CARE HOMES FOR OLDER PEOPLE
Arlington House Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN Lead Inspector
Judy Cooper Unannounced Inspection 29th November 2005 2.00p. 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.V251508.R01.S.doc Version 5.0 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.V251508.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Arlington House Address Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN 01803 294477 01803 212255 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 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 DS0000018317.V251508.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28/06/05 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 necessitates using stairs. In terms of communal space, Arlington House has 2 large lounges, a dining room and a small library area. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Tuesday, commencing at 2.00p.m and finishing at 5.00p.m. Opportunity was taken to tour the premises, examine some records and policies and talk with the home’s owner and manager (non registered), residents and staff, as well as three visitors to the home and a visiting District Nurse and Care Manager. Staff on duty were also observed, whilst in the course of undertaking their daily duties. The majority of the required core standards were inspected at the last inspection in June 2005. Therefore those inspected on this occasion concentrated on resident welfare on a day to day basis, as well as looking at what progress had been made regarding the few shortfalls identified at the last inspection. The two core standards that had not been inspected at the previous inspection were also inspected on this occasion. What the service does well:
The home’s environment continues to provide residents with a homely, comfortable, environment. The staff continue to treat residents with respect and dignity and allow residents to make choices and therefore continue to have as much control over their daily lives as is possible. Residents again 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 continue to 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 are to be met. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 6 Regular in-put from an employed home’s activities organiser continues and ensures residents have the opportunity to participate in appropriate activities, including the sharing of current affairs such as the daily newspaper etc. The manager continues to ensure 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 may 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. What has improved since the last inspection?
An extra carer has been employed to provide residents with the opportunity to regularly go out on supported visits away from the home i.e. shopping, visiting the local pub etc. Residents stated that they had valued these opportunities. The homes’ recruitment programme has improved with the manager obtaining two references prior to a staff member commencing work, which helps protect residents further. The exterior of the home has been re painted and further upgrading continues within the home. The result is that the home looks and feels very pleasant and comfortable and provides residents with a pleasing environment to live in. The home’s fire precautions have been enhanced to ensure that resident safety is not compromised. Residents care plans have been further enlarged to include the residents’ social care needs. Recording within the home is now in accordance with the Data Protection Act and ensures information held about residents is undertaken in such a way that all individual residents details are held separately, therefore ensuring that confidentiality is upheld. The owners are using the findings from the recent health and safety audit they had commissioned last year, to ensure that the home is maintained in a safe manner for the residents, so that their health and safety needs are provided for. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 7 Residents’ privacy requirements have been further enhanced by the owners making it known, within the home’s statement of purpose, that they will provide a suitable lock to a resident’s bedroom door if requested. Screens have also been provided for the two double rooms, which further enhances the privacy of the residents in these shared rooms. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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.V251508.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The admission process remains appropriately managed with residents’ needs explored and known prior to admission to the home. EVIDENCE: By looking at the records for two residents, who have recently been admitted to the home, (one under a planned emergency admission) it was noted that a full and detailed admission procedure was undertaken, even when time was of the essence, which had ensured that Arlington House was an appropriate home for the residents. One of the residents, for whom records were inspected, was able to fully confirm that she had been made to feel comfortable, both on admission and since, whilst the other resident was able to say that she had felt well looked after at the home. The home does not provide for intermediate care. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 the following standard(s): 4,8,10 Residents’ health and personal care needs are very well documented, known and met. Residents are treated with dignity and respect and their individuality and independence maintained. EVIDENCE: Two care plans were inspected which related to the two residents whose admission procedures were previously inspected. The care plans were very concise and detailed and contained all relevant information appertaining to providing for the individual residents care, including any medical needs of the resident, as well as any visits made by District Nurses, G.P’s or any other health professionals. The care plans had been regularly reviewed with the resident. The manager puts a lot of effort into ensuring the plans are as required and she should be commended for the professional and in-depth documents these have now become. The manager and staff liaise with other professionals as required and, during this inspection a District Nurse was asked for feedback and was able to say that the staff care appropriately for the patients she had contact with at the
Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 11 home. A visiting care manager was also asked for feedback and was able to inform that the manager was always very helpful and the resident she visited at Arlington House said they were very happy living at the home. All necessary handling and lifting equipment was noted as having been being provided. Resident feedback was very positive about the care received, with residents saying that they felt well looked after and that the staff treated them well and were very kind to them. The two visitors spoken with also stated that they found this to be the case. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 the following standard(s): 12,15 Residents continue to 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 continues to provide nutritious and varied meals. EVIDENCE: An activities organiser continues to regularly undertake activities with residents. The owner has increased staff hours to allow residents the opportunity to go out of the home on an individual basis and undertake such activities as shopping, going to the local pub etc. A resident stated how much this had meant to them and how they had enjoyed a visit to the local pub. Outside entertainment is also brought in as desired. The home operates an open visiting policy and the visitor’s book showed that the residents continue to have many visitors at varying times throughout the day and residents confirmed that their visitors were able to visit at a time that suited, and were made welcome within the home. Two visitors spoken with also confirmed this to be the case saying they were always welcomed and that the staff were very helpful generally regarding any request they may make.
Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 13 The routines within the home are flexible to ensure that residents can choose how they spend their time. Two residents have been able to have a pet bird in their room, which has given both great pleasure. Several residents had again 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 very happy living at the home. The home’s cook has been at the home for many years and again was available to discuss the home’s menus with. She was able to fully demonstrate that she was aware of the residents’ individual needs, likes and dislikes. Discussion with her again 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. Residents also confirmed that they enjoyed their meals. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 the following standard(s): None of these standards were inspected on this occasion. EVIDENCE: Although none of these standards were inspected, it should be noted that the home has not received any complaints, either internally or by the CSCI, since the last inspection undertaken in June this year. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 the following standard(s): Recent improvements/upgrading measures continue to ensure that Arlington House provides a comfortable, safe, clean and warm environment. EVIDENCE: 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 (since the last inspection the exterior of the home has been completely repainted and some further new carpets laid in residents’ bedrooms). The owners also employ a maintenance member of staff three days a week to help ensure any routine repairs etc can be addressed immediately. Bedrooms have been personalised as desired and residents can bring in personal items with them if they wish to. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 16 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 now recorded in the home’s statement of purpose). The lounge and dining areas are both spacious and well appointed. The management maintains the day to day home’s fire precautions in line with the requirements of the local fire department, and action taken by the owners following the last inspection has resulted in the home complying with the requirements of the local fire department which consequently helps ensure residents are protected from the risk of fire. One room (24) in the home has a high window, which does not allow the resident to have a view out. The room continues to be occupied by the same resident (and has been for several years). The owner has agreed that when this situation changes, this room will no longer be used for resident occupancy. The home was again clean and odour free, and there were infection control measures in place, which helps protect residents from the spread of any infections. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 Staff are employed in sufficient numbers to meet the current resident groups’ needs. The required ratio of 50 of trained staff employed at the home is currently not being met due to a recent turnover of staff within the home. The home’s recruitment programme needs to ensure that it fully protects residents, by ensuring that a senior member of staff is appointed to act as a supervisor for those members of staff for the owner has not yet received their CRB disclosures back. EVIDENCE: Staffing levels were noted as being in sufficient numbers to ensure that residents’ needs could be met. Since the last inspection the staffing levels have been increased by one carer, three to four mornings a week to allow residents the opportunity to have some individual time out with a staff member. The current numbers of residents in the home is twenty five, which the owners consider to be their optimum numbers. Residents spoken to stated that they felt well looked after and that staff were “very kind”. Enhanced C.R.B checks and/ POVA checks, although applied for, had not yet been received back for seven members of staff (including four overseas staff) currently working at the home, and a named supervisor had not yet been allocated for these staff members whilst awaiting the return of the disclosure. It was pleasing to note, that the staff group included two male carers, which helps keep a balance of a mixed gender staff group working within the home
Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 18 and that the staff spoken with felt there was a good staff team generally within the home which helped support each other in their roles. Training provision is in the process of being addressed to ensure that the required number of trained staff is made available within the home. Currently there are two staff members with NVQ level 3 in care and a further two undertaking NVQ level 3 in care and another is due to commence the award imminently. Other, newly appointed staff members, are due to commence the NVQ level 2 in care, in January 2006. When these staff members have completed their various awards the home will then have the required 50 of suitably qualified staff working within the home. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 The owners remain fully committed and involved in the day to day running of the home supported by their manager (non registered), 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 owner/manager, Mrs Mann, qualified as a Registered General Nurse, however her registration is no longer current, as she allowed the registration to lapse. Mrs Mann also holds the NVQ assessors award D32/33 and is a qualified moving and handling instructor. Ms Swann, the home’s non-registered manager is currently undertaking her Registered Manager’s Award, which also incorporates the NVQ level 4 care award. Ms Swann already holds the NVQ level 2 and 3 care awards as well as the advanced First Aid certificate. It is the
Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 20 owner’s intention to put forward Ms Swann’s application to become the registered manager of the home after she has obtained the Registered Managers Award. The owners have now almost completed the planned covering of the home’s hot surfaces. A few remain non covered, however these are radiators that are either not used or are protected by furniture etc. The owner is to undertake a written risk assessment of these hot surfaces, to ensure that residents’ health and safety is not compromised in any way by not providing covers. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 2 Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement The registered owner must ensure that an enhanced disclosure/POVA check from the Criminal Records Bureau has been requested, before a staff member commences work with residents. If the enhanced CRB check has not been returned, when the staff member is due to commence work, but all other required documentation has been obtained as per Schedule 2 of the Care Home Regulations, a senior staff member must be appointed to act as a supervisor for the staff member concerned, until the disclosure is received back. Timescale for action 12/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 23 1 1 OP30 OP38 The registered owners should ensure that 50 of the staff employed have been trained to NVQ level 2 or above within the next twelve months. The registered provider should undertake a risk assessment, in relation to the few radiators that have not yet been protected, and ensure that if there is any risk of a resident sustaining a burn, suitable precautions are taken to minimise the risk. Arlington House DS0000018317.V251508.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office 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 DS0000018317.V251508.R01.S.doc Version 5.0 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!
