Inspection on 31/01/08 for Arkley Nursing Home, The

This inspection was carried out on 31st January 2008.

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

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arkley Nursing Home, The Barnet Road Arkley Barnet Hertfordshire EN5 3LJ Lead Inspector Brian Bowie Key Unannounced Inspection 09:30 31st January-13th February 2008 X10015.doc Version 1.40 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 Arkley Nursing Home, The DS0000010398.V357345.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 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. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arkley Nursing Home, The Address Barnet Road Arkley Barnet Hertfordshire EN5 3LJ 020 8449 5454 020 8364 8087 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) www.bupa.com BUPA Care Homes (BNH) Ltd Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of service users under 65 years of age of with a physical disability must not exceed 10 (ten). 10th July 2006 Date of last inspection 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 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 55 places. At the time of the inspection The Arkley had 50 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 and lounge on the first floor. The home’s 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 home’s stated aim is to provide high quality nursing care. BUPA’s 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. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place over 4 days and involved 2 inspectors. We were assisted 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 10 relatives and 15 residents. We were also able to speak to 5 members of staff individually, as well as the assistant chef manager, manicurist and handyman. 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 home. BUPA had completed the Annual Quality Assurance Assessment form which gives in detail BUPA’s assessment of the service provided by The Arkley. We were also assisted by the detailed information provided on the considerable number of surveys that were completed by residents, relatives, professionals involved with the home, and staff. BUPA had recently appointed the former head of care as the new manager for The Arkley. BUPA were putting forward the new manager for registration by CSCI. We would like to thank all the residents, their relatives, the manager and staff for their assistance during the inspection. Particular thanks go to the many residents and relatives who completed surveys on their thoughts and comments on what it is like to live at The Arkley. These comments have been taken into account when judging the overall quality of care provided by the home. The overall impression from this inspection is that The Arkley generally provides a good standard of care to residents and has a relaxed and caring atmosphere. Within the overall service there are areas of excellent practice. What the service does well: As well as being clean and well maintained The Arkley has a homely and relaxed atmosphere. One resident said: ‘It feels homely. You can go to staff for advice- they’re easy to talk to.’ Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 6 Members of staff have got to know the residents well and understand their individual needs and preferences. As a result many residents are able to communicate confidently with staff. Each resident is seen and treated as an individual in their own right. This means residents have choices about how they spend their time and what they want to do. . There is a committed and experienced team of staff at The Arkley who work well together. Staff feel well supported by the management team at the home. The staff have also had a significant amount of training in working with older people, especially in meeting their health needs. Consequently the residents get the benefit of living in a home where they feel supported and their needs are met. The home has achieved a high standard in meeting the health needs of residents and has close and effective relationships with local health professionals. This is reflected in the care plans maintained for each resident. Residents were generally positive, or very positive, about the food served in the home, with residents having choices about what and when they ate. What has improved since the last inspection? Care plans now contain much more information about the resident’s life history, interests and wishes. As a result residents are benefiting from having care that is more tailored to meeting their individual needs and wishes, including any specific cultural needs. An increasing number of people are being admitted into the home with a terminal illness. As a result staff have gained more experience in palliative care and with guidance and training are improving their skills in this area. Staff training and improved care plan recording has resulted in residents’ needs in the area of nutrition being better met. Staff handovers are used to provide some training in diagnosis & treatment resulting in better care for residents. One relative commented: ‘Having Beatrice as manager is a big bonus. She sorts everything out. There’s more staff around since she’s become manager. There’s some very good and experienced carers.’ Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 7 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. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 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. 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: ‘She’s very happy here, she’s settled in. staff have been very helpful.’ It’s a nice place. The manager & ‘We visited various homes before deciding on this one- It’s homely. The home is fantastic- the staff are very nice’ Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 10 These were the comments from speaking to the relatives of two residents who had recently moved into The Arkley. In contrast a relative of another new resident had detailed a number of concerns in relation to the care of their relative following their move into the home. The manager had already responded to these concerns. As a result the relative considered that the care of their relative was now improving. Records relating to 2 residents who had recently entered the home were looked at. Specialists had carried out assessments on these individuals before they had moved to The Arkley. An assessment had then been undertaken by the home. The assessments detail residents’ needs and abilities. New residents are seen quickly by the GP for the home and specific issues followed up. As a result new residents at The Arkley get a proper and thorough assessment of their needs. A detailed care plan is then drawn up which indicates how these needs are to be met. When there are failings in the provision of care, or relatives raise concerns the home responds quickly and actively to put things right. Consequently new residents benefit by having their needs and wishes appropriately responded to. BUPA had recently agreed a contract with Barnet General Hospital to provide a specialist care service at The Arkley. The manager had already raised with hospital staff the need for better discharge plans so that the home could be more confident about the appropriateness of the placement and their ability to fully meet the individual’s needs. It is recommended that BUPA with relevant staff from The Arkley review this new service after 3 months to ensure it is working effectively. If the new service is considered to be offering intermediate care then it will need to comply with CSCI requirements for intermediate care services. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 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 is good at recording in detail the health and medical needs of residents and has improved how it records people’s life histories, interests and wishes. As a result residents benefit from receiving care in line with their needs and wishes. In general the home is very good at meeting the health needs of residents. Not all residents have the protection of procedures involving all relevant parties where restraint methods, such as bedsides, are being used. Residents are protected by the effective, safe and thorough arrangements in place in relation to the administration of medication. The dignity of residents is promoted since staff treat them with respect and have regard to their need for privacy. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans record clearly and in detail each individual’s needs and how these are being met by staff. Each resident has a named nurse and keyworkers who pay special attention to how they are getting on at the home. A new format has been introduced by BUPA so that care plans now contain much more information about the resident’s life history, interests and wishes. As a result residents are benefiting from having care that is more tailored to meeting their needs and wishes, including any specific cultural needs. In addition there is evidence in the care plans of regular personal and healthcare provided. Care plans are well prepared and subject to regular reviews. ‘I’m very happy here-I’m very lucky. The care overall is good. I can talk to the care staff .’ ‘The general care of my relative is very good. excellent.’ The social activities are ‘My relative is a very difficult man. Nobody could supply all his needs and wishes. The Arkley is very patient with him. I don’t think any home could do better.’ These were the comments of one of the residents and two of the relatives and reflected that in general most residents most of the time felt well looked after so that they had as positive an experience as possible whilst living at the The Arkley. In some cases relatives were dissatisfied with the level of care provided and had made complaints. We looked at these records to check what action had been taken. Where failings in the provision of care were identified improvements had been made and recorded. The arrangements for meeting the personal and healthcare needs of residents were discussed with the manager, a nurse on duty and the visiting GP. They were knowledgeable regarding the needs of residents and how those needs are to be met. They considered the home provided a good standard of care. The GP visits the home weekly and reviews the medication and medical care of residents. The home maintains close liaison with him and he monitors the healthcare received by residents. There was evidence that the home had maintained close liaison with healthcare professionals such as the diabetes nurse specialist, palliative care nurse and the company’s own tissue viability nurse. Monitoring charts were in place to ensure that health related tasks are carried out as required. Three case records were examined. These were up to date and plans of care had been reviewed monthly. The case records of a resident at risk of pressure sores were examined. A relevant assessment, care plan and guidance to staff Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 13 on how this resident’s pressure sore should be managed had been provided. Monitoring charts for change of position were in place. These had been completed. The home had a policy and procedure for pressure area care. The tissue viability nurse used by The Arkley had also been involved. We looked at the case records of a resident with diabetes. A comprehensive care plan (including sugar / glucose monitoring and guidance on diet requirements) with documented guidance to staff on how this resident’s diabetes should be managed had been provided. This resident was noted to have difficulty eating and sometimes needed assistance. However this resident did not have a nutrition / diet monitoring chart to provide the necessary information. Once this was pointed out the manager ensured that a suitable chart was placed on the individual’s file. The Arkley does not have a specific written policy and procedure for the care of residents with diabetes. It is recommended that such a policy and procedure is introduced to improve care further in this area. The case records of two residents in need of bedrails were examined. Both had bedrail assessment forms. One had been signed by staff and relatives involved. The new Mental Capacity Act means that extra care has to be taken where individuals are not able to consent to forms of restraint. To ensure that the need for bedrails has been fully assessed and agreed, there must also be evidence that professionals involved (such as the GP and social worker) have been consulted and agree to it. The overall picture in relation to health care was summed up by one health professional in regular contact with the home: ‘Staff provide decent care to the residents, in a kind, caring and compassionate way. They have improved their care in areas such as nutrition, with new careplans. They are coping well with palliative care patients.’ The arrangements for the administration of medication are satisfactory and medication records are up to date. Two medication administration charts (MAR) were looked at and had been appropriately filled in. The home has a comprehensive medicines policy and procedure. Throughout the inspection staff treated residents with respect and respected their privacy. Residents themselves made comments such as: ‘The staff are very caring and hardworking. They always listen to me.’ Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 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 benefit from a choice of activities in the home and are encouraged to pursue their interests. However residents do not have the benefit of a programme that meets their recreational needs every day of the week. Staff are good at welcoming relatives and friends so that they also feel part of the home. As a result residents are helped to maintain relationships with their families and friends. Residents make their own decisions wherever possible about what they do when. As a result they are more able to maintain their dignity and confidence. Residents enjoy mealtimes and have a choice about what they eat. As a result residents have a healthy and varied diet. EVIDENCE: Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 15 ‘The general care of my relative is very good. excellent.’ The social activities are This was the comment made by a relative. Each time we visited the home we saw residents taking part in a range of activities. These included quizzes, talks, craft activities, and flower arranging. Residents were clearly enjoying these sessions and said they valued them. Staff actively support residents to participate in these activities and where appropriate will take part themselves. Activity organisers put together a varied weekly programme of activities, as well as trying to respond to the individual needs and wishes of residents. Feedback from both residents and relatives was that there were insufficient activities on offer at weekends. Additional staff are being recruited so that more can be provided at weekends. The home must ensure that residents have suitable recreational opportunities at weekends as well as during the week. Cultural and religious needs are responded to. Services for different faith groups are held in the home. Activity organisers also see some residents in their own bedrooms to provide additional stimulation. Feedback from relatives indicated more could be done in this area for people who were mainly in their bedroom or who had particular difficulties with communication. It is recommended that the manager reviews the needs of these groups in relation to recreation so that additional ways of responding to these needs are put into practice. ‘Visitors are always welcome.’ This was the comment of one relative. During the inspection a number of relatives were seen visiting residents or taking them out. Relatives spoken to were positive about visiting arrangements and the good communication by staff with them. Residents clearly valued and enjoyed the contact they had with their relatives which was adding considerably to their quality of life. A regular meeting of relatives is held at the home which enables them to feel part of the home as well as being better informed about what is going on at the home. The home organises an ongoing programme of outings to places of interest so that residents are enabled to get out and about in the community. Throughout 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 meet regularly as a group and make suggestions for activities and outings and raise any issues of general concern. ‘The food’s great.’ ‘There’s a good menu.’ ‘The food is better now, more varied.’ Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 16 These comments from residents, relatives and staff indicated that this is an improving area. Kitchen staff were aware of the individual preferences of residents which they would try to meet by responding to requests for a specific dish. The Chef Manager has undergone appropriate training and has achieved BUPA’s ‘Chef Best’ award. Meals reflecting cultural needs, including Jewish dishes, are available. However feedback from relatives indicated that more could be done to meet the cultural wishes and preferences of residents in relation to meals. 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 received further training in nutrition so that food intake can be monitored more carefully. We participated in two mealtimes. On each occasion there was good food, nicely presented, within a relaxed atmosphere, with staff giving help given as needed. The manager is working towards there being fewer interruptions and more staff available over mealtimes so that these times can be as pleasurable an experience as possible for residents. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 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 are protected by the rigorous way in which The Arkley responds to and investigates complaints. Residents are protected by the arrangements The Arkley has in place in relation to safeguarding adults. EVIDENCE: ‘My complaint was dealt with very well.’ This was the comment of one relative. A considerable amount of written and verbal feedback was received from residents, relatives, professionals involved with the home and from staff. Overall the feedback was in general positive or very positive about the care provided by the home. However there was a small but significant minority of relatives who had raised a variety of concerns over the previous year. We spoke to some of these relatives either prior to or during the course of the inspection. We also looked at the files of some of the residents where complaints had been made to check the action taken by the home. In each case the home was aware of the concerns and was working towards resolving Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 18 these issues. For some relatives the position had already improved. In some cases relatives remain dissatisfied and had taken this further through the home’s complaints procedure. The record kept by the home in relation to complaints indicated that complaints are taken seriously and are thoroughly investigated. In some cases the complaints were historical and related to periods when the home was not being managed as effectively as at the time of the inspection. It is recommended that BUPA reviews the complaints made over the past year so that any underlying issues are identified and all lessons are learnt. Staff have had training in both safeguarding adults and whistle-blowing policies and procedures. Staff were aware of and understood the importance of the safeguarding adults procedures in place in the home. Interviews with residents and relatives did not identify any concerns in this area. One relative commented: ‘Thank you all for the great care and kindness you gave to my mum. Her time with you was short but we know she was happy and content.’ There had been one safeguarding adults referral made since the previous inspection. This had been properly followed up and investigated. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 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: ‘The Arkley presents an extremely attractive and pleasant environment on entering the large ground floor area where residents can remain in their Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 20 wheelchairs to join in the many different activities provided by the 2 excellent organisers.’ This was the comment of one relative. We found the home provides a pleasant and comfortable living environment. The home has an on-site maintenance person who ensures minor repairs are dealt with promptly. A recent power cut to the home had caused some short term difficulties that had been overcome, with lessons learnt to deal better with any future occurrences. Residents spoken to were very happy with the living environment at The Arkley and this clearly adds to their quality of life, with a feeling of space and light created throughout by the central atrium area. ‘It’s always very clean here.’ This was the comment of one relative who was a very regular visitor to the home. Throughout the inspection cleaning was going on with attention paid to infection control. The clinical waste area was well organised with proper attention paid to hygiene procedures. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 21 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 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 largely met because there is a committed and experienced team of competent staff. However residents do not have a consistent level of service throughout the week. Residents enjoy a good standard of care from well trained carers. Residents are protected by the rigorous recruitment procedures in place at The Arkley. Staff have the relevant skills and training. As a result residents are supported effectively and enjoy a good a quality of life at The Arkley. EVIDENCE: ‘The care I get here overall is good.’ ‘There’s some very good and experienced carers.’ Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 22 ‘Staff are very decent.’ These were the comments of one resident and two relatives and reflected the general view of staff that was gained during the inspection from a considerable amount of written and verbal feedback. Throughout the inspection staff interacted in a warm and positive way with residents that respected the dignity of the residents. BUPA runs a ‘Personal Best’ scheme that aims to improve these skills within the staff team. Feedback from residents, relatives and staff indicated that 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. Resident therefore are benefiting from a service that treats every resident as an individual in their own right. 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. The new manager had made changes in staffing arrangements. As a result a relative commented: ‘There’s more staff around since Beatrice became manager.’ However feedback from residents and staff indicated that at times at weekends staffing levels were less satisfactory, especially if 1 or 2 staff had rung in sick on the day and extra staff had not been obtained. One member of staff commented: ‘ Short notice staff sickness can be a problem- it’s worse at the weekend. Maybe the pool of bank staff is not big enough.’ The manager acknowledged that a combination of factors meant that at times the service provided at weekends was not as good as during the week. On the basis of this information we consider that the staffing levels at weekends can at times be inadequate. The manager must ensure staffing levels at weekends are sufficient to meet the needs of residents so that residents get as good a service at weekends as they do during the week. Staff interviews showed 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 people. The manager had identified where staff needed refresher training in areas such as health & safety, food hygiene and manual handling. As a result residents are supported by skilled staff. Staff files were looked at and showed that BUPA has thorough and detailed recruitment procedures in place in relation to new staff. One member of staff commented: Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 23 ‘I was impressed with the checks that were carried out and reassured to know that all staff had the same checks carried out on them.’ As a result residents are protected from being supported by unsuitable staff. As well as the training identified above staff are doing training in more specialised areas such as peg feeds, diabetes, Parkinson’s disease and palliative care. Staff are also encouraged to take part in BUPA’s 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 is to be commended for its commitment to ensuring staff are trained well so that they can better care for residents and for the high standard it has achieved in this area. In some cases we found a difference in view between what staff at the home considered to be in a resident’s best interests and the views of relatives. A professional in regular contact with the home commented: ‘Some of the relatives of residents are very supportive and work with the staff to address issues. Other families are significantly more challenging…’ It is recommended that staff have training in dealing with relatives who may become anxious or agitated regarding the care of their family member so that relatives always receive a professional and appropriate response in these situations. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 24 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 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 are well cared for since The Arkley is managed and run well with an open and inclusive approach in the home. Residents and relatives have a say in how the home is run since staff respond to and 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 staff have 1-to-1 meetings with their line manager to improve their practice. Residents and staff have the protection of a safe home. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 25 EVIDENCE: ‘Having Beatrice as manager is a big bonus. She sorts everything out. ‘Management are very approachable and will listen.’ These were the comments of a relative who visited the home regularly and a member of staff. The new manager will be put forward by BUPA for registration by CSCI. Throughout the inspection it was evident that there are effective management systems and procedures in place in the home. Written and verbal feedback from a range of sources indicated that since the previous inspection in July 2006 there had been periods when the home had not been managed as effectively as at the time of this inspection and this had contributed to the amount of concerns and complaints from relatives particularly. In the light of this it is recommended that BUPA reviews carefully the management structure and support systems needed to ensure that the home is managed effectively at all times. There is an open and inclusive atmosphere in the home so that residents are able to participate in how the home is run. Residents’ meetings are held regularly and give residents the opportunity to make suggestions and raise concerns which are listened to and responded to by staff at the home. BUPA has various formal procedures for reviewing and improving the service on offer at The Arkley, including using surveys to get comments and suggestions from all key parties, including residents, relatives, professionals and staff. A senior manager from BUPA reviews in detail the service each month and sends reports to CSCI indicating findings and action taken. As a result residents have the benefit of living in a home where there is a continuous process of improving the service, and where failings are identified and action taken to put things right. BUPA no longer manages the finances of residents. This is done either by the resident themselves or by relatives. Residents are able to pay on a private basis for additional services such as physiotherapy and chiropody. An account is kept and receipts given for such expenditure. An administrator is employed to ensure that the finances are well kept. BUPA has rigorous audit arrangements in place so that all finances in relation to the running of the home are effectively managed. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 26 ‘They’re sporadic and tend to be reactive.’ This was the comment of one member of staff in relation to supervision meetings. These meetings enable staff to meet on a one to one basis with their line manager so that they learn how to do their job more effectively. Staff files showed that most staff had not had regular 1-to-1 meetings to develop and improve their practice. The manager acknowledged that for a number of reasons there was had not been a fully effective system in place for staff supervision. The manager had held some group supervision sessions for staff and had scheduled individual meeting for all staff for 2008. However The manager must ensure that all staff have a formal recorded supervision meetings at least 6 times each year. Health and safety and fire safety records were looked at. These records were up-to-date and accurate and confirmed that essential checks are being made and acted on. In addition suitable risk assessments are in place to ensure that the premises are as safe as possible at all times. Staff are having regular training in health & safety and fire safety. As a result residents have the protection of a safe home. Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 27 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 12 13(4)(c) Timescale for action Professionals involved in the care 31/03/08 of residents requiring bedrails must be consulted before this form of restraint is used in order to safeguard the rights of residents. Residents must have suitable 31/03/08 recreational opportunities available to them every day so that their leisure needs can be properly met. Staffing levels must be sufficient 31/03/08 to meet the needs of residents at all times so that residents get as good a service at weekends as they do during the week. All staff must have one to one 31/03/08 recorded supervision meetings at least 6 times each year. Requirement 2 OP12 16 (2) (m) & (n) 3 OP27 18 (1) (a) 4 OP36 18 (2) Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 29 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 OP8 Good Practice Recommendations The Arkley should have a policy and procedure for the care of residents with diabetes to promote best practice in this area. In order to achieve best practice 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. BUPA should review the complaints made over the past year so that any underlying issues are identified and all lessons are learnt. Staff should have training in dealing with relatives who may become anxious or agitated regarding the care of their family member so that relatives always receive a professional and appropriate response in these situations. BUPA should review carefully the management structure and support systems needed to ensure that the home is managed effectively at all times. The manager should review the needs of people who spend most of their time in their bedrooms and those with communication difficulties in relation to recreation so that additional ways of responding to these needs are put into practice. 2 OP15 3 OP16 4 OP30 5 OP31 6 OP12 Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 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 © 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 Arkley Nursing Home, The DS0000010398.V357345.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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