Inspection on 16/04/07 for Arnold House

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arnold House 18/09/06

Arnold House 13/12/05

Arnold House 02/08/05

Arnold House 15/02/05

Arnold House 27/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Arnold House 66 The Ridgeway Enfield Middlesex EN2 8JA Lead Inspector Peter Illes Key Unannounced Inspection 16th April 2007 09:00 Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 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 Arnold House DS0000010574.V333050.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 Adults 18-65. 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. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arnold House Address 66 The Ridgeway Enfield Middlesex EN2 8JA 020 8363 1660 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.leonard-cheshire.org.uk Leonard Cheshire Care Home 21 Category(ies) of Physical disability (21) registration, with number of places Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Four specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as any of the specified service users vacates the home. 18th September 2006 Date of last inspection Brief Description of the Service: Arnold House is a care home registered to provide care to 21 people who have a physical disability. The care home is owned and managed by the Leonard Cheshire Foundation, which is a voluntary organisation providing care services to people with disabilities. The care home is in a building, which was bequeathed to the Leonard Cheshire Foundation by the Arnold family. There are extensive grounds to the rear of the care home. The organisation is working on plans to demolish the existing building and replace it with a new purpose built service in the existing grounds of the home. Accommodation is provided in single bedrooms on the ground floor and there are a number of communal rooms and a physiotherapy area available for service users also on the ground floor. The homes administrative offices are on the first floor, as well as accommodation for staff. The organisational mission is: To work with disabled people throughout the world, regardless of their colour, race or creed, by providing the environment necessary for each individuals physical, mental and spiritual wellbeing. At the time of the inspection there were twenty service users living in the service. The current range of fees in the home is from £687 - £1025 a week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took approximately eight and a half hours. The registered manager for the home had recently moved on from the home, taking up another post with the provider organisation. The inspector was assisted by Ms Pauline Lewin, care supervisor, who was in charge of the home at the time. Ms Lewin was present throughout the inspection and was open and helpful. There were twenty-one people living at the home at the time and no vacancies. The inspection included: meeting the majority of people living at the home and speaking independently to three of them. The inspector was also able to talk independently to a relative who was visiting the home at the time. The inspector also spoke to the care supervisor, three care staff, the activities coordinator, two training officers and the cook. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: The home provides a high standard of support and care to people living there. The needs of people living at the home are well assessed and clear care plans, risk assessments and other documentation are produced, in consultation with the individual themselves, to assist staff on how to meet their needs. The home operates a key worker system that helps this process. People living at the home say that they are consulted and can have their say about what goes on at the home to the extent that they want to. Clear efforts are being made to support people with a range of activities, both within the home and in the wider community. People living in the home say that they enjoy the food, receive sensitive care and that overall they are well supported by the home. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The two improvements still needing to be completed from the last inspection are for the home’s complaints record to contain fuller details and for some further specialist training to be made available for staff. Four further areas for improvement are required from this inspection and are as follows: to address a potential health care issue for one person; for staff to undertake some refresher training in two identified areas; for confirmation that identified health and safety remedial work has been properly carried out and for the home to check that its fire evacuation procedures comply with some recent changes in fire regulations/ legislation. A good practice recommendation is made to further develop staff’s knowledge about equality and diversity. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 7 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. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has up to date information about the services it provides to allow people to make informed decisions about living there. People who are newly referred to the service have their needs properly assessed to ensure that the home can meet these. People accommodated have individual contracts so that they are clear about the terms and conditions relating to living at the home. EVIDENCE: The home has a clear and up to date statement of purpose and service user guide that had previously been sent to the Commission. These contained all the necessary information and are in a clear format that is accessible to the service users. One new person had been admitted to the service since the last inspection. This person’s file was inspected and contained a range of detailed assessment information that had been made available to the home at the time of admission. Evidence was also seen of further referrals to relevant health care professionals regarding that person since they were admitted including to a dietician. This was to assist the home to ensure it was able to address the person’s changing needs. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 10 The files of three other people accommodated at the home were also inspected. These also showed evidence of up to date assessment information from health and social care professionals including showing evidence of reviews by the person’s referring authority. A requirement was made at the last inspection that all people living at the home had an up to date contract between the home and the service user. The care supervisor stated that this requirement had been complied with and a number of contracts were sampled that evidenced this. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are involved in documenting their needs in their care plans to assist the home’s staff in meeting these needs. People are assisted to make as many decisions for themselves as they can to promote their independence. People are also supported to take appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: The files of four people inspected all contained detailed care plans, known as individual service plans. These were broken down into clear areas that described the care and support people needed and showed clear goals with guidance to staff on how to meet these. The plans were informed by a personal profile, written with the individual, that showed information that was important to them including their likes and dislikes. The plans were also informed by up to date assessment information and showed evidence that they were reviewed regularly. A requirement was made at the last inspection that each service person’s social worker is invited to a review meeting every 12 months. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 12 Evidence was seen on the files that this had been complied with. The home also operates a key worker system and people living at the home knew who their key worker was and were able to talk about their contact with that worker. Throughout the inspection staff were seen to be interacting with people accommodated in a suitably friendly and respectful manner. Each person has a safe in their bedroom and the inspector was told that eighteen people manage their own finances, either independently or with help from relatives. The three other service users also keep their own money in the safe in their rooms but may be assisted by staff in dealing with this. Peoples spoken to were happy with the arrangements for dealing with their finances. One person spoken to independently told the inspector that they were involved in reviewing their care plans and any restrictions on them were discussed and reviewed including at the review meetings. Files inspected also contained relevant risk assessments that were reviewed regularly and gave staff guidance on how to minimise the identified risks. Risk assessments seen included individual risks relating to bathing, moving and handling, identified risks in people’s bedrooms and support needed when out in the community. A requirement was made at the last inspection that each person accommodated has a Waterlow risk assessment completed regarding skin vulnerability and where the risk of developing a pressure sore is high that there is a care plan in place to address this issue. Waterlow assessments were seen on the four files inspected. Care staff confirmed that where risks were high district nurses were consulted and, where appropriate, separate care plans were in place relating to this. One of these plans were sampled to evidence this. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are supported to have full and active lifestyles. They also enjoy contact with their relatives and friends. People also enjoy healthy and nutritious meals that they like although may benefit from a wider choice of culturally appropriate options. EVIDENCE: The home employs an activities coordinator to assist arrange and run activities in and from the home. The inspector was told that activities within the home include craftwork, playing cards, bingo, flower arranging, indoor bowls and a weekly keep fit session. A small number of people were observed enjoying a keep fit session during the inspection. Activities outside the home include visits, both within the local community such as going to a local pub for a meal and to local parks and gardens. Trips are also arranged wider a field such as into London and to Southend. The home has three vehicles that it uses for outings and these vehicles are driven by both staff and by volunteer drivers. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 14 The care supervisor stated that at present the home was actively looking for more volunteer drivers, particularly at weekends and that all drivers were subject to a criminal records bureau (CRB) check before they started. People living at the home pay a flat rate for mileage if they use the vehicles for a trip. People living at the home said they enjoyed the trips although some spoken to stated that they did not like going out in a larger groups. The activities coordinator stated that trips for individuals were arranged when requested and resources permitted. One person stated that they had recently gone out on a one to one basis with a staff member to Wood Green to shop for clothes. It was noted during the inspection that one person was discussing with the activities coordinator about making a banner to take with them to a music festival in Scotland during the coming summer. Records were seen on individual files of activities undertaken. The home is twinned with a Leonard Cheshire home in Uganda and a display giving information about this was seen in the entrance hall. The care supervisor stated that staff from the Uganda home had visited in 2006 and it was hoped to develop further contact, such as through pen pals, although this still needed further work. The majority of the people living at the home are white and staff spoken to had some understanding of the needs of people from black and ethnic minority communities. However, the inspector felt that this could be built on and a good practice recommendation regarding training in this area is made in the Staffing section of this report. At the last inspection a good practice recommendation was made that people living at the home are supported to access more opportunities to go to college or access employment opportunities within the wider community. The inspector was pleased to note that two people were actively being supported to apply to local education colleges for courses. It was noted during the inspection that one person was discussing with the care supervisor an assessment visit to a college the following day regarding IT courses. The person was assertively seeking further clarification about links with the Connexions service regarding this assessment. Another person living at the home runs a mobile shop for the benefit of others within the home. This person explained that they are assisted to purchase goods such as toiletries, drinks and sweets and that they run the shop on a non-profit making basis. They went on to say that they got a great deal of satisfaction from running the shop and felt it was valued by others at the home. People living at the home told the inspector that they have contact with their families. Relatives are made welcome in the home or service users are supported to go to their family homes. One relative spoken to independently during the inspection told the inspector that they were always made welcome when they visited. Another person living at the home stated that they had a close friend who lives outside of London who they visited and that they were going to go on holiday with them during the summer. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 15 The menu for the week was inspected and this offered a healthy and varied diet. The home has a four-week rolling menu with an alternative available for all main meals. The cook explained that there are six people living at the home who are diabetic but there are no other medical or religious dietary requirements at present. The cook stated that people’s preferences for meals are discussed at residents meetings and that she also talks to people about their meal preferences and will cook dishes such as curry or egg fried rice if asked. Although the majority of people living at the home are white there are at two people from black and ethnic minority backgrounds. A good practice recommendation is made that the home’s menu is reviewed and consideration given to providing more choices on a regular basis for people from black and ethnic minority communities. There was a good supply of food in the home, including fresh fruit and vegetables and a range of health and safety records relating to the kitchen were seen to be up to date. A requirement made at the last inspection that all catering staff have up to date food hygiene training had been complied with. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home receive personal care according to their individual needs and wishes. They are supported to access healthcare services according to their health needs although an identified person needs some further input in this area. People living at the home are protected by appropriate medication administration procedures. EVIDENCE: All of the people living at the home receive a range of personal care from staff and those people spoken to indicated that this care was given sensitively and that they were happy with their care. Care plans seen gave details and guidance to staff on how personal care should be provided and any likes, dislikes and preferences regarding this. Staff spoken to were knowledgeable about people’s personal support needs. A range of aids and equipment were seen to be available at the home to assist with people’s mobility and personal care needs. Staff spoken to confirmed that they had been properly trained to use this equipment. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 17 Evidence was seen in the files inspected that people living at the home were registered with a GP and that people were supported to access a range of health care professionals including dentists, opticians, chiropodists and to attend hospital appointments when required. A requirement had been made at the last inspection that where a person chooses not to access healthcare appointments that this is recorded in their case notes. This requirement had been complied with and evidence to support this was seen on files sampled. It was noted that three people living at the home had pressure ulcers, the inspector was informed that each of these were caused when the individual was away from the home. The inspector noted that all three were being supported by a district nurse who kept their own care plans relating to the ulcers in the home, one of these were sampled and seen to be up to date. The inspector was also informed that team leaders were trained by healthcare professionals to undertake identified and appropriate invasive care techniques in identified circumstances for agreed individuals. Evidence was seen that a referral had been made to a dietician for a nutritional assessment for one person living at the home. It was also noted that regular weight checks were recorded on people’s files. The home had a specialist set of weighing scales for people who use wheelchairs and it was noted that the weight of people’s wheelchairs was recorded in their files to assist accurate weighing. However, it was also noted that an identified person’s weight chart showed that they had lost weight over a period of time and there was no record of any action being taken to address this. A requirement is made regarding this. People living in the home continue to have direct access to physiotherapy input on the premises and continue to access individual specialist mobility aids from the local wheelchair service. A good practice recommendation was made at the last inspection that people living at the home receive a talk from a district nurse regarding managing diabetes to allow them to make informed choices about how to manage their health. The inspector was pleased to learn that this recommendation had been acted upon. The home had an up to date medication policy that was seen and records of medication received and disposed of by the home were up to date. Two people were receiving controlled medication and the storage and recording of this was seen to be up to date and satisfactory. Medication profiles for individuals were seen on the files inspected and the profiles included a note of the possible side effects of the identified medication. The medication and medication administration record (MAR) charts for four people were inspected and were seen to be up to date and satisfactory. Staff that administer medication had received training in safe administration of medication. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are able to express their views and concerns and have these appropriately dealt with by the home. They are also protected by satisfactory adult protection policies and procedures that staff are aware of. EVIDENCE: The home has an accessible complaints procedure that was seen. People living at the home that were spoken to stated that they knew how to raise concerns and did so when they needed to. They indicated that staff and managers took concerns seriously and dealt with them seriously. One relative spoken to stated that they had made a complaint about the home. The relative stated that a general manager from the provider organisation had dealt with this appropriately. They went on to say that they were raising other issues with the general manager and were satisfied with progress to date on how these were being dealt with. The home’s complaints record showed that two complaints had been made to the home in the last twelve months. At the last inspection a requirement had been made that records of complaints includes a record of the outcome of the complaint and the timescale for the issue to be resolved. The care supervisor stated that additional records to show the outcome and timescale of complaints had been obtained but this additional record could not be located during the inspection and following the registered manager’s recent departure. This requirement is restated. Despite this the inspector was satisfied that complaints are dealt with promptly and appropriately by the home and by the provider organisation. However, the requirement is restated Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 19 to ensure that a complete record of how a complaint has been dealt with is available for inspection in the home. The home had an appropriate adult protection policy and procedure that were linked to the local authority procedure and had been reviewed in 2006. Evidence was seen that staff receive core training in adult protection in the first six months of their employment and refresher training every two years after that. Staff spoken to were aware of the action to be taken should an allegation or disclosure of abuse be made. There had been no reported adult protection issues in the past twelve months. At the last inspection a requirement was made that where a person living in the home needs some support to manage their monies that the way this support is provided is recorded in the service users case notes. This requirement had been complied with. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that is generally comfortable, well maintained and which meets their needs. The home was clean and tidy throughout creating a pleasant environment for both those that live and work at the home as well as for those that visit it. EVIDENCE: Accommodation for people living in the home is all on the ground floor and is accessible. This includes twenty one single bedrooms, some with en-suite facilities and all with ceiling hoists; kitchen; dining room/ kitchenette; two lounges; hobbies room; physiotherapy area; adapted and accessible toilets and bathrooms and a staff duty office. Further management, staff and administrative accommodation is available on the first floor. Accommodation for people living in the home is generally comfortable (although the decoration in some parts of the building was starting to look a little tired), well maintained and overall continues to meet their needs. However, the inspector was informed that the home is becoming increasingly old and difficult to maintain. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 21 The provider organisation is actively planning a new purpose-built twenty bed replacement home in the extensive grounds of the existing building. The organisation is applying to the local authority for planning permission regarding this although the inspector was informed that this was currently complex as the grounds include land that is designated as green belt land. People living at the home were generally enthusiastic about the prospect of a new purpose built home. One person stated that they were looking forward to having their own en-suite facilities to their room. Another was also looking forward to the new building but indicated that they were not particularly looking forward to the inevitable disruption they felt would be associated with the rebuilding. Plans of the new building were available and displayed in the home and evidence seen of ongoing consultation and information sharing with people living in the home regarding progress with the plans. A requirement was made at the last inspection that flooding in an identified bedroom was dealt with and evidence was seen that this had been complied with. The home was clean and tidy throughout and had appropriate laundry equipment and infection control procedures. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and effective staff team is able to competently address the needs of people living in the home. The home’s recruitment practises contribute towards people’s protection. People living in the home are also supported by staff who receive a range of effective training although further work is needed to extend this training in identified areas. EVIDENCE: The inspector was able to talk to both the provider organisation’s training and development officer that covers five services including Arnold House and a regional training officer, both of whom are based in the home. The home employs 28 care staff and the inspector was informed 19 of these had completed national vocational qualification (NVQ) level 2 or 3 in care and another 5 were either working towards this or were enrolled and waiting to commence the training for this. This exceeds the requirement in the national minimum standards that at least 50 of care staff must have achieved this award. Staff spoken to and staff files sampled showed evidence to support this. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 23 A satisfactory staff rota was seen that showed 7 staff working an early shift, 4 working a late shift and 2 waking night staff. Further assistance is available for people living at the home from a range of volunteers including 2 community support volunteers, the latter two living in the home while on their placement. Five files of newly appointed staff were inspected at random. These files contained: a criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check taken out by the provider organisation prior to the staff member starting work, a clear application form, two references and proof of identity with a photograph. This showed evidence to indicate that the home operates a robust staff recruitment procedure. Evidence was seen on the staff files inspected that they had completed the provider organisation’s induction programme. The inspector was shown a training matrix that covered all staff, their induction training and core training. These were generally up to date although it was noted that the provider organisation provides regular refresher training in most key areas but not in health and safety or infection control. A requirement is made regarding these. At the last inspection a requirement was made that staff receive training on pressure care and supporting people who have depression or alcohol abuse. Progress had been made towards compliance with this requirement although further work is still needed and for the training to be delivered. The requirement is restated. The inspector was told that equality and diversity is a theme that is promoted through both training and care practice and evidence was seen that the home is currently planning disability equality training for staff. However, a good practice recommendation is made that training and refresher training is also provided for staff in respect of equalities and diversity. This is to further assist staff in recognising and responding to people’s differing needs, including in relation to race, culture and sexuality, and in further developing their confidence in addressing these needs. Despite the two requirements and one recommendation made regarding staff training there was clear evidence, from documentation seen and staff and managers spoken to, that the home is committed to staff training and development. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and staff benefit from the home being effectively managed including while management changes take place. People living in the home also benefit from the home/ provider organisation’s quality assurance system. Effective health and safety procedures contribute to protecting service users, staff and visitors to the home although further evidence is required in relation to this in an identified area. EVIDENCE: The registered manager has recently taken up a new post elsewhere within the provider organisation and Pauline Lewin, the care supervisor, was managing the day to day running of the home at the time of this inspection. Pauline presented as being very knowledgeable about the needs of the people living in Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 25 the home, of the management practices and was very helpful throughout the inspection. Staff spoken to stated that staff morale was good at the home and that they felt well supported by Pauline. A general manager had written to the Commission to inform us that the registered manager had left, that interviews to fill the post were underway and that the successful candidate will be supported to register with the Commission. A requirement was made at the last inspection that the home must update its annual quality assurance exercise. The inspector was told that this had been complied with and the questionnaires were currently at the provider organisation’s head office for analysis. The home also holds regular meetings with people living at the home to ascertain their views and to share information. Minutes of recent meetings were sampled and showed evidence of discussions regarding food/ meals in the home, a coffee morning, a new vehicle for the home, activities such as the need to identify a different swimming pool for people to attend and sharing information about progress regarding the planned new building. Some people that live in the home stated the meetings were useful and a few were not particularly keen on attending so didn’t. Managers from the provider organisation also visit the home on a monthly unannounced basis to check on the quality of the service. Reports of these visits were seen in the home. A range of satisfactory health and safety documentation was inspected that included: a gas safety certificate, portable appliance testing and testing of the home’s water system to minimise the risk of legionella. A requirement was made at the last inspection that the home’s electrical installation certificate was updated. Evidence was seen that a qualified person had checked the system and that some remedial work was needed. A quote for the required work was also seen although not confirmation that it had been carried out. The care supervisor stated that the work had been carried out and the home was waiting for the new certificate. A requirement is made that a copy of the new certificate be sent to the Commission when it was received. The home’s fire log was inspected and showed evidence that fire safety is taken seriously with satisfactory evidence that emergency systems and fire fighting equipment are regularly serviced and that regular fire drills are carried out. The fire log also contained a fire risk assessment dated July 2006. However, new fire regulations (Regulatory Reform -Fire Safety- Order 2005) have come into force from October 2006 and place increased responsibilities on owners and managers of registered care homes. A requirement is made that the home reviews its fire precaution arrangements and produces an updated fire risk assessment and an updated fire plan to evidence compliance with the new fire regulations. The home must consult with the fire officer as part of this process. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 2 X Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 13(1) Requirement Timescale for action 31/05/07 2. YA22 22, Sch.4 3. YA35 18(1) 4. YA35 18(1) The registered person must ensure that effective action is taken to determine the cause of an identified person’s recorded weight loss and ensure that where possible action is taken to address this to maximise their well being. The registered person must 31/05/07 ensure that the complaints record includes a record of the outcome of a complaint and the timescale for the issue to be resolved so that the home has a full record of how the complaint was dealt with (previous timescale of 31/10/06 not met) The registered person must 31/08/07 ensure that staff undertake refresher training at regular intervals in health and safety and in infection control to ensure that staff’s core skills are kept up to date. The registered person must 31/08/07 provide staff training on pressure care and supporting people who have depression or alcohol abuse to ensure that staff have the DS0000010574.V333050.R01.S.doc Version 5.2 Arnold House Page 28 necessary skills in these areas (previous timescale of 30/1/06 not met). 5. YA42 13(4) The registered person must send a copy of a current electrical installation certificate for the home to the Commission, to evidence that the health and safety of all people in the home is being safeguarded. The registered person must ensure that the home reviews its fire precaution arrangements and produces an updated fire risk assessment and an updated fire plan to evidence compliance with the new fire regulations. The home must consult with the fire officer as part of this process. 31/05/07 6. YA42 23(4) 31/05/07 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. Refer to Standard YA35 Good Practice Recommendations The home should provide training and refresher training for staff in respect of equalities and diversity to further assist them in recognising and responding to people’s differing needs, including in relation to race, culture and sexuality, and in further developing their confidence in addressing these needs. Arnold House DS0000010574.V333050.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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