Inspection on 06/09/06 for Arlington House

This inspection was carried out on 6th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arlington House 25/02/10

Arlington House 23/06/08

Arlington House 24/07/07

Arlington House 08/03/07

Arlington House 29/11/05

Arlington House 28/06/05

Arlington House 05/01/05

Arlington House 23/08/04

Arlington House 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arlington House Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN Lead Inspector Judy Cooper Unannounced Inspection 10:00 6 September 2006 th 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.V292201.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.V292201.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 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 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.V292201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 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 1 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 Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place over two days. These were Wednesday 6th September 2006 between 10.00a.m. and 6.00 p.m. and Tuesday 26th September 2006 between 10.00a.m and 2.30p.m. Opportunity was taken to observe the general overall care given to current residents. The care provided for three residents and one day care client was also inspected in specific detail, from the time they were admitted/came to the home, which involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, examination of some records and policies, discussions with the two owners/registered manager, home’s care manager, residents (those who were able to converse) and staff on duty, as well as two visitors who were visiting the home, also formed part of this inspection, whilst staff on duty were observed, in the course of undertaking their daily duties. A visiting District Nurse was also spoken with, on the second day of the inspection, to obtain feedback as to how they felt the home is meeting the clinical needs of the residents. Other information about the home, including the receipt of several completed questionnaires from residents’ relatives, and in some cases residents themselves, as well as verbal feedback from outside professionals has provided additional information as to how the home performs. Further written feedback comments were also received from other professionals, as well as other interested parties that have contact with the home. All of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well: Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 6 The staff continue to treat residents with respect and dignity and allow residents to make choices, as far as they are able, and therefore enable them to have as much control over their daily lives as is possible. The staff remain skilled at managing residents with high dependency levels and challenging behaviour. Comments from visiting professionals include: “Skilled staff. Able to manage residents with dementia who are challenging with a high degree of competence and sensitivity”. “They cope very well with an extremely difficult client group”. Residents benefit from a good, wholesome and varied diet, where their dietary needs are well known and appropriately provided for by an experienced and long serving cook. 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 can benefit from companionship with each other and are not isolated, unless they choose their own company. The home’s employed activity organiser also encourages and supports a variety of regular social interactions within the home, including keeping residents up to date with current affairs which consequently ensures residents, that are able to be, continue to be aware of the world outside the care home. Residents are also enabled to participate in the regular outings made available, to local places of interest. The owners/registered manager and home’s care 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. The current owner/registered manager have owned and run Arlington House for thirty years and as such have a vast wealth of experience in caring for the client groups accommodated at the home. Either the owner/registered manager or the home’s care manager are on call at all times when not actually working within the home. This ensures that staff are always able to refer any concern to an experienced manager which ultimately helps ensure a good delivery of care for the residents. Arlington House achieved “Investors in People” Status in 1998 and they have since maintained the award been reassessed in 2001 and 2004 (due again in 2007). Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 7 This has helped the management focus on the requirements and training needs of the staff working within the home and so develop a service which should meet the staffs’ needs as well as the residents’ needs. What has improved since the last inspection? What they could do better: To ensure that all residents and any other interested parties have easy access to the home’ statement of purpose and service user guide they must be easily available within an area of the home which is available to residents, staff and relatives. For inspection purposes a copy of each resident’s contract should be available within the home, including any privately placed residents. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 8 The member of senior staff, undertaking a pre assessment visit to a prospective resident, should ensure that they personally record the needs of the prospective resident to ensure accuracy in the record of the visit. The home’s medication systems should be further reviewed so that the storage and administration of medication is undertaken in the most safe and efficient manner to ensure that residents remain best protected. Residents’ rights to privacy and dignity should be maintained at all times within the home. Residents that require feeding should be fed on an individual basis to ensure that each resident receives their meal in a timely manner, whilst it is still hot and appetising. Any form of restraint used (i.e. use of cot sides) must be 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 must be kept in the individual resident’s file at all times. To ensure residents remain protected the home’s complaint policy must be available to residents and all other interested parties at all times. The home must also maintain a record of any internal complaints made and of any action taken to resolve them. Additional external adult protection training must be made available to all staff and in particular new members of staff who have little experience of care work to ensure that staff are fully aware of how residents are to be protected from any form of abuse and to ensure that staff are aware of the different types of abuse. The owners should continue with their identified plan to fully upgrade the home and thereby provide good standard of accommodation throughout for all residents. All bedroom doors, and other communal areas of the home i.e. communal toilets, should always be numbered/signed in such a way as to allow residents with dementia to more easily identify their own room/or communal areas within the home. The owners must make arrangements to ensure that the home’s hot water temperature is regulated to a safe temperature (approximately 43degrees Centigrade) where residents have access to the hot water i.e. wash hand basins within residents’ rooms, communal bathrooms and toilets with sinks. This is to ensure residents will be protected against the risk of sustaining a scald. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 9 A suitable means of protecting residents from the risk of sustaining a burn from radiators should be provided, which also ensures residents can still exercise individual choice over the temperature within their room. Any sharp/dangerous tools must be stored in a safe place to prevent residents gaining access to such items and possibly injuring themselves. A regular audit of the home’s premises should be actioned to ensure any defects are noted immediately and remedial action then taken to make the home safe for the residents. The home’s cleaning programme should be reviewed to ensure it is undertaken on a priority needs basis, for example, to ensure that any bed bound resident’s room is cleaned early in the day and therefore provides a clean environment should the resident need to be seen by any outside visiting professional. Due to the high level of physical care that has to be delivered by care staff, antibacterial hand wash should be easily provided within the home at strategic points for staff and other visiting professionals. The registered manager and home’s care manager should ensure that any staff member employed to work as a night carer is experienced in care, even if newly employed at the home. This is to ensure that any night staff member, who has a high degree of responsibility, is fully aware of the specific care needs of the residents. To further protect residents any new care staff, awaiting the return of their Criminal Record Check, must work under supervision, having a named supervisor recorded on their staff file until the Criminal Record Check is returned and deemed to be satisfactory. This is to ensure that residents remain protected by the employment of suitable staff. The manager should also ensure that any written references submitted by any new member of staff are checked to assure their validity, which again ensures the protection of residents through the appointment of suitable staff. The owners should continue to make staff training available to allow the home to achieve its target of having 50 percent of the staff working at the home trained to NVQ level two in care to ensure residents are cared for by suitably trained and aware staff group. Specialist training must be made available in the specific areas of care that the home offers such as dementia care for the same reasons. The owners/manager should formalise an action plan, following the undertaking of their quality auditing and monitoring within the home, to ensure that any feedback received as to how others, including residents and their families, feel the home is running is used as an improvement tool. This is to ensure the home is run in the best interests of the residents. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 10 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.V292201.R01.S.doc Version 5.2 Page 11 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.V292201.R01.S.doc Version 5.2 Page 12 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 (6 is not applicable to this home) The quality in this outcome area is adequate. The admission process is mostly managed appropriately and residents and/or their next of kin/advocate are given the necessary information regarding the service prior to admission so that they can make an informed decision. EVIDENCE: Since the last inspection the home has admitted some new residents. One such resident’s admission process was looked at in detail, along with the details for two other residents who had been admitted within the past ten months. Two of these residents were spoken with during the inspection to ascertain their own thoughts as to the admission process and the subsequent care provided to them. They were able to confirm that they felt they received appropriate care and were quite comfortable at the home. From written details, within the home, it was possible to ascertain that the correct admission processes had in fact been undertaken. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 13 The home’s care manager had visited one of the residents prior to admission to the home, whilst the owner/manager had visited the second resident. The third resident was admitted from out of the county but it was pleasing to note that in depth and sufficient information had been obtained from the placing Social Services team to allow the management of the home to be aware of the prospective resident’s needs and allow the home to be able to offer a placement, confident that the home could meet the client’s needs. An assessment of need had been undertaken at this point from which a care plan had later been drawn up. However, regarding the second permanent resident whose admission process was looked at in detail, it was noted that the pre-assessment of need had not written up by the owner/manager who had made the initial visit, but had been completed at a later point by the home’s care manager using the verbal information she had been given by the owner. This could have led to some points being forgotten/omitted. Therefore the person undertaking the pre-admission visit should be the person to complete the appropriate pre-admission form at the time of the visit. Where possible the resident and/or their family/advocate had been invited to be as involved in the assessment process as possible as well as the subsequent care planning process, which was evidenced in one case in particular. During the inspection it was also noted that a future prospective client’s family was visiting the home with a view to placing their next of kin at Arlington House. The family stated that they had been invited to have a look around the home and had been made welcome by the owner, with the owner/manager fully explaining what services the home makes available, as well as the limits of care the home could provide. The family felt their initial impression of Arlington House was warm welcoming and inviting with a nice feel. The family also confirmed that the owner/manager was now going to visit their family member in the next few days to see if the placement at the home would be suitable. This further confirmed that the management do, if possible, undertake preadmission visits prior to a placement within the home. On the first day of inspection the home’s service user guide/ statement of purpose could not be located. It was however available on the second day of the inspection. The home does not provide intermediate care. Arlington House DS0000018317.V292201.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is adequate. Residents are looked after relatively well in respect of their health and personal care needs and their life style choices are respected. Medications were mostly well managed and securely stored. Residents’ privacy and dignity were not seen as being fully upheld in all instances. EVIDENCE: The care plans inspected related to the residents whose admission procedure was previously inspected. The care plans were again 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. Care plans are regularly reviewed with the residents and/or their families/advocate where possible, although it has to said that this is the exception rather than the rule due to the mental frailty of the residents and families not always wanting to be involved in this area. It was however noted that one of the residents, who was very frail, was in a hospital bed which had cot sides and which were being used. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 15 The use of the cot sides had been recently extended to protect the whole bed rather than just the top end. This was due to the fact that the resident had fallen out of bed twice within the week that the first day of the inspection took place (the home’s accident reporting was inspected and it was noted to be in order with both of these incidents fully recorded) and so consequently it was felt safer to extend the cot sides to their maximum capacity. However a risk assessment was not in place for the use of the cot sides and the District Nurse services had not been involved in any decision making regarding this matter. This could have placed the resident at risk if qualified professionals did not agree with the use of the cot sides. It was also noted that a further resident who also used cot sides had not had a risk assessment carried out on the use of the same to ensure the use was necessary and as risk free as possible. The home’s care manager took immediate remedial action when this was brought to her attention, and contacted the local District Nurse services to inform them of the home’s use of the cot sides and to seek their advice. (On the second day of the inspection appropriate risk assessments and recorded discussions with District Nurses were seen to be in place within the resident’s notes). Another resident currently uses a lap strap, whilst in her chair, to protect her from the risk of falling from her wheelchair and this was noted as having been discussed and agreed with the resident’s family as well as the District Nurses and was recorded appropriately. The manager and staff do usually routinely liaise with other professionals as required including District Nurses, community psychiatric nurses, G.P, s and care managers and the home’s records indicated this. Feedback comments form other professionals received included: “Skilled staff. Able to manage residents with dementia who are challenging with a high degree of competence and sensitivity”. “Patients always well cared for and calls to me appropriate”. “They cope very well with an extremely difficult client group”. In particular one of the residents (who is very frail), whose care was tracked as part of this inspection, was noted as being the subject of some concern when a red area was noted on the resident’s sacrum. The home’s care manager immediately notified the District Nurse who visited, undertook a full audit of the resident’s physical condition and sent out for an appropriate mattress etc. All of this was noted in the resident’s care plan and consequently the change to the resident’s care would be easily available to all staff. (On the second day of the inspection it was noted that an air mattress had now been provided). Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 16 Discussion took place as to how the staff are currently ensuring that the recommendations of a speech therapist are followed in regards to the same resident who is currently unable to swallow. It was noted that the resident has thickened food and drink. It was also noted that there was an up to date fluid chart, which detailed what liquids, had been taken during the day/night. Appropriate handling and lifting devices were in the building including two mobile hoists, slide sheets and lifting belt, the use of which was noted, on the second day of inspection, as being correct. The home’s owner/registered manager is a qualified moving and handling trainer and as such ensures that care staff are fully aware of the correct way to move and handle residents. The staff’s daily written records, appertaining to the residents were professional, concise and in-depth and provided a good understanding of what care had been needed/given throughout the day/night to each individual resident. Those residents, able to, verbally said that their feelings were positive about the care received, saying that they felt well looked after and that the staff treated them well and were very kind to them. Others were again noted as being treated by the staff with kindness and mostly with due regard for the maintenance of their dignity and rights to individuality. Such evidence that supported this was noting the gentle way that staff spoke to residents, taking into account their individual levels of mental and physical ability. However it was noted on one occasion that a staff member entered into a room, to give a resident their lunch, without first knocking. The home’ medication systems were inspected. The home’s pharmacist is due to undertake an inspection of the home’s medication systems later this month. The home’s care manager has undertaken a distance learning course in the safe handling of medications and currently oversees other staff who are designated to administer medication. However there is also a need to ensure that the supplying pharmacist provides back up training and awareness for these staff to ensure that the training remains correct and up to date, and therefore protects residents. On the second day of the inspection, the home’s care manager stated that the home had spoken with the supplying pharmacist who was able to offer relevant pharmacy training. A light was not available within the home’s medication cupboard, but the home’s care manager stated that no drugs are administered from this cupboard and it was only used to store medications. A photograph of each resident was not available on each resident’s individual medication records. Having a photograph of each resident does help ensure that all staff are fully aware of which resident corresponds to which name. As some residents are Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 17 very mentally confused within the home introducing such measures would further help prevent any mistake being made. A controlled drugs book was not seen at the inspection, as it had been stored away. The manager stated that this was because the home had not administered any controlled drugs for about three years. It was noted that the medicines being administered during the second day of the inspection were being do so correctly with the medication being taken to the resident and then time allowed to ensure the medication was taken. The home’s care manager was noted as overseeing a more junior member of staff to allow her to gain an understanding of correct way to administer medication. There was not a copy of all staffs’ signatures, or a list of all staff deemed qualified to dispense medication. Therefore it was not possible to independently identify which staff member had administered medication at any one time. Discussion took place with a visiting District Nurse on the second day of the inspection. She was able to confirm that the home’s care manager does liaise with the District Nurse team if she has any concerns, which had been the case that morning and she did feel felt that the home’s staff followed any clinical guidelines given to the best of their ability. Positively she was able to report that she had recently noticed some improvement in the home’s general environment and in the cleanliness of the home. On the second day of the inspection it was noted that a day care client, whose behaviour was proving disruptive for other residents at the home, had been put into an existing permanent resident’s bedroom for the day with a note, left on the table, telling the client to stay in the room until 4.30 p.m. when the resident would be going home. Although the manager stated that this had been a “one –off” due to the difficult behaviour it meant that the proper occupant of the room was unable to have the use of the room if desired. All the permanent resident’s personal belongings were openly displayed in the room, including ornaments etc. This was not an acceptable solution as it infringed on the privacy rights of the permanent resident, occupying the room for their own personal use and meant that the resident was not able to freely choose to go to her room if desired. (The owner did advise, following this inspection, that this practice would not occur again and only been undertaken as an emergency measure on that one day). Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 18 Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 19 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): 12,13,14,15, The quality in this outcome area is good. Residents enjoy a peaceful life at the home, with visitors encouraged and welcomed. Choices are made available to residents regarding their day to day living and these are respected and upheld by the management and staff. Regular, interesting activities are provided for the residents. The home provides nutritious and varied meals. EVIDENCE: It was noted that residents feel they can take advantage of the informality of the home’s routines and consequently choose how they spend their time. Residents, that were able to, confirmed that they could choose how they spent their time and that their visitors were able to visit whenever they wanted. During the inspection it was noted that some residents had chosen to remain in their own rooms whilst others were socialising together in one of the home’s two lounges (the more frail residents were mostly noted as being in the lower ground floor lounge, with the more able residents in the first floor lounge). This appeared to be the case on both days of the inspection. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 20 During the inspection it was noted that several of the residents were enjoying an activity session provided by the home’s very able and understanding activities organiser in the home’s ground floor lounge. The activities organiser was in the process of reading the day’s newspaper to the residents and discussions were ensuing as to various current affairs. These sessions last for approximately two/three hours and also involve such things as reminiscence, poetry, music and such sessions are carried out three times a week. They were popular and were very much enjoyed by those taking part. One visitor stated that they were unaware of what activities were available for the more mentally frail residents, whom, she felt, sat mostly in the lower ground floor lounge with the television on. Discussions with the owner confirmed that the owner had recognised that more activities could be provided for the more mentally frail and, as such, she was in the process of looking at recruiting a support worker to work specifically with the these more mentally frail residents and provide some additional form of activity. An example of how staff manage diversity to good effect was evidenced in the care provided for a resident whose condition means that they have very specific needs, both socially, emotionally and physically. These needs were met very well and it is to the management and staff’s credit that someone with such diverse needs could state that they: “feel comfortable and well looked after and felt at home at Arlington House”. It was also noted that their very individual lifestyle was understood, met and that the resident remained treated with respect. A second resident whose care was case tracked confirmed they were happy at the home and liked the staff and the food. Comments from her relative also confirmed that the relative felt good care was being given. A comment received in relation to this stated: “ Thank you for your continuing care of my Mother. Your team have has managed to contain her during her crises and restore her to a greater level of acceptance and peace of mind”. Visitors are welcomed and encouraged and the home’s visitor’s book evidenced many visits from many people at differing times. The home’s cook has been at the home for many years (twenty-seven) 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. She has full control over the ordering and preparation of meals within the home. It was pleasing to note that any meals that may need liquidised are done so in a way that ensures they remain visually pleasing and appetising. Discussion with the cook 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.V292201.R01.S.doc Version 5.2 Page 21 The meal on the first day of inspection was roast pork and all the trimmings, followed by strawberry blancmange and on the second day beef stew and jelly and cream. There is always a vegetarian choice and other personal likes are also catered for. One day a week the cook works from 8.00 a.m. until 5.00p.m to allow her time to plan and prepare fully. Other days she works 8.00a.m until 2.00p.m. On her days off the home ensures there is a substitute cook available. It was noted that a few residents have to be fed and this took place in the main dining area but away from the main tables. One care staff member stated that she was usually responsible for feeding two residents at the same time. Although this appeared to be manageable it was noted that one resident, who needed feeding had quite a lot of lunch still to eat when the others had finished as the staff member had been attending to the other resident she had to feed who needed help. This was also the case on the second day of the inspection. Another resident was being fed in their own room, but it was noted that this was quite some time after other residents in the dining room had finished their main meal. This was discussed with the home’s care manager who confirmed that the meal, given on the first day of the inspection, had arrived later than would normally be expected. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 22 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): 16,18 The quality in this outcome area is adequate. The home’s complaint policy was is in order. Arrangements for protecting residents and responding to their concerns are reasonably satisfactory, although the home does not have a formal record of any internal complaints made or of action taken to resolve them. EVIDENCE: The home’s complaint procedure is contained within the home’s statement of purpose. During the first day of the inspection this was not available neither was the home’s complaint procedure displayed communally on the first day of the inspection. Therefore residents and any other interested parties would not have been aware of how to make a complaint should they need to. (On the second day of the inspection both documents were noted as available and noted as being in order). The home has not received any formal complaints since the last inspection carried out in November 2006, although there was a routine vulnerable adults investigation carried out following a fall sustained by a resident. All the correct procedures were carried out and the management of the home kept the Commission fully informed as to how the investigation proceeded. The investigation was concluded with no further action being taken. The resident concerned is now back at the home and stated that she was very happy to be at Arlington Court and that “they looked after her well”. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 23 The home does not have a formal record of any internal complaints made and of any subsequent action taken to address the issues therefore it is not possible to confirm that correct action has been taken when or if any complaints have been raised. The home’s care manager currently provides “in house” training in vulnerable adults but it would be good practice for staff to also receive this training from an external training provider to ensure that they are fully aware of the most recent developments in this important area of resident protection. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 24 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): 19,26 The quality in this outcome area is poor. Although some recent improvements/upgrading measures have allowed Arlington House to provide some comfortable, well appointed bedrooms and an overall clean and warm environment, further upgrading needs to be completed to allow all residents to benefit from this upgrading programme. Residents safety is being compromised by the owners not having regulated the hot water to a safe temperature that services individual residents’ hand wash basins or where full body immersion takes place i.e. baths. EVIDENCE: The home presented mostly as comfortable and welcoming. The tour of the building evidenced that the owners are continuing to undertake an upgrading programme that is aimed at eventually providing a good standard of accommodation throughout (since the last inspection some redecoration and some further new carpets have been provided in residents’ bedrooms). Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 25 The owners employs a maintenance member of staff three days a week to help ensure any routine repairs etc can be addressed quickly and during the inspection it was noted that he was in the process of re-decorating a resident’s room. (On the second day it was noted that this was completed and had since been occupied by a short stay resident). 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. The lounge and dining areas are both spacious and reasonably well appointed, (during the first day of inspection when one very soiled chair was identified to the owner a replacement chair was found immediately). The management maintains the day to day home’s fire precautions in line with the requirements of the local fire department and the fire log book was inspected which confirmed this. The fire officer’s last visit was in February this year to conduct a fire safety audit, however the findings of this were unavailable at the time of the second day of inspection. One room (24) 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) and this particular resident has very limited sight and would therefore not benefit from a window with a view out. However the owner has agreed that when this situation changes, this room will no longer be used for resident occupancy. The home was mostly clean however there have been some fairly recent concerns raised with this Commission, regarding the general cleanliness/presentation of the home, from outside professionals. However a visiting professional, on the second day of the inspection, confirmed that environmental standards had recently improved and it was noted that there was a cleaner working hard throughout the mornings of the inspection, although a visiting professional did have occasion to have to mention that a sink, situated in an en-suite toilet of a resident the professional was providing treatment to, could not be used as it was presenting as dirty. The visiting outside professional mentioned it to the manager and it was noted as being clean later that day. During the inspection it was noted that the home’s hot water supply was not regulated throughout the home, providing very hot water, even to communal baths. This was discussed with the owner who was able to evidence that the home’s water had been checked in August this year. Subsequently the owner telephoned the company, in question, who visited the home the day following the first day of the inspection. However it should be stated that the water temperature had not been checked or reported as being hot until the first day of the inspection (6th September) and the company undertook their service visit in early August. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 26 This could inadvertently have put residents at risk of scalding. The registered manager contacted the Commission in between the two days of the inspection and confirmed that the water regulation they had had previously in place was no longer deemed to be suitable and that hot water regulating valves would need to be fitted throughout the home to fully protect residents. This will have significant cost implications and although it will be undertaken it will take time. Consequently a six month time limit has been given in respect of this. In the meantime the home’s care manger has undertaken risk assessments for each room/resident and has made the staff aware of the potential risks of scalding. She is currently awaiting the delivery of water thermometers to allow the staff to accurately record the water temperature before a resident takes a bath. On the first day of inspection not all radiators, that pose a risk to residents were covered or provided with a low surface temperature. In the new build part of the home there are heated towel rails installed. However the owners gave an assurance that these were not used and on the second day of inspection the owner confirmed that they had all been checked and this was indeed the case. Some radiators were noted as having had their temperature control taken way to disable them and therefore protect residents from inadvertently turning them on high. This unfortunately had had the effect of leaving a sharp point at the base of the radiator, which a resident may catch, their ankle on. The owner stated that they would obtain stoppers for these to protect residents. On the second day of the inspection it was noted that the owners had minimised the risk of residents turning up the radiator temperatures and therefore making the surface of the radiator very hot, by boxing in the temperature controls of those radiators not yet covered. The effect of this is, although residents cannot access the temperature controls, they cannot choose the temperature within their room as the controls have been set and then boxed in and to change the temperature or turn the heating off entails some one unscrewing the box surrounding the thermostat and altering the temperature. Therefore, although the risk of residents sustaining a burn has been minimised resident choice, as to what temperature they would wish their room to be, at has been compromised, as residents are easily not able to access their thermostat. The manager did state that the majority of the home’s current residents would not be able to alter the thermostats unaided. However, should a new resident be admitted, or any other resident currently living at the home have the mental capability to understand how to control the temperature in their own room, this choice would not be available. Some window restrictors were noted as not being in place on the first day of the inspection, however these were back in place on the second day of the inspection. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 27 Two carpets within residents’ rooms that were noted as being trip hazards. One was immediately replaced, following the first day of inspection, and the new one was seen in place on the second day of the inspection. The resident in whose room it was, was delighted with the new carpet. The second carpet was re-glued and the risk of tripping was consequently removed. The home’s laundry room floor was noted, on the first day of inspection, as being worn and not providing an impervious covering, however this was also upgraded to the required standard during the days between the two days of inspection. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 28 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): 27,28,29,30 The quality in this outcome area is adequate. Staff at the home are employed in adequate numbers to meet the residents’ needs. Residents may be at risk by the manager having employed an inexperienced care staff to work in a role that requires an experienced member of staff. The home’s recruitment programme is still not fully protecting residents. Residents are not being cared for by the required complement of NVQ trained staff or by staff who have received specialist training in dementia. EVIDENCE: On the first day of the inspection there were twenty-six residents in the home and on the second twenty-four. There was also an additional day care client on each day of the inspection, day care provision varies from day to day. The home also makes available one respite bed and as such has been able to offer a number of respite placements to different short stay residents. Staffing levels were inspected and it was noted that there is sufficient staff on duty to care for the residents. There has been a high turn over of staff in the past six months with several employed overseas staff having recently left (only one remains). Their posts have been filled with local workers and the home is currently rebuilding its staff team. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 29 In doing so though the management have employed some new staff who have little, if any, previous experience in care. Although a general one days induction training day had been undertaken by these staff, a further recognised in-depth induction course, leading to each staff member being fully aware of their caring role, had not yet been commenced. Further out of the current staff group only two staff members have achieved an NVQ qualification in care, although several others have been identified, or are in the process of undertaking this training. Therefore currently the home does not meet the requirement of having 50 of trained staff (to at least NVQ level 2 in care) working with the residents. However, several of the new staff members are keen to undertake the NVQ training in care and it was noted that the NVQ assessor was in the home during the first and second day of the inspection. It was particularly pleasing to note that one staff member was being given extra necessary assistance to allow them to undertake the NVQ level 3 in care award. It is to the home’s credit that diversity needs are also recognised and met amongst the staff group. Specialist training in such areas, as dementia care has also not been regularly provided, although some statutory “in-house” training has been provided. This has included fire awareness training, moving and handling, medication training and “no Secrets” training. On the second day of the inspection the home’s care manager was able to evidence that the home are addressing the qualification/staff training shortfall identified and has since instigated an individual staff training plan for each staff member within the home which highlighted areas of training that needed to be undertaken. Residents, that were verbally able to, confirmed that the staff cared for them well and are available as required, as did both the relative and advocate of two residents spoken to during the inspection. Since the last inspection the home has experienced a relatively high degree of staff changes, but it is to the owner’s credit that the current staff members spoken with stated that they felt comfortable and supported and enjoyed their job. The management of the home were seen to be in the process of recruiting staff during the first day of the inspection. The home’s care manager explained that the home’s current recruitment process is to invite a prospective care assistant to the home, have chat with them, ask them to fill in the application form and if they are considered to be suitable then references are sent for. An enhanced CRB check is also applied for. The records for five recently appointed staff members were inspected. It was noted that although there were two references for each staff member some were telephone references as the appointments were very recent. Written references had been applied for. In one case, the member of staff had supplied previously written references. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 30 These had not been validated at the first day of inspection, but the manager stated that they had subsequently been before the second day of the inspection. Enhanced CRB checks, although applied for, were not back in three cases. Two of these staff members were already working at night as the second waking night staff member, which obviously involves undertaking all aspects of personal care. A named supervisor had not been identified for each staff member. By the second day of the inspection the inexperienced night carer had been moved onto a day shift (and was seen working whilst the inspection took place) and the home’s care manager confirmed that the home would now only employ any inexperienced night staff after a six week induction period on days to ensure they were familiar with the residents’ needs. The third staff new member was working as a cleaner but was not involved in personal care. Supervision is provided for all staff members, which was seen to be of a good standard. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 31 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): 31,33,35,38 The quality in this outcome area is adequate. The home is mostly managed well, with the owner/registered manager being easily available and approachable. Some aspects of routine health and safety, within the home, compromises residents’ safety. EVIDENCE: One of the owners, Mrs Mann, has recently been successful in becoming the registered manager at Arlington House. Mrs Mann has many years experience in the running of the home having owned and run the home for thirty years. In turn the home’s care manager supports her. Records inspected were mostly in order, however as already stated some polices and procedures were missing on the first day of the inspection. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 32 The residents or the residents’ families/advocates deal with any financial matter and the home’s care manager confirmed that the home has no dealings whatsoever with residents’ finances. The management have recently introduced a resident and family meeting and one took place two months ago, which was valued by those that attended. There was some excellent feed back received from this meeting which stated: “ I would like to thank you for giving the residents present an opportunity to gain insight into the running of the home and for us to express any concerns we may have”. The home achieved “Investors in People” in 1998 and has maintained the award since, having been reassessed three yearly to ensure the necessary standards remain in place. There is some quality auditing that takes place within the home including staff and relative feedback questionnaires, in house meetings (for relatives and residents), resident and staff meetings and a regular audit is undertaken by the home’s care manager in relation to the supply and preparation of food and the general day to day running of the home. From records seen it was evident that the home’s care manger fully understood the requirements of a quality auditing system within the home, however the findings of the audits undertaken had not yet been formally documented and consequently it was difficult to see how the identified shortfalls or ideas for improvement were being addressed. There was a business plan for 2006/2007, which did take into account, identified shortfalls within the home such as some environmental standards (which have already been addressed under environment) and the owner had also identified realistic timescales that these could be addressed within. The home complies with the requirements of the local fire and rescue service and the local Environmental Agency’s last inspection was on the 23/05/05 when six requirements were identified which the manager stated had now been addressed. Other routine health and safety measures are in place such as the testing for Legionella, maintaining the lift and other equipment and maintaining fire precautions as required. Residents’ health and safety is not being fully provided for due to the previously identified shortfall of no hot water regulation within the home. Also it was noted that a large saw was being stored in an unlocked cupboard, within the home’s main hallway, which was easily accessible to residents and could prove a health hazard if a confused resident had got access to it. The home’s care manager immediately removed it when it was reported to her. Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 33 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 34 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 OP1 Regulation 4 Timescale for action The owner/manager must ensure 03/10/06 that there is a service user guide and the home’s statement of purpose easily available within the home at all times for any interested parties to refer to. Any use of restraint measures 03/10/06 such as cot sides must be risk assessed and advise sought as to the use of such restraint from other relevant professionals. The owner/manager must ensure 27/09/06 that a resident’s right to privacy and dignity is upheld at all times. Residents’ room must not be used for any other purpose than to accommodate the resident to whom the room has been allocated. The owner/manager must ensure 03/10/06 that the home’s complaint procedure is displayed and available at all times. The home must maintain a record of any internal complaints made and of any action taken to resolve them. Additional external adult DS0000018317.V292201.R01.S.doc Requirement 2 OP7 13 3 OP10 12 4 OP16 22 5 OP18 13 26/12/06 Version 5.2 Page 35 Arlington House 6 OP25 13 7 OP29 19 protection training should be made available to all staff and in particular new members of staff who have little experience of care work. The owner/manager must ensure 26/03/07 that all full body immersion facilities and residents’ hand basins within the home, are provided with hot water regulated to 43 degrees Centigrade. The owner/manager must ensure 26/10/06 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. (Previous requirement 12/12/05) The registered person must 03/01/07 ensure that suitable staff training is made available, including the provision of specialist training for the categories of residents that the home provides care for. Any sharp/dangerous tools must 03/10/06 be stored in a safe, secure place to prevent residents gaining access to such items and possibly injuring themselves. 8 OP30 18 9 OP38 13 Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 36 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 OP2 Good Practice Recommendations For inspection purposes a copy of each resident’s contract should be available within the home, including those privately placed residents. The member of staff undertaking a pre assessment visit to a prospective resident should ensure that they personally record the needs of the prospective resident to ensure accuracy of the record of the visit. The home’s supplying pharmacist should be requested to provide additional training to those staff involved in the administration of medication within the home. The home’s medication systems should be reviewed to ensure that the administration of medication continues to fully protect residents. The registered owner should ensure that the means of protecting hot surfaces, within residents’ bedrooms, does not compromise residents’ right to choice regarding being able to choose the temperature desired. Residents that require feeding should be fed on an individual basis. 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. All bedroom doors, and other communal areas of the home i.e. communal toilets, should always be numbered/signed in such a way as to allow residents with dementia to more easily identify their own room and other areas. The home’s cleaning programme should be undertaken in a needs led manner, based on resident need. Due to the high level of physical care that has to be delivered by care staff, antibacterial hand wash should be easily available within the home, for staff and other caring DS0000018317.V292201.R01.S.doc Version 5.2 Page 37 2 OP3 3 OP9 4 OP14 5 6 OP15 OP19 7 OP19 8 OP26 Arlington House professionals, at strategic points. 9 OP27 The registered manager and home’s care manager should ensure that any staff member employed to work as a night carer is experienced in care, even if new to the home. The manager should ensure that any written references submitted by any new member of staff are checked to assure their validity. The owner/manager should ensure that 50 of the staff employed have been trained to NVQ level 2 or above within the next twelve months. A regular audit of the home’s premises should be undertaken to ensure any defects are noted immediately and remedial action taken to make the home safe for the residents. The owner/manager should also formalise an action plan following the undertaking of the quality auditing and monitoring within the home, to ensure that any feedback received as to how others, including residents and their families, feel the home is running is used as an improvement tool. 10 11 OP29 OP30 12 OP33 Arlington House DS0000018317.V292201.R01.S.doc Version 5.2 Page 38 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.V292201.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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