CARE HOMES FOR OLDER PEOPLE
Arlington House Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN Lead Inspector
Michelle Finniear Key Unannounced Inspection 24th & 30th July 2007 9:00 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.V343810.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.V343810.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.V343810.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. 8th March 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 range between £280 and £400.00. Inspection reports are available in the home. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report reflects a summary of a cycle of Inspection activity at Arlington House since the last key inspection visits to the home in March and April 2007. To help CSCI make decisions about the home the owner and care manager gave us information in writing about how the home is run; documents and correspondence submitted since the last inspection were examined along with the records of what was found at the last inspection; a site visit of 7.5 hours was carried out by two Inspectors with no prior notice being given to the home as to the specific date and timing of the visit; a short visit was also undertaken several days later to view areas not seen on the first visit; discussions were held with the manager, care manager and staff on duty; various records were sampled, such as care plans and risk assessments; questionnaires were sent to staff who work at the home; a tour was made of the home; discussions were held with visitors and visiting professionals during the first day; and time was spent with the people who live at the home both individually and in groups, which included a two hour period of observation in the lounge of the home. In addition a sample group of people living at the home were selected and their experience of care was ‘tracked’ and followed through records and discussions with staff and management, looking at how well the home understands and meets their needs, and the opportunities and lifestyle they experience. Time was then spent with some of these people where possible. This approach hopes to gather as much information about what the experience of living at the home is really like. 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 with seating and gardens. 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. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 6 There is a programme of refurbishment and maintenance which helps to ensure that the home remains an attractive place to live. The home manages to integrate people with a variety of needs into a homely environment reasonably well. Some people living t the home have behaviours that challenge and the home is receptive to and tolerant of individual lifestyle choices. 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. A relative commented “ I have nothing but praise and gratitude for the service provided to my mother. They stated that the home treats residents with expertise, respect, humour (appropriate), kindness etc. they always have time for family and friends offering trays of tea/coffee/biscuits etc. Excellent communication with family, excellent food for residence, clean warm and friendly environment, and the owner and manager takes their duties with sincerity and dedication. Another said Arlington house, the owners and staff have extremely high standards and many care homes should follow their example. They always have time for each person. I have never heard a sharp word even under difficult circumstances. The house is kept spotless as are the residents. Food is freshly cooked and some vegetables are grown on the premises. Very caring and I as many others do would recommend them highly. Visiting professionals who completed questionnaires for the home owner or who were seen on site confirmed the home made appropriate referrals to them and provided a good standard of care. 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. A staff member who completed a questionnaire said the management and staff work really, really hard to meet all residents care and I feel we do an excellent job. Another said Arlington house is a lovely home with the service users are loved and very well looked after in every aspect. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
The management is making sure that any emergency placement at the home is subject to a full assessment of need being undertaken from which a detailed care plan, review and any necessary risk assessments is being completed. This is to ensure that all staff are aware of the best care to give to a resident admitted as an emergency placement and so ensure the resident’s needs are appropriately met. More person centred information is being put in care files wherever possible, so residents and their families are fully involved in choices made regarding the care provided. Risk assessments have been reviewed to reflect changes in peoples needs. The manager is looking at current legislation which impacts on restraint issues and has put information about the homes front door into their Statement of purpose and other and documentation about the home. This is to make sure that peoples rights are being protected and balanced with the homes needs to protect vulnerable people. Staff are to receive external medication training. This is to ensure that staff are trained in the most up to date medication practices. Any medical interventions undertaken by the management of the home are being done under the directions of a G.P and any findings discussed with individual resident’s G.P., or other relevant medical professional, so that decisions regarding any resident’s diagnosis are undertaken by a professional qualified to do so. The first aid kit has been re-stocked and is being regularly monitored to ensure that it contains all the required emergency equipment in the event of a resident needing emergency treatment. External adult protection training is being made available to all staff to ensure that staff are fully aware of the issue regarding abuse. This will ensure that residents are protected by staff being fully informed and aware of the different forms of abuse and of the correct procedures regarding dealing with any suspected abuse, including how to report any concerns they may have. The owners are monitoring the home’s hot water temperature on a regular basis, to ensure that the home’s unregulated hot water temperature does not pose an unnecessary risk to the residents.
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 8 All cleaning materials are being locked away securely, to protect residents who may be vulnerable to accidental misuse. The banister rail from the ground to the first floor has been made secure to prevent any potential accident. Stair edges have been identified to ensure service users that suffer with perception problems due to dementia are more easily able to identify when the stairs commence and end. Staffing levels within the home are being maintained so that any unexpected event can be dealt with without compromising the day to day care of the residents. The management of the home are in discussion with another local home to access specialist dementia care training. Qualifications in care, obtained outside of England, are being verified to ensure that they are of the same standard as those obtained in England. The management have started regular supervision to all staff, for which records are being kept. Supervision helps staff to work consistently and to their full potential. The owners/manager are continuing with their quality auditing and monitoring ensuring that any feedback received as to how others, including residents and their families feel the home is running is used to help improve the home. The manager confirmed that any form of restraint used i.e. the use of a cot side or a reclining chair will be regularly risk assessed by the home’s management staff, with advice sought from outside professionals, as well as agreement obtained from the resident and/or their family/advocate to the use of such restraint. These details will be kept in the individual resident’s file at all times. This is to ensure that any form of restraint used is always in the best interests of the individual resident and fully meets the individual resident’s needs, whilst at the same time respecting their right to freedom and choice. What they could do better:
A full recruitment process must be completed for each member of staff who commences work at the home, even if they have previously worked there, left and then re-started. This is so that recent information is available on their work history and criminal records bureau status. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 9 A system for reviewing and improving the quality of care provided at the home must be implemented and maintained. This is so that the home can gather information and prepare an action plan on what is working well at the home and what can be improved. A first aid risk assessment should be provided to determine the level of first aid training required, so that people living at the home are protected by staff who are qualified to an appropriate level. The manager should continue to develop the person centred element of the care plans and provide a personal and social history for as many people living at the home as possible. This helps staff to understand as much as possible about the people they are caring for. Consideration should be given to making the service user guide available in other formats to suit the needs of people who may consider entering the home, for example people with a visual impairment. This is so that everyone can have access to information about the home no matter what their disability. 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. 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.V343810.R01.S.doc Version 5.2 Page 10 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.V343810.R01.S.doc Version 5.2 Page 11 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, 2, 3, 4, 5, 6 Quality in this outcome area is good. Information and trial visits are available for people thinking about moving into Arlington House so they can make a decision about whether the home is the right place for them. Pre-admission assessments are carried out so that the homes staff know they can meet the persons needs before a decision on admission is made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arlington House has a statement of purpose and service user guide which is available on a notice board in the hallway or when inquiring or visiting the home. This contains information about the home, the services available, and what people can expect in return for their fees. It also contains a copy of the statement of terms and conditions or contract, which includes information on service user rights, and periods of notice to be given.
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 12 Six peoples case files were selected for examination on the site visit, which included a range of ability and the most recent admission to the home. Discussion was held with the manager about the admissions procedure, and they gave a description of the process that had been followed for the most recent admission to the home. This was later discussed with the person themselves who was able to give a good account of how they had come to live at Arlington House. This admission had been carried out in an emergency, so the home had not been able to carry out their usual full admission process, but had received information from a Social worker about the persons history and a copy of the hospital discharge summery which contained information about their current needs and healthcare. This document was available in the file. The home has an emergency admission procedure and this admission had been completed in accordance with this process, with an initial care plan drawn up based on the assessment. Care plans are important as they identify a persons needs and how those needs can be met in a consistent fashion and in accordance with the persons wishes. They also help the homes staff to identify any risks associated with that persons care and how they can be managed safely. The initial care plan has subsequently been expanded to include other areas and the care manager confirmed that others were still to be completed to provide a full system. In another recent admission the person had come to the home through a more planned route. In this instance there was time to complete a full assessment before a decision was made as to whether the home could meet their needs. Pre-admission assessments are important as they enable the home to ascertain as far as possible that they are able to meet the service users needs, and this avoids people having to move to another home when their care cannot be managed in the home they first chose. The care manager stated it would be the homes usual policy to encourage visits to the home before a decision is made. Discussions with a relative during the site visit indicated that they had visited several homes before deciding that Arlington house was the right one for their relative. Ideally trial visits for people thinking about moving in are good practice, however for some people particularly with memory problems they can be disturbing or confusing and in this instance their relatives felt it more appropriate to make that decision on their behalf. The home does not cater for intermediate care. This means they do not provide specialist programs of rehabilitation with the aim of returning the service user to their home environment on a permanent basis. They may however provide respite care if a space is available. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 13 Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 14 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. People living at Arlington House have their healthcare needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arlington House provides care for people with a wide range of ability from some who have severe physical and mental impairments associated with old age and mental frailty through to others who are more active and able to hold a good conversation about their lives and the care they received. Six peoples files and care plans were seen at the site visit and another three were referred to. Discussions were held with staff and management about the care given and several people were spoken to in depth about the care they received. Time was also spent observing people being supported and discussions were held with a visiting district nurse about the care that the home gives. Questionnaires were sent to relatives, and information was taken also from responses sent in following the last key inspection in March and April
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 15 2007 which were received too late to include in that report. This included comments obtained by the proprietor from visiting professionals. On the main visit there was evidence of a clear care planning and review system in place, with several additions having been made since the last inspection. Some of these had not yet been used or completed but had been put in files ready to be used. Others were in place and in use in some files. The changes made provide for a full toolkit of assessment from which the home can choose the required sections of the care plans for each person. It is important that these are regularly reviewed and kept up-to-date to ensure that peoples changing needs are monitored and identified. Files seen had all been reviewed within the last month and that also included the risk assessments. Risk assessments seen covered areas such as moving and handling, pressure areas and mobility. Risk assessments are a way of identifying and managing risks within the home, in a way that ensures the least restriction and maximum opportunity for people to experience a full life. Staff were seen moving and transferring people in a way that preserved their dignity and also maintained the safety of both staff and people being supported. Three plans seen now include additional information on person centred care, which reflects the individuality of the people being cared for, their preferred routines and information on their lives before coming into the home. This has been a positive development which the manager confirmed will be extended across the client group. Discussion was held with a visiting district nurse during the course of the visit who indicated that the home referred people to her appropriately and that when instructions were left for the staff to manage a particular area of care it was dealt with appropriately. This helps to demonstrate that the home can support peoples healthcare needs appropriately. During the site visit an occupational therapist also visited the home to provide information and support for one person living there with an equipment and seating problem. Other equipment available at the home includes hoists, bath hoists, grab rails and a passenger lift to access all of the floors. Medication systems seen were satisfactory, with staff recording medication that is received into the home and given to people living at the home in accordance with a prescription. Medication is stored in a locked cupboard, and blister packs are used which are prepared by the pharmacist, which help to reduce any risks in medication being given out wrongly and ensure staff can easily assess medication remaining. One controlled medication tablet had been pushed out of the packaging and the manager agreed to discuss with the supplying pharmacist. Controlled medication is medication that is subject to particular security measures due to it’s strength or effects. The Care manager Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 16 confirmed that staff who administer medication have received training to do so. Staff who wrote in support of the home following the last inspection or completed questionnaires from this inspection made comments such as “In my experience the care given to residents is of an exceptionally high standard, far superior to many nursing and residential homes in Torbay”. Relatives who completed questionnaires said that if there is a decision to be made they always contact us make sure we see them on our visit. They would never make a decision without us however small. They are helpful and caring to both my mother and ourselves. They are extremely caring and are always looking to improve the quality of life of those in their care. Nothing is ever too much for them. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 17 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 opportunities to take part in activities and follow familiar patterns in their lives. 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: During the first site visit time was spent talking to the people who live at the home, and any visiting relatives. Time was also spent talking to the homes activities co-ordinator. For people with severe impairments and communication difficulties a two hour period of observation was undertaken, looking at how people spent their time and the quality of interaction with other people they received. Those people able to give a good account of the time at the home expressed the view that they were able to do as they wished within the usual routines of daily living. During the visit in the morning some people were taking part in a newspaper reading session, followed by games. After lunch people also had
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 18 the opportunity to participate in a crossword session. Some people choose not to participate in the activities provided, but stated this was their choice and that they enjoyed either spending time alone in their rooms. One person spoken to said that they really missed their dog who was being looked after by a relative, and discussion was held with the care manager and manager on facilitating access visits. The homes activities coordinator comes to the home three days a week, and as well as carrying out group work with more able clients she is also able to spend some one-to-one time with these people who are much more frail. Discussion was held with her on working with people who may be functioning only at a sensory level, and how she completes this work. Two relatives who completed questionnaires felt people with a high level of frailty would benefit from additional stimulation, and one other commented that their relative, who was very able, would benefit from more trips out. During the site visit, visitors were seen to be welcomed to the home. Discussion with one indicated that they feel free to visit at any time and regularly took their relative out for short periods of time. They felt that the home communicated well with them about their relatives needs and that their relative was happy with the care they received, although on occasions felt that they would benefit from being able to speak to other people who were more able. Another relative spoken to confirmed that their relative was being well cared for and that the homes staff were kind and considerate. Discussion was held with a visitor over the locked front door to the home. The owner has included information on restraint at the home in the statement of purpose, and is currently examining the homes position on locked doors in relation to recent legislation. Two hours were spent in the lounge/dining room using an observational tool, looking at how staff interacted with the more frail people living at the home and how much contact they had with the world around them. 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. Staff observed speaking to people were using their preferred form of address. They were giving them time to answer any questions they asked. People were being asked what they would like to drink or eat. Four different drinks were being offered during the period of observation, which shows that people are offered choices. People who commented said that the meals served were of a good quality and the meal being cooked and served on the day of the main site visit was Roast pork with fresh vegetables and mousse for dessert. People who did not wish to
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 19 eat meat had the vegetables only, which the care manager stated was their preference. People who require assistance with eating had their meals prepared in an attractive way. This helps to ensure that food is appetising and that people can differentiate between different tastes and textures. A relative who completed a questionnaire said the food is freshly cooked each day and care is taken to use fresh produce. Excellent. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 20 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 adequate. The arrangements for complaints management are satisfactory, ensuring people feel they are listened to. The procedure for dealing with and reporting abuse is satisfactory, ensuring people are adequately 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. The procedure needs minor attention to ensure it is up-to-date but 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 on the visit, including a visitor and people living at the home stated that they were clear about who they would go to if they had any concerns or worries about anything, and commented that if they did make any comments they were listened to and acted upon. The home has a complaints log indicating any issues brought to the managements attention. Discussion was held with the owner about a recent concern raised about cleanliness in a room, which had been recorded in the
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 21 daily update record, but not yet in this book. The concern had been attended to without delay. A relative who returned a question their indicated I have never had occasion to raise concerns but have sometimes questioned some aspects of my mothers illness and presentation and have always been given time, consideration and most satisfactory responses. Staff have received some training on adult protection and additional external training is being provided within the next few months for all staff. The home has a number of policies and procedures for adult protection, including a Whistle blowing policy, that is available for staff to access if they have concerns they feel they cannot raise with the management. Staff spoken to on the main site visit were clear about what they would do if they suspected abuse or abusive practice towards people living in the home. A high level of staff understanding about abuse is important in protecting people from poor care or abusive practice, particularly where people are very vulnerable. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 22 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, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. Arlington House provides a comfortable environment for people to live and work in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 23 There are attractive gardens and some private parking with good free on street parking close by. A tour was made of the most areas of the home on the first site visit and a second visit was made a few days later to look at four rooms not seen on the first visit. 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. 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 home has some rooms suitable for shared occupation, and screens are available to ensure a level of privacy can be maintained. Many rooms have en suite facilities. There is a laundry room to the lower ground floor which has been refurbished recently. 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 decor of the building is generally satisfactory and a number of areas requiring attention have been identified and are to be addressed. The manager confirmed that some areas requiring attention such as replacement of handles on cupboards and damage to the paper in a lower ground floor en-suite will be attended to when the maintenance man returns to work. Regular fire tests and drills are carried out and evidence was seen of this in the fire log book. People spoken to enjoyed their rooms and said they had comfortable beds and furnishings. One person requested a bedside lamp as they had broken theirs otherwise all spoken to felt they had sufficient light, heating and hot water available in their rooms. The majority of the home was clean and odour free, however a few bedrooms did have an odour associated with incontinence management. It is understood that the home tries to remedy this as it is important that people can live in comfortable, hygienic and pleasant surroundings.
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 24 Window openings have been restricted according to the manager, which means that the windows could not be opened wide enough for a person to fall through by accident. Two tested at random were restricted. Water temperatures are being regularly monitored to ensure people cannot be accidentally scalded by very hot water. Water tested at random was at a hand hot temperature. There are gardens to the front and rear of the home, and a roof garden with outdoor seating level to the first floor lounge. One lady said she enjoyed feeding the seagulls from her window. The homes care manager is completing an infection control audit system, which will ensure that any risks of cross infection are kept to a minimum. Specific infection control risks are identified and equipment provided. On the second visit some potentially infected dressings had been left in an unsealed clinical waste bag by a visiting nurse. The home would benefit from having an enclosed bin available in this area, and have asked visiting nurses to contact them when they have concluded their visit so that soiled dressings can be removed without delay. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 25 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 adequate. Staffing arrangements are satisfactory, but some attention was required to the recruitment procedures to ensure people living at the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Time on the first site visit was spent talking to the people working at the home and a sample of staff files were selected for examination. Files contained information on how staff had been employed and trained to do their jobs. In addition people living at the home commented on the people looking after them, as did people who completed questionnaires, and a district nurse who was visiting during the day. Staffing levels on the day of the site visit were appropriate for the number and needs of the people being accommodated, although as the cook was on holiday the care manager was preparing the meals. On the inspection site visit four staff files were selected at random to reflect the staff on duty that day. Files contained copies of application forms, evidence of identity and information on qualifications, but two of the files seen did not contain two written references. Other more recent files were seen to be complete. Evidence was not available in one file on a Criminal records bureau
Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 26 check as the record had been destroyed following previous inspections, but by the second visit the home had prepared a list of the reference numbers in relation to these which demonstrated that they had been undertaken appropriately. One person who had returned to work at the home only had a CRB in their file from the last time they worked at Arlington House in 2004. The manager confirmed that a new CRB had been applied for. References had been requested but had not been received. Criminal records bureau checks and other checks such as references help to ensure that the people living at Arlington House are being cared for by people who are suitable to work with vulnerable adults. Evidence was seen of the training undertaken by staff, and further training is planned in Dementia care. The care manager has compiled a schedule of training undertaken and needed for each staff member, including when training in core subjects was last given. This will help them in planning for the future. Staff spoken to on the Inspection site visit said they were proud of the work they were doing with the people living at the home, and had a good understanding of their needs and wishes. A member of staff spoken to said that it “made her day when a resident smiles”. Another who wrote in following the last inspection said “Manager-staff relations, communication, teamwork and training are all of a high standard. Each member of staff receives all the help they need to pursue their development goals”. People living at the home and people who completed questionnaires said that the staff in the home were really kind and helped them a lot. One staff member wrote I have worked in three nursing homes over the past 25 years (5 1/2 of which are at Arlington house) and consider the care provided to be excellent. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 27 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 adequate . The home is being well managed. Many new management systems are being provided, but are not yet fully completed or implemented. Further work is needed on the homes quality assurance systems. 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. She is supported by the care manager, who is currently completing her Registered Managers Award. 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.V343810.R01.S.doc Version 5.2 Page 28 Staff spoken to said they felt very supported to do their work and that the management of the home were open and approachable. The home has commenced a programme of supervision for care staff. Supervision is a system which combines performance management and observation with personal and professional development. It should help to ensure that staff are working consistently and to the best of their ability to support people living at the home. The care manager has undertaken a mentoring qualification which will support her in developing staff members full potential. Discussion was held on a quality assurance system for the home. Work is being undertaken by the manager and care manager on completing a full audit of the home’s compliance with the national Minimum Standards for care homes for older people. The home is also due to be re-inspected for the Investors in People award in the near future. There is not an currently an annual development plan and quality assurance report for the home but these systems will support the home in developing this, following the gathering of information from stakeholders about the operation of the home. A quality assurance system will help the home identify what is working well and what can be improved to benefit the people living there. A series of questionnaires are available to gather information from as many people as possible about how the home operates, and this will also be used to help gather additional perspectives on how what the home does impacts on the people who live there. Discussion was held with the owner on the health and safety policy and arrangements at the home. There is a comprehensive system of environmental risk assessments that have been undertaken. Discussion was held on legionella tests which the owner stated had been done and she was also confident that the home had been assessed for asbestos. Arrangements for food hygiene practices were in place, and discussion was also held on first aid, fire prevention and COSHH practices. The home has some training that is due for some staff in these areas and an assessment has been completed for this. There is currently no first aid risk assessment, but the home has the majority of staff having at least a basic first aid qualification, with senior staff having a higher qualification. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 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.V343810.R01.S.doc Version 5.2 Page 30 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 OP33 Regulation 24 Requirement A system for reviewing and improving the quality of care provided at the home must be implemented and maintained. A full recruitment process must be completed for each member of staff who commences work at the home, even if they have previously worked there, left and then re-started. Timescale for action 30/10/07 2. OP29 19 30/08/07 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 OP19 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. Consideration should be given on making the service user guide available in other formats to suit the needs of people who may consider entering the home, for example people with a visual impairment.
DS0000018317.V343810.R01.S.doc Version 5.2 Page 31 2. OP1 Arlington House 3. OP12 OP7 OP38 4. The manager should continue to develop the person centred element of the care plans and provide a personal and social history for as many people living at the home as possible. A first aid risk assessment should be provided to determine the level of first aid training required. Arlington House DS0000018317.V343810.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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