Inspection on 29/06/05 for Arkley Nursing Home, The

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arkley Nursing Home, The 12/01/09

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE THE ARKLEY NURSING HOME Barnet Road Arkley Barnet, Hertfordshire EN5 3LJ Lead Inspector Tola Akinde-Hummel Unannounced 29 June 2005 at 10.00am 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. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Arkley Nursing Home Address Barnet Road, Arkley, Barnet, Hertfordshire EN5 3LJ 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) 020 8449 5454 020 8364 8087 woodalllu@bupa.com Robin Comerford for Care First Care Homes Ltd (BUPA) Lucy Woodall N Care Home with Nursing 60 Category(ies) of PD Physical Disabilities (10 beds) registration, with number OP Old Age of places PE(E) Physical Disabilities over 65 THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The number of service users under 65 years of age with a physical disability must not exceed 10 (ten). Date of last inspection 28 October 2004 Brief Description of the Service: 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 older people and care for up to ten younger adults. The home is located in a rural setting near Barnet in Hertfordshire. The home is an attractive three storey building, with a large car park, attractive shrubbery and landscaped gardens which is accessible to wheelchair users. There is a central atrium with a glass-domed roof. This provides a very attractive feature and a good good source of natural light. Service users 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,a smaller dining room and lounge is situated 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. Their vision is to take care of the lives in their hands and provide an individual service as possible to all residents. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The main part of this inspection was carried out over one day with two inspectors. Mrs Tola Akinde-Hummel and Ms Margaret Flaws. The CSCI pharmacy inspector, Mrs Marilyn McKenzie conducted the inspection of medication. The main inspection took approximately 6 hours. The manager Ms Lucy Woodall and the senior nurse in charge Mrs Beatrice Godfrey assisted the inspectors. The activities organiser and the head chef in the home also assisted the inspectors. There were 18 nursing and care staff on duty in the morning and 14 in the afternoon. The inspectors were able to speak to three relatives/representatives of service users, and seven service users. The inspectors also spoke to six members of staff. All these interviews were in confidence. The inspectors also had a tour of the whole building, looked at care plans health and safety documentation, staffing files, complaints,and policies and procedures. The inspectors looked at the requirements from the previous inspection, examined five care plans, four staffing files looking particularly at recently recruited staff and looked at staff training profiles. The statement of purpose was seen, as were the health and safety records in the home. The kitchen area was inspected and the inspectors looked at complaints and compliments, accidents incidents and some policies and procedures. The inspector would like to thank all the service users, their representatives, the manager and staff for their assistance during the inspection. What the service does well: The Arkley have an open management approach, which allows service users and their representatives to approach all staff if they have any concerns, ideas or suggestions. Service users are happy with the quality of care they receive. The home encourages service users to maintain their independence and assist where required. Staff receive regular training and supervision and are able to contribute their ideas in staff meetings. This enables messages relating to the ethos of the home and care standards to be shared. This also enables staff to be clear about their roles in the home. The home encourages consultation with service users and their representatives and actively seeks their views. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 6 Feedback received is acted upon. The building is well maintained, clean and comfortable. What has improved since the last inspection? What they could do better: The Arkley have made many improvements in the care of service users. There are however nine requirements in this report that will assist the home to improve upon their current practice for the benefit of service users. The service user guide has information that is irrelevant to the Arkley and needs to be amended. This will then provide accurate information to prospective service users. All service users or their representatives must sign a consent form for pressure sores to be photographed. The home has gone most of the way to ensuring that this is done but there are a few outstanding. Pressure sores are often in intimate areas of the body so consent is the respectful way of ensuring all parties understand why this record is required. Although staff understands the protection of vulnerable adults policy and procedure, they are less familiar with the whistle blowing policy. Staff must read and understand this policy. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 7 The medication brought into the home must be signed for and the charts completed correctly. This way any errors can be clearly identified. All medication not administered must be properly coded. Preventing any mistakes occurring. Medication for disposal must have a clear audit trial with proper recording. This will guarantee that medication does not go missing and is properly disposed of. Staff must have clear guidelines for the administration of emergency medicine, these instructions should be provided by the service users GP. This will ensure that correct doses are given to prevent under or over medication of service users. The storage area where medication must be maintained at 25C to make certain that medicine is effective when administered. As a reccommendation, the home should consider a chart specifically for wound care. This should record creams used and dressings applied. Although all staff have completed fire training and have done refresher training they are still a little confused as to what fires the extinguishers can be used to control. Staff need to be reminded of this on a regular basis. Staff continue to prop open fire door with chairs in the hot weather. This practice must stop as it is a health and safety hazard and would put service users at risk in the case of fire. The inspectors are confident that these requirements listed will be met. 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 ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 Service users benefit from a detailed assessment and visits prior to entering the nursing home. This ensures that staff can provide full care to service users who may not always be able to express their needs. The statement of purpose requires minor alteration to remove any details on restraint, which does not apply. EVIDENCE: The Arkley Nursing home has a statement of purpose prominently displayed in the foyer of the home. This makes clear what services are on offer in the home and how the needs of prospective service users will be assessed. The home has a policy on restraint in the statement of purpose that does not relate to the home. This should be removed from the policy to avoid any confusion. The inspector was able to speak to the friend of a service user who had moved in the day before. The inspector was told that the service user had his needs assessed prior to moving in. This was undertaken from hospital. The relative had visited the home prior to admission as the service user was unable to do THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 10 so. He was allocated the room that had become available with a view to moving to another room if he wished. As he had only just arrived there had been no time to begin collecting belongings from his previous address to the home. This will be done in due course to make the room his home. The friend reported that he had had a peaceful night and all his immediate needs were well understood by the nursing and care staff. At the previous inspection, a requirement was made for the registered manager to apply for a variation to the registration to continue to accommodate service users with dementia this variation has now been applied for. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The Arkley Nursing home treats service users in a dignified manner and make great efforts to direct support in a manner that is preffered by the service users. The individual plans of care are detailed and information is recorded clearly and sensitively. This demonstrates respect that staff have for service users in their care. The home must ensure that consent to take pictures is always recorded on service users plans to maintain their dignity and respect. A tightenning of the homes medication procedures will ensure safe storage and administration which will minimise any risks to service users. EVIDENCE: The inspector looked at the care plans of five service users. The care plans detail the assessment that took place prior to admission and the post admission assessments with reviews. The plan is separated into sections that cover areas such as physical, behavioural, medical, communication, social and elimination needs. All sections are accompanied by regular reviews. This was a requirement at the previous inspection and has been met. Service users have risk assessments particularly around falls and pressure care. The mobility THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 12 assessment details how many staff is required to assist with mobilisation and what equipment must be used to ensure safe transfers. The risk assessments are also regularly reviewed recording every fall and where it took place, and where necessary if there should be an increase or decrease in support. The home looks at the area of pressure care with great detail. The waterlow tool is used to establish the level of risk to service users. The treatment of pressure areas is also well documented the tissue viability nurse is called upon where necessary to give advice about pressure care. There are wound are plans in the MAR sheets which relate to the treatment of specific wounds. The medical advice given is recorded and followed. The Arkley take pictures of all pressure areas and place them on the service user plan. The inspector noted that most files have consent forms, giving permission to take pictures of the pressure areas. Some service user plans do not have consent forms. A requirement is made to ensure that consent is sought from those where this is outstanding. The home keeps a record of multi disciplinary appointments so detail of treatment received by service users is up to date. There is a GP attached to the home who attends at least twice a week and will see any service user that requires attention. Records of GP visits to service users are kept in their file and also in the GP file. Records show that relatives are invited to meetings with the GP or nurse. The senior nurse in charge advised the inspector that the home will be introducing more formal medical reviews The Arkely record the weight of service users on admission and risk assess those service users who have poor nutrition advising staff to encourage them to eat and drink regularly whilst monitoring any weight fluctuation. Recommendations are also made by the GP to increase build up drinks where required. The CSCI pharmacy inspector visited the home prior to the inspection taking place and found that the medicines policy is complete. The section on disguising medication and the accompanying agreement form is satisfactory. Some service users are having their medication disguised with the agreement of their GP, relative or advocate and the manager of the home. The assessment and agreement forms for service users who are responsible for their own medication have been completed. The records for the receipt, administration and disposal of medication were incomplete. Some medication received during the monthly cycle had not been signed for on the administration charts and there where a few gaps in the administration charts where medication administered at night had not been signed for or non administration coded. No instructions from the doctor on how to administer specific emergency medication were available. The home no longer return unwanted medication to the pharmacist; instead it is put into a special waste bin provided. The home is not documenting the medication disposed of in this way. Controlled Drugs are still being returned to the pharmacist for disposal. Medication histories can be obtained by using the records of the changes made by the doctors in the special section of the THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 13 individual service user’s care plan. It was difficult to trace when dressings were being changed as it was only noted with other information in the service user’s individual care plan. Medication is stored in two clinical rooms with suitable cupboards and trolleys. The temperatures of the rooms where medicines are stored are now monitored and recorded but in hot weather the rooms’ temperature is above 25oC. The temperature of the dedicated medication refrigerator is being monitored and recorded and maintained between 2-8oC. A metal cupboard has been bought for the Storage of Controlled Drugs. The Controlled Drug register was found to be satisfactory. Three service users told the inspector that the nurses are very kind and gentle with them. One service users said , “Most staff understand what I need, some staff do not but pretend to know” when pressed the service user said that staff always try and do the best they can. One service user said “ Some staff ask what I want to wear others choose, I insist upon what I don’t want to wear”. All service users were smartly dressed and spoken to with respect by staff. Service users all said that staff knock before entering their rooms and that they are seen by the GP in the privacy of their room. Staff address service users as they wish and this is recorded in the service user plan. One relative told the inspector , “ I see my mother has gained weight, there is an upbeat environment and everybody seems to be motivated” I visit at least three times a week and my sister in law also comes regularly as a relative you can monitor what is going on” my mother is privately funded so if we were not happy we would have moved her. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 14 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 Service users exercise choice in the home. They and their relatives are vocal and confident that their views will be listened to. This enables staff to deliver care to service users in a respectful person centred way. EVIDENCE: The Arkley record the social interests of service users in their plans and try to ensure that those interests are followed whilst in the home. There are activities available every day with the activity coordinator and assistants to ensure that service users are supported to participate. One service user said, “I have just done the flower arranging in the morning and enjoyed this, yesterday I did the exercises, they also organise days out and I have been to Whipsnade” The afternoon activity was a debate about the existence of flying saucers. The inspector observed that both activity sessions were well attended. Service users said that they do not have to participate in activities if they do not wish to. The inspector observed that there are many visitors to the home some of whom collect their relatives for trips out and others who come to spend time in the home. Service users said that there was no fixed time for them to see relatives or wake up or retire to bed in the evenings. The service user determines this. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 15 All service users spoken to have family members who are welcomed into the home. Service users are able to see their relatives in private if they wish. The inspector observed a gentleman wishing to see a service user who did not know he was coming to visit. The staff member asked his name and advised that she would go and see the service user and asked if he wished to have any unexpected visitor that day. Service users and relatives told the inspector that they go out with their relatives and extended family. The inspector looked at the minutes of the residents meetings and these indicate that the service users are vocal about the areas of the service that they believe should improve. Service users had recently been critical about the quality of food on offer. This has resulted in separate meetings to look at menu choices. The chef recognised that there have been issues with the level of satisfaction form service users and is actively addressing these. The chef set about undertaking a detailed consultation about what people would like to see on the menu and regularly asks for feedback. Service users continue to have mixed feelings about the food some service users were happy others not so complimentary but not overly harsh. One service user said, “The food is very good for an institution and I get enough of it”. The food seen and tasted on the day of inspection was of a good standard and well presented. The chef has completed a course in the cooking and presentation of soft and pureed food diets. The kitchen was very clean as were the fridges and freezers. All temperatures are recorded as well as the food during cooking and prior to being served. The chef has introduced a silver service. This allows service users to be attended to without staff standing over them during mealtimes. The inspector observed service users during lunch who require assistance. This is given this in a discreet respectful way. Service users are able to eat when they wish and this is by the kitchen staff. However most service users said they like set mealtimes and consider this a social occasion. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 16 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) 16,17 The home has a complaints system that gives service users and their relatives access. This allows service users an opportunity to voice their concerns about the service. This ensures that the home learns lessons from such complaints and improves the experience of service users. Staff must familiarise themselves with the whistle blowing policy. This will assure them that they have a duty to report any unacceptable behaviour in the home without fear of discipline. EVIDENCE: The inspector looked at the complaints policy and procedure. This policy is easy to understand and follow. There have been three complaints since the last inspection. These complaints are recorded in the complaints folder. Relatives made the complaints relating to care and communication. The complaints were all resolved within timescales. Service users advised the inspector that they were able to vote in the last election. The home has an adult protection procedure, which was seen by the inspector. The manager is very clear about the Barnet Adult protection procedure. Seven staff members in total were spoken to during the inspection. Of the seven, four staff were asked specifically about their understanding of the protection of vulnerable adults. All staff were very clear about who they would approach if they suspected or witnessed abuse. Staff were not so clear about the whistle blowing policy and require some further reminding about what this means. This is a requirement of this report. Two service users, when asked told the inspector that they have had no cause to complain. One service user said “ I will complain if I want to” The other said THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 17 “ I would have no trouble complaining and I know how to complain”. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 18 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) 19,20,21,23,24,25,26 Service users live in a well-maintained odour free environment. This makes the experience of living in the home more pleasant. Service users personalise their rooms as they wish and are encouraged to do so, making for a more homely environment. EVIDENCE: The previous inspection stating that covering on the kitchen floor must be replaced has been met. The carpet in the stairs has also been replaced due to excessive wear. This requirement has now been met. The main area on ground floor will also benefit from new carpet in July. The Manager informed the inspector that part of the annual maintenance programme will be to replace some chairs in the ground floor communal area. Service users benefit from a number of communal areas that they can make use of in the home. There are two areas on each floor of the home where service users sit during activities or can relax when there is no organised activity. Service users have a lounge that is spacious and bright and THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 19 there are spaces in the open plan area around the home where service users and their relatives can sit in peace and comfort. The gardens in the home surround the home and are well tended. Service users told the inspector that they make use of this space and enjoy this in good weather. The garden has appropriate seating and service users have several points of access from within the home. All service users in single rooms have en suite facilities. The corridors in the home accommodate seven bedrooms all of which have a bathroom with an electricly operated bath hoist, a shower and two toilet for service users. The bathrooms contain hoists and other equipment required to safely assist service users with their personal care. All rooms have call bells and service users wear alarms around their necks if they wish to. Service users confirmed that they have personalised their bedrooms and this is reflected in the different furniture seen in individual rooms. The home is currently in the process of changing all the beds to profiling electric beds. There is one service user in a double room. This service user has chosen to remain there and this is respected by the home. The inspector observed that the home is comfortable with natural ventilation. As the home has a large central atrium there is plenty of natural light. The home has emergency lighting, which is regularly tested, and radiator covers to avoid scalding. The home has a laundry area away from the main part of the home where all laundry is done. There is adequate hand washing facilities and control of infection procedures is available and also detailed in care plans. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 20 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) 27,29,30 Staff at The Arkley, have a wealth of knowledge and experience which supports Service users. Staff are trained, which compliments and improves the care service users receive. This is also reflected in their approach with friends and relatives. The homes recruitment practices are robust and service users benefit from staff that are properly vetted prior to taking up any post in the home. Staff must be reminded what the fire extinguishers in the home can be used for and one staff member must have Home Office documents amended. EVIDENCE: The inspectors interviewed seven staff in the home. The staff team is very mixed coming from the U.K, Africa, Eastern Europe, India and the Caribbean. Staff have all had mandatory training and all had an induction when they started. Staff talked to the inspector about their roles and how they would deal with varying types of behaviour. Staff all said that working in the home is sometimes challenging. During an interview with a student nurse, she said, “Service users are treated like individuals, they are free to do as they wish and they have choice”. In general, staff find the management style very inclusive. Staff are clear about the recording of accidents and incidents and how to deal with challenging behaviour and the level of understanding about and who to access support from. Staff also made clear that where service users can do things for themselves staff do not intervene ensuring that service users retain some of their independent living skills. One staff member added, “We always do things according to service users preference”. The catering and ancillary staff have THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 21 also completed mandatory training and are clear about their role in relation to the health, safety, dignity and respect for service users. All staff in the home develop relationships with service users and get to know their likes and dislikes fairly well. One relative told the inspector, “ when I am distressed about my mothers condition, the nurses are on hand to support me and my family”. The inspectors sampled eight staff files. The majority of files were in order having an application form, proof of identity; criminal records bureau checks (CRB), references, contracts and other relevant information prior to commencing employment. The inspectors’ saw one staff member who had a discrepancy with her date of birth, the manager was aware that this is an issue. The staff member must rectify this with the Home Office. A requirement is made to ensure that the relevant document is amended to avoid any confusion. The Arkley do not use any agency staff they operate their own bank, which they draw upon as necessary. All staff have undergone mandatory training and receive other training identified in supervision that they require. These include challenging behaviour training, Makaton levels 1and 2, pain control, managing service users who are dying, safe bathing, and wound management. Staff also draw upon each others skills to provide quality care for service users. When questioned most staff were unable to advise the inspector what the fire extinguishers could be used for. Staff need to be reminded about their use. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 22 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) 31,32,36,38 A manager that is experienced and competent runs the home. Service users and their representatives have confidence in the management of the home and can approach the manger with ideas that may improve the service for individuals and the home as a whole. Staff must be reminded not place chairs at fire exits to keep doors open. EVIDENCE: All staff and service users spoke highly of the management style adopted by Lucy Woodall. Three staff members who have been working at the home longer than the manager have said “ Lucy has turned this home around”, “ Lucy is very supportive and has raised standards in the home”. One relative said that the manager has made attempts to include her in family meetings and asks if she can raise any issues on her behalf. “ Lucy engages well with relatives, I think she is tremendous, approachable and if there any issues, she deals with it”. The relative gave the inspector an example of an issue that was brought to Lucy’s attention,(this was recorded in the complaints book) “ This was well handled, and was monitored. I am able to look and see this, good systems are THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 23 actioned”. The managers open approach allows new ways of working to be introduced in the best interest of service users. One service user has a sleep diary as she constantly tells her relatives that she does not get any sleep. A record is kept in a diary in the service users bedroom, which is completed by staff when they go into the service users bedroom to check on her. This was in agreement with the family to ascertain if their mother was able to sleep. All staff are receiving regular supervision and attending monthly staff meetings. An agenda is placed in the staff room and staff can add any items they wish to discuss. The senior staff nurse advised that she is responsible for clinical supervision and appraisals. This is an opportunity to do an overall assessment of practice aside from the day-to-day input. The registered general nurses are given responsibility to supervise staff where there are issues around practice. This is closely monitored and the senior nurse will then carry out an audit at least three times a week to check compliance. The inspector looked at health and safety records in the home. These were all found to be in order. Fire alarms are tested weekly; the gas safety check has been completed. The lift, nurse call, assisted baths; fire alarm and emergency lighting have all been serviced or inspected in recent months. However the inspector found that staff continue to prop open fire doors with chairs. This is dangerous. A requirement is made to remind staff that this practice is not acceptable and is a fire risk. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 24 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 2 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 x x x 3 x 2 THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 25 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 1 Regulation 4 (b) Requirement The registered person must make a minor amendment to the statement of purpose to remove any reference to restraint of service users. The registered person must ensure that all service users or their relatives give consent for photographs to be taken. The registered manager must ensure that a record of all medication disposed of or leaving the home is documented and witnessed to ensure a clear audit trail. The registered manager must ensure that the administration charts are completed correctly. All medication received into the home must be signed for and dated on the administration charts. Also administration of medication must always be signed for and non administration coded as to the reason for the medication being omitted. The registered manager must ensure that staff have available clear instructions on how to administer emergency Timescale for action 30/10/05 2. 8 14,(2) 30/09/05 3. 9.3 13 30/10/05 4. 9.3 13 30/10/05 5. 9.4 13 30/10/05 THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 26 6. 9.4 13 7. 18 18, (4) 8. 9. 30 38 medication. These instructions should be provided by the service user’s GP. The registered manager must ensure that the temperature of the areas where medication is stored is maintained at 25oC or below. The registered person must ensure that staff read and understand the homes whistle blowing policy. The registered person must ensure that staff know what fire extinguishers can be used for. The registered person must remind staff about the need to keep fire exits closed and not to prop open doors with chairs. 30/10/05 30/10/05 30/10/05 30/10/05 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 9.4 Good Practice Recommendations The registered manager should consider using a wound care cream/ dressing recording chart so that wound care management is more clearly documented. THE ARKLEY NURSING HOME G59 S10398 The Arkley V221942 29.06.05 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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