CARE HOMES FOR OLDER PEOPLE
Aronel Cottage 5-11 Highfield Road Bognor Regis West Sussex PO22 8BQ Lead Inspector
Judith Farrell Unannounced Inspection 11th January 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 Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 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. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Aronel Cottage Address 5-11 Highfield Road Bognor Regis West Sussex PO22 8BQ Telephone number Fax number Email address 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) 01243 842000 01243 842001 www.aronelcottage.co.uk Aronel Cottage Care Home Ltd Mr. Julian Trevor Hitchcock Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Aronel Cottage is a care home able to provide personal Care and nursing care for up to 38 service users in the category of Old Age. It is situated in a residential area of Bognor Regis. Shops and other local Facilities are close by. Communal Space consists of a lounge/dining room with additional sitting areas available throughout the home. There is a large lift making all parts of the home accessible to the service users. Private accommodation consists of 34 single bedrooms and 2 twin bedrooms. 19 bedrooms have en suite facilities. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours on 11th January 2006. This is the second statutory inspection of this year. The purpose of this inspection was to inspect standards that were not assessed on the announced inspection and to generally monitor care practices. This report must be seen in light of the previous inspection report, which was carried out in September 2005. This is a consistently high achieving home, which responds to any constructive criticism actively and is proactive in improving the services for the residents. The inspection in September 2005 highlighted practices above the minimum standards in 12 areas and the inspector scored these areas at a 4, which is commendable. The Inspector saw nothing, which would change her mind regarding this good practice. No requirements were made following this inspection. What the service does well:
Aronel cottage continues to provide a varied programme of activities, which include: a garden club, visiting entertainment, voice therapy, art club, exercise to music and reminiscence therapy. A visiting therapist commented that they are always impressed about the level of choice residents have and that staff ‘sit along side residents, not interfering but just befriending them’. The ongoing environmental improvements to the home have created a homely and relaxed atmosphere, whereby residents take ownership of their surroundings. At the time of this inspection the home was being efficiently managed. Systems are in place to ensure residents are safeguarded and their health and social care needs are being met. The home has an experienced team of staff who enjoy their work and have a good understanding of the needs of the people living at the home. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. Meals are varied, balanced and well presented, offering both choice and variety. Residents are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. All records and files were found to be neat and easily assessable. Residents and relatives spoke very highly about the services offered at the home and described the staff as friendly and caring. One relative said staff are always so polite. Comments from residents included that staff were ‘fantastic ‘ ‘so caring’ ‘always there for you’ ‘I could not want for better care’. One resident talked about the amount of genuine affection offered by the staff and how this made up for not being in her own home. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 6 Relatives confirmed that they were kept fully informed about healthcare issues and invited to attend meetings. What has improved since the last inspection? What they could do better: 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. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 7 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 Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 8 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): 2,3,4,5,6 There are systems in place to ensure residents and their representatives’ make an informed choice about the Home. No resident moves into the home without having had a thorough assessment of their needs discussed with them. Residents confirmed that their varying care needs were being met. The home does not provided intermediate care. EVIDENCE: Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new residents needs are properly assessed and planned for. The Inspector talked to four residents and one relative, they were all very happy with the way they were introduced to the home. All confirmed that they had received a contract. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 9 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): 7,11 Arrangements are in place to ensure that the health care needs of residents are identified and met. EVIDENCE: Resident care plans were sampled, they contain information about the needs of residents. Responses from health professionals indicate that staff demonstrate a good understanding of the care needs of residents and that specialist advice that is given is incorporated into the care plan. The nurse manager is looking forward to her study day on end-of-life care. The home is looking at the possibility of introducing a new type of care planning which will enhance the quality of the already good documentation. Most staff have had practical training on what to do after the death of a resident and there are clear policies to guide staff on what to do. The inspector was impressed with the staff knowledge and their sensitive approach to this difficult subject. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 10 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): 14 Residents confirmed that they are able to exercise personal choice in their dayto-day life. EVIDENCE: Discussion with service users during this Inspection confirmed that service users are encouraged to exercise choice and some control over their lives. A lockable facility is provided in all bedrooms for service users to keep important items in. Service users are encouraged to handle their own financial affairs for as long as they wish or have the ability to do so. Advocacy services are provided if needed. No residents spoken with required any outside advocates. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 11 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): 17 The service users legal rights are protected EVIDENCE: Residents informed the inspector that they could vote if they want to. This is by postal vote or by the staff in the home accompanying them to the poling station. They is clear evidence that the home would help the resident to find an advocate if needed. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 12 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): Service users benefit from a clean, comfortable and well-maintained home. EVIDENCE: Aronel Cottage is situated in a residential area of Bognor Regis. Shops and other local facilities are close by. The home is well maintained and décor is homely and nicely coordinated. Furniture and fitting are domestic in character and of a good standard. Mr Hitchcock told the Inspector that new furniture was gradually being bought for the areas in the home. There was a discussion regarding the types of adjustable beds. The grounds are kept tidy and accessible to service users. At the time of the inspection, all communal areas and the six bedrooms seen by the Inspector were found to be clean, tidy and well maintained. All residents and relatives spoken with confirmed that the home was always clean and free from odour. The staff interviewed stated that they take pride in maintaining a very clean environment and all were very clear regarding the issues of infection control. A Legionella policy is in place, and regular health
Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 13 and safety checks are carried out. Water temperature checks are regularly recorded. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 14 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 Resident’s benefit from an effective team of staff to support them. EVIDENCE: On the day of inspection, there were sufficient staff to support the needs of residents as detailed in the care plans. Staff spoken with confirmed that staffing levels were more than adequate at all times. The residents who spoke with the Inspector commented how nice staff were and how they felt relaxed and happy to ask for help. The Inspectors observed lots of positive interaction between residents and staff. Residents commented that staff ‘always come if I ring the bell’ ‘they will always sit and talk to me if I need them’ ‘they are kind’ ‘they are always helpful’ one resident who has just started to experience short term memory loss explained that the staff come in every morning and tell her what the day is and what she is going to do. They then write everything down on a calendar for her ‘they never mind telling me again and again’ ‘ they are lovely’. A relative and outside professional suggested that the staffing levels were well above what was ‘normally found in other homes’ All people spoken with regarding the home praised the staff and the team approach the home has. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 15 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): 37,38 Residents are protected by the management systems in the home. EVIDENCE: The registered manager is very experienced having worked in residential homes for many years. Residents said the home is run efficiently and they said this they thought was down to strong leadership. Visitors made positive comments about the management and staff giving good examples of best practice. Policies and procedures are in place to ensure the smooth running of the home. Staff confirmed that regular meetings were held where the manager informed them of any changes in legislation. Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 16 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 3 4 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 x x x 3 3 x 3 3 x STAFFING Standard No Score 27 4 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x 3 x x 3 3 Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 17 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aronel Cottage DS0000046617.V273499.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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