Inspection on 21/07/06 for Arle House

This inspection was carried out on 21st July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arle House 24/08/09

Arle House 05/09/07

Arle House 13/12/06

Arle House 04/10/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Arle House Village Road Arle Cheltenham Glos GL51 0BG Lead Inspector Mrs Eleanor Fox Key Unannounced Inspection 09:30 21st July 2006 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 Arle House DS0000064574.V304126.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. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arle House Address Village Road Arle Cheltenham Glos GL51 0BG 01242 514586 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) The Orders of St John Care Trust To be appointed Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate three (3) named Service Users under the age of 65 years. The home will revert to the original service user category when these service users reach the age of 65 or no longer reside at the home. 4th October 2005 Date of last inspection Brief Description of the Service: Arle House is a purpose built Care Home providing personal and nursing care; it is situated in a large housing estate close to local shops and other amenities. The Orders of St. John Care Trust is responsible for the management of the Home. The accommodation, consisting of forty-eight single rooms and one double room, is on two floors and has been equipped with a shaft lift to access the first floor. Although none of the rooms have en suite facilities, there are several assisted bathrooms and separate toilet facilities throughout the Home. Some of the bedrooms at the front of the property have the benefit of a small balcony. There are three lounges within the Home plus a large dining room and a number of smaller sitting areas where service users and their visitors may meet. The enclosed rear gardens are easily accessible and have attractive shaded areas where residents may sit when the weather permits. The provider supplies information about the home, including the most recent CSCI report in a file at the entrance of Arle House. Current fees range from £352.70 to £693. Hairdressing, chiropody and any personal items are charged extra. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector undertook this unannounced inspection of Arle House over two days in July. During the visit, she chose five of the residents for close scrutiny. She spoke to each of these people, read their care records and other relevant documents, visited their bedrooms and observed their interaction with members of staff. One person was seriously unwell and she was able to observe the additional care that was being given to this resident The inspector read selected personnel and recruitment records, walked around the property and observed the service of the mid-day meal. She also spoke with some of the staff who were on duty on these two days. Finally, she talked to the acting Manager, who has been working at the home on a part time basis until a permanent appointment could be arranged, and to the administrator, particularly in relation to general management issues. Both were open and most cooperative in providing information as requested. She also met the newly appointed manager of the home who commenced her duties on the final day of the inspection. CSCI surveys were distributed to residents, relatives and members of staff working at the home. Although only a very few comments were received from residents, twenty relatives returned completed forms and five care workers responded. Some of their comments have been reflected in the content of this report. What the service does well: Each prospective resident is fully assessed before admission to Arle House to ensure that the home is able to meet his or her needs. Throughout the two days of this visit, members of staff were observed talking to the residents in a friendly encouraging manner. Many of the staff appear to have established a good rapport with the residents and two people spoke enthusiastically about the staff caring for them, describing them as, “wonderful to us” and “always so patient”. All grades of staff have received training on abuse, giving them a good understanding of these important issues. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 6 The gardens of the home are well maintained and looked particularly attractive on this occasion. The home does focus on improving standards, conducting regular audits on satisfaction with all areas of care. Management of residents’ personal monies is also handled well. What has improved since the last inspection? What they could do better: The home needs to review the documentation provided to prospective residents and their families to ensure that it reflects all the changes at the home and contains the information they require. Some urgent improvements are required in the content and review of care plans; these have deteriorated markedly in the last year. In addition, medicine administration also requires attention. Controlled drug storage is now being addressed. Residents would enjoy a greater and more frequent choice of activities. One person did say that, “There is so little to do here – I get fed up sitting about.” Improvements are required in the security of the building to ensure that residents are not placed at risk. Recruitment processes must be addressed thoroughly and consistently so that every new employee is fully screened prior to commencing duties at the home. Each person must be fully inducted to his or her role. Concerns raised suggest that some selected members of staff may require some additional training, particularly in general care and medicine administration. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 7 Comments from members of staff suggest that morale is very low at Arle house and there appear to be some serious relationship difficulties. These concerns have been raised with the senior managers although none of the staff have been identified. Urgent attention is required to develop a cohesive staff team at the home; it is hoped that the provision of consistent strong management will achieve this outcome. 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. Arle House DS0000064574.V304126.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 Arle House DS0000064574.V304126.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A thorough assessment process plus the provision of literature about the Home, although now requiring some revision, enables prospective residents to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: Although a selection of information about Arle House is provided to prospective residents and their families, this has not been reviewed and updated to reflect all the management changes at the home; information about room sizes and geographical position is also no longer supplied. It was observed that a contract outlining the terms and conditions for admission to the home had been provided to each of the five residents who were selected as part of a case tracking exercise during the inspection of the Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 10 home. Signed copies of the completed documentation were seen in their personal files. A full assessment is undertaken of each prospective resident to ensure that the home is able to meet his or her needs. Copies of the completed records for one person who was about to be admitted were seen on this visit. These contained details about the person’s care needs and were also supported by the assessments provided by the hospital and Social Services. Intermediate care is not provided at this home. Arle House DS0000064574.V304126.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Urgent improvements are required in the care planning and medication administration systems so that the residents’ care needs are addressed appropriately and also to ensure that the people living at the Home are not put at any risk of potential error. EVIDENCE: The care plans for the five selected residents were read in detail on this visit to the home. These had been developed following an assessment of care needs. However, they were very variable in content and, in the examples seen, had only been reviewed on an irregular basis during recent months. There was little evidence that either the resident or their advocate had been involved in any way in the preparation of the documentation. A nutritional care plan for one person required updating to reflect the current condition; another person did not have a care plan to address continence needs. Where plans had been written, they did not always give clear direction to carers; for example, in urinary catheter care and covering some personal Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 12 care needs. However, it was observed that one person did have very clear guidance to manage deteriorating eyesight. A manual handling risk assessment for one resident did not identify a major deterioration in his condition. However, this person was receiving appropriate care to address his altered circumstances. The management of one person’s diabetes was not being addressed consistently with only variable recordings of blood sugar levels. Residents’ weights were also recorded inconsistently, even if they had been identified as being ‘nutritionally at risk’. Another person had been identified as ‘at risk’ of developing a pressure sore but no reviews of this risk assessment had been completed since January 2006. The new deputy manager is aware of the short falls in care planning processes and intends to address these issues as a matter of urgency. Five relatives have expressed concerns in their completed surveys about the care provided at the home although nine were completely satisfied with the attention their relative was receiving. One person was seriously ill on this day. Although written recordings of fluid intake and two hourly turns had not been consistently completed, on observation of this person, it was evident that the resident had been receiving regular and attentive care. The person was being nursed in a fresh bed, her mouth was clean and moist and she was resting peacefully. Despite the hot weather conditions, the room was comfortably cool. Only the medication administration systems relating to the five selected residents were scrutinised on this occasion. Senior managers from the Orders of St John Care Trust were also undertaking a full medication audit of Arle House at this time. Photographs of four of the residents had been provided to assist identification; the fifth person had refused consent for this process. All the medication storage cabinets were securely locked but at the time of the visit, the home was still not providing approved storage for controlled drugs. Confirmation has been received that the cabinet has now been delivered to the home. The controlled drug stocks, which were checked on this occasion, were all correct. However, it was observed that the administration of controlled drugs to one person had been recorded correctly in the controlled drug record book but omitted from the medication administration records Two prescribed drugs had not been administered to one resident but no explanation for the omission recorded. The nurse on duty confirmed that the resident had not received the medication. A nutritional supplement had been handwritten on one medication sheet but there was no signature or countersignature to support this directive. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 13 Members of staff were observed addressing the residents in a respectful but friendly manner. Any personal care was given behind closed doors. One relative did comment that, although her Mother has dementia, she receives “loving care” from the staff. Arle House DS0000064574.V304126.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Additional opportunities must be provided for varied and stimulating activities to occupy the residents and thus improve their quality of life. A reasonable choice and variety of meals ensures residents normally receive a nutritious and balanced diet. EVIDENCE: The home is currently trying to recruit an activities coordinator. In the meantime, members of the care team are making time to provide diversional stimulation for the residents when they can. According to the residents’ activities records, which were commenced recently but, in the examples seen, only partially completed, activities are arranged on an occasional basis only. They are not yet developed to suit each resident’s particular interests as, in many cases, these have not been identified and recorded. On both days of the visit residents were sitting in various areas around the home with only the television for stimulation. Residents having their hair dressed were evidently enjoying the process, as there was considerable discussion and laughter coming from this room. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 15 There are two trips organised for residents to visit the Cotswolds in the near future and there is also a fete planned for later in the month. There were a number of visitors in the home. Some chatted in the privacy of the residents’ bedrooms; others preferred to meet in one of the many communal areas. One daughter of a resident did raise a concern that the staff “appeared terribly busy and did not have time to talk to her Mum.” However, this lady was impressed by the friendliness and patience of the staff. Residents, who spoke to the inspector, confirmed that they were able to get up and retire when they wished and that they were free to eat their meals and spend their days where they preferred. The service of the mid day meal was observed on this visit. The majority of the residents ate their lunch in the large dining room. It was an extremely hot day and the windows had been covered to reduce the glare of the sun. However, a large fan placed in the room had not been switched on and residents and staff were evidently adversely affected by the uncomfortable conditions. Very few residents ate much food but all were encouraged to drink the soft drinks that were provided. Some were also assisted to drink nutritional supplements. It was observed that there were no clean napkins or other aids available to protect residents’ clothing during the meals and alternatives had to be used. The home does provide a varied choice of food to the residents and one gentleman told the inspector that, “The food is much better than the home I was in before although they can’t make decent gravy here”. However, two relatives did feel that the food was sometimes of poor quality; one mentioning that it was often served cold in residents’ bedrooms. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The Home’s written policies and procedures, if fully implemented, would give residents the reassurance that they may expect to live in a safe environment and that any concerns they raise will be addressed in a timely manner. EVIDENCE: Since the last inspection, there has been one formal complaint sent to the home plus a complaint referred to the Commission for Social Care Inspection; this is currently being investigated. Concerns had been raised about standards of care and staff competency. Information about how to lodge a complaint is clearly detailed in the published policy, a copy of which is available in the front hall of the home. There is also a notice displayed in the home indicating that the Manager is willing to talk to anyone if they wish to speak to her. The Company has published comprehensive policies on all aspects of abuse and on whistle blowing; these are made readily available to staff working at Arle House. However, written comments in the questionnaires returned to the Commission for Social Care Inspection suggest that staff are not prepared to use the whistle blowing procedures. The concerns raised have been communicated to the Manager although none of the staff have been specifically identified. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 17 The training manager has recently completed a series of training workshops, which all grades of staff were invited to attend; these sessions addressed a variety of abuse issues. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 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 the following standard(s): 19, 23 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Further improvements in the standard of the environment are required to ensure that the residents live in a safe and comfortable Home. EVIDENCE: On this occasion, the small lounge on the ground floor was being decorated. Requirements identified at the previous inspection were checked for compliance. Most of the communal areas and the bedrooms of those residents selected for case tracking were visited. Each was in reasonable decorative condition and it was observed that window restrictors had now been fitted, where appropriate. However, window frames in some areas did require maintenance attention and the furniture in many of the rooms appeared worn and scratched. Nevertheless, it remains serviceable. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 19 On the first day of the inspection one of the rear doors of the home had been left wide open providing unrestricted access in and out of the building and therefore, a security risk. The nearby bedroom doors had also been left wide open with residents’ personal belongings clearly evident. In addition, trailing flex at the doorway created a further health and safety hazard. These issues were addressed during the inspection. There has still been no improvement to the cramped and difficult laundry conditions. It was also observed that the clean laundry, including residents’ personal clothes, was folded but very creased. It was returned to the bedrooms and to the storage areas in this condition. The home was fairly clean and there were only mildly unpleasant odours in some areas. With the exception of the dining room, efforts were being made to keep the building as cool as possible. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 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 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, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Although residents now receive care from a more stable workforce, urgent improvements in recruitment, selection and training are necessary to ensure that residents are fully protected. EVIDENCE: On this occasion, there were forty-nine residents living at Arle house with the remaining vacancy being filled with a new admission on the final day of the visit. Observation of the duty rotas showed that there are normally two trained nurses plus a minimum of eight carers on duty each morning to care for the residents; in fact there were ten carers on duty that day. There are always at least six carers working in the evenings, although there were seven booked that evening. Normally only one nurse is on duty to cover the evening shift but permission has recently been granted to extend this to two trained nurses to accommodate the increased dependency levels of the home. At present there is one nurse and three carers on duty over night. Eight relatives and three members of staff who responded to the surveys felt there was sometimes insufficient staff on duty to meet the residents’ needs Of the twenty-seven care staff now employed at Arle House, ten are already trained to the National Vocational Qualification in Care, Level 2 and seven have Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 21 now commenced the training. One person has achieved a Level 3 qualification and two more are now undergoing this course of study. Personnel files relating to six members of staff employed since the last inspection were read in detail. These were all stored tidily in a secure cabinet. The records showed that recruitment practices, although correctly observed in some cases, had not been undertaken consistently in recent months. Three people had not supplied a full employment history; another person had only provided a photocopy of a reference from an employer – the other referee was a friend. Records of the interview processes were also of varying consistency and did not provide any explanation for any gaps or lack of employment. POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. It was not possible to see any recorded evidence that all the recently employed staff had completed full induction although the new Deputy Manager was being inducted to his new role at this time. A senior member of staff now takes responsibility for training in the home. This person maintains meticulous records and was able to demonstrate that mandatory training is addressed in a timely manner. However, the competency of some of the nursing staff has given rise for concern with some of the respondents to the questionnaires. The inspector also experienced evidence of this prior to the inspection. The concerns are now the subject of investigation by the Orders of St John Care Trust, the results of which will be reported to the Commission for Social Care Inspection when they are completed. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 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 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The development of an open and inclusive management ethos will help to restore staff morale and thereby improve all aspects of the residents’ life. EVIDENCE: Following the departure of the manager and her deputy at the beginning of the year, the manager of another care home has been covering the role at Arle House on a part time basis. However, a permanent manager has now been appointed for the home. A trained nurse, she already has good experience in the care of the elderly and the management of a care home. This person is now making a formal application to the Commission for Social care Inspection to be registered in this position. A well-experienced senior nurse has also just commenced duties as the deputy manager of the home. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 23 Issues identified in the questionnaires returned from members of staff employed at the home show that there are significant relationship problems within the staffing team. It is clearly evident that staff morale is very low and there are also allegations of bullying and racism. These serious issues have been identified to the senior managers and are now being addressed as a matter of urgency The home does undertake a number of auditing processes. Residents’ satisfaction with meals provided, complaints, and accidents continue to be monitored monthly. Senior managers in the Company were conducting a medication audit on the first day of the inspection; a number of issues were identified for correction. An annual quality survey of relatives’ satisfaction was being undertaken at this time. Early responses show mixed results with some people very satisfied with the care provided and others raising concerns about the standards in the home. Once this survey has been completed in mid August, an improvement report will be developed to address any issues raised. The Administrator continues to take responsibility for the personal monies for the majority of the residents in the home; the records relating to the five residents selected for case tracking were checked on this occasion. It was observed that correct records are maintained and that individual secure storage is provided. Residents’ status in relation to ‘Power of Attorney’ is also maintained on file. There are records in the Home to show that all necessary maintenance is undertaken in a timely fashion. The current documentation was provided for inspection. An Environmental Health report relating to an inspection undertaken on 9/6/06 has identified a number of serious issues in the catering department; these are currently being addressed. A Fire Risk assessment was completed in March, again identifying a number of issues at Arle. These have all now been addressed. Records are maintained to show that members of staff receive training relevant to Health and Safety topics. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x 2 x x 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 3 x x 3 Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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. OP1 Standard Regulation 6 (a & b) Requirement Timescale for action 30/09/06 2. OP7 15 (1) The Statement of Purpose and Service User’s Guide must be fully reviewed and updated. Once completed, copies must be made available to current and prospective residents. A copy must also be provided to the Commission for Social Care Inspection. Every care plan must detail how 30/09/06 all needs in respect of health and welfare are to be met. (This requirement has been repeated from the last three inspections.) Care plans must be kept under review to reflect resident’s current condition. Where possible the resident or advocate must be consulted in this process. Any risks to residents, particularly in relation to developing pressure sores and in manual handling needs, must be identified and addressed. Consistent and accurate records must be maintained relating to DS0000064574.V304126.R01.S.doc 3 OP7 15(2) 30/09/06 4 OP8 13(4c & 5) 30/09/06 5 OP8 Schedule 3.3k 30/09/06 Arle House Version 5.2 Page 26 6 OP9 13(2) each person’s care. The Controlled Drug cupboard must be replaced and fixed to comply with Misuse of Drugs (Safe Custody) Regulations 1973 (This requirement has been repeated from the last four inspections.) The administration (or reason for omission) of all medications must be recorded on the medication administration sheets. All medications handwritten by a member of the nursing staff must be signed and countersigned by another person The registered person must ensure that opportunities are provided for all the residents to be consulted about the provision of social activities. Residents must be given the opportunity to eat their meals in well-ventilated conditions. The Manager must ensure that any unnecessary risks to the health and safety of service users are identified and, so far as possible, eliminated, particularly in relation to trailing leads in corridor areas Appropriate repairs must be undertaken to the damaged window frames in residents’ bedrooms. Each applicant must provide a full employment history plus a satisfactory written explanation of any gaps in employment. Two written references must be obtained for each newly recruited member of staff. Where applicable, one must relate to the person’s last period of employment. Staff employed in the Home DS0000064574.V304126.R01.S.doc 05/08/06 7 OP9 13(2) and Schedule 3.i 13(2) 31/08/06 8 OP9 31/08/06 9. OP12 16(2)(m) & (n) 30/09/06 10 11 OP15 OP19 23(2p) and 13(4c) 31/08/06 05/08/06 13 OP23 23(2b) 31/10/06 14 OP29 Schedule 2(6) Schedule 2 (3) 05/08/06 15 OP29 05/08/06 16 OP30 18 (1(ci) 30/09/06 Page 27 Arle House Version 5.2 Schedule 4 (6(g)) must receive training appropriate to the work they are to perform including structured induction training. Evidence of this must be retained on record. 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 2 3 4 5 Refer to Standard OP7 OP9 OP18 OP26 OP32 Good Practice Recommendations Care plans should be reviewed once a month Medication administration instructions should be written in plain English. Staff should receive further information and reassurance about whistle blowing processes. Where appropriate, residents’ clothing should be ironed before it is returned to the owner. Staff team building exercises should be encouraged as a matter of urgency. Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI Arle House DS0000064574.V304126.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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