for these tests. Not all staff had had recent diabetes management training. The manager must ensure all staff have up to date training in this area to ensure that residents needs in relation to diabetes are met at all times. During the inspection the manager developed a new policy for the home on diabetes management which will be discussed further with the specialist diabetic nurses from the Primary Care Trust to make sure it is up to date and reflects current best practice. The overall picture in relation to healthcare was summed up by one health professional in regular contact with the home: Staff provide very good care to the residents. They are now more confident in the area of palliative care, as well as liaising closely with the tissue viability and diabetic nurses. Care Homes for Older People Page 14 of 31 Evidence: Nurses interviewed were familiar with the homes medication procedures. Medication administration charts showed that medication is administered as prescribed and appropriately signed by staff. The home has a comprehensive medication policy and procedure. The temperature of the treatment room and medication cupboard are recorded and were at the appropriate levels. A small amount of a controlled drug had not been accounted for. The manager agreed to submit an incident form to CSCI to report this incident and action taken. Throughout the inspection the staff treated residents with respect and respected their privacy. One relative said: Staff treat people here with respect. Ive never seen anyone not being treated well here. Staff have ongoing training and encouragement through schemes such as BUPAs Personal Best to provide care that respects the dignity of residents and highlights their individuality. Care Homes for Older People Page 15 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area. This judgement has been made using availalble evidence including a visit to this service. Residents benefit from a choice of activities in the home and are encouraged to pursue their own interests. Staff are good at welcoming relatives and friends so that they also feel part of the home, as well as enabling residents to maintain relationships with families and friends. Residents make their own decisions wherever possible about what they do and when. As a result they are more able to maintain their dignity and confidence. Residents get a healthy and varied diet, as well as in general enjoying mealtimes and having a choice about what they eat. Evidence: I like drawing and the quizzes. I enjoy the outings. The organisers are very good. This was the comment of one of the residents. Each time we visited the home we saw residents taking part in a range of activities, including quizzes, talks, physical exercises and craftwork. Residents clearly enjoy these sessions and said they valued them. Staff Care Homes for Older People Page 16 of 31 Evidence: actively support people to take part, although at times people may not be fully engaged. Activity organisers put on a varied weekly programme as well as responding to individual requests. One of the organisers confirmed more time is now spent by the activities team seeing people in their bedrooms providing individual programmes, such as playing games, reminiscence work and discussions. Some light exercises take place but we would recommend this forms a larger part of the programme, so that residents, especially those in wheelchairs, do simple appropriate exercises more regularly. Volunteers assist with some of the activities, with scope for greater use to be made of volunteers to enable more one to one work with residents as well as the structured group activities. As required at the last inspection there are now more activities at weekends following the appointment of an additional activities worker. Cultural and religious needs are responded to with services for different faith groups held at the home. I always feel welcomed here. This was the comment of one relative and reflected their general view. During the inspection a number of relatives visited residents or took them out. Relatives said that staff communicate well with them. Residents clearly enjoy and value the contact from their families which was adding significantly to their quality of life. The home organises an ongoing programme of outings to enable residents to get out and about in the community, including going shopping. Througout the inspection staff offered choices to residents about how they spent their time, what food they wanted and if they wished to go out. Residents meeting take place occasionally. It is recommended these meetings are held more regularly, for example three-monthly so that residents have frequent opportunities to raise issues as well as contributing more fully to the runnng of the home. The food is first class. This was the comment of a relative who is in The Arkley very regularly and frequently has meals at the home. Feedback from residents was more mixed with most saying they were very happy with the food, but some making comments about over-large portions or meat that was too chewy. One resident commented: Occasionally the food isnt so tasty, but overall its improving. Kitchen staff are aware of individual preferences of residents. Meals reflecting cultural needs, including Jewish dishes, are available. However feedback from relatives and residents indicated that more still could be done in this area. One resident said: Care Homes for Older People Page 17 of 31 Evidence: I would like more rice dishes. In order to achieve best practice in this area it is recommended that the home identifies ways in which the cultural and ethnic needs of residents in relation to food and mealtimes can be further responded to. Staff have had training in nutrition so that food intake can be monitored more carefully. We had lunch with the residents. The food was nicely presented within a relaxed atmosphere, with staff giving help as needed. As a result mealtimes are being made as pleasurable an experience as possible for residents. Sample menus indicate that residents are offered a balanced diet containing recommended amounts of foods and vitamins. There is a good choice of food with an alternative menu always available, including a night-bite one. The manager said there were plans to plate meals in front of the resident so that residents can choose more easily how much food they want. Care Homes for Older People Page 18 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are protected by the rigorous way in which The Arkley responds to and investigates complaints, as well as its procedures in relation to safeguarding adults. Evidence: Staff and Beatrice are very responsive if I have any concerns and follow things up. This was the comment of one relative. A considerable amount of feedback was received from residents, relatives, professionals involved with the home and from staff. Overall the feedback was positive or very positive about the care provided by the home. In 2007 relatives had made a number of complaints about the running of the home. In 2008 the position had improved significantly with far fewer complaints. We looked at the record of complaints which showed that the home investigates concerns thoroughly and works hard to resolve issues. The manager has built up effective relationships with many relatives, as well as with the residents. As a result issues and concerns are picked up early and resolved before they become more serious. Staff training and BUPAs Personal Best Care Homes for Older People Page 19 of 31 Evidence: scheme mean that staff now respond to complaints more effectively. Staff have training in both safeguarding adults and whistle-blowing policies and procedures. Staff understand the importance of safeguarding adults procedures. Interviews with residents and relatives did not identify any issues in this area. One relative who visits regularly commented: If theres a problem staff always ring me- I cant fault them. Ive never seen anyone not being properly cared for. There had been no safeguarding referrals since the previous inspection. As a result residents are kept safe at The Arkley. One resident said: The staff are wonderful. I feel safe here. The home is to be congratulated on the high standard achieved in the areas of complaints and adult protection. Care Homes for Older People Page 20 of 31 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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a spacious, comfortable and attractive home that adds to their quality of life. Residents enjoy a hygienic and clean living environment that helps to safeguard their health. Evidence: As soon as I came into the atrium area I knew this was the right home for me. The Arkley has a very attractive central atrium area with plenty of plants and natural light. The home provides a very pleasant and comfortable living environment. The home has an on-site maintenance person who ensures minor repairs are dealt with promptly. The communal areas are attractive and bedrooms reflect the individual preferences of residents. Residents said they were very happy with the environment at the home and this clearly adds to their quality of life. The manager confirmed that all bedrooms are now for single use, previously some of them had been designated as doubles. As a result the capacity of the home has reduced to 51 places. The Expert by Care Homes for Older People Page 21 of 31 Evidence: Experience had expertise in accessibility issues and commented that with the increasing number of residents using wheelchairs, in some cases large powered ones, the environment was not as accessible as it needed to be. In some cases the design and shape of bedrooms made it difficult for residents to access them easily, and some areas of the home were not big enough for people with larger chairs. The BUPA estates surveyor was interviewed and confirmed that there will be a major refurbishment of The Arkley within the next few years. It is recommended that these plans take account of the changing and increasing needs of residents in relation to the accessibility of the building. Its always very clean here. This was the comment of one relative who is a regular visitor to the home. Throughout the inspection cleaning was going on with attention paid to infection control. Comments from both residents and relatives were positive about cleanliness in the home. Care Homes for Older People Page 22 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents needs are met because there is a committed and experienced team of competent and well trained staff. Residents are protected by the rigorous recruitment procedures in place at The Arkley. As a result residents are supported effectively and enjoy a good quality of life at The Arkley. Evidence: My relative was well looked after here. The staff were very caring. This was the comment of one relative and reflected the general view about staff from the considerable feedback given during the inspection. Throughout the inspection staff interacted in a warm and positive way with residents that respected their dignity. BUPA runs a Personal Best scheme that aims to improve these skills within the staff team. Feedback from residents, relatives and staff indicated the scheme had indeed made a difference. As a result staff are more able to respond to the emotional, as well as the physical, needs of residents. Residents therefore benefit from a service that treats every resident as an individual in their own right. Care Homes for Older People Page 23 of 31 Evidence: The home employs a large team of permanent staff, with a pool of bank staff to provide back up. No agency staff are used which means residents get continuity of care from a regular team of carers. Feedback from relatives indicated that staffing levels had improved over the past year, including at weekends, resulting in fewer complaints in this area. At times staff are stretched and residents may have to wait a little longer for attention. Feedback indicated that staffing at weekends, especially Sundays, could be affected by staff ringing in sick. This was discussed with the manager and regional manager who acknowledged the issues and agreed to investigate ways of reducing this problem. It is recommended that the manager reviews weekend staffing arrangements to ensure that staffing needs are met at all times. Staff interviews and records show that staff have had a range of relevant training to enable them to do the job well, with a significant number doing NVQ Level 2 or 3 in caring for older people. The training coordinator confirmed there is an ongoing programme to ensure staff have refresher training as needed in areas such as health and safety, food hygiene and manual handling. As a result residents are supported by skilled staff. Staff files showed that BUPA has thorough and detailed recruitment procedures in place in relation to new staff. As a result residents are protected from unsuitable staff. New staff have a comprehensive induction so that they can carry out their duties effectively. The training coordinator confirmed that individual staff have been encouraged to develop specialist skills, such as diabetes management, phlebotomy, and pressure care. Staff are also doing more training in palliative care, with close liaison with Macmillan nurses and the North London Hospice. The home is working towards achieving the Gold standard best practice award in relation to end of life care. Staff are also encouraged to take part in BUPAs own Personal Best scheme which trains staff to provide as good a service as possible to residents, families and all those involved with the home. As a result residents feel more valued as individuals in their own right with their dignity promoted. BUPA and the staff team are to be commended for their commitment to providing better care for residents and for the high standard achieved in this area. Care Homes for Older People Page 24 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are very well cared since The Arkley is managed and run very well, with an open and inclusive approach in the home. Residents and relatives have a say in how the home is run since staff act on comments and suggestions about how the home is run. Residents are protected by the secure arrangements in place in relation to their monies. The home is good at supporting staff but needs to ensure that supervision meetings between staff and their line manager cover all essential areas and are recorded properly. Evidence: Since Beatrice has been in charge the home has gone from strength to strength. The staff are wonderful. Staff morale is higher now. Care Homes for Older People Page 25 of 31 Evidence: These were the comments of a relative who visits the home regularly. Throughout the inspection it was evident that there are effective management systems and procedures in place at The Arkley. Feedback from a range of sources indicated that since the previous inspection in January 2008 there had been a steady and sustained improvement in the quality of care provided at the home. This had been reflected in the significant reduction in the number of complaints made. There is a very experienced and committed team of staff in place who are being well led by the manager with additional support from the BUPA senior management team. CSCI are dealling with Beatrice Godfreys application to be the registered manager. Her commmitment and leadership have enabled the home to improve as it goes along and reach a higher overall standard of care. In order to maintain this high standard it is recommended that BUPA reviews with the manager the existing management and staffing arrangements to ensure there is sufficient capacity to sustain this improvement. There is an open and inclusive atmosphere in the home that enables the residents to participate in how the home is run. Residents and relatives meetings take place infrequently. It is recommended that these meeting take place at least quarterly so that both residents and relatives are more fully involved in the running of the home. BUPA regulary reviews the service provided by using surveys to get views from all key parties, including residents and relatives, about the home. A senior manager from BUPA visits and reviews in detail each month the service provided and sends reports to CSCI indicating findings and action taken. As a result residents benefit from living in a home where there is a continuous proces of improving the service, and where failings are identified and action is taken to put things right. The administrator for The Arkley was interviewed and was able to demonstrate that there are effective and up to date systems in place in relation to residents monies. BUPA no longer manages the finances of residents. This is done either by residents themselves or relatives. Residents are able to pay privately for additional services such as physiotherapy and chiropody. An account is kept and receipts given for such expenditure. BUPA has rigorous procedures in place so that all finances in relation to the running of the home are effectively managed. Staff now have supervision meetings with a senior worker in order to learn how to do their job as effectively as possible. Systems are now in place to ensure each member of staff has at least six of these meetings each year. Staff files showed that these meetings are not always recorded, and may not cover all key areas, such as training and professional development, values and care practice. The manager must ensure supervision meetings take place for all staff that are recorded and cover all essential Care Homes for Older People Page 26 of 31 Evidence: areas. Health and safety and fire safety records were up to date and accurate and confirmed that essential checks are being made and acted on. In addition appropriate risk assessments are in place to ensure that the premises are as safe as possible at all times. Fire safety arrangements had been updated and there are detailed procedures in place to deal with any emergencies or serious incidents that may arise. Staff have regular training in health and safety. As a result residents are kept safe at The Arkley. Care Homes for Older People Page 27 of 31 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 28 of 31 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 8 12 All nursing staff who have not had updates on the care of residents with diabetes must be provided with such training. To ensure all staff are suitably trained to meet the needs of residents. 31/03/2009 2 36 18 The manager must ensure that staff supervision meetings cover all essential areas and are recorded. To improve the care practice of staff. 31/03/2009 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 1 1 A simpler, more user-friendly version, of the statement of purpose, making use of pictorial information, should be produced so that it is easier for people to see quickly what the home looks like and what it has to offer. Residents, especially those using wheelchairs, should be encouraged to do more simple physical exercises to Page 29 of 31 2 12 Care Homes for Older People improve circulation and improve general well-being. 3 15 The home should identify ways in which the cultural and ethnic needs of residents in relation to food and mealtimes can be further responded to. Refurbishment plans for The Arkley should take account of the changing and increasing needs of residents in relation to the accessibility of the building. The manager should review weekend staffing arrangements to ensure that residents needs are met at all times. BUPA and the manager should review the existing management and staffing arrangements at The Arkley to ensure that there is sufficient capacity to sustain the high quality of care. Residents and relatives meetings should each be held at least four times yearly so that both groups can contribute more to the runnng of the home. 4 19 5 6 27 33 7 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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