CARE HOMES FOR OLDER PEOPLE
Arkley Nursing Home, The Barnet Road Arkley Barnet Hertfordshire EN5 3LJ Lead Inspector
Tola Akinde-Hummel Unannounced Inspection 4th January 2006 09:15 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.V265254.R01.S.doc Version 5.0 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.V265254.R01.S.doc Version 5.0 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 woodallvebupa.com 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) BUPA Care Homes Limited Miss Lucy Amanda Woodall 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.V265254.R01.S.doc Version 5.0 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). 29th June 2005 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 older people and care for up to ten younger adults. The home 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, 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 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. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took approximately 9 ½ hours to complete. The manager Mrs Lucy Woodall and a number of nursing and care staff assisted the inspector. At the time of inspection there were sixteen care and nursing staff on duty. The inspector was able to speak to two relatives, and six service users. The inspector was also able to speak to four members of staff individually and seven staff during handover. The inspector received six comment cards from relatives and four from visiting professionals. The home presently accommodates 53 service users. There are seven vacancies. The inspector completed a tour of the building, examined five care plans, accident and incident reports, complaints and compliments, medication management, policies and procedures and the requirements from the previous inspection. The inspector would like to thank all the service users, their relatives, the manager and staff for their assistance during the inspection. What the service does well:
Service users told the inspector that they are happy at the home and well looked after. Two service users stated that they felt “very lucky to live here”. Service users have care plans written to monitor and assess their changing needs. Care plans demonstrate staff members understanding of the needs of service users. Service users have a good variety of activities provided by the home. This enables service users to socialise and promotes stimulation. The home provides a varied diet for service users. They are encouraged to give their views about how to improve the food and catering staff ensures that they meet the 5 a day recommendation of fruit and vegetables. The environmental health service recently completed a microbiology report on a sample of home made sandwiches. The results carried out were all favourable. Service users stated that staff are caring and kind. Relatives are welcomed into the home and their opinions are also sought to ensure service users are satisfied with the care and surroundings they live in. The manager has the confidence of service users, relatives and staff in the home. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Service users can be confident that detailed assessments are carried out prior to admission to ensure the home is suitable to meet their needs. EVIDENCE: An inspection of the statement of purpose confirmed that this has been amended to remove any reference to restraint, as the home does not practice this. This was a requirement from the previous inspection. Four service users who recently entered the home were interviewed. Specialists in hospital or in the community assessed two of the service users prior to admission. This was then followed by an assessment undertaken by the home. The assessments outline service users needs and abilities. The remaining service users confirmed that assessments had taken place by the home. The files inspected confirm that these meet the required standard. Three service users spoken to visited prior to inspection and were accompanied by relatives.
Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 9 Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 8,9,11 Improvements have been made to the handling and storage of medication in the home thereby minimising the risk of confusion and error, which could affect service users. The Arkley does not consistently record service users and their relative’s wishes in planning for and dealing with deteriorating health and death. EVIDENCE: The care plans of five service users were examined. It was evident that the home pay attention to the physical emotional and psychological health needs of service user. Service users have access to a variety of specialist medical services. On the day of inspection a physiotherapist visiting a service user stated “ Staff do support service users, they ensure they position service users in the correct way and with the correct equipment. The equipment is serviced regularly by the home and because of the care in the home I can see an improvement in my patients condition”. Care plans demonstrate that deterioration or improvement in the management of pressure sores is adequately recorded. However, the format of care plans can be confusing and some information difficult to find. The manager advised the inspector that she
Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 11 is on a BUPA project to review all care plan documentation. This is planned as BUPA recognises that there is room for development with care plans. The needs of service users are discussed in staff handover, which was observed at the time of inspection. This was detailed and informative. Consent forms are present in service user files where photographs of pressure areas are taken. This requirement has been complied with. The medication was checked during the inspection, which is accompanied by the medication policy updated in December 2005. The policy gives clear instruction pertaining to the completion of medicine charts, how to code non administered medication and what procedure must be followed in cases of emergency medication prescribed to service users by their GP. The temperature of the medication cupboard, which gave cause for concern at the previous inspection, now has an air condition unit, which ensures the correct temperature is maintained. The new policy is being cascaded to all staff. All nurses’ are familiar with the policy and have signed to say they have read and understood it. The home has created a new system of recording the disposal medicines. This is simple, clear and easy to follow. The four requirements made at the previous inspection regarding medication have now been complied with. One nurse spoken to stated that the new policy and practice was an improvement. An inspection of care plans reveals that the wishes of service users in the event of their death are not clearly recorded. This is particularly relevant where relatives are often out of the country and may be unable to immediately attend to arrangements. Service users relatives and staff must be clear of arrangements to ensure dignity is properly maintained. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12,13 Service users benefit from a choice of activities in the home and are encouraged to pursue their interests. These programmes promote mental and physical stimulation for service users. EVIDENCE: Six service users and two relatives were interviewed at length during the inspection. Service users stated that they are able to join in activities arranged by the home. One service user stated, “ I particularly enjoy the flower arranging this is very popular. I keep my arrangement into my room”. Another service user has Internet access in her room and is in the process of writing a book. “ I can do what I like when I like, there are no restrictions here”. On the day of inspection a discussion group was being held. Service users were participating in a “ What the papers say” debate. A mobile librarian was also in the home distributing and talking to service users about books. Service users are able to go out with relatives when they wish and relatives stated that they are welcomed into the home. Relatives also confirmed that the activities are satisfactory and that service users are encouraged but not forced to participate in activities. Service users also develop friendships with each other and choose to spend time together where common interests are shared. This is positive and encouraged by the home.
Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 13 Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16,18 Service users complaints are properly recorded and investigated in the home, thereby giving confidence to service users and relatives that their complaints will consistently be taken seriously. EVIDENCE: Service users and their relatives informed the inspector that they are aware of how to make a complaint of any kind in the home. Of the seven relative comment cards received, the majority of relatives know how to make a complaint. The four care managers and health professionals returned comment cards. Two stated that minor complaints have been made to them about the home and two have not received complaints. The complaints file was seen. There have been three complaints since the previous inspection these have been managed and resolved within timescale and one has resulted in an improvement of practice in the home. The previous inspection revealed that whilst staff are familiar with the types of abuse that service users could be exposed to, staff were not entirely clear about their responsibilities and protection in relation to whistle blowing. Staff interviewed at this inspection confirmed they were all given a copy of the whistle-blowing policy and this is discussed during team meetings. This requirement has been met. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19, 26 Whilst The Arkley continues to provide a welcoming hygienic environment, attention must be paid to maintenance in the communal shower rooms and toilets. EVIDENCE: The Arkley is a large nursing home organised into suites where service users bedrooms and bathrooms are situated. The home is warm and welcoming. The home is well furnished and the cleaning staff maintain a high standard of cleanliness in the home. Service users, their visitors and visiting professionals, confirm this. The home is wheelchair accessible allowing service users access to all communal areas and the gardens that surround the home. The shower and bathrooms were inspected. Shower room one requires re tiling by the toilet. The lino in the walk in shower on the ground floor has lifted and needs replacing. This was brought to the attention of the manager who advised that this in on the homes work programme and the walk in shower is not currently in use due to its condition.
Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 16 The extractor fans in bathrooms 14, 22 and 36 all require cleaning. All other areas are properly maintained. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 Service users are supported by staff that receive regular training and supervision. This ensures service users needs are understood and met. EVIDENCE: The home is constantly recruiting new staff to ensure the home can adequately provide care for service users in the home. There has been three new staff employed since the last inspection. Staff will undertake a TOPPS induction programme, which is delivered in-house. Of the six relatives comment cards received, three relatives believe that there are not always sufficient numbers of staff on duty and sometimes the staff are stretched. The manager stated that at present the staff ratio is adequate. Staff confirmed this during handover who stated that staffing is fine, however what makes the job manageable is working with a staff team who takes equal amounts of responsibility and help each other where more support is needed. There are currently 25 permanent care staff members employed in the home and 14 bank care staff. 50 of which have completed the NVQ level 2 or 3. A number of staff are also undertaking the BUPA personal best programme which encourages staff to further improve the care provided to service users. During a tour of the building it was observed that staff are not propping fire exit doors open. This requirement has been met. Staff were asked at random the various uses for fire extinguishers and were able to answer satisfactorily.
Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 18 Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 Services users, relatives and visiting professionals are encouraged to express their opinions about how the home is organised with a view to improvement. Service users finances are properly managed thereby minimising any risk of incorrect financial accounting. EVIDENCE: The home ensures that service users views are incorporated in how the home is run. Two service users advised the inspector that they participate in the residents meetings, which take place on a regular basis. The minutes of recent meetings were examined. Service users bring issues that have an impact on their experience of care in the home. The minutes demonstrate that service users are confident about vocalising their concerns and the manager and staff address these. The meetings are also used for the home to advise service users of changes and improvements in the home. Relatives meetings are also held separately for the same purpose. The home ensures that it keeps abreast of practice issues and meetings are held to discuss these with the Registered
Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 20 General Nurses, discussions include wound care and oxygen. The care assistants also have meetings to reflect on practice issues. The home manager advised the inspector that the finances of service users are mainly managed by their relatives. Where service users have no relatives, they are supported to open bank accounts. Their personal allowance is paid into their account and any charges incurred in the home are invoiced to the service user who will then settle any debts to the home by cheque. This will be further explored at the next inspection. Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 21 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 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 22 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 OP11 Regulation 12 (3) Requirement The registered person must ensure that service users and their families wishes concerning terminal care and arrangements after death are discussed and carried out. The registered person must ensure that the tiling in the shower rooms and lino in the ground floor bathroom are replaced. The registered person must ensure that the air vents in three toilets are regularly cleaned to reduce any build up of dust Timescale for action 30/03/06 2. OP19 23(2) d 09/02/06 3. OP19 23(2) (p) 30/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 23 Arkley Nursing Home, The DS0000010398.V265254.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office 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
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