Inspection on 04/10/05 for Arle House

This inspection was carried out on 4th October 2005.

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 21/07/06

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 GL51 0BG Lead Inspector Eleanor Fox Unannounced 4 October 2005, 10:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Arle House Address Village Road Arle Cheltenham Gloucestershire GL51 0BG 01242 514586 01242 224259 manager.arle@osjct.glos.co.uk The Orders of St John Care Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) To be arranged Care Home 50 Category(ies) of OP Old Age (50) registration, with number of places Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) To accommodate two (2) named service users under the age of 65 years. Date of last inspection 20/4/05 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 Home is now managed by the Company, The Orders of St. John Care Trust. 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. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of five hours. During this time, she spoke with the Manager, her deputy and eight members of staff. She also walked around the property and visited six residents in their bedrooms. She had the opportunity to speak to other ladies while they were having their mid-day meal. The inspector selected five care files relating to residents living at Arle House. She then went on to check a variety of aspects of their daily lives during her visit. Residents and staff at the Home were experiencing a certain amount of disruption owing to the need for major maintenance to the passenger lift and the replacement of the carpet in the dining room. Nevertheless, careful planning for the resulting difficulties ensured that most of the residents were inconvenienced as little as possible; in fact some were enjoying the novelty of the temporary situation. What the service does well: What has improved since the last inspection? Since the last inspection, successful recruitment has resulted in a full complement of nursing staff being employed at the Home. There are also only a minimal number of care staff vacancies at the present time. Agency and relief staff are now only required on an occasional basis allowing improved consistency of care. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 6 There has also been an improvement in the standard of record keeping at the Home. A new call bell system has just been installed. This incorporates a number of safety features to assist staff to provide a timely response to residents. 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. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 standard(s) 1,2, and 5 A visit to Arle House plus the provision of detailed information about the Home, enables the majority of prospective residents to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: The Home provides a comprehensive pack of literature to each prospective resident and their families detailing information about the Home. One lady confirmed that she had found this most useful before she was admitted to Arle House. The brochure is now being reviewed and updated following the management changes in the company. In recent months, only residents who are privately funded have received a copy of the terms and conditions for admission to the Home. Although the majority of details are contained in the service user’s guide, the additional information is now being prepared for each person admitted to Arle House. Of the five people who are waiting to come into the Home, it was confirmed that four had already been to visit the establishment. They had had the opportunity to tour the building and to meet some of the other residents and Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 9 members of staff. One resident had been greatly reassured by her preliminary visit when she and her daughter had been shown the two available rooms and had had a chat to “such a nice carer.” Intermediate care is not provided in this Home. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 standard(s) 7,9 and 10 Improvements are required in the care planning systems to ensure that all members of staff have a clear understanding of the care each person requires. Urgent improvement in the storage of medications is required to ensure that residents are not put at any potential risk. Temporary arrangements during the maintenance disruptions have meant that some residents’ privacy has been compromised. EVIDENCE: Care plans are normally developed following an assessment of each resident’s care needs. However, in the examples seen on this occasion, these were either very limited or in one case, did not exist at all. Specific care plans were reasonably clearly documented but during this year, have not been reviewed in a consistently regular fashion. One person who had been identified, as ‘at risk of falling’ had had no risk assessments completed or a care plan prepared to manage his condition. Care assessments are also not all dated for clarity. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 11 It was explained that now the Home employs a full complement of nursing staff, these anomalies would be addressed as a matter of urgency Arle House still does not provide approved storage for controlled drugs. Nevertheless, assurance was provided that an appropriate cabinet has now been ordered and will be delivered shortly. In the documentation seen on this occasion, other medications are stored, recorded and administered correctly. Arrangements are being made to change the supplying pharmacist to ensure that medicines no longer required may be collected and removed from the Home. Photographs are now provided of every resident to aid identification. While the building work is being completed, two residents’ bedrooms are being used as a passageway for staff, deliverymen and contractors. The inspector was assured that permission had been given and one lady was able to confirm that this was so. This situation will only be a very temporary arrangement. Staff addressed the residents in a respectful but friendly fashion. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 standard(s) 13 and 15 Residents are given the opportunity to maintain contact with family and friends as much as they wish. The provision of a good choice and variety of meals throughout the day ensures residents receive a nutritious and balanced diet. EVIDENCE: Although there were no visitors free to speak to the inspector on this occasion, two residents did agree that their relatives were able to visit them when and where they wished. The monthly newsletter prepared by the Home keeps residents and their families in touch with any relevant information about planned events or issues of interest in the Home. For this short period, residents are being served prepacked meals, which are then heated in the kitchen. Those people who were questioned were quite satisfied with the choice and taste of this food. In the long-term, menus are devised on a seasonal basis following consultation with the people living in the Home. Food is discussed at the Residents Council meetings. In recent months, the Home has focussed on providing a full nourishing breakfast. This has been most popular with the residents; many of whom Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 13 spoke very positively about the meal. Staff and families have observed improvements in residents’ general conditions, as a result of this recent development. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 standard(s) 16 A satisfactory complaints system enables residents and their families to feel assured that their views would be listened to and acted upon. EVIDENCE: The Home’s clearly detailed complaints procedures are included in Arle House’s Service User’s Guide, a copy of which is prominently placed in the main foyer of the Home. According to the Complaints File, there has been just one formal verbal complaint since the last inspection. This was addressed immediately and fully resolved. Two residents confirmed that they feel comfortable to discuss any concerns with members of staff. Issues are also discussed at the Residents Council meetings. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 standard(s) 19, 22, 24, 25 and 26 Further improvements in the standard of the environment are required to ensure that the residents live in a safe and comfortable Home. EVIDENCE: Due to the urgent lift maintenance work that is being undertaken in the Home, access to some parts of the building is seriously restricted. Where possible, alternative temporary arrangements are being made. Window boxes at the front of the building looked most colourful on this occasion. Many pieces of furniture, particularly in residents’ bedrooms, are scratched and ‘worn looking’. There are also stained carpets, which have now been identified for replacement. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 16 There is still no restriction on the opening of the majority of windows on the first floor and no risk assessments have been completed for any of these areas. A new effective call bell system has now been provided throughout the Home. There has still been no improvement to the cramped laundry facilities. Nevertheless, laundry is segregated and washed at the correct temperatures. Residents wear their own clothes. Despite the current difficulties, the majority of the Home was reasonably clean and fresh. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Appropriate staffing levels are maintained to meet the needs of the residents. However, some improvements in training are required to ensure the competency of staff to undertake their duties. EVIDENCE: On this occasion, there were forty-five residents living in the Home. The remaining available beds will be filled when the maintenance work has been completed. In the short term additional staff have been allocated to work in the Home during this difficult period to ensure residents’ needs are not compromised. The Home has now recruited a full complement of trained nursing staff, reducing the need for agency and relief cover and providing greater consistency of care. In recent weeks, nobody has been allocated to take over responsibility for arranging training in the Home. As a result, some mandatory update education and induction training is now overdue. This is being addressed. Manual handling, however, continues to be addressed in a consistently timely fashion. Many care staff have achieved or are studying for their National Vocational Qualification (NVQ), level 2 or 3. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 33 The open inclusive management style in the Home allows residents and staff the opportunity to provide input and feedback, as desired. EVIDENCE: Minutes of residents’ and staff meetings undertaken in the Home provide evidence that both groups are actively encouraged to be involved in the day to day running of the Home. This was strongly confirmed by the positive responses from six members of staff who spoke to the inspector. There are clearly defined lines of responsibility within the Home. These are also documented in the literature given to residents living in the Home. The Orders of St. John Care Trust has a good focus on quality improvement. Audits are undertaken on complaint management and accidents that occur in the Homes. A satisfaction questionnaire has just been distributed to families of residents; the results are still to be collated. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 19 The Quality Manager employed by the Company has undertaken an audit of the Home since the last inspection. Action has now been taken to address any issues identified. Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 4 COMPLAINTS AND PROTECTION 2 x x 2 x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 3 x x x x x Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation Requirement Timescale for action By 31.12.05 By 30.11.05 2. 7 3. 9 4. 22 5. 22 6. 24 Regulation Each person must be provided 5 with a written copy of the terms and conditions for admission to the Home Regulation Every care plan must detail how 15 (1and all needs in respect of health and 2b) welfare are to be met. (Previous timescales 30.11.04 and 31.6.05 not met). Regulation The Controlled Drug cupboard 13(2) must be replaced and fixed to comply with Misuse of Drugs (Safe Custody) Regulations 1973 (Previous timescales 30.11.03, 30.6.04 and 31.10.04 and 31.5.05 not met). Regulation All the rooms on the first floor 23(2n) must be checked to ensure that and fully functioning window Regulation protectors have been 13(4) installed.(Previous timescales 31.10.04 and 31.5.05 not fully met). Regulation The Manager must ensure that 13(4c) any unnecessary risks to the health and safety of service users are identified and, so far as possible, eliminated.(Previous time scale 1.5.05 not met) Regulation Adequate furniture, furnishings, 16(2c) floor coverings must be provided D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc By 30.11.05 By 30.11.05 By 31.10.05 By 31.12.05 Page 22 Arle House Version 1.40 7. 30 in rooms occupied by service users Regulation Staff employed in the Home By 18 (1(ci) must receive training appropriate 31.12.05 to the work they are to perform including structured induction training. 8. 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 Good Practice Recommendations Arle House D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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 D51_D03_64574_Arle House_v247973_041005_UI_Stage 4.doc Version 1.40 Page 24 - 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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