CARE HOMES FOR OLDER PEOPLE
Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF Lead Inspector
Julie King and Trish Thomas Unannounced Inspection 6th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Arncliffe Court Nursing Home DS0000005450.V334736.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.V334736.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Arncliffe Court Nursing Home Address 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF 0151 486 6628 0151 448 1934 southark@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Deborah Lanceley Care Home 150 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (90) of places Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 90). Dementia over 65 years of age: Code DE(E) (maximum number of places: 60). The maximum number of service users who can be accommodated is: 150. Date of last inspection Brief Description of the Service: Arncliffe Court is registered to provide care for 150 individuals. The Home is situated in Halewood, Knowsley, Merseyside. Arncliffe Court is on a housing estate close to all local amenities and has good links with public transport. There are local shops nearby and 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 (currently undergoing refurbishment and temporarily not occupied). 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.V334736.R01.S.doc Version 5.2 Page 5 Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors made an un-announced visit to Arncliffe Court and went separately to four of the units (Gateacre, Speke, Chidwall and Woolton). Garston House was being refurbished and there were no residents living there at the time of the visit. The methods used during the visit were, discussion with residents, staff and visitors, observation of residents for a specific period of time, and reading records relating to residents’ health/personal care, safety and staff. A tour of each of the premises was carried out and a sample of quality questionnaires was read. At the end of the visit, feedback on the outcomes was given to the manager, Mrs. Deborah Lanceley. What the service does well:
To ensure that each person’s needs will be met in Arncliffe Court, senior staff carry out pre-admission assessments and each person is offered a place on the unit which will best meet their health and personal care needs. Care plans were in place to meet each aspect of need identified in assessments. Care plans and risk assessments are regularly reviewed to ensure the safety and welfare of residents. Residents looked well cared for and said they thought staff were competent and they had trust in staff to manage their medication. Arncliffe Court is divided into five self-contained units, which provide homely and comfortable accommodation and are individually staffed. Each resident is allocated a named key worker, who provides a familiar and continuous point of contact. Residents’ diversity is respected through ongoing consultation in the planning of their care and in all aspects of their daily lives, such as rising and retiring times, what to eat and where to spend time. Residents appeared relaxed and at ease in each other’s company and with the staff who were on duty. A resident said, “I could not find better people to look after me.” Arncliffe Court is managed in a way, which protects the health and welfare of residents. Health and safety records, and training levels relating to safety and the protection of residents, were to a good standard, and staff said they receive ongoing training and good support from management. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The temperature of the medication rooms was in excess of the required maximum storage temperature for drugs. To ensure that medication is stored safely, a requirement is made that the storage rooms be maintained at a safe temperature. Advice was given to ensure that when treatment plans are changed the care plans should be completed in full on each occasion, including any photographs taken of wounds or pressure areas, which should be clearly marked with sufficient and appropriate details. The manager was advised to make sure all care plans are updated immediately if treatment plans change. This would help avoid confusion and protect the health and welfare of residents. A member of staff, who had undertaken a one-day training course in dementia care, suggested that more in depth training in this be provided. To ensure that staff have the skills to support residents and that their training and development needs are met, a recommendation is made that staff have access to more in depth training in dementia care.
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 8 Arncliffe Court has an equal opportunities policy which is made available to staff. A number of staff said they had not received training in equality and diversity. To better equip staff with the knowledge and skills to address equality and diversity matters in the care home, a recommendation is given that this training is provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 9 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.V334736.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ needs are assessed before they move in, to ensure that their health, social and personal care needs can be met within the service and facilities on offer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 3,4, There is a procedure in place for senior staff to assess the needs of people who are referred to Arncliffe Court for a placement. The standard pre-admission format is followed, to ensure that each individual will be offered a place on a unit, which best meets his/her needs. For residents referred by social services, social work assessments are obtained. The care files, which were read,
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 11 contained copies of the assessment outcomes, and these formed the basis of each individual’s care plan. Multidisciplinary healthcare input is evident in residents’ care files, and this includes reference to NHS out-patients appointments, opticians, dentistry, and tissue viability nurse specialist input at Arncliffe Court when needed. Care staff who were spoken with had undertaken one-day training courses in dementia care. To ensure that staff have an improved skill base in addressing the needs of people who have dementia, more in depth training in this is advised. It is also recommended that staff receive training in Equality and Diversity. Although they could demonstrate knowledge of residents’ rights and the policies in place to support them, some of the staff said they had not received specific training in promoting equality in care settings. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Resident’s health, personal and social care needs are being recorded, providing staff with most of the information they need to meet each resident’s care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7, 8, 9, 10. A random sample of most recently admitted residents’ files and those of long stay residents were reviewed. The pre-admission documentation used was informative, concise and contained sufficient detail to inform the care plans once admitted.
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 13 The care plans were generally completed to a high standard and contained evidence of multi-disciplinary involvement in residents’ care. The care plans were reviewed on a monthly basis or more often if required. Advice was given to ensure that when treatment plans are changed the care plans should be completed in full on each occasion, including any photographs taken of wounds or pressure areas, which should be clearly marked with sufficient and appropriate details. The manager was advised to make sure all care plans are updated immediately if treatment plans change. This would help avoid confusion and protect the health and welfare of residents. All residents are registered with local G.P.s and there was evidence in files that they have access to paramedical and health services not provided on site. Examples referred to include hospital appointments, dental clinic, audio and chiropody services. Medications which were examined and on the day of this unannounced site visit, were found to be managed in accordance with current requirements, but the temperature of the medication rooms was seen to be in excess of the maximum storage temperature on a regular basis. The responsible individual gave assurances that there would be in place, a system of ensuring all medication rooms stay within the required limits, as soon as practicable. Four residents who were asked said they receive their medication from staff, and prefer this arrangement. One lady said, “I would never remember to take it myself and it would be a worry trying to deal with it. I trust the staff and don’t mind them looking after it for me. I think they keep a chart so there will be no mistakes.” There are policies on privacy and confidentiality and staff of Arncliffe Court, who were spoken with, were aware of best practice in supporting residents’ privacy when giving care and support. Residents expressed no concerns regarding this aspect of service. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The lifestyle in the home meets residents’ needs and expectations and there are good links with the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. People who live in Arncliffe Court are asked when they move in, about their lifestyle preferences, their choice of food and social activities. Since the previous inspection there has been an improvement on the level and recording of activities. This is a welcome addition according to residents spoken with during the visit. A “hobby therapist” is employed and there is a programme in place, which includes outings and in-house events. Bingo had been arranged on the day of the visit. This was held in Childwall House and was open to residents of other units, giving them a chance to meet one another and socialize.
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 15 Residents and staff said that visitors are made welcome and there are no unreasonable restrictions on visiting times. Residents may entertain their visitors in the communal lounges, or in their own bedrooms. There are individual gardens with level access from each unit. The gardens are well maintained, providing an ideal place for residents to sit with their visitors, in fine weather. Seating, umbrellas and tubs of flowers are placed on the patio areas the residents’ enjoyment. Residents’ diversity is respected by recording their beliefs and personal preferences in their care plans. In consultation with them, arrangements are made for religious services to take place in the Arncliffe Court, which are attended in accordance with individual choice. To ensure continuity of care, residents are allocated a key worker who takes personal responsibility for overseeing their care plans and general well being. The manager, Mrs. Lanceley, confirmed that advocacy services are arranged for residents who have no family or representation. Meals are cooked in a central kitchen by qualified staff. Residents said they enjoy their food and are offered alternatives and choices. Special diets are catered for and there was evidence of nutritional assessment and weight monitoring in care plans. Lunch being served on Childwall unit was delivered from the main kitchen in a heated trolley. Staff had assisted residents to dining tables and served drinks, some were served in the lounges on trays, or in their rooms. There were five alternatives on offer (hot and cold) and every resident was given their choice from the menu. The mealtime was enjoyable and residents needing assistance and prompting were well supported. A menu is distributed and staff mark down residents’ preferences. Residents made positive comments on the food served in Arncliffe Court, saying it is well cooked and well presented. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The rights and welfare of residents are protected through the policies, procedures and training in place in Arncliffe Court. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16, 18. Arncliffe Court has complaints and adult protection policies and procedures in place to protect the safety and welfare of residents. The procedures are freely available to residents and their families and include information on ‘whistleblowing’ (reporting concerns regarding poor practice), in accordance with the Department of Health ‘No Secrets’ guidelines. CSCI has not received any complaints about Arncliffe Court since the last visit. Most of the staff have training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Arncliffe Court is well maintained and provides a comfortable home which is suitable for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19, 26. Arncliffe Court is a purpose built care home divided into separate selfcontained units with centralised administrative, catering and laundry areas. There is a small kitchen on each unit, suitable for preparing drinks and snacks. Hot meals are delivered to the units in heated trolleys from the main kitchen, which services all units. There is a lounge/dining area on each unit and an enclosed smoking area for residents’ use only. Each unit has access to a
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 18 secluded, garden from the main lounge. Some of the residents’ bedrooms have French windows, with garden furniture placed outside for their personal use. Residents’ bedrooms are personalised and those, which were visited, were in good condition. A resident said, “I love my bedroom and have all I need here.” Another said that she had chosen the colour scheme of her bedroom, which had been redecorated whilst she was away for a few days. The lounges have televisions and music systems with easy chairs and occasional tables, and the dining areas were well presented at the time of this visit. One of the nursing units was in the process of being completely refurbished and there is an on ongoing decoration and replacement programme in evidence. Domestic staff are employed to work in all areas of Arncliffe Court. There are procedures for infection control and for the control of substances hazardous to health. Training records give evidence that domestic staff receive relevant training, and those who were spoken with were aware of the policies and procedures in place relating to hygiene and safety. The building was clean and well organised in the areas, which were seen. A visitor said, “The place is always clean when I come here, staff seem to work hard to keep it up.” Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff numbers and skills are suited to the needs of people who live in Arncliffe Court who are protected through the recruitment procedure being followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 27, 28, 29, 30. Staff rosters are maintained on each unit and those seen during the visit gave an accurate account of staff who were working on that day. A training programme has been established, to ensure that staff have the skills to fulfil their roles and responsibilities. Staff said they have received mandatory and service specific training, which they said is regularly updated. Records of training planned and carried out, were read and gave evidence to support the comments made by staff. A resident said, “Staff here know what they are doing, I have trust in them.” Arncliffe Court has a recruitment procedure, which is based on protecting residents and underpinned by an equality and diversity policy. There was evidence in staff files that they have been vetted and have CRB clearance. On
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 20 taking up their posts, newly appointed staff receive induction training to ensure they have the necessary skills to support the people in residence. For nursing staff an up to date list of pin numbers was seen. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Arncliffe Court is managed in a way, which protects the safety and best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31, 33, 35, 38. Ms. Deborah Lanceley is the registered manager and has overall responsibility for Arncliffe Court. Managers on individual units said there is always a point of contact to give managerial advice and support if needed. Staff who were
Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 22 spoken with said they receive two monthly one to ones (formal supervision), and have staff appraisals, as was in evidence in their records. There is a quality assurance system in place in Arncliffe Court, which is based on obtaining the opinions of residents, family and staff. Outcomes are monitored and remedial work carried out to address any areas of concern or dissatisfaction. A sample of questionnaires was read during the visit. Positive feedback had been given in most of the areas addressed. Further consultation with residents is in evidence in their care plans, where their preferences are recorded. Also, there are regular residents’ meetings to ensure that they have an opportunity to state their opinions. The manager confirmed that staff do not become involved in the management of residents’ personal finances. For residents who have no representation, advocacy services are arranged and this is documented in individual care plans. To reduce risks to residents’ health and welfare, staff have received training in moving and handling and first aid, food hygiene and infection control. There are procedures to cover all aspects of health & safety and staff were aware of best practice in the areas discussed (fire safety, COSHH, infection control). A record of accidents to residents and staff is kept and any identified environmental risks are, as far as possible, eliminated. Health and safety certification and the fire safety log were in good order and gave evidence that equipment in the home is regularly maintained and suitable for use by residents and staff. Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13 Requirement To ensure the safe storage of medication, storage rooms to be maintained not in excess of the required safe temperature. Timescale for action 04/08/07 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. 3. Refer to Standard OP4 OP4 OP7 Good Practice Recommendations To ensure that staff have the skills to support people who have dementia, more in depth training is recommended. To ensure that staff are fully aware the means of promoting equal opportunities in the care home, equality and diversity training is recommended. To avoid confusion and protect the health and welfare of residents, it is recommended that when treatment plans are changed, the care plans should be completed in full on each occasion. This should include any photographs taken of wounds or pressure areas, which should be clearly marked with sufficient and appropriate details. . Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 25 Arncliffe Court Nursing Home DS0000005450.V334736.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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