CARE HOMES FOR OLDER PEOPLE
Arrigadeen 20 Cambridge Road Clevedon North Somerset BS21 7HX Lead Inspector
Barbara Ludlow Key Unannounced Inspection 25th July 2006 11.40a 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.V301195.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. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 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 Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 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. May accommodate one named service user under 65, as detailed in application dated 12 January 2006. May accommodate one named service user under 65, as detailed in application dated 7 February 2006. May accommodate one named individual, under 45 years old, for a maximum of three months. 14th January 2006 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, with split landings each served by a lift. It is comfortably furnished and has the appropriate handrails and grab rails to assist independence. The home offers seventeen 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 floors can be obtained via a passenger lift. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key standards inspection was undertaken by B.Ludlow for CSCI on two separate days. Pre inspection information had been completed by the homes Manager. A sample of service users were sent questionnaires, three were returned to CSCI. One GP practice was surveyed for comment. The first visit was unannounced and the second by appointment on 11/8/06 to complete the inspection with the homes administrator present and to give feedback. The Proprietor and the newly appointed Manager were available on day one of the inspection. A tour of the premises was made on day one. Service users and staff were seen and spoken. Lunchtime was observed. Twenty service users were in residence. Positive comments were heard about the care at the home two people commented that they are ‘very happy here’. Records were sampled these included care plans and maintenance records. The Manager, Proprietor and her daughter were present on day two. A discussion took place with regard to the Statement of Purpose, the Service User Guide and the feedback from day one was given. The premises in part were seen with the Proprietors daughter / homes Administrator and further discussion took place regarding the premises, infection control issues and medication storage facilities. Service users and staff were seen and spoken with during this second visit, the lunchtime meal was observed and care records were examined. Feedback was given separately to the proprietor / her daughter and the manager. What the service does well:
A new Manager has been appointed at the home. Mrs Roberts has a lot of input into the running of the home and her daughter attends to the administrative task, which is well managed. Maintenance logs seen were up to date. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 6 There is a positive approach to care in a safe environment; one service user recently admitted has been encouraged to retain their mobility by freely walking around the home. This person is reported to have settled in very well. The new Manager praised the skills of the staff team and their abilities as carers. What has improved since the last inspection? What they could do better:
Arrigadeen is a pleasantly situated and well adapted residence. The main decoration of the communal areas of the home and the corridors and hallways is tastefully done and in good repair. However individual accommodation is less pleasing, some rooms are bare, items that are basic essentials only were seen in some bedrooms. Bedrooms were sampled that were not personalised, some items of furniture were old and worn, and one new wardrobe was damaged. Pull cords for the nurse call alarm needed attention, one was seen that was very dirty and one that had been extended using a belt from a dress. Less able or bedridden service users would benefit from more homely and individualised accommodation. The use of one en suite for the storage of spare bedding left no access to the wash hand basin or toilet, toiletries were stored on a shelf in the bedroom. This was very poor. Deep cleaning and minor repairs were identified. The medication storage room is in the cellar. A trip hazard had been removed from the stairs between the inspection visits. The cellar was seen to be very damp with plaster and paint falling off the walls in places. The cellar also smells very damp and needs cleaning. The storage of medical supplies and prescription items adjacent to the two very wet walls were identified for relocation. Alternative storage and remedial work is required.
Arrigadeen DS0000020294.V301195.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. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 8 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.V301195.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, 5, NMS 6 does not apply. The outcome for this area is good. There is information available for prospective service users and their families/carers to help them make an informed choice of care home. Pre admission assessment is undertaken by the Manager to ensure care needs can be met at Arrigadeen. Examples of assessments seen clearly demonstrated this practice. Contract information was clearly stated. EVIDENCE: The home has a statement of purpose and service user guide that were revised in November 2003, these will require updating to include the details of the newly appointed manager and to amend a discrepancy. The home also has an informative printed brochure. Pre admission assessment is carried out; the Manager of the home would make an assessment visit. A sample of paperwork undertaken for the admission of a new service user was seen, this was very detailed and care needs were clearly recorded.
Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 10 Prospective service users and/or their family or carer are welcome to visit and w the home and the bedroom available. One example was discussed where this had been arranged. The proprietor had assisted to facilitate the visit by a family at very short notice due to pressure from the hospital. Care given demonstrated physical and social care needs being met for the service users at the home. Contractual arrangements were sampled, two were examined these were satisfactory. Copies of the community care assessments and reviews were seen held on the service users personal file. The fees range from £494.58 to £530.00. The Registered Nurse Care Contribution (RNCC) is paid to the home and is deducted from the fees for the private individuals at the home; for those who are social services funded the price is set (contract price) which is inclusive of the RNCC. The RNCC (paid at middle band only) is not clearly stated in the breakdown of the fees paid by North Somerset Social Services under contract. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The outcome for this area was good although the medications store is poor as reported under NMS19. Some work undertaken between visits has raised the standard. The individual care planning following the pre admission assessment is to a good standard. Care given was seen to be thoughtful and supportive of achieving as much independence as possible. Staff were kind and polite in all the interactions heard with service users and in all observed practice. EVIDENCE: All service users looked well cared for, clean and well groomed. The care plans sampled at this inspection demonstrated thoughtful care planning. The information seen on one care plan with regard to changing nutritional needs could have been more detailed. There is good input from the community health care services. Care records demonstrated input from the wider health and social care community. G.P’s visit if requested to do so, the majority of the service users are registered with the Sunnyside GP practice. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 12 One GP reported that it was not always clear who was in charge. The home now has a Manager in post and this should improve communications between the health professionals and the home. Recent input by community professionals allied to health, such as the dentist and the chiropodist were reported for those case tracked. The Manager is working closely with the Pharmacy service to improve the working medication records and prescription ordering practice. The Medications storage room in the cellar is very damp and is not suitable for medical equipment storage in its present poor state of repair. Two walls require attention and the stock held on racks close to these walls must be relocated until the remedial work is carried out. See NMS 19. Medications management was addressed between visits and some aspects such as the storage of oxygen and the labelling of creams to define an opening or discard by date has been achieved. The new Manager is in the process of spring cleaning the store cupboards to ensure that no medications or dressings are held that are no longer in use or needed in stock at the home. This is good practice and a task, which requires the new managers attention. The home does not have a homely remedies policy, North Somerset PCT has recently prepared one, and this should be obtained. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15 The outcome for this area was good. Service users are able to spend their time as they choose. Independence is encouraged positively through supporting mobility and choice in daily living. Friends and family are welcomed and social activity is supported. The catering was well managed, nicely presented and good quality. Positive comment from service users including there is ‘plenty to eat’. EVIDENCE: The pre inspection information indicated that there are a range of activities offered, these include Bingo, quizzes, music, reminiscing, reading aloud poetry and articles of interest and music. Visits out have included the Cadbury Garden Centre and Strode Road Community Centre. The new Manager has brought some activity reminiscence aids with her and expressed her interest in the provision of good social care. Service users asked said there are usually suitable activities at the home. Seven service users were seen having lunch together in the dining room. Meals were prepared to suit tastes during the extremely hot weather that was being
Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 14 experienced at the time of the visits. For dessert fruit jelly and ice cream was on the menu. Service users commented that ‘there is plenty to eat’ and when asked about choice the inspector was told you could have ‘what you want’. The kitchen was seen; this was clean and well presented. Catering is well managed, the cook who has been at the home for some time, holds a food certificate in Heath and Nutrition. Special diets, 4 diabetic diets and 3 soft diets are currently catered for. All temperature recording had been carried out and was within safe limits, There is a washing up facility with dishwasher on the top floor, the waste bin for hand wash waste should be a foot operated flip top type. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The outcome for this area was good. There are policies and procedures in place for handling complaints. Service user response was positive about raising a concern at the home. EVIDENCE: The home has policies and procedures for dealing with complaints made at the home. There have been no complaints or concerns raised with CSCI. The home had one complaint logged; this had been dealt with within 28 days and was closed. Feedback from service users indicated that they would feel able to raise any concerns at the home. Staff recruitment was examined and followed up following the last inspection when a requirement was made for health checks and application forms. These were seen to be in place. However one CRB was outstanding and one staff member did not have two references on file. Mrs Roberts followed this up in between the inspection days and the CRB was returned, as was one of the written references, by visit day two. See also NMS 29 Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 16 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): The outcome for this area was poor. The communal areas and corridors are attractively decorated, carpeted and lit. The home needs some attention to maintenance and cleaning. Some of the bedroom decoration and furnishing was poor. Bedrooms were seen that needed personalising as they had little other than essential items and in some cases worn or damaged furniture. EVIDENCE: A tour was made of the premises. The communal areas and corridors were nicely decorated and carpeted and adequately and attractively lit. The lounge leads into a large conservatory, which looks out onto the garden. The home is on three floors with two levels, these separate levels are all accessible by passenger lift. The home has a sluice facility on three floors, the ground floor is seldom used but houses the sluice disinfection cycle machine, this should be tidied and
Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 17 made more accessible. The sluice facilities on the second and third floors have spray wash and toilet style emptying facility. One requires repair where water had leaked causing damage to the wall and the tiles. The bedrooms were sampled, cleaning was identified as required and attention to furniture. Some of the rooms looked very bare and in need of updating, personalising and generally making more homely. Risk assessments for hot surfaces should be undertaken with remedial action where identified before the central heating is turned back on in the autumn. Some widely the decorators who had just finished re painting the outside of the home had derestricted opening windows, these must be readjusted. The medication store, staff room and freezer room are in the cellar. A trip hazard of a torn carpeted tread was removed between the inspection visits; this was previously a requirement, June 05. Bed rails were inappropriately paired; this was rectified between inspection visits. The kitchen was clean and tidy, with sufficient equipment. The laundry was clean and tidy, with two washing machines and one dryer. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The outcome for this area was adequate. Prompt action was taken to resolve the recruitment deficits. The home has sufficient staff on duty. Staff receive training and regular supervision is planned. One service user commented that the nursing staff are ‘very kind’. Of the ancillary staff: ‘smashing cook’ and a ‘hard working’ cleaner. EVIDENCE: Service users spoke positively about the staff in all departments; praise was heard for the catering staff and a varied response for the cleaning staff, one was described as ‘hard working’. Care staff were described as ‘very kind’ further comment was made about living at the home, ‘likes it very well here.’ Staff recruitment was examined at the last inspection a requirement was made for health checks and application forms. These were seen to be in place. At this inspection one CRB was outstanding and one staff member did not have two references on file. Mrs Roberts followed this up in between the inspection days when the CRB was returned and one of the missing written references was returned. See also NMS 29 The home has a stable staff team and a new manager. Staff receive training however formal supervision has not yet been established by the new manager. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 19 The number of staff with an NVQ qualification is low at 11 but the home has a number of overseas qualified nurses who work as carers in the home. No agency staff was being used at the home to supplement the staff team. Staff training has included a focus on fire training. The inspector was informed that this was to ‘sharpen practice’. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 20 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): 34,35,37,38 The outcome for this area was adequate. Some health and safety deficits were identified for attention to improve the environment for service users (see also NMS 19). There is a full management team at Arrigadean. Monies are well managed and held securely. Paperwork and records are safely managed EVIDENCE: There is a good level of management input from the proprietor and the administrator. The home has a newly appointed Manager and has a deputy. The Manager application for the Fit Person process with CSCI has been started. Services users finances and personal monies are safe and access is very restricted to improve security. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 21 The home has a part time handyman; work is needed to improve the safety and presentation of the premises. Deficits reported back to the provider included wardrobes to be secured, en-suites to be de-cluttered and recommissioned. Attention to the damaged tiling in one sluice. Radiators are not all covered these must be risk assessed and action as identified taken preferably before the heating has to be switched back on. Waste bins that are used for contaminated hand wash waste should ideally be foot operated flip top type. This is essential for waste bins in communal facilities to reduce the risk of cross infection. The Manager should risk assess the need in each bedroom in line with care interventions and the disposal of personal protective clothing such as gloves and aprons. The home had an adequate supply of gloves and aprons for staff to use. Nonpowdered latex gloves are used and a latex policy should be in place. Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 1 3 2 3 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 X 3 1 Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Requirement 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. This was required at the last inspection by 14/02/06 CRB POVA First and two written references must be taken up before the person commences working in the home. The damp in the cellar must be addressed and the medication storage must be dry, safe and suitable. Personal accommodation en suite facilities must be accessible and must not used to store the homes spare bedding. The personal accommodation must be brought up to a higher standard of decoration and cleanliness. One wardrobe must be repaired. All freestanding wardrobes must
DS0000020294.V301195.R01.S.doc Timescale for action 20/09/06 2. OP19 OP9 23(2)(b) 13(2) 16(1) 20/09/06 3. OP19 20/09/06 4. OP19 23(2)(d) 20/11/06 5. OP19 13(4)(c) 20/10/06 Arrigadeen Version 5.2 Page 24 6. 7. OP38 OP38 13(4)(a) and (c) 23(2)(b) be checked for safety and if found necessary, be secured to the walls. Radiators / hot surfaces must be risk assessed and protected as necessary. The sluice facility with water damaged to the wall and tiling must be repaired. 20/10/06 20/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP38 Good Practice Recommendations A latex policy should be in place where latex gloves are used. (See Health and Safety Executive guidance) Arrigadeen DS0000020294.V301195.R01.S.doc Version 5.2 Page 25 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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