CARE HOMES FOR OLDER PEOPLE
Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF Lead Inspector
Mrs Joanne Revie Unannounced Inspection 13th 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 Arncliffe Court Nursing Home DS0000005450.V311388.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. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Arncliffe Court Nursing Home Address 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF 0151 486 6628 0151 448 1934 southark@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited 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) Deborah Lanceley Care Home 150 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (90) of places Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 90). Dementia over 65 years of age: Code DE(E) (maximum number of places: 60). The maximum number of service users who can be accommodated is: 150. Date of last inspection 31/05/06 Brief Description of the Service: Arncliffe Court is registered to provide care for 150 individuals. The Home is situated in Halewood, Knowsley, Merseyside. It is on a housing estate close to all local amenities and has good links with public transport. Local shops can be accessed easily; a main shopping area can be reached by bus or car. Arncliffe Court is divided into five units all of which are physically separate and operate on an individual basis. Each unit has access to a secure courtyard garden and all the units are situated in landscaped grounds. The Units all have names and vary in function: Gateacre House: Nursing care for Older People with Mental Health needs, Speke House: Nursing care for older people Childwall House: Residential care (personal care only) for Older people Garston House: Nursing care for older people . Woolton House: Residential care for older people with mental health needs. There is a smoking policy in operation across the site and residents who wish to smoke can do so in designated areas. A site manager is responsible for the management of the home with each unit being managed by a unit manager. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced and took place over two days. A pharmacy inspector also attended to assess compliance and progress with requirements that had been made following a pharmacy inspection in January 2007. The findings for this part of the visit can be found under the heading Health and Personal Care in the evidence section of the report. Seven questionnaires were completed by residents and returned to CSCI before the visit took place. Discussions were held with eight residents, two relatives and three staff as well as the manager for the service. Their comments are included in the summary section of the report. A variety of documentation was viewed during the visit, which is referred to in the evidence section of the report. The home provides care and support to residents of the boroughs of Knowsley, St Helens and Liverpool. The range of fees is wide because of this and also because of the variety of care and support provided by the service. Advice should be sought about cost directly from the home including the cost of any extras. Equality and Diversity was not the main focus of the visit however there has been a significant improvement in maintaining and respecting residents privacy and dignity which would suggest that the staff have the skills to respect equality and diversity also. Further information regarding individual requirements should be sourced from the home manager or the responsible indivual for the service (operations manager) What the service does well:
Each House has a unit manager. The unit managers are responsible for assessing the needs of new residents before admission takes place. The unit managers have a good understanding of the skill mix of staff on their unit therefore the likelihood of a resident moving into the unit that staff cannot care for is reduced. Residents believe that they are well cared for and that the staff know what they are doing. One resident commented” the girls are angels- they’re so kind” another stated “ they work very hard and they always look after me when I’m ill - My daughter never has to worry about me any more”.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 6 Staff have had training to keep residents safe and care for them properly and greater than 50 of the care staff have achieved NVQ qualifications, which are, recognised care awards. One resident agreed that staff offer choices by stating – “ I can do as I please, If I want to stay in bed I stay in bed- If I want to get up early, I get up early”. Offering and supporting choice helps residents to feel empowered and in control of their lives. Residents and Relatives believe their concerns are listened to and acted on A discussion took place with one relative who commented, “ if I’m not happy – I tell someone- and it’s fixed, its as easy as that- No I’ve no worries about this place”. The home has robust recruitment procedures which means that necessary checks are carried out to ensure staff are safe to work with vulnerable people. The units are clean and warm and decorated and furnished to a good standard. The Home acts responsibly toward managing Health and Safety, which means that maintenance checks are undertaken routinely to ensure that the home is a safe place to live. What has improved since the last inspection?
BUPA have introduced new care records known as QUEST. These records contain clear detailed templates for staff to complete. In particular greater emphasis is put on the assessment process for a new resident. The findings from this are then developed into a plan of care, which includes both residents and relative’s expectations. This means that once staff have completed the records, clear detailed instructions are available to follow regarding resident’s needs and wishes. It also means that staff can be aware of what residents, representatives and relatives expect from the service and that support can be offered to both parties. Staff have made efforts to include residents and relatives in the formulation of the new plans. Greater detail was available about the resident’s social history and how they preferred to spend their time. This information is useful and can be used to plan activities that are meaningful to residents. Progress has been made in raising levels of basic care and this was most evident in the areas of respecting privacy and maintaining dignity. If promoted correctly these areas can add to a resident’s sense of well being and raise self esteem. Staff also believe that these areas have improved which can help to raise their morale and give them greater satisfaction in their role. This means that the residents are more likely to receive care from staff that are happy to deliver it.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 7 Nursing and Care Staff have worked hard to ensure that mealtimes are a relaxed pleasant experience on Gateacre House. This means that residents who (sometimes due to the nature of their needs) become distracted when eating are encouraged and supported to eat their meals. This helps to promote their health. Improvements were noted in how residents are supported to be part of the local community. All units are supporting residents to go out on short trips to local shops, walk around the grounds or go out with relatives. Residents have been enjoying attending local tea dances and have the opportunity to spend some time at a local day centre. The garden areas of the home have been tended to and present as pleasant places to spend time in warmer weather. In particular Woolton House has had this area re flagged since the last visit so that it is safe for residents use. The lounge on Gateacre house has been redecorated and fitted with new curtains. A wall mounted T.V. has been purchased so that all residents can view this wherever they sit in the room. The redecoration makes the room appear much brighter and more homely. Staff files have been audited and re organised so that vital information regarding staff can be accessed quickly if needed. BUPA has introduced the use of whiteboards in all unit offices. These boards contain details of which staff work on the unit and the training they have undertaken to date. This means that staff training can be monitored “ at a glance” and shortfalls addressed. This reduces the risk of staff training becoming out dated. BUPA has introduced a “ nitebite” menu so that residents who are hungry during the night can access snacks and light meals. Easy to use flip charts have been provided to help residents make choices. The manager has recently become registered with CSCI to be the registered Manager for the home. This means that necessary checks have been undertaken to make sure that she is suitable to manage the service. Staff and residents believe she has the ability to organise and manage the home. What they could do better:
A number of requirements were issued following a pharmacy inspection in January 2007 because the service had breached the Care Home Regulations 2001. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 8 During this visit it was identified that theses serious concerns have not been addressed despite action being taken by management, which included re training all nursing staff. At the time of writing this report CSCI had held a management review of the service. This process occurs when a service is identified as poor or presenting serious concerns. A meeting has been arranged with the responsible individual and the manager of the service to discuss how they intend to stamp out bad practise and ensure medications are managed safely at the home. Staff should continue to try to gain assessment information from other Health care professionals for new residents before admission to the home takes place. This information can be added to the homes own assessments to ensure all areas of need have been assessed. This will give staff greater opportunity to plan for residents care and could provide further information which can be used to decide whether the home can meet the residents needs or not. All of this can help reduce the risk of a resident not being cared for properly. Some improvements were noted in the provision of activities across the units however some units were providing insufficient or no activities for the residents to take part in. The new care record asks that staff assess resident’s social needs. Once staff have completed the care records system this information must be used to ensure a range of fulfilling activities are provided across site to ensure residents are supported to spend their time in a fulfilling way. Although no complaints were received regarding the standard of food provided by the service residents were not particularly enthusiastic about it either. The manager stated her intention to request opinions from all residents about this topic so action can be taken to ensure residents are offered food that they enjoy. This intention should be carried out so that this matter can be addressed. In particular consideration must be given to how the combination of foods will appear when presented together on a plate. Efforts must be made to ensure that this is addressed and that residents are offered a range of fresh fruit and vegetables as part of their usual diet. This will help to promote resident’s health and welfare. If not in place already risk assessments should be developed for staff around the use of the specialised seating that has been purchased for the residents who live on Speke House. This will reduce the risk of staff injuring themselves when preparing the chairs for the residents use. Management have taken action over the last four years in trying to eradicate an unpleasant sour smell in the communal areas of Gatecare House. Action to date has included re carpeting all communal areas and purchasing an air filtration system. Despite these actions the unit still smells unpleasant. Management must continue to explore this issue and take steps to eradicate the unpleasant smell so that the unit smells fresh and clean and provides a pleasant environment for the residents. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents receive a full assessment from staff who are skilled in assessing need. Documentation has been developed to support this process. Staff don’t always have access to other health care professionals assessments, before admission takes place . EVIDENCE: The service does not provide intermediate care therefore standard 6 was not assessed. Since the last inspection BUPA have introduced new documentation called QUEST. This includes a very thorough assessment section. The RI ( responsible individual) for the service explained that staff were in the process of transferring old information into the new documentation.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 12 Seven plans were viewed during the visit on four units (Speke, Gateacre, Garston and Woolton). All except for Woolton unit were in various stages of completion. Woolton unit had completed the documentation to very good standard. All plans except those viewed on Woolton had other assessment information from other health care professionals. A plan for a newly admitted resident on Woolton was viewed. This didn’t contain this extra information. The unit manager explained that attempts are always made to get these assessments but that they are not always provided before admission takes place. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. New care plan documentation is providing the scope for staff to develop very clear detailed plans with input from residents and relatives. Staff believe standards of care have improved and residents believe they are looked after well Medications are not managed safely which could significantly impact on the Health and welfare of the residents. EVIDENCE: Since the last inspection BUPA have introduced new documentation called QUEST. This includes a very thorough assessment section. The RI for the service explained that staff were in the process of transferring old information into the new documentation. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 14 Seven plans were viewed during the visit on four units (Speke, Gateacre, Garston and Woolton). All except for Woolton unit were in various stages of completion. Woolton unit was found to have completed the documentation to very good standard. The new QUEST system focuses on a very detailed assessment. A plan is then developed around the needs identified during assessment. The documentation has the scope to produce a very detailed useful overview of the residents needs. Other pieces of information such as Doctors visits and Health care risk assessments are still in use and included within the plans viewed. As explained by the RI not all the plans viewed were completed fully. Viewing the plans showed that Staff were making progress and the information provided had been completed consistently across the four units visited. Efforts have also been made to include updated information regarding resident’s social needs and wishes. This is an improvement since the last inspection. Evidence was also viewed which showed that staff are making efforts to include views of residents and relatives (were appropriate) within the plan. One plan on Gateacre contained smaller details such as how to support a resident regarding the use of spectacles and included details such as storing the spectacles in a case when not in use and ensuring the spectacles were clean before the resident wore them. This level of detail regarding a residents needs is a great improvement since the last inspection. The new documentation includes a section on medications which provides an ideal opportunity for staff to record any trigger points for ‘as required’ medication to be administered or details of any support required by the residents when taking medications. One resident had been identified on Speke House as having a full medication review and as a consequence a complete change in medications had occurred. This had not been recorded in the plan. Evidence was also available in one plan viewed, which showed that staff are monitoring basic health care needs such as recording weight etc. This information is supported by nutritional risk assessments. Dietary needs were recorded in one plan viewed for a resident who was prone to weight loss. Two plans were viewed for residents who are requiring wound care. Documentation was in place, which gave a clear overview of the wound, and the treatment that was to be given. Records also showed that a tissue viability nurse had been involved in both sets of care at the staff’s request. Records viewed in the plans gave details of G.P. visits, hospital visits (consultants) and Chiropodist visits. Three residents spoken with believed that they were well cared for and two staff on two units felt that standards of care had improved in general. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 15 Seven surveys completed and returned showed that the box “always” had been ticked when answering whether residents believed they were well cared for or not. Since the last inspection, steps had been taken to address the concerns that had been raised about the handling and recording of medication. All staff responsible for handling medication had completed appropriate medication training and had their competence checked. New medication audits have been introduced. These have identified some areas where improvements need to be made. The standard of handling and recording medication differered in the units inspected. Medicines management in the Gateacre unit was adequate, there were some areas of concern noted in the Speke unit, but in the Garston unit the standards were particularly poor. Evidence was seen that not all residents received their medication as prescribed. A sample audit of Medication Administration Record charts (MARs) and current stock, showed 10 examples of medication that had been signed for as administered but had not actually been given. There were 4 examples where medication could not be accounted for. One resident had detailed instructions stating the dose of medication to be given on each day, but this was not being followed accurately meaning that the resident did not always get the correct dose. On the day of the visit, some residents had still not been given their morning medication at 11:50am. Staff did not always have enough information to administer medication safely. All medicines that are only to be used ‘when required’ should have clear instructions. The health and wellbeing of residents is at risk of harm if medication is not administered correctly and recorded accurately. Four residents had not received some of their medicines as no stock had been available. One of these was a Controlled Drug for severe pain. The health and wellbeing of residents is at risk of harm if medication is not available to be given as prescribed. There must be adequate supplies of all medication for all residents at all times. Stock of a medication for one resident was found in a cupboard, even though the bottles were clearly labelled as needing to be kept refrigerated. This product was specially prepared and staff had failed to notice that the current stock would have gone out of date before the next supply was due to be delivered. The health and wellbeing of residents is at serious risk of harm if medication is administered after it’s expiry date or after it has been kept in the wrong conditions. Emergency medical equipment, including oxygen cylinders and suction devices were inspected. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 16 Oxygen cylinders were kept padlocked and not all nurses on duty knew the combination codes needed to access the cylinders in an emergency. One suction device seen was very dirty. There was no evidence that the unit had been serviced recently. Blood glucose meters had not been checked and calibrated and two blood pressure meters did not work at all. When routine and emergency medical equipment is kept, then it must be serviced regularly and available for use at all times. Through out the visit all residents spoken with (8) appeared well presented. All had basic hygiene needs met such as nail care, shaven, clean hair etc. In particular residents on Gateacre house appeared very well cared for. This is a great improvement since the last inspection. One resident was heard shouting inappropriately regarding toilet needs- staff were observed to reassure and support this resident in a quiet and dignified manner. Specialist seating has been purchased for one unit (Speke) to enable residents to sit more comfortably. These were viewed in use and appeared to promote residents comfort. Two resident spoken with confirmed that they believed that staff were respectful towards them and that they never felt embarrassed when staff were supporting them with personal care. Throughout the visit staff were observed knocking on bedroom doors before entering. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The amount of activities offered to residents has improved but this provision is not consistent across the units. Residents are being supported to be part of the local community Staff welcome visitors to the home A variety of food is offered which residents are indifferent to. EVIDENCE: Seven surveys were returned for viewing. Three commented negatively about the provision of activities i.e. either said they didn’t enjoy them or they were not offered any and the remaining four left this section blank. Four units were visited. Woolton was the only unit that had an up to date activities rota on display. Speke’s activities rota was blank. Garston’s detailed that the activities organiser was either on holiday or a day off.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 18 Despite this three staff spoken with believed that the amount of activities offered was better than before. One activity was observed during the two days on Woolton House. This was a quiz, which was being supported by a large number of residents who appeared very engaged in the activity. The home manager stated that since the last visit three places had been acquired at a local day centre on an ongoing basis for who ever needed or wished to attend. Staff agreed that they were identifying which residents would benefit from this and these residents were being supported to attend. Records viewed on all units showed that residents were being supported to undertake regular short outings either around the grounds or to the local shops. This is an improvement. The manager also stated that until very recently residents had been enjoying attending a local tea dance in Liverpool. One activities organiser is available for Woolton house that also provides some one to one time for residents on Gateacre House. Residents on Garston were receiving the least input however staff on this unit felt that the other activities organiser who supports Speke House would provide activities also for Garston. Records viewed showed that the activities staff are keeping records of activities undertaken however records viewed for Speke House showed that no activities had been recorded since the 26/01/07. Records on Gateacre house showed that activities were happening on a weekly basis. Family / friends are supporting residents to go out on all units visited. On Woolton some residents are staying overnight away from the unit as part of the visit. St Mary’s church visits the site weekly and provides communion for those residents who wish to receive it. Viewing the visitor’s book on each unit showed that visitors are visiting the units when they choose. One visitor spoken with on Gateacre stated that staff are always very welcoming and that there’ was always some one available to answer any questions. The home has an open visiting policy but discourages visiting during meal times to enable protected mealtimes to take place. Three residents spoken with on three of the units visited agreed that they are supported to make choices in their everyday life. One resident gave the example of feeling tired therefore lying in bed late. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 19 Another agreed that they went to bed and got up when they chose and one stated “I can do as I please”. Staff were overhead offering choices such as food and drink, asking where residents wanted to sit, and whether they wished to take part in activities throughout the visit. Since the last visit a “ nitebite” menu has been introduced. This means that residents have light meals/ snacks available through out the night if desired. Each satellite kitchen viewed had a poster displayed explaining how food could be ordered and how to offer choices to the residents. 8 residents spoken with discussed the food on offer. Comments received were mixed with some residents believing that the food offered was “okay most of the time” and others only commenting that the “staff try hard to please”. Protected mealtimes are in place on all units. A sign displaying and explaining this procedure was available in the porch of each unit. The lunchtime meal was observed on Gateacre House. The dining area had been set with tablecloths and residents were being supported to use protective cloth tabards to protect their clothing. The TV was turned off which promoted a quiet atmosphere. Staff were observed to offer support in a dignified manner to the residents. In particular two residents who were finding it difficult to sit and eat were supported to eat an adequate amount of food. The food offered appeared to have been cooked to a satisfactory consistency. The choice of food available on this unit during this meal was baked beans, omelette, mashed potatoes, tomato soup and sandwiches. Staff tried to present the food nicely however residents who required a soft diet had omelette with mashed potatoes and baked beans, which did not appear particularly colourful or attractive. During feedback the manager revealed that although no serious complaints had been made regarding the standards of food she intended to develop a questionnaire for the home to gain the views of the residents and relatives about the food offered. A monthly menu was viewed. This showed that a variety of hot and cold choices are offered on a daily basis. Some meals (such as the one observed) contained little or no element of fresh fruit and vegetables. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 20 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and acted on. Staff have the skills to protect the residents from abuse EVIDENCE: A discussion took place with a relative on Gateacre who commented, “ if I’m not happy – I tell someone- and it’s fixed, its as easy as that- No I’ve no worries about this place” Complaints procedures were viewed on all the units visited and also in the main reception building. This was found to meet the Care Home Regulations 2001.Two complaints have occurred since the last inspection. Both were investigated thoroughly by the responsible individual. Viewing complaints records within the home showed that the manager undertakes the majority of investigations keeps clear records and ensures complainants receive a response to their concerns within the procedures timescale. All four units visited had copies of the local authorities adult protection procedures. One staff file viewed showed that senior management had taken action when a member of staff had not correctly reported a potential abuse situation.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 21 Since the last inspection all staff have revisited protection of vulnerable adults training. Two staff spoken with were able to reveal what they thought abuse was and what they would do if they suspected it occurred. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 22 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The units present as comfortable clean places to live. The malodorous smell on Gateacre deflects from what other wise would be a very pleasant environment following the recent redecoration. Residents are supported to make their bedrooms individual by furnishing them with personal effects. EVIDENCE: Four units were viewed plus the garden areas for each of the units. All garden areas appeared well-tended and provided pleasant places to sit in warmer weather. This is an improvement from previous visits. Woolton House has had the garden area re flagged and new garden furniture purchased. This has ensured that the garden is safe for residents use.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 23 Gateacre house has benefited from having the lounge redecorated, new curtains and a plasma screen T.V fitted. This is a wall mounted T.V so that all residents can view it. This unit has had ongoing difficulties in eradicating a sour unpleasant smell over the past four years. Actions taken to date have included recarpeting the corridors and lounge and providing an air filtration system. On the day of this visit the unpleasant smell was present on entering the unit and pervaded through to the lounge. Cleaning staff were on the unit and the areas that they had cleaned smelt fresh and pleasant. All communal areas in all units visited presented as clean and comfortable with good quality furnishings. Corridors had pictures to make them appear more homely and interesting. A sample of bathroom and toilets were viewed on each of the units. These were clean with paper towels and liquid soap. Sluice rooms on all units were visited. These were also clean with paper towels liquid soap and coloured disposable bags for laundry and clinical waste. Three staff confirmed that they had sufficient supplies of disposable aprons and gloves. Two stock cupboards were viewed on two units and appeared adequately stocked. A total of 24 bedrooms were viewed across the four units. All were personal to the occupant and contained good quality furnishings and bedding. Each unit employs full time cleaning staff who work opposite shifts to each other so that domestic staff are available from early morning to late evening each day. Viewing rotas confirmed this. The laundry room was viewed. This was well organised clean and tidy and is organised in such a away that clean and dirty laundry are dealt with separately which helps to reduce the risk of infection occurring. Viewing training matrix’s and staff files showed that many staff have undertaken training in preventing cross infection. The recent quality assurance survey results were viewed which showed that cleanliness of the home achieved 21 higher than the previous year. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to meet the resident’s needs. Over 50 of staff have achieved an NVQ Qualification. The home has robust recruitment procedures in place. Staff are offered training which is appropriate to their role. EVIDENCE: Off duty rotas were viewed on all units. Gateacre House and Speke House are amalgamating in the near future which will provide extra staff on site. Notices were displayed on notice boards to confirm this. All units visited appeared calm. Occupancy is lower on some than others therefore the units are staffed differently. Staff on Speke House stated that they were looking forward to the forthcoming move and being busy again. No evidence was found during the visit, which would suggest that the units were not staffed sufficiently. During discussions the manager confirmed in front of the RI that 54 of care staff have achieved an NVQ qualification in care and that a further 6 staff are undertaking training to achieve the award.
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 25 Since the last visit the staff files have been audited and organised. Five of these were viewed. Each contained references, applications forms, proof of crbs, qualifications and identification in line with the Care Home Regulations 2001. Staff files x2 were viewed for nurses who had qualified overseas. Both files revealed that adaptation course and taken place and suitable visa were in place. Two files were viewed for new staff. These both showed that induction training had taken place in line with that recommended by the national training organisation. Both new members of staff had also received supervision. Since the last visit each unit has been provided with a staff training matrix board. This means that staff training on each unit can be viewed at a glance. The boards showed that mandatory training (health and safety, manual handling, first aid, infection control, Fire awareness) are on going. Qualified nursing staff have recently completed medication training also. Three staff spoken with confirmed that they believed that they had received enough training to do their job and that the training offered was good. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is in control of day-to-day operations and ensures key staff are involved in this process. Residents are consulted about their view of the service and action is taken to make improvements based on their opinion. The home is a safe place to live. Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 27 EVIDENCE: Standard 35 was not assessed during this visit. Confirmation has been forwarded by the CSCI central registration team that the manager has recently succeeded in becoming registered with CSCI as the registered manager for the service. The manager’s personal file was viewed. This showed that she is a registered nurse with many years experience as manager. The file also contained accolades from her present employer for her management ability. Three staff commented positively on her ability to organise and manage the home. Evidence of minutes showed that the manager arranges six monthly residents and relatives meetings. A relative confirmed that they had attended one of these. Three monthly staff meetings are also held at a time convenient for both day staff and night staff to attend. A monthly heads of department meeting is also held. The manager explained that each day for a short time the person in charge of each unit meets with her to discuss any key activities for that day. The most recent customer and relative satisfaction questionnaires were viewed. This showed that the overall satisfaction from residents had increased by 19 from last year, “ treats you as` an individual” 14 increase and cleanliness of the home 21 increase. No scores were lower than the previous year. The manager explained that this audit had only just been completed and her intention was to develop an action plan to identify how further improvements could be made. BUPA as an organisation also undertake other quality assurance checks. These are undertaken by key staff who are employed specifically for monitoring and improving quality assurance. Evidence was shown that the RI undertakes regulation 26 visits. All four units had information in place to support Health and Safety. Speke House has obtained specialised seating for some residents. A member of staff explained that this involves shaking out a large beanbag cushion, which staff sometimes struggle with. It is not known whether a risk assessment has been developed for this activity. The maintenance officer takes overall responsibility for ensuring Health and safety checks are carried out across the site. Evidence was shown of potable appliance testing. Water temperature testing and certification showing that a safe electrical and gas safety supply existed. The maintenance officer has been training to carry out LOLER testing so is able to periodically test and check all hoisting equipment on site as required. Evidence was viewed which showed
Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 28 that the RI audits these files. Records revealed that all fire fighting equipment including alarm systems is checked and serviced regularly and staff have undertaken training in this area. Evidence was also viewed which showed that the maintenance officer also carries out sterilisation of water systems and information relating to COSHH Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X X X X 3 Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 30 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must ensure all medicines are administered and recorded as prescribed. Previous timescale of 28/08/06 and 17/02/07 not met The registered person must ensure all staff that administer and handle medicines are competent to do so. Previous timescale of 28/08/06 and 17/02/07 not met The registered person must ensure that there are adequate supplies of prescribed medication available for all residents at all times. Previous timescale of 17/02/07 not met The registered person must ensure that oxygen cylinders and other equipment for emergency medical use are maintained and available for use at all times. The manager and responsible individual must continue to explore the source of the unpleasant smell on Gateacre
DS0000005450.V311388.R01.S.doc Timescale for action 31/05/07 2. OP9 13(2)18(1 )(a) 31/05/07 3. OP9 13(2) 31/05/07 4 OP9 13(2) 31/05/07 5 OP26 16.(2)(k) 30/06/07 Arncliffe Court Nursing Home Version 5.2 Page 31 House and continue to take steps to eradicate its presence so that the unit smells fresh and is a pleasant environment for residents to live. 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 OP9 Good Practice Recommendations There should be clear, personalised directions for the use and administration of when required and variable dose medication for all residents prescribed such items. When required and variable dose medicines should also be included in the residents care plan A second member of staff should witness and countersign all hand written entries on Medication Administration Record charts Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber The above actions will reflect best practise and will help to ensure that medications are managed safely by the home and will help to ensure that resident’s health and Welfare needs are being promoted. 2 OP3 Staff on Woolton House should try to ensure that admission for new residents only takes place once they have received a copy of the social workers/District Nurse assessment. This will help to ensure that the homes own assessment is correct, will help to identify any further needs and will reduce the risk of staff being unable to provide the right care for the resident. The manager should consider developing the provision of activities further to ensure that residents spend their time in meaningful way. Staff should continue discussions with
DS0000005450.V311388.R01.S.doc Version 5.2 Page 32 3 OP12 Arncliffe Court Nursing Home residents and their relatives to find out how residents would prefer to spend their time and activities should be offered which reflect these choices. 4 OP15 The manager should carry through her intention to gain the residents opinions about the standard of food served at the home. Consideration should be given to how combinations of food will appear once presented. Mealtimes are an important part of daily life and visually unappetising food may reduce some resident’s appetite. Residents should be offered five fresh portions of fruit and vegetables per day as recommended as part of government healthy eating guidelines. The manager should continue to keep the staff training matrix board on each unit up to date. This is a good tool, which is there to remind everyone of training that has been and needs to be undertaken. A risk assessment should be developed (if not in place already) regarding the preparation of the beanbag cushions on the specialised chairs on Speke House to ensure staff do not injure themselves 5 OP30 6 OP38 Arncliffe Court Nursing Home DS0000005450.V311388.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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