CARE HOMES FOR OLDER PEOPLE
Arrigadeen 20 Cambridge Road Clevedon North Somerset BS21 7HX Lead Inspector
Nicola Hill Unannounced Inspection 14th January 2006 10:30 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 Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 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. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Arrigadeen Address 20 Cambridge Road Clevedon North Somerset BS21 7HX 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) 01275 879405 NONE Mrs Maureen Roberts Mrs Linda Mary De`ath Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. May accommodate 29 persons aged 65 years and over requiring nursing care. May accommodate up to 3 persons aged 65 years and over requiring personal care only. Manager must be a RN on Parts 1 or 12 of the NMC register. Staffing notice dated 30/07/1998 applies. May provide nursing care to one named individual aged 50 years and over. This condition relates to a specific person and lapses when that person leaves the home or becomes 65 years old. 29th June 2005 Date of last inspection Brief Description of the Service: Arrigadeen is registered for 29 older people requiring nursing care. It is a large house situated on a hill in Clevedon and has been adapted to meet the needs of the residents. The area around the home is pleasant and level and mainly comprises of private houses. Transport would be required to access the facilities of the town. The accommodation of the home is provided on three floors, each served by a lift. It is comfortably furnished and has the appropriate handrails and grab rails for the group. The home offers 17 single bedrooms, five of which have en-suite facilities; there are four double rooms one of which has en-suite facilities. The communal areas on the ground floor consist of one large lounge/dining room, one smaller lounge and a conservatory. Access to the first and second floor can be obtained via a passenger lift. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of this home took place on a weekend in order that the inspector could observe the practice and the running of the home out of normal office hours. The manager was on duty and was able to assist the inspector by providing relevant documentation concerning the assessment and care planning for the newer residents to the home. The inspector also briefly toured the home and noted the continual upgrading of facilities in order to offer a higher standard of physical environment to prospective residents. The inspector was able to observe the staff working in the home, and their interaction with the residents. The inspector also spoke with some residents whilst touring the home and met one relative who was visiting the home. What the service does well: What has improved since the last inspection?
Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 6 Since the last inspection several more rooms have been refurbished. The rear ramp access to the home has been replaced with a permanent concrete ramp. The home continues to raise its profile within the local community; however, further improvement in this area requires continual investment in both the staff and the care home. 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. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 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 Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 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): 3,5 All prospective residents have a comprehensive assessment of care need undertaken prior to admission. EVIDENCE: The inspector reviewed the most recent admissions to the home. The admission process for one resident was undertaken under pressure from the care manager, and resulted in the resident moving into the home immediately prior to Christmas. The circumstances of this admission were discussed with the manager. The pre-admission assessment was undertaken satisfactorily. The documentation provided by the care manager was a multi disciplinary care assessment, and this provided additional information for the manager on which to base the decision to admit the resident. The events surrounding the admission were referred to the commission and were investigated. However, the inspector was satisfied with the documentation provided by the manager, and in particular the care plan produced by the home to meet the residents’ needs.
Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 9 The inspector was also able to read the pre-admission assessment for a resident who had moved into the home on the day prior to the inspection. The information provided by the hospital was extremely poor, and no discharge letter was sent. The manager had visited the resident in hospital and had carried out a very comprehensive assessment, which identified areas of concern for which no information was provided. The inspector was able to see the nursing staff following admission of the resident to Arrigadeen, following up the information required. For both the admissions, friends/families visited the home to view the facilities on behalf of the resident. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 The care plans fully identified the support needed by residents for their continued health and well-being. EVIDENCE: The care planning reviewed by the inspector was of a good standard and very detailed. The plans showed evidence of being evaluated for effectiveness, and where necessary changes to the plan were made. The manager has a good understanding of the health care needs of older people and monitors the staff to ensure that the support identified is fully implemented. The care plans were very individual, supported by additional assessments where required, such as continence assessments in order to identify a toileting plan, or a suitable aid to support residents to remain continent. The home has developed good relationships with health care providers such as the GPs and the project nurse for older people based in Clevedon. This allows for current good practices to be introduced to the home and improve the quality of care for the residents.
Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 The preferred lifestyle of residents is respected at the home. EVIDENCE: The inspector was able to observe the residents in the lounges and around the home. One resident remained in their room but observed the coming and going of staff, residents and visitors by keeping the door open. This allowed the resident to remain in an environment of which they had control, and felt secure. Other residents prefer to use communal areas, and the fundraising over the Christmas period has purchased a DVD/video for residents to use; the Sound of Music was the preferred DVD for Saturday morning. The inspector also observed that personal items were taken with residents to communal areas so that they can occupy themselves in an individual activity such as reading but still enjoy the company of others. The inspector spoke with one resident about the meal that had been served lunch. This resident was able to confirm that as they did not like what was on the menu, an alternative had been provided; in this case it was an omelette. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 12 The kitchen area was extremely clean and tidy; the home has a cook who maintains a high standard of meals using fresh ingredients and providing home cooking for items such as cakes. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 There is an open culture when dealing with complaints. EVIDENCE: Since the last inspection there have been three complaints made to the manager concerning aspects of the day-to-day running of the home and the support provided by the staff team. Two of these complaints were referred to CSCI for investigation. One complaint relating to staff support has been upheld and the manager has been pro-active in addressing the issues this complaint raised. There are two other complaints outstanding which had not been fully resolved at the time of this inspection. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Arrigadeen is a converted older property that requires regular maintenance and refurbishment in order to offer potential residents a nice place to live. EVIDENCE: The manager and the inspector toured the building and it was noted that money has been invested in the physical environment, and to refurbish some of the bedrooms. Arrigadeen is clean and welcoming to potential residents, it is a small home and has retained the characteristics of a family home. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 15 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): 29 The staff records are incomplete. EVIDENCE: The manager and inspector discuss the staff team in relation to the skill mix within the team. The manager stated that she is confident in the skills and ability of the trained staff and is working with them to change the shift pattern so that the good practice demonstrated by the nurses can be passed on to other staff who work during both day and night shifts. The intention is to raise the standard of knowledge and skills within the team, which will allow for further delegation of responsibility through the trained staff group. Staff are supported to attend the North Somerset PCT clinical training in order to keep skills up-to-date, the trained staff are also expected to provide teaching sessions for carers at the home. Currently the home operates on one trained nurse and four carers on duty between 8 a.m. and 8 p.m.; night time cover is one trained nurse and one carer. The home has recently recruited 2 Chinese employees as carers through an agency. At the time of the inspection the manager was unable to demonstrate to the inspector that these employees had gone through the recruitment procedures used at the home, there were no application forms, which would
Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 16 have detailed their qualifications and experience relevant to being suitable to work at Arrigadeen. The inspector also noted that the staff files generally were very good with all the records up-to-date, however there was no evidence of a health declaration included in the application form and therefore the records do not meet the required standard. The home has a high ratio of overseas staff, with only four UK nationals employed as carers. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 38 The home is well managed by the current registered manager with the health, safety and welfare of service users and staff promoted by the procedures implemented at the home. EVIDENCE: The manager at the home has continued to provide support for the development of the staff team by offering training and supervision on a regular basis to maintain improvements in the standards of care offered to the residents. The home admits residents with a wide range of need, and is proactive in sourcing additional equipment or expertise as needed. The atmosphere at the home during the inspection was relaxed, with the staff enjoying the DVD with the residents. The residents who spoke with the
Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 18 inspector were spontaneous and positive in their comments. The inspector observed that the manager was approachable to residents. On the tour of the building no health and safety hazards were identified other than the stair gate on the bottom of the stairs which is due to be replaced for a gate more fit for purpose. The hoists and fire equipment seen by the inspector had the inspection label on them; there was a record of water temperature tests, and fire safety drills were being implemented as required. Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 19 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 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 3 Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement Timescale for action 14/02/06 2 OP29 19 (5) (c) Information held on all staff files including those recruited through an agency must be as listed in schedule 2 of the regulations and demonstrate that the staff employed are qualified and experienced to perform the job for which they are employed. The management must be able 14/02/06 to show that staff employed at the home are physically and mentally for the work they are employed to do. 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 Arrigadeen DS0000020294.V271687.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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