CARE HOMES FOR OLDER PEOPLE
Arncliffe Court 147b Arncliffe Road Halewood Merseyside L25 9PF Lead Inspector
Joanne Revie Unannounced 24th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Arncliffe Court Nursing Home Address 147b Arncliffe Road Halewood Liverpool L25 9QF 0151 486 6628 0151 448 1934 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Mrs Joanne Farrell Care Home 150 Category(ies) of OP Old Age (114) registration, with number DE(E) over 65 (30) of places TI(E) (6) Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 84 OP and up to 30 OP (PC) in Childwall House and up to 30 DE(E) and up to 6 TI(E) That the flexible staffing matrix be used as a guideline for minimum staffing levels only, and that staffing levels are fluctuated to reflect the service users needs and not just occupancy levels. The service shall accommodate one named service user out of category; this variation to cease once this named individual either reaches age 65 or leaves the home. That a variation exist for 1 named service user on Childwall House, this to cease following his departure or once he reaches his 65th birthday. That a variation exists for one named service user for Garston House only. Date of last inspection 08/11/2004 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 with all units being 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·Woolton House: Nursing care for Older people·Childwall House: Residential care (personal care only) for Older people·Garston House: Nursing care for older people and palliative care for those who have been diagnosed as terminally ill. Each unit has a large communal area which is used as a lounge and a dining room.Meals are prepared in the main kitchen and transported to the satelite kitchens on each unit. Alcohol is permitted on an indivual basis once an assessment has taken place to identify whether this may effect the residents health.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.The home has an open visiting policy however all units are secured by a lockable key pad which means that visitors have to allow staff time to answer the door
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This is an overview of what the inspector found during the inspection. General The inspection took place over one day. Woolton House was closed due to refurbishment. Gateacre House was not inspected during this visit due to the suspected outbreak of Chicken Pox. Five inspectors were involved with the inspection. Lorraine Farrar- inspected and assessed Childwall House Diane Sharrock inspected and assessed Garston House Lynne Paterson inspected and assessed Speke House Joanne Revie visited each unit and held discussions with staff and assessed the management of medication on each of the units. Trish Thomas was available for meetings with relatives who wished to discuss the home. Mrs Thomas also assessed the laundry and kitchen areas of the home. Following the visit each inspector wrote a report on their findings. These were then compiled into one report. The findings were as follows: What the service does well:
General Relatives from Childwall, Garston, and Gateacre House confirmed that they are consulted regarding their loved ones care including provision of meals and activities. This makes them feel involved and makes them feel as though the home has nothing to hide. Those who commented said they trusted staff and were optimistic that past concerns which they had experienced, would be rectified. All relatives who commented said that the standards of care were good. The home has up to date certificates and records in place for health and safety checks and staff have received training on this subject. This means that Service Users are safe. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 6 Childwall House Staff on the unit have a good system in place for passing information about residents to each other. This system means that residents receive a good level of care and that appointments, health checks etc are made within a reasonable period of time. Care plans on the unit are all clear and easy to follow, they are kept up to date by staff and reviewed and changed if needed on a regular basis. Residents’ families are regularly invited to take part in the process of planning care. The unit offers residents a variety of choices in their everyday lives, this includes meals, activities, times they want to get up or go to bed and who will help them with their personal care. The overall appearance of the unit is comfortable and welcoming with seating arranged in groups and residents able to watch TV, take part in activities or chat as they choose. Staff take the time to talk with residents and have a good understanding of not only their needs but also their personalities. The unit has an activities co-ordinator who arranges different leisure opportunities ranging from bingo and quizzes to trips out. Speke House The unit has a group of staff that have worked together for a long time. This means they work as a team. They are committed to giving good quality care for all the residents. Home records and observations of staff showed that the staff work hard to encourage residents to be as independent as possible. This is important for the Residents health and Welfare. Comments received from Residents included “staff are very kind and look after us well”,” staff seem to know what we want”. Staff comments included “I just love coming to work”, “we all work as a team”, and “our manager gives us guidance, leadership and support”. Care plans and daily records were clear and relevant which means that staff have access to clear instructions of the residents needs. Garston House The Manager on Garston unit feels that the company BUPA support Staff in accessing training courses. He feels that Staff get on very well with the Residents and the Relatives and Staff comments supported this. The Manager also stated that he feels that the new Activities Organiser will make a big difference to the range of activities on offer. He also feels that the Staff have a good relationship with the Macmillan Nurses who have recently given a lot of support in palliative care training. The unit Staff were seen to be friendly, relaxed and welcoming. Residents stated that they were happy with the home. The Staff had arranged a birthday party for one resident and everyone appeared involved in the festivities. A visiting entertainer and a buffet was provided for everyone’s enjoyment. Prior to lunch staff made the dining area look attractive by setting the tables with tablecloths cutlery and condiments.
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General Senior staff have worked hard to ensure medications are handled, stored and administrated safely to residents on all units. Regular audits are carried out by senior staff to ensure medications are handled correctly. The site manager was new to post at the last visit and has now settled into her role. She has had a positive impact on the service. A second assistant manager has been employed to support the site manager. The assistant manager is able to monitor standards of care across site. The site manager has commenced resident and relatives meetings on each of the new units to enable both groups to feel involved in the running of the home. A monthly newsletter is also distributed which informs the reader of forthcoming events, Staff achievements and results from satisfaction surveys such as quality of food, care etc. Staff commented that they feel supported under the guidance of the new manager and that communication across the site in general was much better. Many staff commented positively on the amount of training offered by the service and how enthusiastic the new manager is about staff development. This is important as it enables staff to feel valued and enthusiastic about their role. Childwall House At the last inspection of this unit in November 2004 there were a number of requirements given to improve the service. BUPA and the unit have worked hard in meeting these. In particular the cleanliness of the unit has improved. Care plans on the unit were up to date and provided good information particularly regarding the person’s health and support required. Speke House Since the last inspection Care plans now show that staff are providing consistent care and that this care is being reviewed regularly and any changes are addressed. Plans also identify that residents and their representatives are fully involved in all aspects of care planning. This is important as it helps to make relatives feel involved and residents” in charge” of their own lives. Staff training files showed that staff receive ongoing training. This training is appropriate to their duties. Records held details to show that wound care management has improved greatly. This is important as consistent care promotes better healing of wounds. Staff have received training in health; hygiene and infection control. Following discussions with staff it became clear that they feel valued and supported by the new site manager. Garston House One comment made from a Residents Representative was that they had seen improvements to the home since the commencement of the new site Manager. They commented that this was especially true with the environment, the provision of activities and the introduction of Resident meetings. Garston House also has a new unit manager who is settling into his role. New furniture has been purchased for the dining room, which with the new decoration promotes a homely atmosphere.
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General Relatives from Gateacre House commented that the unit often smells unpleasant and the carpet in the lounge is dirty and stained and the unit needs redecorating. An inspector did not view this unit never the less the home should explore these comments and make changes where necessary. Comments were also made by a relative about Childwall unit regarding the environment, which should be investigated by the home. Childwall House Although staff talk with residents relatives about their care plan, there was no evidence that they also talk to residents about their plan or about whether they want it to be discussed with their relatives. Some information is written down about residents social likes and there is an activity co-ordinator however there is no forward planning on the unit to make sure they are addressing individuals choices. The kitchen area on the unit is in need of some work, the grout is stained and some of the tiles are broken, both the site Manager and Maintenance Man explained that there are plans in place to refurbish this room. Relatives stated that the patio doors to the courtyard area are broken and residents who are able to walk unaided experience difficulty in using the courtyard because of this. This comment should be explored by the service and any damage repaired so that residents are free to come and go. During a discussion with a relative it was stated that although staff set the dining tables with tablecloths these are sometimes torn and cold drinks are not always readily available. Although this was not viewed on the day of the visit the manager should explore these comments and address any concerns. The unit has equipment and clothes available to prevent the spread of infection but they need to look at how they get rid of disposable items, which could be infectious. Although the management of medication is greatly improved staff are not recording the temperature of the fridge on a daily basis. This must be rectified to ensure that medications are being stored at the correct temperature. Speke House Comments received from residents included “we do nothing much during the day other than sit here”, “I would like to have more activities during the day”, “nothing much goes on here”, “we get bored”. Records indicated that activities were not provided on a regular basis, and that those provided were not always suitable for the residents needs. Staff commented,” They need to get out more”. This matter must be addressed by ensuring that residents are consulted about how they wish to spend their time. Activities should be regularly introduced which are constructive for those residents who have memory difficulties.
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 9 Garston House The Manager of Garston unit acknowledged that the unit would benefit if he undertook a management course. It was also stated that he hopes to commence one quite soon. The Manager agreed that Moving and Handling procedures should be reviewed with all Staff and he also agreed that there was a need to review the issues around “wedging bedroom doors open”. These are both important issues as residents could be at risk of injury if staff handle them incorrectly and “doors wedged open” could encourage the spread of fire if one should occur. The Manager also acknowledged that he needed to access a copy of the “national minimum standards for Older People” so that all staff on the unit could familiarise themselves with the standards that they were expected to achieve. Although some policies and procedures are stored on the unit many are not. This must be rectified so that staff have access to a full range of the homes policies and procedures. During discussions with staff it became evident that not all staff are receiving regular one to one time with a senior staff member. This must be rectified so that staff feel supported in their role. Although a birthday party was taking place on the unit no activities information was displayed for forthcoming events. This must be rectified so that service users are aware and included in “what is going on” on the unit. Copies of Menus should also be displayed for the same reasons. During discussions staff and residents commented about the provision of blended diets saying, “they were bland” and “are all the same colour”. Training records should be updated and further training should be offered to Staff in a number of subjects listed within the evidence section of the report. Staffing levels should be reviewed in light of Staff comments and in providing evidence that enough staff are employed to care for the Residents. The Managers rota should also be reviewed to provide a necessary overlap with the next nurse. This would help to improve communication on the unit and in turn promote consistency. 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. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x EVIDENCE: No standards were assessed from this section during this visit. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Childwall Staff understand the health and personal care needs of residents and plans are in place to provide support and identify any changes or outside help that is needed. Residents and relatives agree that health needs are met and that staff treat residents with dignity and respect. However changes need to be made to the environment to uphold this. Medication could be managed more safely by the recording of fridge temperatures on a daily basis. Speke House Staff give the care that the residents need. Residents are involved in the care planning process. Staff are respectful towards the residents and promote their dignity. Medication is managed safely. Garston House Care plans continue to be developed. Residents are supported with Health needs. Medications are safely managed. Staff do not have access to all required policies and procedures however Staff do respect residents dignity and privacy. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 13 EVIDENCE: Comments made by relatives during the relatives meeting Four relatives said that they were satisfied with the care and support provided in Arncliffe Court and no shortfalls were stated. They confirmed that residents are registered with a G.P. and chiropody visits (and general paramedical and specialist support) are arranged. A relative commented that her husband had gained weight since he had been living in the home and that she had trust in the staff. Another said, “The care is good.” They were aware of the care planning process. From their comments, there was evidence that there has been ongoing consultation by the home regarding care plan reviews and medical treatment. A relative said that, in her experience, the staff are very good and that the manager is approachable. She said she was confident that the manager is attempting to provide continuity and a good balance of staff skills on Childwall Unit. There was a general feeling of optimism amongst the relatives, though shortfalls were expressed in other aspects of service. Comments for all units regarding the management of medications All three units were assessed for the storage management and administration of medications. This included looking at storage systems, procedures for receiving and returning medication and recording of medication administration. All units were found to be managing and consistently recording medication on the medication administration records. Evidence of regular medication audits were viewed which showed that senior staff were regularly reviewing procedures and identifying and rectifying any shortfalls. All units were storing medication correctly and carrying out necessary checks on fridge temperatures records examined showed that staff on Childwall were not always recording the fridge temperature on a daily basis. Childwall House Individual care plan files are in place for all residents. These are handwritten by staff and personal to the individual. Care plans are reviewed monthly and changes made as they occur. Staff also contact relatives every three months to ask them if they want to discuss their relatives plan of care however this is not recorded. Staff have a good system in place for recording information about residents and making sure this is followed up. The care planning and information system on the unit means that Residents needs and particularly their health needs are identified and any new or increased needs are dealt with in a reasonable time frame. Residents spoken with didn’t appear to know much about their care plan and plans did not contain evidence that they had been discussed with them. There was no evidence that Residents had agreed to their care plan being discussed with their Relatives. There is a risk that not all of the needs a resident considers important will be identified and met and also that information they want to remain private is shared with others.
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 14 A District Nurse and Physiotherapist were spoken to on the unit, both advised that they are satisfied with the relationship they have with the unit and the staff team. Care plans monitor residents health in a number of ways, this includes their weight, food and drink intake, mobility, any falls and the chances of them getting pressure sores. This regular monitoring quickly identifies any changes and staff then seek advice from other health care professionals to support the resident. During the inspection staff were talking to residents with respect and knocked on doors before entering their room. One care plan identified that a male resident preferred support from a male carer and that this would be provided, a member of staff explained that if needed they would use a male staff from another unit on site. During staff discussions examples were given of how staff would respect a residents dignity and maintain their privacy especially when assisting with personal hygiene. Bedrooms viewed have curtains but no net curtains for daytime; this can lead to a lack of privacy for residents. During the inspection, for residents who use a commode in their room, this could be an issue if they are unable to manage their own curtains. Some of the residents spoken with said that staff explain things to them and help them make a decision, care plans contained information that supported this. The unit has an activities coordinator and care plans contain a list of the activities the person likes. However there was little evidence that this information is used in planning activities for the person. Speke House Individual care plans were available and all plans viewed held information about heath, personal and social care needs. Staff advised that all care plans had been updated to include recording full information in respect of pressure areas, wound care and access to sight, hearing, dental checks and tissue viability. I was identified that Staff have the knowledge and understanding of the Residents individual needs and of the systems in place to record and monitor these needs. Observations of staff carrying out their duties showed that they maintained the privacy and dignity of the residents. Residents commented that they felt that they were treated with respect at all times. Garston House –During the visit six staff were interviewed and three staff had general discussions with the Inspector, four Residents and one Relative had a discussion with the Inspector and a selection of comment cards were left on the unit with freepost envelopes to be forwarded to CSCI for further comments. Residents and Relatives were very happy with the care provided at the home. Residents said that Staff always knock at their door before entering. One Resident said they were happy with their care plan. The care records seen
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 15 had a lot of detailed information including Resident and Relatives signatures agreeing to their care plan. Staff could not locate a full index of policies and Procedures on Garston unit. Staff also didn’t have access to information on how to manage a subcutaneous infusion. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12/13/14/15 Childwall House Residents are offered choices at meal times, with their routines, and in the variety of activities available. There is a lack of planning around activities, which could lead to the smaller choices people make not being met. Residents are not entirely happy with the quality of the meals being served by the home. Speke House- Meals are well managed with choices being available at all times. Residents stated that the provision of Activities is insufficient and no evidence was available to show that activities are provided according to the residents needs. Garston House Social activities and meals are managed within the unit and there are a variety of choices available for Residents, however some areas need to be developed further such as how blended meals are provided, the provision of large print menus and the development of an ongoing activities programme. EVIDENCE: Comments made by relatives and Staff during the relatives meeting The chef, and four relatives of residents were spoken with regarding menus and diet. Two relatives stated that the presentation of meals could be improved. The chef said that the menus were due to be reviewed for summer, and that questionnaires had been distributed to residents and their representatives to state their preferences and general comments. All relatives
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 17 confirmed that they had received the questionnaires. Residents are consulted daily on what they want from the menu for each meal and the chef provided a record of daily meal orders for inspection. There is a four weekly rotating menu and special diets are catered for. The menus and daily order sheet gave evidence of a variety of meals and alternatives being available. On a visit to the kitchen, (where all meals are cooked and transported to individual units), the newly purchased heated trolleys were seen, and the food stores were visited. The chef orders basic provisions from nominated suppliers and there is an allocated food budget. Fresh fruit, meat, vegetables and milk are ordered locally and delivered as necessary. There are storage areas for dry, fresh, chilled and frozen foods and food stocks were at a good level at the time of inspection. Relatives who commented confirmed that the home has an activities coordinator and one mentioned that quizzes and sing-a-longs had been arranged. A relative said he has requested day trips. From another relative’s comments, there was no evidence of an activities programme that is specific to residents who have dementia on Gateacre Unit. She said that she could sympathize with the difficulties staff may have in motivating residents with dementia, to become involved in social events. Childwall House Care plans contain information about the persons likes and dislikes in terms of activities, however these do not state how the home intends to meet the individuals preferences, for example one plan stated the person like music and sport but did not state the types they like and whether they like to listen in their room, participate or watch it on TV. The unit has an activity coordinator who works 20 hours a week although it was stated that this might be reduced in the future. She was very enthusiastic and explained she has attended training courses and joined an organisation looking at providing activities for older people. The Coordinator is funded by BUPA however activities are limited to the funds raised by the unit. In May 05 activities on the unit included, quizzes, crosswords, card games, parties, pampering day, visit by local library and bible classes. The home tries to arrange for either an entertainer or large screen cinema to visit monthly, a local church visits every three weeks and trips out are arranged to Southport, Harry Ramsden’s etc. Time is also found to talk with or read to people staying in their rooms. The unit has a varied activity programme but in not planning properly for individuals they may be missing meeting choices that can make a difference to how people feel about living there, for example if all staff are made aware of a residents liking for a particular sport or music they can ensure they provide support to the person in accessing that. Residents spoken to said that they are able to decide what time they get up or go to bed etc and that their visitors are welcomed. Staff were heard asking residents what meals they wanted and residents explained that they are asked the day before to choose their meals for the
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 18 following day, they also confirmed that if they don’t like what is on offer they can pick an alternative. Staff take the time to make sure tables are nicely laid with cloths, salt and pepper and matching crockery. However a relative commented that on occasions tablecloths have been used which are torn. Drinks are served throughout the day and available on request. However one relative commented that cold drinks should be provided automatically so residents don’t have to ask. Residents’ comments about meals varied from “they are all right” to “they are cold and soggy”. Speke House Menus were varied and balanced and observations of a mealtime showed that meals and eating arrangements were provided on a flexible basis according to the resident’s needs and wishes. Resident’s comments about the food provided included “the food is generally good”, “we get plenty of good food here”, and “we are given choices as to what we want to eat”. However resident’s comments about the activities included “we do not do anything here”, “we get very bored with nothing to do”, “ I wish we had more activities”. Staff advised that the home had recently appointed activities staff, who worked throughout the home on a one to one basis with residents and would play cards or dominoes or engage in conversation. Residents advised that this did happen on occasions but it was not felt to be sufficient. It was also noted that several care plans advised that some residents have memory difficulties. Residents commented that they wished an activities coordinator could be employed to arrange a full activities programme to meet individual choices, interests and capabilities. There has been no provision for a trip out for sometime. Staff commented,” They need to get out more”. Garston House Six staff were interviewed and general discussions were held with a further three staff. Discussions were also held with four Residents and one Relative. A selection of comment cards were left on the unit with freepost envelopes to be forwarded to CSCI. During the visit the Staff were organising a birthday party in which a lot of people attended. Residents and Staff described the recent improvements to the activities on offer. However an activities programme was not displayed on the unit. The Unit Manager stated that they have recently employed an activities organiser for the unit and he felt that this area would be developed further to offer the Residents further choice and to meet all parts of the standards. The Staff had no knowledge of how much they had for the activities budget, which needs to be accessible in order to plan the ongoing choices of Residents living on the unit especially in organising trips out which Staff are hoping to eventually arrange as a regular event. There were positive comments about the recent resident relative meetings in which people felt they could bring any issue up and they explained that they can visit whenever they want and that the atmosphere in the home was so much better. There were positive comments about the food and some suggestions to the current menus for “blended diets” so that action could be taken to try and improve their
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 19 presentation. As a matter of good practice Staff ask all individuals the day before what they would like to choose from the menu for their meals the next day, it was acknowledged that access to menus would also help people remember and acknowledge their choice of meal. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Only Speke House was assessed on the above standards during this visit. SPEKE HOUSE Complaints are handled sensitively and residents are confident that their complaints/concerns will be listened to and resolved. The home has a vulnerable adults procedure in place and staff have been trained to follow procedures to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: SPEKE HOUSE The home has a complaints procedure and staff identified that they had full understanding of the process. Records examined held clear concise details of complaints and outcomes. Comments from residents include “ I know how to complain if I wish to”, ”the home has a system in place to deal with complaints/concerns “,”I have never wanted to complain but I know how to if necessary”. A procedure for identifying and responding to allegations of abuse is in place and staff interviewed revealed that they had received training in how to identify and respond to any suspicions or allegations of abuse. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24,26 Childwall House The unit is clean, welcoming and generally well maintained. There are areas that need to be addressed to make sure residents are safe, the system for disposing of clinical waste is unsafe. The small courtyard requires a risk assessment. Speke House Observations and maintenance records revealed that the people living in the home are provided with safe, secure, comfortable surroundings. Garston House The environment is well managed and kept clean and tidy. Sufficient equipment is available for the Staff to use in ensuring that good hygiene and cleanliness levels are maintained. Risk assessments need to be reviewed. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 22 EVIDENCE: Comments made by relatives during the relatives meeting The evidence is based on the comments of four relatives on their opinion of the conditions experienced by the residents. Although Gateacre unit was not assessed during the inspection it was said to be “in serious need of decoration and there is a strong smell of urine throughout the building. The lounge carpet is fairly new but is badly stained and foul smelling. The place should be gutted.” It was stated that the conditions on this unit give particular cause for concern, as the residents do not have capacity to complain. A relative said that the chairs on Garston Unit have recently been replaced, which is an improvement. Relatives of a resident of Childwall Unit said they have ongoing concerns regarding the conditions in this building. They said that they do not like the “institutional” layout of the furniture in communal areas and suggest more intimate groupings of chairs to stimulate communication between residents. They also said that the lighting is poor, the building is not clean and the armchairs are in poor condition. They said that there is usually a smell of dust and urine on Childwall Unit. Relatives said that they approved of the improvements to the newly refurbished Woolton Unit (which is not occupied) where the meeting took place, but felt frustrated by the inferior standards experienced by the Service Users on Childwall Unit when a refurbished unit remains empty. Childwall House The small kitchen on the unit was clean but had several broken tiles, this room is dated and both the tile grout and floor are stained making the room appear uninviting and drab, the home manager and maintenance man both advised there are plans to refurbish this room within the next year. The small garden was landscaped last year and provides a pleasant area to sit in; some of the flags appeared uneven and could cause someone to trip. The home needs to carry out a risk assessment of this area. Relatives stated that the patio doors to the courtyard are broken and residents who are able to walk unaided experience difficulty in using the courtyard because of this. The unit was generally tidy and clean; bedrooms were comfortable with a basin, lamps, furniture and space to lock personal items up in. Residents are able to bring their own furniture within reason and can have TV’s music centres etc in their rooms. The unit has equipment in place to prevent the spread of infection, this includes wipes, disposable gloves and aprons, and they also use designated disposable yellow bags for items that may be infectious. In was noticed that these bags are only placed in the sluice and staff walk through bathrooms and corridors with possible infectious items in their hands. A member of staff explained that they do not have any other way to dispose of this waste. There is a risk of infection being passed on as staff open doors etc, the home must
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 23 look at a system for safe disposable of these items in the room they are obtained from. Speke House Residents commented that they felt safe and comfortable in the home. The general appearance of the home is good and all essential services have records to show that they are serviced and managed as appropriate. The home carries out risk assessments as an ongoing process to ensure that residents live in a safe and well-maintained environment. The inspector toured the premises and noted hand rails, hoists, pressure mats, bathing aids, specialist seating and a dining facility had been provided. The home also had a security system to ensure that the outer doors could only be opened by a key- pad code. Residents are encouraged to make their bedrooms feel like home and those viewed were decorated and furnished to a good standard. Garston Unit –Six staff were interviewed and three Staff had general discussions with the Inspector, four Residents and one Relative had a discussion with the Inspector and a selection of comment cards were left on the unit with freepost envelopes to be forwarded to CSCI. Residents were very happy with the homes facilities especially their bedrooms and they were happy that they could bring a lot of their own belongings into their bedroom. The home was very clean and tidy especially the sample of areas seen. Risk assessments were also seen and gave detailed information about any identified risks, these records would benefit from review to ensure the safety of the unit. Some bedroom doors were noted to be wedged open and a discussion was held around the fire safety and of the basic principles of care including “privacy and dignity” of Residents in the rooms who may not be able to communicate their choices. The charger for a Stand aid hoist was noted to be in need of repair and had been out of use for some time. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Childwall House was not assessed on the above standards during this visit Speke House- The home has clear procedures for the recruitment and selection of staff, which offer safeguards for the protection of residents. Staff are provided in sufficient number and skill mix to meet the needs of the residents and receive ongoing training to ensure they are competent to do their job. Garston House- Residents and Relatives say they are very happy with the home and the care provided by Staff. There is no written assessment nor rationale as to why Staffing levels have been reduced other than there is a reduced occupancy of Residents in the unit. Training records should be updated to show ongoing evidence to meet this standard. EVIDENCE: General. Samples of staff files were viewed. These were from all staff employed across site. These files contained application forms, personal details, two references, CRBs and identification. The files were found to meet the requirements of the Care Home Regulations 2000, Schedule 2. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 25 There was verbal evidence from laundry and cooking staff that they receive training appropriate to their job descriptions, and regular training updates. Staff also receive formal supervision and appraisals. A discussion was held with the laundry assistant, who had been recently employed. She described the recruitment process, which included written application, interview, taking up references and CRB clearance. During her induction period she confirmed having received training in fire safety, first aid, C.O.S.H.H., and was due to undertake infection control training. She described infection control and MRSA procedures followed in the home, when asked. A discussion was held with the deputy head chef, who is acting up to cover sick leave. Rosters have been amended to cover the long-term absence of the head chef and agency and existing staff will cover holidays. The home manager later confirmed this during feedback. Staff who cook have Intermediate Food Hygiene Certificates and all staff that work in the kitchen have Basic Food Hygiene Certificates. All kitchen staff have undertaken COSHH, Fire and Health & Safety training. Speke House Staff turnover is low and staff interaction was observed as being good. Staff spoken to said that they had undertaken Criminal Records Bureau (CRB) checks and all new staff said they had also provided three references prior to commencement. Staff on duty appeared to have the knowledge; skills and understanding to provide well planned care for the residents. All staff stated that they felt staff were provided in sufficient numbers to carry out their duties. However some concerns were raised about how staff would cope once occupancy levels were increased. Observation of residents showed that they were content with the care practices and general assistance of the staff. Staff training records held information to show that staff training was an ongoing process and all staff received structured supervision and support. Staff stated that they had received “loads more training “ since the new site manager had come to post. They stated that this training included first aid, manual handling, food hygiene, managing challenging behaviour and understanding dementia. Three staff spoken with were undertaking NVQ training and were close to completion. It was noted that whilst the unit is registered to accommodate 30 residents, only 16 people were accommodated at the time of the inspection Garston Unit –Discussions were held with six staff, four residents and one relative. Residents and Relatives said they are happy with the care and say “the Staff are lovely”. Staff interviewed were very enthusiastic and motivated to do a good job and provide a homely atmosphere and give as much choice as possible. Everyone in the lounge was seen to be given a good level of care and respect. The atmosphere was very informal and happy and everyone was helped to feel comfortable.
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 26 The Staffing rotas show a reduced number of Staff to the unit and there was no assessment or rationale as to why the levels had changed especially in relation to the current dependency of Residents on Garston unit. Some Staff felt that they were very busy and stretched to do the work, and this was noticeable during this inspection. The training records showed individual records for each member of Staff. This means that the unit can give written evidence of each individuals training to date. Some records viewed showed that staff had received a variety of training and this was later confirmed during discussion with staff. However some of the records viewed were in need of being updated and further training needed to be offered to some staff. Topics to be offered should include ; MRSA, Health and Safety, Abuse Awareness, Cross infection, Induction and ENB training in Palliative care. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 27 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36/38 Childwall House Satisfactory records and certificates are in place to make sure the building is safe, this includes, fire, main electrics, small appliances, water and gas, staff attend a fire lecture twice a year. Speke House The home is well managed and staff feel supported. Service users feel safe. Garston House Staff in the home are not receiving Supervision as required. Risk assessments need to be updated. The practice of wedging fire doors open is unsafe and must cease. EVIDENCE: General Discussions were held with staff on Childwall, Gateacre and Speke House. All commented positively on the abilities and qualities of the new site manager. Staff feel that the new manager is enthusiastic about staff development and that since the commencement of her employment more training has been
Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 28 made available. Staff also commented that communication within the home is much better. The manager has achieved registered managers status with the CSCI, which means that steps have been taken to prove that she is suitable to manage the home. The manager is a qualified nurse and holds a Level NVQ 4 in management qualification. Evidence of assessment of Health and Safety in the Kitchen and Laundry Areas of the home Kitchen The kitchen and food stores were visited and these areas were clean and well organised at the time of inspection. The chef said that all kitchen equipment in use was in working order. A replacement urn was on order and a microwave. Staff who cook have a good level of domestic support (two domestics on duty at time of visit). Equipment, surface and floor areas are cleaned at least daily, and cleaning schedules were seen to be completed, and were signed by domestic staff. The heated trolleys, (used for transporting meals to units) have recently been replaced. The chef said these work efficiently. There is walk-in freezer and a walk-in fridge and both have exit devices from inside. During this tour of the kitchen, the following shortfalls were observed. There is a moisture outlet from the walk-in fridge (a tube leading to a bucket), which leads directly into the kitchen. The bucket was placed on the kitchen floor and was filling with water at the time of inspection. This constitutes a tripping hazard. Staff confirmed that this had been reported to the maintenance department. The wires from the cooking equipment and streamer are exposed and constitute a tripping hazard. The tiles around the kitchen window are in need of re-grout some being pitted and could potentially trap stale food and cause contamination. Laundry. The laundry was visited and was well equipped and well organised at this time. There are two doors and soiled and clean laundry is transported in and out in one direction, through separate doors, to avoid cross contamination. The home employs three designated laundry assistants and one assistant is on duty throughout the week. Items for laundering are colour-bag coded and collected from individual units in trolleys. Laundered items are returned to the units and distributed to the owners’ by staff from that unit. The laundry appeared to be well ventilated. There are three industrial washing machines with sluice programmes and two dryers. Protective clothing is provided for laundry staff. There are also ironing facilities in the laundry. Childwall House Some of the residents on the unit said that they feel the unit will benefit once a new manager for the unit is in place, as they feel unsettled by changes of staff. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 29 Speke House Staff comments included “I just love coming to work”, “my line manager is wonderful”, “everybody works as a team”, ”we now feel supported and valued”. Residents stated that they like the atmosphere in the unit. They said that the unit manager and the home manager often talk to them about the management of the home and as a consequence feel valued. Garston House Staff acknowledged they did not all have formal supervision. The Manager explained the forthcoming plans in implementing supervision. The way that Staff are supervised must include opportunities for formal 1:1 time so that staff can discuss issues and develop care practices. Risk assessments were also seen and gave detailed information about any identified risks, these records would also benefit from a more recent review to ensure the safety of the home Action should be taken regarding the wedging open of fire doors. One observation of moving and handling by Staff identified an urgent need for Staff to have appropriate training and assessment of their competencies. This will provide up to date support to all Residents needing assistance with moving and handling. There were compliments from the Residents and Staff about the Manager of the unit and his style of management, which some felt was a great improvement to the unit. It was acknowledged that there are two managers to the unit and presently the duty rota shows they have no overlap, this should be reviewed to continue improvements to the overall management of the unit and improve on continuity to the home. Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 30 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2
COMPLAINTS AND PROTECTION 1 x x x x 3 x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x 2 x 2 Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 31 NO 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 OP7 Regulation 15(1) Requirement Childwall House - The unit must add a section in care plans stating how they intend to meet residents needs and choices. Childwall House - The unit must consult with residents about the contents of their care plan Childwall House - The unit must get residents permission wherever possible to discuss their care plan with a relative. Childwall House-Staff must ensure fridge temperatures are monitored and the findings recorded on a daily basis. Childwall House- The service must ensure suitable curtains or blinds are supplied so that residents can maintain their dignity and privacy when using their bedrooms. Garston House-The Responsible Person must ensure that a full index of policies and procedures are available to all staff on Garston unit including those specifically for palliative care and a policy guidance for subcutaneous fluids Speke House- The responsible Timescale for action 10/09/05 2. 3. OP7 OP7 15(2)c 12(3) 31/08/05 31/08/05 4. OP9 13 (2) immediate 5. OP10 12 (4)(a) immediate 6. 0P11 12(1)(a) immediate 7. OP12 16(1)( n) 10/09/05
Page 32 Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 8. OP12 16 (1)( n) 9. 10. 11. OP19 OP19 OP25 13 (4)( a) 23( 2)( b) 13(4)( c) 12. OP26 23( 2)( c) 13. 14. OP26 OP27 13 (3) 18 (1) (a) person must review the provision of activites for the residents.Individual preferences must be taken into account and actvities provided which are suitable for those residents who have memory loss.This must include the provision of trips out. Garston House-The Responsible Person must review the provision of activities for the Residents within the home. Individual preferences must be taken into account and Social inclusion must be promoted. Funds must be made available for activities in a designated budget and a detailed programme should be accessible for all Residents. Childwall House - The unit must carry out a risk assessement of the courtyard area The wall tiles in the main kitchen (window area) must be regrouted/replaced as necessary. Garston House- the Responsible Person must take appropriate action to reduce all risks associated with inappropriate moving and handling techniques and ensure Staff are suitably trained and assessed as competent to support Residents with all support in moving and handling Garston House-To repair the broken charger for the standaid hoist so that Staff can use this equipment. Childwall House - The unit must review the procedure for the disposal of clinical waste . Garston and Speke House-The Responsible Person must ensure that the Staffing of the home meets the ongoing needs of the Residents and submit evidence to the CSCI describing the 10/09/05 31/08/05 31/08/05 10/09/05 immediate 31/08/05 31/08/05 Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 33 15. OP36 16. OP38 17. OP38 actions taken to meet this regulation and carry out a written assessment to show written evidence that the Staffing levels are appropriate. 18 (2) Garston House-The Responsible 10/09/05 Person must ensure that all staff receive supervision at least six times per year 13 (4)( c) Garston House-The Responsible immediate Person must arrange a review of manual handling arrangements for the Resident identified during the inspection 13 (4)( c) The manager must ensure that a immediate risk assessment is undertaken in relation to tripping hazards observed in the main kitchen, and remedial action taken accordingly. 18. 19. 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 OP12 Good Practice Recommendations Garston House-Consultation should be ongoing with residents and their representatives, regarding the content of menus and cooking staff should regularly monitor the quality of meals as they are served. Garston House-Consultation should be ongoing with residents and their representatives, regarding provision of social activities, which meet residents’ individually assessed needs. The Manager should explore the comments made regarding the provision of activities on Gateacre House.An audit should be undertaken to ensure that these are appropriate for residents with mental health needs. The Manager should explore the comments made by a relative reagrding the use of torn tablecloths and the acessibility of cold drinks on Childwall House.
F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 34 2. OP12 3. OP12 4. OP15 Arncliffe Court 5. 6. 7. OP15 OP19 OP19 8. 9. op27 OP30 Garston House-To develop the accessibility to menus and to review the current presentation of all blended meals. The manager should explore the comments made by relatives regarding the environment of Gatacre and Childwall House The comment made by relatives regarding the patio doors on Childwall unit should be explored by the service and any damage repaired so that residents are free to come and go Garston House-Staffing levels should be reviewed when the unit returns to full capacity of numbers. Op 27 Garston House-To continue developing training for all Staff and update all training records and provide evidence were training has been paid for so that each member of staff has evidence of at least 3 days per training per year,Provide outstanding training for those staff who have identified a need and update in MRSA/Health and Safety/Abuse Awareness/Cross Infection/ and ENB training in Palliative care. Garston House-To provide an increase to the unit Managers hours to provide necessary overlap to improve communication and continuity. To provide suitable Management training for the unit Manager. Garston House-To implement updated reviews to all risk assessments as part of an ongoing and regular review. 10. OP31 11. OP38 Arncliffe Court F53 F03 S5450 Arncliffe Court V228310 250505 Stage 4.doc Version 1.30 Page 35 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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