CARE HOMES FOR OLDER PEOPLE
Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF Lead Inspector
Mrs Joanne Revie Unannounced Inspection 31st May 2006 09:30 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.V296448.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.V296448.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 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Joanne Farrell Care Home 150 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (84), of places Terminally ill over 65 years of age (6) Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service Users to include up to 54 OP and up to 30 OP (PC) in Childwall House and up to 60 DE(E) in Woolton and Gateacre 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 The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 4. 5. 6. Date of last inspection 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 and palliative care for those who have been diagnosed as terminally ill. 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.V296448.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted over three days (21 hours). Due to the layout of the individual units two inspectors carried out the inspection. Residents were spoken with on each unit and their views have been included within the report. Discussions were also held with staff. A variety of documentation was viewed which is referred to in the evidence section of the report. What the service does well:
Each prospective resident receives a full assessment of their needs before admission takes place. This means that the home has time to plan to ensure that it can meet a new residents needs. This reduces the risk of a resident moving to a home that cannot care for them. Staff keep clear daily records of the residents progress on all units. This gives staff written information that they can reflect on. Woolton, Childwall and Garston were found to uphold resident’s dignity and privacy and residents on these units all stated that they believed that their needs were being met and that they were well cared for. In some instances it became evident that residents have formed close relationships with individual staff members. All units were found to be clearly recording any visits from outside professionals such as G.P. s, District Nurses, Tissue Viability nurses, Community Psychiatric nurses, Dieticians and Opticians. This shows that staff approach these professionals for advice should a residents needs change. Medications are managed safely on Speke, Garston and Woolton House. This reduces the risk of a mistake occurring and a resident being given the wrong medication. Although shortfalls were identified in the provision of activities Garston house has developed activities the most with group activities as well as individual one to one support for those residents who can’t or don’t wish to join in. Most residents spoke with warmth of the staff’s ability to care. Comments included “the girls are great- they work very hard” and “they’re so kind”. All confirmed that their visitors were always made welcome and were free to visit whenever they choose. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 6 The service takes any concerns or complaints seriously and follows its own complaints procedure strictly. This shows a commitment to improve the service and to ensure clients are satisfied. The home has strict recruitment procedures in place, which means staff, are checked for their fitness and ability to do the job before employment starts. This helps to keep residents safe. Over half of the staff have achieved an NVQ qualification in care which means that over half of the staff have undertaken in depth training rather than basic training to meet the residents needs. What has improved since the last inspection? What they could do better:
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 7 BUPA have produced documentation known as the Service users guide and the Statement of Purpose, which meets the requirements of the law, which governs nursing homes. However residents and staff spoken with were not aware of the contents of this information nor were they aware of the outcome of the previous inspection. This matter must be addressed to promote empowerment for the residents and involvement of the staff in any future development of the home. Care plan documentation on all units must be developed further so that the residents’ social needs are included. In some cases staff have tried to do this however this is not consistent. Reviews must be undertaken on the resident identified and discussed during the inspection on Gateacre and the four residents who require two staff to mobilise on Childwall. In the case of Childwall- if this cannot be undertaken staffing levels must be reviewed to ensure all residents needs are being met. The issues, which do not reflect promotion of privacy and dignity on Gateacre House and Speke House, must be addressed. Staff must recognise the importance of this to maintain the residents self esteem and encourage the units to be resident led rather than staff led. Staff in Speke house need to familiarise themselves with the different types of pressure relieving equipment that is available on the unit and ensure it is put to good use. Mattress protectors must be swapped for something, which promotes the resident’s comfort and does not increase the risk of skin breaking down. Risks identified as high on risk assessments must be transferred to the care plan as a need, so that clear written instructions are available for staff on how to reduce the risk. Gateacre, Speke and Garston House must ensure that wherever possible residents and if not, relatives are involved in the formulation of the care plans and prioritisation of which is the most important need to the resident rather than which need the staff consider is the greatest. The management of medications on Gateacre and Childwall must be revisited. Both incidents identified during this inspection must be fully investigated by the registered person and any outcome/action taken reported to CSCI. Documentation on Childwall house must be reviewed to ensure it is appropriate for a residential unit rather than a nursing unit. Further documentation should be developed on Woolton house so that residents’ abilities and their mental health needs are recorded separately. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 8 Staff must ensure that they store eye ointments at room temperature and not in the fridge. The medication room on Woolton House must be treated for ant infestation and staff reminded of how to address this should it reoccur in the unit manager’s absence. Wound care documentation on Garston House was found to be clear but would benefit from photographs being taken on regular basis rather than erratically or when the type of dressing changes. Numerous concerns were identified regarding the provision of activities across site. These were as follows and must be addressed: Activities for those residents who have mental health needs must be implemented without further delay. It was a particular concern that this has been identified as a need on Gateacre House in the past and although initially addressed it has fallen by the wayside. All units must display an up to date activities rota detailing what is available for the residents on a daily basis. Records must be kept of any activities, which the residents participate in. During the inspection many staff commented that they felt as though they didn’t have the time to assist residents with activities. These comments must be explored and acted on. The provision of trips and outings must be regularly included in the provision of activities. Although residents stated that the provision of food was satisfactory nobody was particularly enthused by the standard offered. This should be explored. Some units have instigated “protected mealtimes” so that eating can become a quality experience. It became clear that staff were trying to implement this but had not fully grasped what protected meal times were about and this subject must be revisited. Plans must be also developed to provide meals that are suitable for those residents who are of an ethnic minority. Many of the staff employed have undertaken training on Abuse awareness however some staff have not. Not all the units had access to the local guidelines on what to do if they think abuse has occurred. These concerns must be addressed. The company did not demonstrate on this occasion that they had suitable numbers of appropriately trained staff to support the resident’s needs. There was no evidence of any discussions with Staff, Residents, Relatives regarding Staffing levels and Residents needs. There was no written rationale or
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 9 documented calculation and there was no evidence of staffing levels for each unit in the statement of purpose held at reception. Procedures for covering staffing levels should be openly available to ensure each unit has sufficient staff in place at all times to support each Residents needs. Staffing levels must be clear and agreeable to all parties and must demonstrate they meet the Residents needs. It would be of benefit if Staffing levels are displayed in each unit’s statement of purpose as a basic level and commitment from the company regarding the appropriate minimum levels for each unit, this would enable openness and transparency to all comments raised during this inspection. The deputy manager has worked hard to ensure staff undertake mandatory training. She has developed a training matrix which clearly shows who has undertaken training. This needs further development to evidence that all staff have received three days paid training as recommended in the national minimum standards. A new manager has been employed since the last inspection. Although this manager is registered with CSCI to manage another home, a fresh application is required for this home. The operations manager stated her intention to support the new manager with this. Client satisfaction surveys are carried out across site, which shows a willingness to gain and listen to the views of the residents. However this would fit better with the national minimum standards if residents were surveyed on a yearly basis on each of the units. Health professionals and staff should also be included. The results of the surveys should be formulated into action plans for each of the units. A copy of the outcomes should be forwarded to CSCI. Personal allowances are managed safely by the home and strict procedures exist. However these procedures are so strict that monies can only be obtained during office hours or by prior agreement with the office. This should be reviewed so that residents can access monies when they want to. During the visit to Woolton House it became evident that some flagstones in the garden area are raised and present a tripping hazard. These must be repaired and in the meantime a risk assessment developed to reduce the risk of a resident injuring themselves. The manager expressed her intention to ensure staff practise evacuation techniques in the event of a fire occurring. This is vital and must be carried out. A recent servicing of all fire fighting equipment was undertaken however the home had no certificate available to show this had occurred. This must be followed through. The deputy manager reviews any accidents that happen across site. It was noted that a larger number of falls than expected occur unwitnessed. A
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 10 system must be developed identifying what time of day falls are occurring, where they are happening and whether someone has seen them occurring. During the visit to Garston House it was identified that staff are supporting nine residents with mobility needs who have fixed beds. This could pose a risk under manual handling legislation to both residents and staff and must be reviewed. 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 Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 12 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Residents receive a thorough assessment before admission takes place by a person who is qualified to do so. However it could not be determined whether residents receive sufficient written information about the home before admission takes place. EVIDENCE: ALL UNITS Care plans case tracked showed evidence of a detailed assessment taken by the homes staff to show that they can meet the Residents needs. The assessment and admission record showed a list of the persons needs and requests. A senior nurse from the home had undertaken all assessments viewed with those units who provide specialised care involving unit managers (i.e. Gateacre and Woolton). However both Staff and Residents/Relatives had no knowledge of a statement of purpose or service users guide. This was later discussed with the manager and the operations manager who confirmed that this information is provided in
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 13 residents bedrooms on admission however the view was that this becomes misplaced at a later date. Care staff spoken with on each unit (except Woolton which was being inspected for the first time) had no knowledge of the inspection report, which was produced following the last visit. This should be reviewed following this inspection as each unit should have open access to these necessary documents to enable Residents to make an informed choice and to have necessary information about the home and its facilities and services offered on each unit. Also staff and residents should be made aware of the recommendations and requirements made by CSCI so that they can be involved in any development process. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 14 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Each resident has a plan which reflects most of their physical needs but has` little input showing their social needs. Residents health needs generally are being met. However shortfalls were identified on Gateacre House and the use of equipment on Speke House. Documentation needs to be improved on Speke and Childwall House to reflect this. Medications are not managed safely on Childwall and Gateacre House but are managed safely on the other units. Privacy and dignity is not upheld in all cases on Gateacre and Speke House. However no concerns were identified in this area on Childwall, Garston and Woolton EVIDENCE: Woolton One care plan was case tracked and showed evidence of a detailed care plan with monthly updated reviews. The only area of the care plan in this particular
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 15 case that needed further development was the social support required by the resident, as care plans are not currently in place to identify these needs. There was a list of activities the resident would like to do which had been recorded on admission however there was no further evidence or plan to show what action was to be taken to support this person needs socially. This Resident stated they were bored, had little to do and would like to go out, however the care plan did not reflect any of these important views. Another two plans were viewed. Staff were keeping good clear records of progress. Risk was managed well and was detailed. One piece of documentation that required further development was a template, which had been developed to identify what abilities the resident had on admission so staff would know how to support them to continue their independence. Included in this was the residents health needs. A discussion took place with the unit manager who agreed that these two areas should be separated. Good practise was evidenced in that staff were keeping clear records of actions/visits by the district nurse and regular reviewing of the plans and identification of which was the greatest need. Health care needs were being met through regular weighing and monitoring of the residents health. Evidence was found that showed staff had requested the outside help of dieticians, G.P.s etc should a residents needs change. Staff and residents confirmed that either a family member or a member of staff always escorts them when they attend appointments. The medication room was noted to be clean tidy and organised. The medication policies were accessible to staff on the unit and all staff had received medication training to enable them to administer medications appropriately. The sample of medication records and storage of medicines were noted to being managed appropriately. It was noted that it was a warm day and there were ants in this area. This needed attention to address this issue, especially in the medication room. Gateacre The Care plan that was case tracked showed evidence of the identified persons needs and regular reviews. The care plan gave no details of how to fulfil the Residents social needs. Various concerns noted by this Resident had not been addressed in their care plan nor was their any evidence of supporting this person in making their views known or acted upon. The Manager acknowledged the need to review this persons needs and care plan and arranged for this to take place during the time of this inspection. This incident raised concerns about the inappropriate management of this persons needs and the possible risk that this resident was living on a unit, which could not meet his needs. The company to ensure that all Residents on this unit have their needs met appropriately must investigate this. On this unit there was some evidence of good practice in how Residents had been supported with personal care so that they were dressed appropriately. However one resident was sat in the lounge with no stockings and her hair
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 16 appeared to have not been combed. Another resident was sat in the lounge, unshaven with dry skin, and was sat opposite another resident who continually shouted. It was noted that this person was not opposite a TV or anything else purposeful for his entertainment. The Staffs reasoning around the condition for these 2 Residents was that “the night staff had got them up.” This was discussed with the manager who supported the staff’s claims. The medication room was clean tidy and organised. One record on the medication sheet showed evidence that the nursing staff had discontinued a Residents medication with no input from a G.P. however there was no evidence of any refusals or wastage recorded on the medication sheet or care plan. This serious issue was discussed with the homes Manager and raised concerns about the management of this resident’s care and the unit manager’s misunderstanding of the nurse roles and professional obligations. The manager confirmed her intention to arrange a review of this person’s care following this inspection and to investigate why staff had believed that the stopping of medication was the right action to take. Childwall Two care plans were viewed. It was identified that the unit is using a dependency scale, which is devised for a nursing unit and therefore does not clearly reflect residential needs. Generally the plans were well written and easy to follow. One resident was suffering from a pressure ulcer, which was being treated by the district nurse. Staff were keeping clear records of visits and action taken. However staff were trying to identify the risk of sores occurring using a tool called a Douglas Scale. No key was available to identify whether the overall score indicated low, medium or high risk therefore this was a futile exercise. Staff were keeping clear records of visits from Health professionals such as G.P.s dietician, CPN and Chiropody. The unit has a keyworker system in operation but clear records were not being kept of this. Activity profiles were not completed so it was unclear whether resident’s social needs were being met or not. Staff are taking photographic evidence of any injury sustained by a resident or the presence of any bruising. This reflects good practise. Both plans viewed were updated regularly. During the inspection it was identified that four residents required two staff to aid them with mobility. This seems a rather high dependency level for a residential unit and should be either reviewed or staffing increased so that all residents needs on the unit are being met. The management of medications was reviewed as part of the visit. Generally staff were managing medicines to the required standard. However it was evidenced that one resident hadn’t received any medication for four days. This was discussed with staff who stated that a breakdown in communication had occurred with the pharmacist and G.P. as this resident had recently changed doctors. Staff appeared unaware of the impact of missing four days worth of
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 17 medication. This was later discussed with senior management who stated their intention to address this serious concern. Speke Two plans were viewed. These had been produced around the activities of daily living. Risks such as development of pressure sores were identified in separate risk assessments but this information had not been transferred to the plan as a need. Evidence was viewed which showed that other health care professionals such as the dietician and optician were involved in the residents care. One resident was receiving wound care and these records were found to be clear and reflected good practise through the use of wound mapping and photographs. No input could be found from the resident or their representative on either plan. No social needs, wishes or preferences were recorded for either resident. However both plans had been regularly reviewed. One resident who was at risk of pressure sores developing was found to be using an outdated piece of equipment when better equipment was available on the unit. Several residents appeared to be sleeping on mattress protectors, which have been identified as reducing skin integrity and do not promote comfort. Another plan was viewed which showed staff had made some efforts to address the resident’s social needs. This particular resident informed the inspector that she likes to be dressed smartly and always uses perfume. This information was not available on the plan. Six people were viewed in bed during the visit. All had their bedrooms doors open and staff were seen to walk in to the room and directly address the resident without knocking. Medications were viewed and were seen to be being managed safely on the unit. Staff were keeping clear records of receipt, administration and disposal. Garston One care plan was case tracked. A discussion with this resident showed that he was very fond of one particular staff member yet his keyworker was someone else. The plans covered all aspects of the activities of daily living with the exception of the resident’s social needs. This had been identified in the initial assessment but had not been transferred to the plan of care. The care plan priority showed that maintaining a safe environment was the residents greatest need yet discussions with the resident did not reflect this. No evidence could be found of the residents input into the plan of care. Staff were keeping very clear records of the residents daily progress. This included visits by health care professionals.
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 18 Wound care records were viewed for another resident, which showed involvement from a tissue viability nurse. Records were clear however measurement of the wound appeared to be happening erratically. Medications were viewed. Generally these were managed safely. However eye ointment was being stored in the fridge rather than at room temperature. Records were viewed which showed that the homes Deputy Manager carries out internal audits of medications on each unit on a weekly basis to ensure the medication processes are appropriate on each unit. Part of the deputy manager’s role is to audit care plan documentation also. Records showed that 12 care plans per month are reviewed using this process and the named nurse responsible for completing the care plan is made aware of the outcome. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Activities are not provided in sufficient amounts for all residents. Some units are not providing activities at all. Outings are arranged infrequently. Visitors are free to visit when they choose and take residents out if they wish. Residents are offered small choices around their daily lives but this is seldom recorded. Resident’s believe that the food provided was average but agreed they are offered choices of meals EVIDENCE: Garston Staff state the activities organiser works 20 hours a week and tries to organise monthly trips out. The organiser tries to organise group activities including bingo, dominos, card games, exercise movements, the mobile shop, and 1 to 1’s for some Residents once a week. Staff state a programme is usually displayed to inform everyone of what’s planned but a programme was not displayed during this inspection. The organiser also completes an activities record for each Resident which gives information on what they have either refused or got involved with, some records needed updating. Staff acknowledged they would like to organise more activities on the unit if they had the time to do it. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 20 Visitors and Residents stated that visitors can call to the home at any time and are always made to feel welcome. Staff explained they have implemented “protected meal times.” However it was noted that the TV was still on, staff were hoovering at lunchtime, the lounge and kitchen doors were open. If these issues were addressed with Staff it may help their implementation and understanding of protected meal times. Lunch was served during this visit and Residents were seen to be given various choices for their meal. One Relative explained “that they had complained about the evening meal the night before which she felt was of a poor standard and inappropriately cooked”. The manager explained that she had already addressed the concerns with the agency who had provided the chef and would give feedback to units on the actions she had taken about the quality of the meal served. Woolton Staff state they have an activities organiser for 30 hours a week. During this inspection the activities organiser was in the process of organising a crossword game. There was no advertisement of what activities were planned on the unit or any evidence of any discussions with Residents to ascertain their views on what activities they would like organised. Staff explained they had only had 1 organised trip out in the last 6 months and acknowledged they would like to see more. 2 Residents stated they were bored and didn’t like the group activities. It was noted that the garden area needed attention and immediate repair of uneven flagstones that should have a risk assessment in place with action taken to minimise any risks including falls. One Resident acknowledged the uneven flags and stated they tried to be careful when they went outside. They stated they liked to sit out and get fresh air especially how they were unable to go outside on their own without staff. There was just one bench for Residents to sit out on however staff stated they had garden furniture on order but could not give a date of when this would be in place. If the garden area was maintained and managed appropriately it would have the potential to provide additional facilities and day space for Residents especially during this period of good weather. Residents and staff state that there is open visiting on the unit and that relatives are encouraged to access the small kitchen to make drinks which helps them feel at home. 2 Residents stated that they felt restricted and not always able to go out as they do not always have Staff to do this. They both stated they would like to regularly go out. The company and staff should look at developments of how Residents can be supported in “choosing” and maintaining their “autonomy”. This could be further evidenced by the use of residents meetings, reviews,
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 21 questionnaires, sharing planning and development plans and look at eliciting regular opinions on necessary topics such as, meals, activities, and maintenance and decoration plans and statement of purposes, service user guides and inspection reports. Gateacre It was noted that this unit had not had an activities organiser since aprox the end of January 06. This was a matter of concern and one that has not been appropriately addressed despite prior identification by the inspection team. The main focus of the day was noted to be around routines and tasks of daily living associated with both personal and nursing care. Staff acknowledged their limitations in being unable to provide social support due to the needs of Residents. One Resident stated, “They felt trapped like a prisoner”. This persons feelings were of concern and were discussed with the manager. Evidence should be developed to personalise this person’s care and support and enable them to be supported in expressing their views. This Resident also expressed a view that they felt degraded by having intimate personal care delivered by young female staff. The company must explore this view and ensure Residents needs and requests are heard regarding very important points and opinions. It was acknowledged that specific diets such as Spanish meals should be reviewed and developed with the Chef to ensure an appropriate menu was on offer to Residents who would appreciate meals specific to their upbringing and native country. Speke No activities rota was displayed on the unit. A resident stated that she had been invited to attend activities on other units but wasn’t happy with this as “ this is my home why cant we have activities here”. Two staff and a resident stated that no trips out were arranged. One resident had agreed to attend a trip for another unit but staff had forgotten about her and she had been left behind. Two residents stated that visitors were always made welcome and could visit when they choose. Viewing the visitor’s book confirmed this to be true. A risk assessment was viewed for one resident who wished to self medicate but little evidence could be found in the three careplans viewed of resident’s other choices. One resident stated that she required a soft diet but her choices were limited as she always chose meals from the alternative menu. Two residents stated that the food offered is okay but confirmed that they were always offered choices Childwall This unit has an activities organiser but she was on annual leave at the time of the visit. Due to the residents needs staff felt unable to continue with activities
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 22 in her absence. No activities rota was displayed on the unit. Two care plans viewed did not have completed activities profiles in place. Residents stated that a trip had been arranged for the following week and staff confirmed this to be true. Little evidence could be found in the plans viewed of resident’s choices. A discussion took place with the unit manager who is new to post. She had identified this shortfall and stated her intention to develop the plans to reflect personal choices. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 23 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The service takes complaints seriously and informs complainants of outcomes. Not all staff have the skills or access to information to protect residents from abuse EVIDENCE: A copy of the company’s complaints procedure was displayed on each of the units. This meets the required standard. All complaints received plus progress are monitored by the responsible individual for the service on a monthly basis. The complaints book was viewed which showed that concerns, plus action and the timescale resolved are all recorded. The Responsible individual for the service has investigated complaints in the past and informed CSCI of outcomes to a satisfactory standard. Abuse awareness training is on going across site. However one member of staff was identified who had never undertaken this training despite being employed for a number of years. Some units had a copy of the local authorities guidelines regarding protection of vulnerable adults but some units did not. All units had copies of BUPA’s abuse awareness policy. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 24 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 All units presented as clean comfortable places to Live. Staff support residents to make their bedrooms “home”. EVIDENCE: All units were found to have sufficient supplies of paper towels, Liquid soap, disposable aprons and gloves and sufficient hand washing facilities. Garston This unit was noted to be clean tidy and well presented. On inspection of a sample of areas within the environment it was noted that 2 currently empty bedrooms did not have nurse cords attached to the panels. The manager acknowledged this and stated she would ensure they have the cords in place. Childwall This unit was noted to be clean and tidy. Some rooms were noted to have loose grills on the end of radiators that needed repair.
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 25 Speke This unit presented as clean and tidy. One Resident stated she was very happy with her room and had no problems. Some rooms had been refurbished and had new armchairs and laminate flooring. Woolton This unit presented as a bright comfortable place to live. Staff have developed corridors by including memory boxes and pictures of interest. Bedrooms were personal to the individual. Gateacre This unit presented as clean and tidy and smelt pleasant. Although some areas require refurbishment staff have worked hard to make them appear comfortable and homely. Memory boxes are in use and pictures have been added to corridors to make them more interesting. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 26 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Staff may not be 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: The off duty was viewed on all units. The units were staffed according to the numbers recommended by management. However Childwall House was visited at 2:30 pm in the afternoon, which is usually a quieter time. Staff were seen to be working very hard and considering the needs of four residents who require two staff to mobilise were not staffed sufficiently. Throughout the visit staff complained that they were moved from unit to unit to cover other staff absences. Staff on Gateacre House found this a particular problem. The unit manager on this unit also stated that he found it difficult to be site cover and manage the unit effectively. Particularly when he was the only nurse on duty. The company did not demonstrate on this occasion that they had suitable numbers of appropriately trained staff to support the resident’s needs. There was no evidence of any discussions with Staff, Residents, Relatives regarding Staffing levels and Residents needs, there was no written rationale or documented calculation and there was no evidence of staffing levels for each unit in the statement of purpose held at reception.
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 27 Procedures for covering staffing levels should be openly available to ensure each unit has sufficient staff in place at all times to support each Residents needs. Staffing levels must be clear and agreeable to all parties and must demonstrate they meet the Residents needs. It would be of benefit if Staffing levels are displayed in each unit’s statement of purpose as a basic level and commitment from the company regarding the appropriate minimum levels for each unit, this would enable openness and transparency to all comments raised during this inspection. A sample of training records showed evidence of a varied amount of organisation and training that had been developed and put in place. Most staff interviewed during this inspection stated they had attended most of the training offered; just 1 staff member had not attended the “abuse awareness” training. The training records are in the process of being updated and still need to show evidence of at least 3 days paid training per week. The sample of personnel files was reviewed as part of case tracking (9). These files contained most of the information required by the Care Home Regulations 2001. The manager explained that she was in the process of reorganising these files with a new index so information was easy to find. One file for a recently qualified nurse needed to be developed to demonstrate that appropriate mentorship will take place, however the homes deputy had explained verbally the support she had planned and was continuing with. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 28 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 A new manager is in post who is not yet registered as the registered manager with CSCI. Quality assurance is carried out but this could be developed further. Personal allowances are managed safely but could be more accessible. Although some concerns were identified the service generally acts responsibly in maintaining Health and Safety. EVIDENCE: The new manager was in post on the day of the inspection. The operations manager stated her intention to forward the managers application to CSCI in the immediate future. The new manager was previously registered with CSCI to manage another nursing home. A discussion with staff and viewing of documentation showed that the company undertakes quality audits for the home as a whole and distributes client satisfaction surveys for particular areas e.g. food.
Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 29 A discussion was held with the senior finance administrator. Viewing of records and residents personal files showed that personal allowances are managed safely. However there is no system in place for residents to spontaneously request sums of money such as fifty pounds. A contract with a waste disposal firm was viewed. This was current and covered the removal of all medical waste including medications. Records showed that Small electrical appliances have been tested for safety. These items were viewed on the units also. A service report dated April 05 was viewed which showed all fire equipment had been serviced. The deputy manager confirmed that this was repeated in April 06 but the up to date certificate had not been received. Fire logbooks were viewed on each of the units also. Staff are recording in these when the fire alarm is sounded other than a random test. The manager stated her intention to ensure practise evacuations are carried out on each of the units. Records showed that all hoisting equipment on site was serviced and is current. The maintenance officer is keeping clear records of any repairs and redecoration undertaken, plus evidence that random temperature tests are being undertaken on the water supply. A contract was viewed which showed that the water supply has been cleansed. Accident records were viewed which showed that the deputy manager reviews any accidents/falls, which occur on site. Records showed that action is taken if an individual falls several times. This is addressed through a risk assessment. However no full audit is in place to monitor times of accidents and whether staff saw the accident occurring or not. All units were viewed on the day of the visit. Training records showed that staff have undertaken mandatory training such as fire prevention, manual handling, food hygiene and first aid. It was noted when visiting Garston House that staff are supporting 9 Residents who would need a hoist and all have fixed style beds. The company as a matter of priority must address this. Appropriate risk assessments and actions to be taken to minimise any potential risks to Residents and Staff must be developed. Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4.1,2,3, and 5 Requirement The registered persons must ensure that the Statement of Purpose and inspection report are displayed in a prominent position on each unit and that staff and residents are encouraged to read these documents. Care plan documentation on all units must be developed further so that the resident’s social needs are included. In some cases staff have tried to do this however this is not consistent. Activities for those residents who have mental health needs must be implemented without further delay. Reviews must be undertaken on the resident identified and discussed during the inspection on Gateacre and the four residents who require two staff to mobilise on Childwall. In the case of Childwall- if this cannot be undertaken staffing levels must be reviewed to ensure all
DS0000005450.V296448.R01.S.doc Timescale for action 31/08/06 2 OP7 15.1 31/08/06 3 OP7 16 m n 31/08/06 4 OP8 14 1 2 31/08/06 Arncliffe Court Nursing Home Version 5.2 Page 32 5 OP10 12 4 a residents needs are being met The issues, which do not reflect promotion of privacy and dignity on Gateacre House and Speke House, must be addressed. Staff must recognise the importance of this to maintain the residents self esteem. Staff on Speke house need to familiarise themselves with the different types of pressure relieving equipment that is available on the unit and ensure it is put to good use. Mattress protectors must be swapped for something, which promotes the resident’s comfort and does not increase the risk of skin breaking down. Risks identified as high on risk assessments must be transferred to the care plan as a need so that clear written instructions are available for staff on how to reduce the risk Gateacre, Speke and Garston House must ensure that wherever possible residents and if not, relatives are involved in the formulation of the care plans and prioritising which is the most important need to the resident The management of medications on Gateacre and Childwall must be revisited. Both incidents identified must be fully investigated by the registered person and any outcome/ action taken reported to CSCI Documentation on Childwall house must be reviewed to ensure it is appropriate for a residential unit rather than a nursing unit. Staff must ensure that they store eye ointments at room
DS0000005450.V296448.R01.S.doc 31/07/06 6 OP10 16.2. c 31/07/06 7 OP10 15.1 2 31/07/06 8 OP7 15.1 2 31/08/06 9 OP9 13.2 31/08/06 10 OP8 15 .1 2 30/09/06 11 OP9 13. 2 31/07/06
Page 33 Arncliffe Court Nursing Home Version 5.2 temperature and not in the fridge. 12 OP9 12 1 a The medication room on Woolton House must be treated for ant infestation and staff reminded of how to address this should it reoccur in the unit manager’s absence. All units must display an up to date activities rota detailing what is available for the residents on a daily basis. Records must be kept of any activities, which the residents participate in. During the inspection many staff commented that they felt as though they didn’t have the time to assist residents with activities. These comments must be explored and acted on. The provision of trips and outings must be regularly included in the provision of activities. Following an audit those staff that have not undertaken Adult Protection training/ Abuse awareness must do so without further delay. Copies of Knowsley’s Adult protection procedures must be made available on each of the units. A review of staffing levels must take place across site. A rationale must be developed to evidence when staffing levels are to be increased or decreased. A risk assessment must be carried out on the flagstones to the garden area of Woolton House. The new manager must follow through her intention to submit a completed application to be the registered manager to CSCI.
DS0000005450.V296448.R01.S.doc 31/07/06 13 OP12 16 m n 31/07/06 14 15 OP12 OP12 OP18 16 m n 18.1 31/07/06 31/08/06 16 OP13 16 m n 31/08/06 17 OP18 18.1 I and 13.6 31/08/06 18 OP27 18.1 31/07/06 19 OP19 12.1a 31/07/06 20 OP31 8.1 and 9 31/07/06 Arncliffe Court Nursing Home Version 5.2 Page 34 21 OP33 24 1 a b 22 OP35 16.2.l 24 25 26 OP38 OP38 OP38 23 4 c 12.1a 12.1a Senior management must familiarise themselves with the recommendations of this standard. The management of personal allowances must be reviewed so that residents can access their money when they want it. Practice fire evacuations must be carried out at regular intervals across site. The occurrence of falls and whether they are unwitnessed must be monitored. A risk assessment must be carried out on the use of the nine fixed beds on Garston House. 30/09/06 31/08/06 31/08/06 31/08/06 31/08/06 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 2 Refer to Standard OP8 OP15 Good Practice Recommendations Wound care photographs should be taken regularly rather than erratically on Garston House. Some units have instigated “protected mealtimes” so that eating can become a quality experience. It became clear that staff had not fully grasped what protected meal times were about and this subject should be revisited. Although residents stated that the provision of food was satisfactory nobody was particularly enthused by the standard offered. This should be explored. The service should consider making basic minimum staffing levels vailbale in the statement of purpose for each unit. The manager should carry through her intention of indexing all staff files. Written guidelines/procedures should be developed for newly qualified staff that require mentorship.
DS0000005450.V296448.R01.S.doc Version 5.2 Page 35 3 OP15 4 5 6 OP27 OP29 OP29 Arncliffe Court Nursing Home 7 8 9 OP30 OP38 OP7 The training matrix should be developed further to evidence that all staff have received three paid days training per year. The manager should follow through her intention to obtain an up to date certificate following the recent servicing of all fire equipment. Further documentation should be developed on Woolton house so that resident’s abilities and their mental health needs are recorded separately. Staff should review the provision of the service users guide to each resident from time to time to ensure that the residents have all the written information that they need regarding their rights. 10 OP1 Arncliffe Court Nursing Home DS0000005450.V296448.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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