CARE HOMES FOR OLDER PEOPLE
Arlington House Kents Road Wellswood Torquay TQ1 2NN Lead Inspector
Judy Cooper Announced 28 June 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Arlington House Address Kents Road, Wellswood, Torquay, Devon, TQ1 2NN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 294477 01803 212255 Mr Edward Brian MannMrs Caroline Susan Mann Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 05/01/05 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 also necessitates using stairs. In terms of communal space, Arlington House has 2 large lounges, a dining room and a small library. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day. One resident relative’s written feedback form, as well as a letter from a relative was received prior to the inspection. Opportunity was taken, at the inspection, to tour the premises, examine records and policies and talk with the owners (one of whom was present throughout the inspection) and the home’s manager. Several of the residents were spoken with during the inspection as well as a visitor to the home, and staff on duty were also observed and spoken with, whilst in the course of undertaking their daily duties. What the service does well:
The home’s environment provides residents with a homely, comfortable, environment. The staff treat residents with respect and dignity and allow residents to make choices and therefore have as much control over their daily lives as is possible. Residents benefit from a good, wholesome and varied diet, where their dietary needs are known and appropriately provided for. Residents also benefit from a “community spirit” within the home and are encouraged and enabled to socialise with each other as desired. The result of this is that residents benefit from companionship with each other and are not isolated. The owners and manager run the home in an open and transparent manner which allows both staff and residents to gain an understanding of how the home operates and how residents’ needs will be met. Regular in-put from an employed home’s activities organiser ensures residents have the opportunity to participate in appropriate activities, including the sharing up current affairs such as the daily newspaper etc. The manager ensures that any agency member of staff the home uses, is made fully aware of the routines regarding the way the home runs and, importantly regarding all of residents individual care needs which sometimes residents could be unable to easily communicate. This has been achieved by the creation of an excellent, detailed folder, which contains such details and is made available to any agency staff member.
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 6 The owner and manager have created links with the Care Advocacy Service. This organisation provides a detailed information pack, which residents and/or their families have easy access to and which contains very useful information about what advocacy services may be beneficial to residents and how to best to access those services. What has improved since the last inspection? What they could do better:
A full recruitment procedure must be in place, and followed through, which includes the obtaining of two written references for each staff member employed at the home, to ensure that residents are fully protected by the appointment of suitable staff. An enhanced C.R.B disclosure must also be undertaken for each staff member working at the home for the same reasons. The owner must ensure that residents are protected from the risk of fire within the home by ensuring that the home’s fire precautions are in place and maintained as required. (An immediate requirement was given at this inspection in relation to one fire door that was seen as not being a close fit,
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 7 however the owner dealt with this situation immediately). A further immediate requirement was issued in respect of a door wedge being used by a resident to hold open a fire door. (Again, the owner dealt this with immediately and the wedge removed). 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. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 (6 is not applicable). The admission process is appropriately managed with residents’ needs explored and known prior to admission to the home. EVIDENCE: By looking at the records for a resident, who had recently been admitted to the home, it was noted that a full and detailed admission procedure was undertaken, which had ensured that Arlington House was an appropriate home for the resident. The resident was able to confirm that they had been made to feel very comfortable, both on admission and since, and that their needs were being well met. The home does not provide for intermediate care. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Some information has yet to be recorded in the residents’ care plans. Absence of this information could leave to staff being unaware of all the residents’ needs. Residents are treated with dignity and respect and their individuality and independence maintained as much as is possible. EVIDENCE: Some care plans do not yet contain all relevant details appertaining to providing for each individual resident’s care. The manager has commenced the process of upgrading the care plans and has included all necessary details in respect of more recently admitted residents. The care plans for longer stay residents still need to be upgraded to include all relevant details (such as social care needs) and therefore ensure that, staff caring for such residents are fully aware of all of their needs. The care plans had been regularly reviewed and did contain full details of any medical needs of the resident, as well as any visits made by District Nurses, G.P’s or any other health professionals. The staff maintain daily records in the form of a kardex and a communication book. These were seen to contain necessary details to ensure that information is passed on to staff on different shifts,
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 11 ensuring all staff are aware of the residents’ changing needs. However it was noted that some of this information is recorded in a manner that would not comply with the requirements of the Data Protection Act 1998. Although some residents are suffering from severe dementia it was pleasing to note that these residents presented well, wearing appropriate clean clothing, were spoken to respectfully and attempts were seen to be made by staff to ensure that individual choices were upheld. An agency staff member spoken with stated that she liked to work at the home because she felt residents’ rights to individuality and dignity were upheld “and that residents were always treated well, and spoken to with respect”. The owner is awaiting the delivery of an additional screen for a double room, which will ensure those residents that occupy this room have their privacy further protected. The manager and staff liaise with other professionals as required including District Nurses. The home had asked for some feed back from a visiting District Nurse as to the services they offer and it was pleasing to note the positive statements given by the nurse in relation to the care they had seen made available. The home’s medication systems were noted as being in order with the senior member of staff confirming that medication was being administered correctly, whilst the storage and recording of medications were also in order. The home’s pharmacist had visited the home a week ago and the report from that visit indicated that all was in order at that time. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. Residents enjoy a varied, yet peaceful life at the home, with visitors encouraged and welcomed. Choices are made available to residents regarding day to day living and staff take time, and put in effort in, to ensure that all residents enjoy a good quality of life. The home provides nutritious and varied meals. EVIDENCE: An activities organiser regularly undertakes activities with residents. On the day of inspection a discussion on current affairs was taking place, which was being enjoyed by all those participating. The manager maintains an excellent record of events that residents participate in and this evidenced that there was a variety of activities offered and that residents, regardless of ability, were enabled to take part in some recreational activity if desired. Outside entertainment is also brought in as desired, with a clothes party having been held in the home recently. The home operates an open visiting policy and the visitor’s book showed that the residents had many visitors at varying times throughout the day and residents stated that their visitors were able to visit at a time that suited, and were made welcome within the home. One visitor spoken to described Arlington House as “their second home”. Another relative stated “I feel very comfortable leaving my_____ in their care and I cannot praise them enough for the quality of life they give my ____”.
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 13 The routines within the home are flexible to ensure that residents can choose how they spend their time. One resident has been bought a pet bird by the home, which has given the resident great pleasure. Several had chosen to spend their time in the homes’ communal lounges whilst others had chosen to spend their time in their rooms. Several residents stated that they were well looked after and were happy living at the home. The home’s cook has been at the home for many years and was clearly fully aware of the residents’ individual needs, likes and dislikes. Discussion with her evidenced that she had a good awareness of the requirements of elderly people and that she had the delegated responsibility and knowledge to plan and deliver good quality meals. A letter received from a relative of a previous day care user at the home stated, “ Everything was always presented very nicely. The food and cleanliness was to our satisfaction. We found the staff really caring and helpful and always having a cheery smile and making a joke of many a serious situation”. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The home’s complaint procedure was clear and had been made individually available to each resident. The owner/manager has dealt appropriately with any complaint made (either through CSCI or internally) and has satisfactorily addressed any identified shortfall arising from the complaint investigations. There are appropriate adult protection policies which staff have easy access to and staff have now received adult protection training. Staff confirmed this had been of benefit to them and increased their understanding in this area. The owners and manager holds some monies, or makes purchases on behalf of some residents as agreed with the resident/their family, and there were detailed records of these etc in respect of these, ensuring that those residents that do use this service can be reassured that their monies/expenditures are being handled and kept appropriately and securely. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 Recent improvements/upgrading measures have helped ensure that Arlington House provides a comfortable, clean and warm environment. Residents’ safety was being compromised by the owner not fully maintaining some fire prevention measures within the home. EVIDENCE: Overall the home presented as comfortable, clean and welcoming. The tour of the building evidenced that the home has recently, and continues to, undertake an upgrading programme that is aimed at providing a good standard of accommodation throughout. Bedrooms have been personalised as desired and residents can bring in personal items with them if they wish to. The owner stated that the home would provide a suitable lock if requested by a resident, but they are not provided as standard on admission. (This is not recorded in the home’s statement of purpose). The lounge and dining areas are both spacious and well appointed.
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 16 The management maintains the day to day home’s fire precautions in line with the requirements of the local fire department, however it was noted during the inspection that a fire door was not fitting to the floor, leaving a gap which would be a high risk in the event of a fire. Also it was noted that a resident was using a fire wedge during the inspection. An immediate requirement notice was issued for both instances, and the owner did take immediate remedial action before the inspection ended. One room (24) in the home has a high window, which does not allow the resident to have a view out. The room has been occupied for several years by the same resident. The owner has agreed that when this situation changes, this room will no longer be used for resident occupancy. The home was clean, and there were infection control measures in place, which protects residents from the spread of any infections. Since the last inspection a hand wash facility has been installed in the laundry room to aid hygiene control. During the inspection I noted that the domestic working within the home, was doing a thorough job and was very willing to clean any area that required it, to ensure the home remained hygienic. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff are employed in sufficient numbers to meet the current resident groups’ needs. Increased staff training has allowed the staff the opportunity for further personal development and to increase their skills and awareness in caring for this resident group. Residents are currently not fully protected by the home’s recruitment polices as these do not currently include the obtaining of written references and enhanced C.R.B checks for all staff members. EVIDENCE: Staffing levels were seen to be in sufficient numbers to ensure that residents’ needs could be met during the day and night. Ancillary staff were also available to undertake laundry duties, as well as general housekeeping duties, which staff confirmed had helped free up some more time for them to spend with the residents. Residents spoken to said that they felt well looked after and that staff were always available if needed. Another comment was that staff were “very kind”. A relative reported the following “I have found the carers are all very kind and helpful”. It was pleasing to note, that the staff mix included two male carers which helps keep a balance of a mixed gender staff group working within the home. Training was well planned and supports the staff in providing for the varied needs of the residents with statutory training and other work related courses being made available including NVQ training.
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 18 The staff recruitment programme had not been completed to the required standard. Two written references were not available for all staff working within the home. Enhanced C.R.B checks had not been undertaken for all staff. The owner has recruited the services of some overseas staff. Full records were obtained from the employment agency involved, however enhanced C.R.B checks also need to be carried out for these staff members. One of these staff members was present during the inspection. It was noted that they interacted appropriately with the residents, and staff spoken with agreed that the appointment of these new staff members had helped the workload within the home and that they, and residents, valued them. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 The owners are fully committed and involved in the day to day running of the home supported by their manager, which ensures that residents’ best interests are maintained. Routine health and safety precautions are being maintained appropriately which helps protect residents from any undue risks to their personal safety. EVIDENCE: The home operates satisfactory internal quality monitoring systems with residents’ and their families feedback invited as part of the overall process. The manager also does quality audit checks at night and should be commended for this as this helps ensure the home operates well at all times. The home retained its “Investors In People” status last November, with the process involved in this helping the home to re-focus on what it needs to do to maintain a good service. This has ensured that practices within the home have been regularly reviewed and that the care provided is as residents and their relatives would expect/want.
Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 20 Routine health and safety issues are well managed within the home with the required records being made available, including fire training for staff and routine testing of fire awareness equipment. The home’s hot water supply was noted, at this inspection as being maintained to a regulated temperature. The owner has ensured that there has been a test carried out to minimise the risk of Legionella within the home, and so protect residents further. The majority of the home’s hot surfaces have now been protected throughout the home, with any outstanding to be done in the near future. The owner had a full health and safety audit carried out by an external qualified health and safety advisor. The home is acting upon the recommendations of this report, which will again ensure residents’ safety is maintained. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 3 x x x 2 Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 17 Requirement Timescale for action 28/08/05 2. OP19 23 3. Op19 23 The registered provider must ensure that there is a full recruitment procedure for all staff employed within the home. This must also include the obtaining of two written references and an enhanced C.R.B disclosure for each staff member employed. The use of a door wedge to hold 28/06/05 open any fire door within the home must cease immediatly. Discussion must be undertaken with the local fire and rescue department to ensure any means that is to be used to hold a fire door open is in accordance with current fire prevention legislation. All fire doors within the home 28/06/05 must be maintained as per the requirements of the local Fire and Rescue Service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 23 No. 1. 2. 3. Refer to Standard OP7 OP10 OP24 Good Practice Recommendations The manager should enlarge resident care plans to ensure that all aspects of a residents care is covered in each plan, including how residents social care needs will be met. The owners should follow up the order, that has recently been placed by the owners, to provide a screen for the double room which is shared by two residents. The owners should provide a suitable lock to residents bedroom doors if desired. The owner should state within the homes statement of purpose that such locks are not provided as standard within the home. The owners should continue to cover the few remaining radiators within the home that have not already been covered, and therefore ensure that residents are fully protected from sustaining a burn from a hot surface. The manager should ensure that any recorded information appertaining to the residents is recorded in accordance with the Data Protection Act 1998. The owners should carry out the recomendations contained in the report arising from the recent health and safety audit carried out in the home. 4. OP25 5. 6. OP37 OP38 Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Arlington House D54-D07 S18317 Arlington House V222140 280605 Stage 4.doc Version 1.30 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
