Inspection on 08/03/07 for Arlington House

This inspection was carried out on 8th March 2007.

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 06/09/06

Arlington House 29/11/05

Arlington House 28/06/05

Arlington House 05/01/05

Arlington House 23/08/04

Arlington House 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 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 8th March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Arlington House DS0000018317.V334711.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.V334711.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 mannchann61@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Edward Brian Mann Mrs Caroline Susan Mann Mrs Caroline Susan Mann Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This care home service can provide care for thirty elderly people over the age of 65 who may also have dementia and/or a physical disability. 06/09/06 Date of last inspection Brief Description of the Service: Arlington House Care Home offers accommodation with personal care to older people (65 ), older people with physical disability and older people with dementia. The building itself is a large detached property located in the Wellswood area of Torquay. It is close to local shops and amenities and a short bus ride from the town centre. The home is registered to provide care for up to 30 residents both male and female. Accommodation is provided over 3 levels with the home having a passenger lift and a stair lift as well as a range of other aids and adaptations to support those with mobility problems. With regard to residents bedrooms, the home has 20 single bedrooms, (11 of which have en suite facilities) and 5 double bedrooms (all of which have en suite facilities). A few of the bedrooms require the resident to be mobile as access necessitates using stairs. In terms of communal space, Arlington House has one large lounge, a second lounge area and a dining room as well as a small library area. The weekly fees charged range between £280 and £400.00. The owner will make the home’s inspection report available if requested. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection consisted of three site visits, which were undertaken on the 8th March and the 11th and 12th April. A CSCI pharmacist inspector also visited the home on the 20th March to inspect medication issues within the home. The visits were undertaken following a complaint received regarding the care of a resident, which was addressed within the multi-agency safeguarding adults policy and procedures. On the 8th March an inspector and a regulation manager from the Commission visited the home and two inspectors were present during the site visits carried out on the 11th and 12th April. Feedback was obtained from various sources, including several care managers who also visited the home on the 8th March, as well as relatives and staff. Questionnaires were also made available to relatives, residents and visiting professionals. During the visit made on the 12th April a period of two hours was spent sitting with residents who were more frail in the lower lounge, observing how they spent their time and the contact they had with staff and others. This approach aims to try to understand the experience of people who live at the home who have difficulty in communicating this verbally, either because of physical problems or mental frailty. Other service users, who were able to communicate their feelings were also spoken with, as well as those staff members present during the 12th April. A number of records were examined which included some care plans and staff files as well as general health and safety records and other documents such as the home’s statement of purpose and complaints procedure. 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 as well as standard 36. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 6 What the service does well: Arlington House provides an informal environment where residents feel they have choices about their daily lifestyle. Residents also continue to 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 as desired. The activity organiser continues to encourage a variety of regular social interactions within the home with the less frail residents, including keeping them 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. She visits three times a week and has been working at the home for several years so is well acquainted with the residents’ levels of need, and therefore provides the appropriate level of support as required to ensure service users benefit from these sessions. Residents who were more frail were still involved in and aware of what was going on around them, which is positive, even though there were no organised activities for them during the course of the site visit. Staff interacted well with residents, with lots of contact and good humour seen. Relatives and friends visiting the home receive a warm welcome and stated that they feel comfortable visiting at any time. Residents continue to 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. 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 a member of the management team and staff spoken to stated that they felt supported by the home’s management. There are pleasant, light and airy communal areas, which the residents enjoy. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The management must ensure that any emergency placement at the home is subject to a full assessment of need being undertaken from which a detailed care plan, review and any necessary risk assessments are completed. This should then be made available to all staff involved in the care of the resident. This is to ensure that all staff are aware of the best care to give to a resident admitted as an emergency placement and so ensure the resident’s needs are appropriately met. The upgrading of the care plans should be undertaken in a more person centred manner to ensure, wherever possible, residents and their families are fully involved in choices made regarding the care provided. Risk assessments, contained within care plans, must be further enlarged to ensure that all details appertaining to any risk to a resident is regularly reviewed and updated as individual resident’s needs change. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 8 Any form of restraint used i.e. the use of a cot side or a reclining chair must always be regularly risk assessed by the home’s management staff, with advice sought from outside professionals, as well as agreement obtained from the resident and/or their family/advocate to the use of such restraint. These details must be kept in the individual resident’s file at all times. This is to ensure that any form of restraint used is always in the best interests of the individual resident and fully meets the individual resident’s needs, whilst at the same time respecting their right to freedom and choice. As the front door of the home is kept locked to prevent residents from wandering outside of the home, a restraint policy should be incorporated within the home’s statement of purpose. This is so that prospective residents and their families will be aware of how the home manages any risk to a resident wandering from the home. External medication training, by a recognised trainer, should be provided to all staff involved in the administration of medication. This is to ensure that staff are trained in the most up to date medication practices which, in turn, protects residents by staff being fully informed and aware of the correct procedures regarding the administration of medication to residents. Any medical interventions undertaken by the management of the home must be done so under the directions of a G.P and any findings discussed with individual resident’s G.P., or other relevant medical professional, so that decisions regarding any resident’s diagnosis are undertaken by a professional qualified to do so. The first aid kit should be re-stocked and regularly monitored to ensure that it contains all the required emergency equipment in the event of a resident needing emergency treatment. Management should ensure that external adult protection training is made available to all staff to ensure that staff are fully aware of the issue regarding abuse. This will ensure that residents are protected by staff being fully informed and aware of the different forms of abuse and of the correct procedures regarding dealing with any suspected abuse, including how to report any concerns they may have. The owners must continue with the arrangements in place, regarding checking the home’s hot water temperature on a regular basis, to ensure that the home’s unregulated hot water temperature does not pose an unnecessary risk to the residents. This is to ensure residents will be protected against the risk of sustaining a scald. All cleaning materials must be locked away securely, to protect residents who may be vulnerable to accidental misuse. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 9 The bannister rail from the ground to the first floor should be made secure to prevent any resident grabbing it and it giving way. The stair edges should be identified to ensure service users that suffer with perception problems due to dementia are more easily able to identify when the stairs commence and end. The management should ensure that the staffing levels within the home are maintained so that any unexpected event can be dealt with without compromising the day to day care of the residents. The management should ensure that specialist dementia care training is made available, as the home offers care to a large number of residents suffering with dementia, and these residents and their families need to be sure that the care provided will meet the specific needs of the residents suffering with this condition. Qualifications in care, obtained outside of England, should be verified to ensure that they are of the same standard as those obtained in England. The management must provide regular supervision to all staff and keep records of the same. This is to ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member the opportunity to discuss any issues regarding their role that they may wish to have extra support with and also for the management of the home to monitor the progress of each staff member and to offer support/training as required. The owners/manager should continue with the undertaking of their quality auditing and monitoring within the home, and ensure that any feedback received as to how others, including residents and their families, feel the home is running is used to help improve the home. The way that the home will be improved should also be fed back to the people that have contributed to the quality auditing process to ensure they are aware that the management intends the home to be run in the best interests of the residents and takes all views into account. Please contact the provider for advice of actions taken in response to this Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 10 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arlington House DS0000018317.V334711.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.V334711.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 is not applicable as the home does not provide intermediate care) The quality in this outcome area is adequate. Although the admission process was in order for planned admissions to the home with these prospective residents being assured that their care needs could be met on admission, there were shortfalls identified in the emergency admission procedure of a resident to the home, which caused the resident to be at risk of receiving inappropriate care. EVIDENCE: The files of three residents who had had planned admissions to the home were inspected and these were seen to be in order with pre-assessment visits having taken place either outside the home or with prospective resident and/or their family visiting the home prior to admission. An assessment of need had also been undertaken which had led to the completion of a care plan and other necessary information in relation to the care need of these residents. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 13 The file of one resident, who had been admitted as an emergency placement at the home, was also inspected. It was noted that the prospective resident’s next of kin had visited the home, prior to the placement and had felt it was an appropriate home for the resident. At this point a basic assessment of need was undertaken, with the resident’s next of kin relaying some care details regarding the prospective resident whilst the resident’s community psychiatric nurse was also contacted for further details regarding the resident’s history. These details were recorded however there was no social history of the resident recorded. The resident was also known, prior to admission, to have had some recent behavioural problems due to advancing dementia, but there were no risk assessments in place in relation to this as to how the staff were to deal with the resident’s needs arising from this condition. Although, following discussion with the resident’s G.P and community psychiatric nurse, new medication was prescribed prior to the resident’s admission to the home with the discontinuation of a previously prescribed medication, there was no monitoring document in place in relation to this new medication to ensure it did not have adverse effects on the resident. A care plan was not subsequently compiled for this resident following their admission and the only information available was what had been written, by the home’s care manager, prior to/on admission. Therefore staff would not have been fully aware of how best to provide care for this resident or of and how best to deal with any potential risks associated with the resident’s behaviour or of the need to monitor the resident following a new change of medication. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10. Quality in this outcome area is poor. Service users health and personal care needs are being maintained to a reasonable level. However, one service user with more complex needs did not receive the appropriate care to fully ensure their needs were met. EVIDENCE: In some cases, the care plans and associated care records were noted, by the care managers on the 8th of March, as needing updating and to contain fuller more detailed care related information. Since their visit the home’s care manager and owner have updated a significant amount of the residents’ care records including care plans and care plan reviews and those inspected evidenced that a new easy reference system the home are to use will be a more efficient way of maintaining clear concise records. Care plans would also further benefit from an increase in person centred planning, which takes greater account of the individual life patterns and choices of residents and ensures care is given in accordance with the residents Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 15 wishes as far as possible. For example, during a period of observation a resident was seen being assisted to drink fluids by staff on two occasions, but on a third occasion they helped themselves to a drink. This could demonstrate that with additional assessment the resident many be able to be more independent on occasions. The CSCI pharmacist inspector also carried out a recent inspection of the home’s medication systems on the 20/03/07. At this inspection a number of shortfalls were identified, but these had been substantially improved by the time of the site visits of the 11th and 12th of April. In particular the medication recording sheets are now being completed appropriately; lockable storage has been obtained for the medication, which requires refrigeration; security has been improved; better records are being kept of the stock of medication received; Herbal medication is appropriately labelled and has been discussed with a pharmacist; and better records are being kept of the administration of medication. However variable medication dosages (such as dosages that might be regularly changed following blood tests) are not always being received in writing but only being received verbally. If this is the case then two staff should listen to the verbal instruction to minimise any risk of errors. During the inspection of one resident’s records it was noted that when a resident refused to take their medication it had been, on occasions, given by staff disguised in the resident’s food or drink. This practice had not been discussed with any professional such as the resident’s G.P to ensure that this was in the best interests of the resident concerned and no risk assessment was in place to monitor this practice. Although care staff spoken to by the pharmacist on the 20/03/07 stated that they had either undergone training or are currently working through a safe handling of medicines course it was later confirmed that this training is given only by the home’s care manager, following on from a distance learning course that she attended two years ago. As the recent medication administration practice noted as being undertaken by the staff, in connection with the resident whose medication was disguised in food or drink, is considered to be inappropriate unless specialist advice has been sought and the practice agreed to be in the best interests of the resident it is necessary for staff to receive external medication training. This is to ensure that they are familiar with current good practice methods of administering medication and know when to refer to a health care professional, should a resident refuse their medication. However during the inspection it was noted that the routine administration of medication was undertaken correctly and a fairly recently appointed staff member was able to correctly describe the correct way to administer medication. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 16 The home’s first aid kit examined needs some re-stocking and would benefit from regular monitoring to ensure that it contains all the required emergency equipment. Inspection of care records of one resident stated that the resident had been placed in a specialist reclining chair to help manage the risk of the resident mobilising and falling. An entry in the home’s communication book in relation to this states: “If the chair is not reclined X is able to get up and walk and therefore very high risk of falling”. When the chair was reclined it would have made it much more difficult for the resident to get out of the chair unaided. The resident was in the chair for an extended period of time, which included fourteen days and twelve nights, other than when he was given personal care in his allocated bedroom. Night staff made the decision as to whether the resident should spend the night in the chair or go to bed, with no associated records to inform the decision, nor a record of the reasons for the decision made. If the decision was taken that the resident was to remain in the specialist reclining chair, during the night, the resident was then taken to their own room for personal care in a wheelchair, but returned to the reclining chair afterwards which was sited within the lower ground floor lounge area of the home. During the night time, if the resident slept in the chair, the chair remained in this communal lounge area. Therefore the resident did not sleep in their allocated room within the home for the twelve nights that they slept in the chair. On the first visit to the home on the 8th March the home’s care manager was unable to provide a risk assessment in relation to this procedure, although a risk assessment in relation to this was made available at a later date. However the information contained in the risk assessment was very limited and there was no evidence of any regular reviews with other professionals regarding the sustained use of this restraint measure to ensure it was considered by all to be in the best interests of the resident. Also there was no specific moving and handling risk assessment in place for this resident or any review made regarding the resident’s changing mobility needs. It was also noted that a risk assessment was not in place regarding the use of a cot side on a bed currently being used in the home for a different resident. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 17 Inspection of care records, in relation to the resident who was placed in the specialist reclining chair, indicated that the home’s care manager undertook some medical observations on the resident including taking the resident’s temperature, blood pressure and pulse as well as obtaining a blood sugar reading using a finger prick machine. This machine was not the resident’s own but rather one the home had general possession of. These observations were undertaken, in isolation, by the home’s care manager, without a G.P.’s agreement or involvement. The results subsequently obtained were not shared with the G.P or any other qualified care professional. The home’s care manager, herself, then made a decision regarding the reasons for the resident’s obvious decline in health, and advised staff to undertake certain care practices, including ensuring that the resident had increased fluids as she felt the resident to be de-hydrated. Again this information was not shared with the resident’s G.P or any other care professional involved in his care. The home’s care manager is not a qualified healthcare professional, and even if she had been, there would be a requirement for her to consult with a G.P or District Nurse as the home provides residential care not nursing care and as such staff are unable to undertake medical interventions in isolation. Although the care provided to the service user had been given in good faith by the home’s management, making these decisions in isolation could have placed the resident at risk of inappropriate care being provided and a misdiagnosis being made by persons not qualified to make these decisions. However there were also some other very positive comments made about the care provided at the home from the relatives of other residents. Comments received regarding the care given included: “The home cares well for residents. X was a resident before he died. On the day that he died we were phoned to suggest we would like to go in as X was poorly. We arrived to find the home’s care manager had also come in from her day off and was holding X’s hand and talking to him.” “ The manager and senior staff seem genuinely concerned about X’s well being”. A recently admitted resident’s family member stated: “ I have no worries over X’s care. I am made to feel welcome when I visit. The staff are friendly and helpful and X’s room is very nice and comfortable” Other relatives stated: “X is cared for well, without a doubt. X’s room is always clean, the staff are always welcoming, I have no concerns over X’s care”. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 18 “ A thank you to the owners and staff from our family”. “Arlington House cares for my mother well” Arlington House DS0000018317.V334711.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15. Quality in this outcome area is adequate. Those residents that were able to vocalised that they enjoyed living at the home. Visitors are also encouraged and welcomed. Choices are made available to residents regarding their day to day living. Regular, interesting activities are provided for some residents, but less so for the more frail residents at the home. The home provides nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was noted that residents feel they can take advantage of the informality of the home’s routines. 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. Comments received included: “ I like it here, the staff are alright and the food is perfect”. The hairdresser was visiting during the inspection. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 20 He has visited this home for seventeen years. He stated that he felt the home was a good one with staff supporting residents as required to be able to have their hair done. He visits regularly, sometimes twice a week but usually once a week. It was noted that he had a very kind manner with the residents who also responded well to him. This allows residents to maintain the their chosen pattern of hairdressing and to have nicely styled hair as required. 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). A period of two hours was spent with the more frail residents, in the lower ground floor lounge as a part of this inspection, looking at how they spent this time and who they had contact with. This was then cross referenced with evidence gathered elsewhere during the visits, for example from discussions with staff and from their care records, as the residents were unable to communicate their feelings verbally about their life in the home. Throughout this period, no formal activities were provided for these residents, but there was plenty of interaction from staff and residents remained aware of and engaged with their surroundings. Residents would benefit from an increase in life history information being gathered. Information about a resident’s life can help staff interpret some behaviours that challenge or help them understand better the whole person they are caring for. It was noted that several other residents were enjoying an activity session provided by the home’s very able, experienced 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. A large interactive game of snakes and ladders was also being played with the residents and those playing were noted as enjoying the activity. These sessions last for approximately two/three hours and also involve such things as reminiscence, poetry, music and the sessions continue to be carried out three times a week. They were popular and were very much enjoyed by those taking part. Discussions with the owner confirmed that the owner recognises that more formal activities needed to be provided for the more frail residents and, as such, she is currently trying to actively recruit a support worker to work Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 21 specifically with the these more mentally frail residents and provide some additional form of activity. Visitors are encouraged and the home’s visitor’s book evidenced visits from many people at differing times whilst, during the inspection, several visitors to the home were noted as coming and going as desired. When spoken to the visitors stated that they felt free to visit at any time and were always made welcome. The home’s cook has been at the home for many years (twenty-seven plus) and 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 who were able to communicate verbally also confirmed that they enjoyed their meals. 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 8.00 a.m until 2.00p.m. On her days off the home ensures there is a substitute cook available, usually drawn from the existing staff group. It was noted that a few residents had to be fed or be supported by staff with feeding themselves and that this was undertaken sensitively and appropriately. Arlington House DS0000018317.V334711.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18. Quality in this outcome area is poor. The home’s complaint policy was is in order. However the staffs’ understanding of abuse issues needs to be improved, in particular, regarding knowledge around restraint EVIDENCE: The home’s complaint procedure is contained within the home’s statement of purpose. It is also displayed communally on a notice board within the home’s hallway. Therefore residents and any other interested parties are made aware of how to complain should they need to. Since the last inspection one vulnerable adult investigation has been undertaken. This concerned the care provided to a service user. The complaint received led to this key inspection being undertaken as described previously in the summary of the report. During the inspection it was identified that a resident, living at the home, had been subject to restraint by the inappropriate use of equipment. The police have also been involved in looking at the use of this equipment as part of the multi-agency safeguarding adults policy and procedures. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 23 Issues regarding care practices, which have been identified as needing to be amended, are being addressed through the regulatory processes of the Commission. The owner and manager have been very co-operative throughout this investigation. The home now has a formal record of any internal complaints made and of any subsequent action taken to address the issues. It is to the manager’s credit that all complaints, however minor are now being recorded. This evidences that the management are taking the residents’ concerns seriously and doing all possible to rectify any such concerns as best as they are able. The home’s care manager currently provides “in house” training in vulnerable adults but it would be good practice for all 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.V334711.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards19,26. Quality in this outcome area is adequate. Some recent improvements/upgrading measures have allowed Arlington House to provide a comfortable, well appointed clean and warm environment. Continued upgrading needs to be undertaken to ensure that the whole home is of a good environmental standard. EVIDENCE: The home presented 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. The owners employ a permanent maintenance man who is on hand to deal with any environmental issue needed. A maintenance book is kept recording jobs needing to be done and a record of when they were completed. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 25 This helps ensure that the standard of accommodation remains at a satisfactory standard. Some environmental shortfalls were noted by the care managers who visited the home on the 8th March but it was pleasing to note that the owners had fully addressed these by the time of the site visit of the 11th and 12th of April. 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 well appointed. 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. 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 presented as very clean during the days of the site visits and the member of staff responsible for the cleaning of the home was noted as undertaking her work in a focussed and planned manner as was evidenced by her domestic duty book, which showed which parts of the home had been cleaned on what days. The owner is intending to incorporate some cleaning time into the weekend shifts to ensure that the cleanliness of the home is fully maintained at all times. All cleaning materials must be locked away securely, to protect residents who may be vulnerable to accidental misuse as some were noted during the site visit as being easily accessible to residents. It was noted that it may be difficult for residents that suffer with perception problems due to dementia to easily identify the stair edges as the current carpeting is very patterned. The owner agreed and will take some action to rectify this. The bannister rail from the ground to the first floor was noted as being loose and may therefore pose a risk to a resident if they grabbed hold of it to steady themselves. The home’s hot water supply is not regulated throughout the home due to difficulties in connection with the current hot water system existing within the home. However the owner has had all the water temperatures checked by a local plumber and none exceeds 50 degrees centigrade with many being much lower. The temperatures continue to be checked regularly. There are also risk assessments in place in relation to the maintenance of the hot water throughout the home to ensure that residents are as protected as Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 26 possible, even though the home does not have uniform water regulation throughout. In the newer part of the home there are heated towel rails installed. However the owners again gave an assurance that these were never used. The owner confirmed that all other accessible hot surfaces throughout the home have now been protected and those seen were noted as being protected appropriately. The laundry room has been completely upgraded to a good standard with new equipment being provided to meet the needs of the residents. The owner/manager is in the process of undertaking a review of how the laundry system will be most effective to ensure that infection control measures are in place. This will necessitate the separation of dirty laundry coming into the laundry room from the clean laundry going out. These measures will help ensure that residents are protected by the upholding of good infection control measures and therefore minimise the risk of cross infection. The owners are hoping to provide some sensory stimulation within the home. They have applied for a grant from the government to enable them to create a sensory garden area for all the residents to be able to enjoy. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is adequate. Staff at the home are employed in adequate numbers to meet the residents’ needs. The recruitment programme is in order and protects residents. Residents are not yet being cared for by staff who have received specialist training in dementia which may mean that staff are not fully aware of the correct care to give in this specialised area of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota/numbers was discussed. The manager tries to ensure that there are always three carers plus the home’s care manager as well as the owner on duty, giving a total of three carers and two management staff that will also provide care to service users as required. Additionally the home employs a maintenance man and a cleaner and a full time week day cook. However at weekends the cook does not always work and currently the cleaner also does not work at weekends. Either the owner or the home’s care manager are “on-call” and will come in and provide additional support if required. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 28 There was a recent occasion when the lower weekend cover was very stretched due to an unexpected event occurring within the home and when one of the four care staff rotered to be on duty was undertaking the cooking of the Sunday lunch. This then left only three carers on duty to care for the twenty two service users in the home at the time, some of whom had high dependency needs. One of these staff had only been working at the home for a very short period of time with little experience previously, and so therefore could not be fully familiar with the home’s routines or the individual residents’ needs. The registered manager (who is one of the owners) was away on holiday, therefore, the home’s care manager came into the home at 11.00 a.m. to provide some cover but on this occasion it needed to be mostly in a managerial role, rather than being able to provide care to the residents, due to the unforeseen circumstances that occurred. These lower staffing levels at weekends would not allow for the three designated carers on duty to be able to be fully able to provide the necessary care for all other residents as several have high dependency needs due to quite advanced levels of dementia. At the commencement of this inspection, on the 8th March, it was noted that some staff CRB checks had not yet been received back for staff already working in the home. It was pleasing to note that by the time the inspection was concluded on the 12th April, the majority of the necessary CRB checks were in place with the outstanding one having also been applied for. One other staff member had recently come to work at the home with a previous CRB check. However as this was two years old the manager stated she had already applied for an updated one. Since the first visit to the home the home’s care manager has put training plans in place for all staff members which clearly show what training has been made available. This is a positive move as, at the first visit to the home on the 8th March, it was not possible to verify what staff members had undertaken what training. The owner/manager has almost ensured that 50 of the staff employed have been trained to NVQ level 2 or above. The management should further ensure that qualifications in care, obtained outside of England, are independently verified to ensure that they are of the same standard as those obtained in England and the relevant staff members can be included in the required 50 percent of trained staff needed to be employed at the home. The home has a daily shift planner which helps to ensure that, for each shift, staff members are aware of their individual and collective tasks and this makes it easier to monitor that residents are receiving the care they need and that their care plans are being followed through. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 29 This was seen as a positive way of helping ensure residents receive their necessary and expected care. Staff members still require some additional training in working with people with dementia which should include communication in ways that support and enable residents with dementia. The staff, on duty, during the visit on the 12th April were spoken with. They stated that they felt positive about their role within the home and enjoyed their job. They felt that they now have a good, strong supportive staff group operating within the home, which provides good care for the service users and support to each other. One staff member stated: “When I make a resident smile it makes my day” and another stated: “I like to think from “top to toe” and ensure that the resident is comfortable with necessary things like glasses and teeth. This is especially important for residents with dementia as they cannot always do this for themselves” Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards31,33,35,36,38. Quality in this outcome area is adequate. The home is mostly managed well, with the owner/registered manager being easily available and approachable. The home’s quality assurance systems have not yet been developed sufficiently enough to ensure that the home is run in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the owners, Mrs Mann, is the registered manager for the home. 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, who is currently completing her registered manager’s award supports her. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 31 However, currently there is no formal staff supervision offered to any staff member which therefore does not give staff the opportunity to have individual time with the home’s management, to allow the staff member to discuss any issues regarding their role that they wish to have extra support with and also for the management of the home to monitor the progress of each staff member and give feedback and/or offer additional support/training as required. The home’s care manager did state that there is regular informal supervision provided but she will now ensure that this is now formalised. It is to the home’s care manager’s credit that she has chosen to undertake a unit in her current Registered Manager’s Award training that will help her with the future mentoring of staff within the home. Records inspected were mostly in order, however as already stated some care records were incomplete on the first day of the inspection as were some staff records. However it was very pleasing to note that a substantial amount of work had been undertaken following this first visit, which resulted in the updating and amending of some of the required records, with further work also identified and planned for by the management to ensure that all records will comply as required and consequently provide good reference for staff working with the residents. 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 with residents’ finances. 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. A re-assessment is due again this year. Quality auditing is due to be commenced within the home, which will include staff and relative feedback questionnaires, as well as feedback from resident and staff meetings. The information received will be used to formalise a quality auditing system within the home. It was particularly pleasing to note that the home’s care manager, who is currently undertaking the Registered Manager’s Award, has chosen to undertake the unit on quality auditing as part of her award. This is because she has recognised that she has a need to gain training in this area to be fully able to ensure that there is a good and useful quality auditing system put in place at Arlington House. The home is undertaking the necessary fire precautions, which was evidenced by the inspection of the home’s fire log book. Residents’ health and safety is given due consideration with the recent protection of hot surfaces within the home and with regular monitoring of the unregulated hot water (as previously described under environment). Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 32 Arlington House DS0000018317.V334711.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 1 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 3 17 x 18 1 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 2 2 x x 2 Arlington House DS0000018317.V334711.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 OP3 Regulation Requirement Timescale for action 28/05/07 14(1)(a) A new service user’s needs must and (2)(a) be fully assessed by the management and staff providing the care and any changes appropriately provided for. This will ensure that the service user and/or their family can be assured that the staff are able to fully meet these needs. 15(1) and (2)(b) 2 OP7 3. OP8 13 (7) All people using the service must 28/05/07 have an up to date, detailed care plan. This will ensure that they receive person centred support that meets their needs. The use of restraint measures 28/05/07 such as the use of cot sides or a reclining chair must be risk assessed and advise sought as to the extent and use of such restraint from other relevant professionals. This will ensure that the service users health care needs are being met. (Previous requirement with previous date of 03/10/06) Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 35 4 OP10 12(1)(a) Any medical intervention undertaken by the management must be done so under the directions of a G.P. and any decisions made regarding a resident’s diagnosis must be shared with a professional with medical expertise. This will ensure that service users receive appropriate care to meet their health care needs. 28/05/07 5 OP18 13 (6) External adult protection training should be made available to all staff and in particular new members of staff who have little experience of care work. This is to ensure that staff are aware of issues that can be abuse. (Previous requirement with date of 26/12/06) 28/11/07 6 OP27 18(1)(a) 7 OP30 18(1)(a) The management should ensure 28/05/07 that the staffing levels within the home can always meet the needs of the service users at the home. This will ensure that service users can be provided with necessary care at all times. (Previous requirement with date of 03/01/07) 28/05/07 The registered person must ensure that suitable staff training is made available, including the provision of specialist dementia training. This will ensure that the categories of residents that the home provides care for can be assured of receiving appropriate care. The management must provide DS0000018317.V334711.R01.S.doc 8 OP36 18 (2) 28/07/07 Page 36 Arlington House Version 5.2 regular supervision to all staff and keep records of the same. This will ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member to discuss any issues of their role that they may wish to have extra support with and also for the management of the home to monitor the progress of each staff member and to offer support/training as required. 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. OP1 Refer to Standard Good Practice Recommendations A restraint policy should be incorporated within the home’s statement of purpose to ensure that all prospective service users and /or their families/carers are aware prior to admission to the home of the arrangements in respect of this. 2 OP9 Additional external medication training should be provided to those staff involved in the administration of medication within the home. Variable medication dosages (such as dosages that might be regularly changed following blood tests) are not always being received in writing but only being received verbally. If this is the case then two staff should listen to the verbal instruction to minimise any risk of errors and this should be recorded. Arlington House DS0000018317.V334711.R01.S.doc Version 5.2 Page 37 3 OP10 The first aid kit within the home should be re-stocked and regularly monitored to ensure that it contains all the required emergency equipment in the event of a service user needing emergency treatment. The registered manager should ensure that there are activities provided for the more frailer service users that are suited to their level of need. 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. In particular the bannister rail from the ground to the first floor should be made secure to prevent any service user grabbing it and it giving way. The stair edges within the home should also be identified to ensure service users that suffer with perception problems due to dementia are more easily able to identify when the stairs commence. 4 5 OP12 OP19 6 OP19 The owners must continue with the arrangements in place regarding checking the home’s hot water temperature on a regular basis to ensure that the home’s unregulated hot water temperature does not pose an unnecessary risk to the service users. All cleaning materials must be locked away securely, to protect service users who may be vulnerable to accidental misuse. 7 OP26 8 OP30 Qualifications in care, obtained outside of England, should be verified to ensure that they are of the same standard as those obtained in England. Arlington House DS0000018317.V334711.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Arlington House DS0000018317.V334711.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. 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!