Inspection on 23/06/08 for Arlington House

This inspection was carried out on 23rd June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arlington House 25/02/10

Arlington House 24/07/07

Arlington House 08/03/07

Arlington House 06/09/06

Arlington House 29/11/05

Arlington House 28/06/05

Arlington House 05/01/05

Arlington House 23/08/04

Arlington House 24/02/04

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Arlington House Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN Lead Inspector Rachel Proctor Key Unannounced Inspection 23rd June 2008 09:40 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 Arlington House DS0000018317.V364397.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. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arlington House Address Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN 01803 294477 01803 212255 manncmann61@aol.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) Mr Edward Brian Mann Mrs Caroline Susan Mann Mrs Caroline Susan Mann Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This care home service can provide care for thirty elderly people over the age of 65 who may also have dementia and/or a physical disability. 24th July 2007 Date of last inspection Brief Description of the Service: Arlington House Care Home offers accommodation with personal care to older people (65 ), older people with physical disability and older people with dementia. The building itself is a large detached property located in the Wellswood area of Torquay. It is close to local shops and amenities and a short bus ride from the town centre. The home is registered to provide care for up to 30 residents both male and female. Accommodation is provided over 3 levels with the home having a passenger lift and a stair lift as well as a range of other aids and adaptations to support those with mobility problems. With regard to residents bedrooms, the home has 20 single bedrooms, (11 of which have en suite facilities) and 5 double bedrooms (all of which have en suite facilities). A few of the bedrooms require the resident to be mobile as access necessitates using stairs. In terms of communal space, Arlington House has one large lounge, a second lounge area and a dining room as well as a small library area. The weekly fees charged ranges (as of 23/06/08) between £350 and £450.00 and are dependent on the needs of the person. Inspection reports are available in the home. The service users guide is displayed in the reception area of the home. Arlington House DS0000018317.V364397.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. This was a key unannounced inspection, which took place on 23 June 2008 between 9 am and 4 Pm. The manager provided an (AQAA) Annual Quality Assurance Assessment for the Commission prior to this inspection. This provided information about how the home manager viewed the services provided at the home and what planned improvements would take place in the next 12 months. Three people living at the home had their care followed. Discussion with the manager, care manager and people living at the home took place during the inspection. Surveys were returned from 1 relatives and 7 staff members prior to this inspection. Some comments made in the surveys and some comments made during the inspection have been included in this report. A tour of the home was completed and some records were inspected. What the service does well: Arlington House provides a spacious environment, which is set in an attractive residential area of Torquay. There is level access to local shops and facilities. Arlington House provides an informal environment where residents feel they have choices about their daily lifestyle. The home offers several communal lounge areas so people can have a choice of where they spend time. There is also an outside roof terrace sensory garden with seating. The home has an activities organiser who visits several days a week to provide occupation and stimulation both to groups and on a 1:1 basis with people who are more frail. People living at the home receive a well balanced diet with nutritious and home cooked meals. People spoken to said they enjoyed the meals provided. The staff seen had a good rapport with people living at the home who were treated with warmth and respect. Evidence was also seen of good practice in supporting people with memory loss, and staff were seen to be engaging well with people when carrying out care tasks. This helps to demonstrate that there are good relationships between people living at the home and the people caring for them. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 6 Evidence was seen of good links with external support services such as district nurses. A number of aids and adaptations have been provided for service users with physical impairments, such as hoists and raised toilet seats. This means those service users who are more frail can receive additional support. More person centred information is being put in care plans wherever possible, so people and their families are fully involved in choices made regarding the care provided. Risk assessments have been reviewed to reflect changes in peoples needs; care plans are reviewed monthly or sooner if the persons needs have changed. What has improved since the last inspection? What they could do better: The care manager did not have a copy of the last medication return to the pharmacy. This means that the records needed to provide a clear audit of medication returns are not available. The new return medication system should include keeping a copy of the list of medication returned to pharmacy. The hot water to baths accessible to people living in the home was above the recommended 43°C. Checks had not been carried out since the 9th June 2008 on the hot water temperature in washbasins or baths. This has the potential to put people at risk of scalds if they used the water without assistance from staff. Although the manger has completed a quality audit and used surveys to ask people their opinion of the home, this had yet to be summarised and a copied to people who live in the home, and to the Commission. This may mean people are unaware of the changes that have been made to improve the service provided for them. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 7 The owners should continue with their identified plan to fully upgrade the home and thereby provide a good standard of accommodation throughout for all the people living there. 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. Arlington House DS0000018317.V364397.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 Arlington House DS0000018317.V364397.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): 1,3,6, Quality in this outcome area is good. The information provided at Arlington house for the people who lived there and visitors provides sufficient information for them to make an informed choice about whether the home can meet their needs. The way peoples care needs are assessed and recorded should ensure that people receive the care they need from a staff team who understand them. Arlington house does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users guide is available in the hallway of the home and it is easily accessible for people who live there and people visiting. This contains information about what the service has to offer. A copy of the complaints procedure and a sample of service users views of the home are also included. The home manager has provided the Commission with a copy of the statement of purpose and service users guide. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 10 Three people had their care followed as part of this inspection. The assessments completed by the home manager or care manager had been fully completed. These gave information about the health and personal care needs of the individual and also stated what was important to them. Risk assessments were integral an part of the assessment process and included risk of falls and manual handling risks. Since the last inspection the manager has developed a lifestyle profile for people admitted to the home. This covers the person’s life experiences and whats important to them as well as their aspirations. The manager advised that this had enabled them to better understand the people they were caring for. One relative spoken to during the inspection said, The manager and staff at Arlington house have taken time to get to know my mother-in-law. They understand what she likes and whats important to her and have helped her to settle into the home. One person living at home spoken to set the staff understand what I like and make sure I have what I need. Each of the three people whose plans of care were viewed had a plan of care develops from their assessment. People who required nursing care were receiving this from the district nurse team who provided their own health assessments for the person. Although Arlington house does not offer intermediate care and rehabilitation for people. It does offer respite stays for people living in their own homes or with families when rooms are available. Arlington House DS0000018317.V364397.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Arlington House have their health and personal care needs fully met. Medication practices are safe. EVIDENCE: The three people, who had their care followed during this inspection, all had plans of care in place, which reflected their needs. One person who was identified as a risk of falling had a plan of care for staff to follow that would help them to minimise the risk of the person falling. The care manager advised people are reassessed if their needs change and new care plans are put in place to ensure their safety is maintained. The way the care plans are recorded showed that people and/or their supporters had been involved in the development of their plan of care. The plan of care identified what the person was able to do themselves and what they needed help with. One person who had been assessed as having a low mood had had a psychological assessment and a plan of care put in place to ensure they felt Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 12 supported. The care plan guided staff how to care for the person’s emotional needs as well as their physical needs. One person living at the home had identified that they did not like male carers to provide their care. The care manager advised that the staffing rota was arranged to ensure that the person always had a female carer to provide their care. People were receiving nursing care from the district nurses. A visiting district nurse was spoken to, she advised that the staff at the home were helpful and followed though any instruction she gave. She commented that people were receiving good care at Arlington House. The care manager advised that the health team assess people who need pressure relief equipment and they supply this. One person visited in their own room had a hospital style bed with bed guards and an airflow mattress to reduce the risk of pressure sore development. The care manager confirmed that if a person needed bed guards for their bed the occupational therapist and district nurse team carry out the assessment and supply a hospital style bed with bed guards fitted. One person’s plan of care seen had an assessment from the health team regarding the use of bed guards. Records of health professional visits were being recorded separately. These gave information about the treatment or advise they had given. People were seeing health professionals in the privacy of their own rooms. The care manager confirmed that all the people living at the home have a manual handling assessment completed. The three care plans seen all had manual handling risk assessments completed these guided staff how the person should be assisted and whether the person needed help from one or two carers and any hoist or other equipment they needed to move safely. One person returned form hospital during the inspection. The care manager carried out a new manual handling risk assessment because she said they were not able to stand and walk as well as they could. Staff were seen to encourage the person to stand with support making conversation with them as they did this. The manager confirmed that all staff have manual handling training and have been made aware of the homes no lifting policy. Staff observed helping people to stand and or walk were doing so safely. How the homes medication is managed was discussed with the care manager. Records of medication given were seen; the staff member administering the medication had signed these. A method for recording the reason for not giving medication was in place. The controlled drug record was checked against the stock for one person as correct. The manager advised that the pharmacist had advised her of a new recording system they were introducing for controlled medication. A record of medication returned to the pharmacy was not available for the last return made. The manager advised that the pharmacist had not returned a copy of the record to the home. She also said she had contacted the pharmacist to request this was returned. The staff training records showed that staff had received training for medication administration. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 13 The care manager confirmed that only staff that had received training administered people’s medication. Information about the medication the person was taking was seen in the care plans viewed during this inspection. Arlington House DS0000018317.V364397.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. Quality in this outcome area is good. People living at Arlington House have good opportunities to take part in activities if they wish. The staff team have an understanding and caring attitude towards the people who live at Arlington House. This means that people who live there are treated with dignity and respect by the staff team who care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care manager advised that she was always looking for new things to improve the social interaction for people living at the home. Since the last inspection an additional activities person had been appointed to provide one to one support for people. This was in addition to the regularly activities provided three times a week by the activities coordinator. During the morning of this inspection the activities coordinator was providing a quiz for people to take part in. People could be heard joining in and answering questions. The activities coordinator said she tried to vary what they did so that it interested more people. Since the last inspection a sensory garden has been provide, which is accessible from the lounge. This had fragrant plants and flowers planted to Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 15 planters that people who were wheel chair users could access. A small area growing salad vegetables and herbs was also provided. These were also in planters that people could work with if they wished. The manager said she hoped people who had an interest in gardening would be able to use this to plant flowers or vegetables they liked. Seating areas were provided around the garden for people and their relatives to sit. A small fountain was in the centre of the garden. The manager said that the local school were preparing a sign to be placed in the garden and they would put this up for the open day. A notice in the home gave information about the open day. People were able to choose to stay in their own rooms if they wished to do so. One person who had chosen to stay in their room was spoken with. They said they had all they needed in their room and preferred to be there. They went on to say that the staff made sure they had all they needed. They also said they had a regular visitor who came each week to have a chat and pass the time. They were watching a film on the television. The care manager advised that they had completed a life profile with the person and had been able to find out what was important to them and what they enjoyed as well as their life experiences. During the inspection, visitors were coming and going and were seen to be welcomed to the home. One visitor spoken with said the manager and staff are excellent and understand how to make people feel at home. Nothing is too much trouble for them they make sure the visitors are looked after as well as the people living at the home. They also commented that they had been able to manage their relative’s occasional verbal aggression well with out the use of sedative medication that would suppress their personality. The staff observed at Arlington House were skilled at encouraging the people who live there to take an interest in what was happening around them. In the interactions witnessed, staff treated individual people with respect ensuring that they knew what was happening when assistance was being offered or given. Individual peoples rooms entered had been personalised with items of their choice and furniture had been arranged to meet their preferences and care needs. These included family pictures and ornaments that had significance to the person. One person had chosen to have an easy chair in their room instead of a bed, as they preferred to sleep in the chair. Drinks were being given or offered to people through out the inspection. The manager said she was aware of the importance of keeping people hydrated and wanted to be sure they had enough drinks available for them. One relative and a visiting district nurse said they are always offered drinks of tea or coffee when they visit. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 16 People asked said they enjoyed the food provided. The lunchtime meal was being served in the dining room for people who wanted to use this. Others were eating their meals in their own rooms. Staff were giving people that needed assistance to eat, help in a sensitive supportive way. Staff were speaking to the person as the helped them eat their food. Food had been prepared to allow people to experience the different tastes of the food. The meal time was unhurried with people eating their meals at their own pace. The cook advised that she regular talked to people about their meals. She also commented that the menus had been planned with the care manager to ensure people had the type of food they liked. Very little waste was seen from the lunchtime meal. Arlington House DS0000018317.V364397.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. Quality in this outcome area is good. People who live at Arlington House can feel confident that their concerns will be treated seriously. The procedures for dealing with and reporting abuse is satisfactory, ensuring people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arlington house has a complaints procedure, which is included in the service user guide. This clearly states the process to be followed in making a complaint, and gives information about organisations outside of the homes complaints procedure in case people feel unable to raise a concern directly with the homes management. People spoken to during this inspection stated that they knew who to speak to if they had any concerns. A record of concerns raised was being kept. This provided information about the concern raised and what the management team had done to address these. Concerns raised included Manual-handling practices for staff and the cleanliness of the home. The care manager had developed a role-play training session that gave the carers the opportunity to experience being lifted and helped by others in both the right and the wrong way. One staff member had provided feed back from this session saying it helped them to understand how this made people feel. The care manager said that she regularly gives staff Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 18 practical training up dates to ensure they continue to practice safe manual handling. One safeguarding referral had been made since the last inspection. This had not been substantiated. The manager had introduced safeguards to protect the people living at the home. This included providing training for staff and ensuring care plans reflected the persons care preferences as well as their physical care needs. And ensure risk assessments for people that are frequently reviewed. The care manager confirmed that all staff are given training for the protection of vulnerable adults. Training records seen for the staff files viewed confirmed this. The home manager has provided a policy to guide staff how to recognise and respond to allegations of abuse. The manager provided information prior to the inspection that the policy had been reviewed in March 2008. Arlington House DS0000018317.V364397.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): 19,25, 26,Quality in this outcome area is adequate. Arlington House provides a comfortable environment for people to live and work in. However not all areas are decorated and furnished to the same standard. This means that the quality of the room and furnishing would depend on which room was being used. The way hot water supply for baths was monitored had not ensured that the hot water temperature was close to 43 °C. This poses a scald risk for people using the bath. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was completed with the care manager as part of this inspection. Communal spaces, bathrooms and individual peoples rooms were visited. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 20 Arlington House is a long established care home situated in a residential area of Torquay, close to local shops and facilities. The home is a period villa, which means that rooms are converted from their original purpose and so vary in size, shape and outlook. The home is over three floors with a passenger lift linking most areas, which is important for older people with mobility problems. Some rooms have a few stairs from an area of level access, which would make them unsuitable for people who need walking aids or need access to mobile hoists. The home has attractive communal space, with a dining room, two lounges, and a small library or quiet room. This means that people have a variety of places in which to sit. A new sensory garden, which has level access form the ground floor lounge patio doors, has been developed since the last inspection. Seating areas are provided around the garden for people and their visitors to sit if they wish. The garden has several raised planters, which people could easily access to plant flowers or vegetables of their choice. There are communal toilets and bathrooms throughout the building, including close to lounge areas, which means people have access to a nearby toilet wherever in the home they choose to be. On the lower ground floor the toilet is up a few stairs, so people in this area needing support with personal care may have to be taken to other floors to receive this support. Hoisting equipment is available in bathrooms so that people with impaired mobility can be bathed more easily. The care manager advised that two of the bathrooms no longer had the baths used because people were unable to access them. She further commented that the hot water had been turned off. However the water was running in all the three bathrooms. The hot water was too hot to hold a hand under and the temperature was above 50 ο C in all three baths. Before the inspection was completed the maintenance man had disabled the two bathroom hot water taps that were no longer used and the boiler temperature was adjusted to ensure bath water temperatures were close 43 o C. The records of hot water temperature checks for the hand wash basins in individual rooms showed that the water temperature was close 43 °C each time it was checked monthly. The maintenance man last checked these on The 8th June 2008. The manager confirmed that the same boiler supplies the hot water to the baths. The decor of the building is generally satisfactory and a number of areas requiring attention have been identified. The manager confirmed that some areas requiring attention such as redecoration of the lower ground floor bedrooms and en-suit bathrooms are planned. One ground floor bedroom does not have a window that the person could see out of when seated. It was above head height and had obscured glass. The room smelt damp and the paint on the walls and woodwork looked shabby. The care manager confirmed that the room was being occupied by a person with compromised sight. She also stated that the manager had said she intended to take this room out of service. Another of the ground floor rooms had a radiator cover that had Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 21 become dislodged and was no longer fixed to the wall. This was rectified before the inspection was completed. The carpets in three of the ground floor rooms appeared worn and two had stains on them. These rooms were below the standard of décor seen in the rest of the home. There is a laundry room to the lower ground floor. Changes have been implemented to the laundry management systems to minimise any contact between clean and dirty laundry and there are machines capable of achieving a sluicing cycle, which is important in ensuring appropriate infection control measures. The home has an infection control policy available for staff. The staff observed were using gloves and aprons when attending to peoples care needs. Disinfecting hand gel was provided in the reception area of the home for people visiting the home or staff to use. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is good. People who live at Arlington House are generally well supported by staff that are receiving the training they need to provide good care. The manager is committed to ensuring that the staff have training to improve their knowledge and skills to care for people living at the home. This means that people have a knowledgeable staff team to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A staff rota provided shows the number of staff on duty each shift. This showed that additional staff were on duty at peek times. In addition to the care staff the manager has employed a cook, domestic and maintenance man. The manager and care manager confirmed that one of them is on duty each day. The care manager added that she also completes a night sleeper duty to enable her to work with night staff to assess their practice. The AQAA (Annual Quality Assurance Assessment) the manager provided for the Commission prior to this inspection showed that out of the 12 health Care Assistance employed six had achieved an NVQ level 2 or above and four staff were working towards this. This meets the Standard for 50 of care staff to have achieved an NVQ level 2 or above. They will exceed this when those who have started the training have completed it. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 23 Two new staff files were seen during the inspection. These contained the pre employment checks needed before a new staff member works in the home. The date the police check was returned was before the persons started work in the home. Two references had been provided as well as proof of identity. The manager confirmed that staff don’t start work in the home until all pre employment checks have been returned. A record that staff had received a copy of the code of conduct was being kept in their personnel file. The care manager provided information regarding the training staff had received and the training planned. This included dementia care. An information folder about the Mental Capacity Act was also available for staff to use. The AQAA (Annual Quality Assurance Assessment) indicated that the manager intended to access further training for staff relating to the Mental Capacity Act. This showed that staff have access to training that will improve their knowledge and skills to care for the people living at Arlington House. A complaint had been received that care staff do not always use safe manual handling practices. The person also said that new staff do not receive training in manual handling before they work with people. This was discussed with the manager and care manager. The manager and the care manager confirmed that they are both manual handling assessors. The care manager advised that she regularly provided practical sessions for manual handling training. The induction checklist seen for two new staff included manual handling. The care manager advised that she had used a role play training session to give the carers the opportunity to experience being lifted correctly and incorrectly. She further commented that the carer being lifted was blindfolded so they could not see what was happening. One of the carers who had completed this had given feed back about the session. One comment received from a staff member stated: -our manager is constantly thoughtful about our manual handling skills performance and shes always with us if something isnt properly done and needs to get revise for a better quality of care. The care manager confirmed that she regularly works along side the carers and assesses their manual handling practice. The survey forms returned from staff indicated that the manager had provided manual handling training for them. The wheel chairs being used to move people during the inspection all had footplates attached. However a wheel chair in one of the lower ground floor rooms did not have footplates. The care manager advised that the person who used this was in hospital. The footplates had been removed because the wheel chair could not easily be moved up the few steps to the person’s room with them on. The care manager advised that she was looking at discussing a move to one of the more accessible rooms with the person because their needs had changed. Arlington House DS0000018317.V364397.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. Quality in this outcome area is good, The home is being well managed. Many new management systems have been introduced. This should ensure that the home is run in the best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home is also one of the registered owners and she has run the home for 30 years. The care manager, who is currently completing her Registered Managers Award, supports her. The Registered Managers Award is a nationally recognised qualification in running a care home. Mrs Mann the registered manager was able to explain how the management responsibilities are shared between herself and the care manager. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 25 Staff who returned surveys indicated that they felt very supported to do their work and that the management of the home were open and approachable. Comments received from staff in the survey forms included: - Everything was explained very well there, you are made to feel very welcome”. “We are encouraged to voice our views or new ideas, some of which have been put in place The manager and the care manager had separate audit files, which looked at various quality control issues. These included auditing the completion of medication records, monitoring health and safety and an annual development plan for the home up to January 2009. Since the last inspection Survey questionnaires completed by people living at the home and visitors have been added to the service users guide displayed in the reception area of the home. The manager advised that she was looking at ways to summarise the audits and quality checks that had been carried out since the last inspection to provide information for people living in the home and their visitors. One relative spoken to said they had been asked their opinion about how the home was meeting their relatives needs. Another relative commented in a survey form: - “I find the management and staff at Arlington house to be kind, caring, vigilant quick to react to my aunts needs and generally first-rate in difficult circumstances. They have never given me any cause for concern whatsoever The home manager and care manager have made improvements since the last inspection that have enabled them to meet the Requirement made at the last inspection. This shows that the management team are committed to improving the services offered at Arlington House. The manager advised that the home does not mange finances for any one living at the home. Relatives or advocates the person had nominated manage these. The manager confirmed that staff received fire safety, and health and safety, which included manual handling training to ensure they understood how to maintain peoples health and safety. Chemicals used in the home for cleaning were being stored safely. The cleaner had moved a trolley containing cleaning materials into a disused bathroom. However this was not locked. A system for reporting incidents and accidents was in place. The records of accidents that had occurred were being kept. Records in the home were generally in order. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 26 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 27 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 OP25 Regulation 13(4)(c) Requirement The manager must ensure that a system for checking the water regular for the hot water for full emersion baths is provided close to 43 °C Timescale for action 23/07/08 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 Refer to Standard OP19 OP9 OP33 Good Practice Recommendations The owners should continue with their identified plan to fully upgrade the home and thereby provide a good standard of accommodation throughout for all residents. Copies of the record of all medication returned to pharmacy should be kept in the home. The manager should provide a copy of the summary of the quality audit when this is completed. Arlington House DS0000018317.V364397.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Arlington House DS0000018317.V364397.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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