Inspection on 29/06/05 for Arrigadeen Nursing Home

This inspection was carried out on 29th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arrigadeen Nursing Home 28/06/07

Arrigadeen Nursing Home 25/07/06

Arrigadeen Nursing Home 14/01/06

Arrigadeen Nursing Home 06/10/04

Arrigadeen Nursing Home 08/06/04

Arrigadeen Nursing Home 21/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Arrigadeen 20 Cambridge Road Clevedon North Somerset BS21 7HX Lead Inspector Nicola Hill Announced 29 & 30 June 2005 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 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 D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Arrigadeen Address 20 Cambridge Road Clevedon North Somerset BS21 7HX 01275 879405 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Maureen Roberts Mrs Linda Mary Death Care Home 29 Category(ies) of 1. Old age people both male and female. registration, with number of places Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate 29 persons aged 65 years and over requiring nursing care. 2. May accommodate up to 3 persons aged 65 years and over requiring personal care only. 3. Manager must be RN on Parts 1 or 12 of the the NMC register. 4. Staffing notice dated 30/07/1998 applies. 5. 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. Date of last inspection 6 October 2004 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 grabrails for the group. The Home offers 17 single bedrooms, five of which have ensuite facilities; there are four double rooms one of which have ensuite facilities. The communal areas on the ground floor consists 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 D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken with the manager Linda De’Ath, the registered provider Mrs M Roberts and her daughter. Talking with the residents at Arrigadeen and consultation with staff provided some of the evidence for this report. The inspector also reviewed care files for residents and administrative records relating to the implementation of health and safety at Arrigadeen. At the time of the inspection there was one vacancy at the home. The inspector spoke with several residents, all of who were very complimentary about the lifestyle offered to them. Several of the residents had been at the home for some considerable amount of time. The residents discussed the activities they were able to follow in the home. One resident talked about the visiting arrangements for her family, who she felt were made welcome by staff at the home and always offered refreshment. The inspector observed the staff at the home treating the residents with respect. What the service does well: The manager felt that the standard of care offered at the home was of a high quality and that the home provides a continuity of person centered care for the residents. The quality of care provided at the home could be linked to the longevity of the residents there. The comments made by the residents were that they were happy at Arrigadeen and lucky to be there and that staff were very kind to them. They enjoyed the atmosphere at Arrigadeen and had their personal preferences respected by the staff. The home also has very detailed personal support plans in place for all the residents at the home, which clearly identify any action needed to be taken by staff in order to support the residents to be as independent as possible. Paula, the cook commented on how pleasant she found working at Arrigadeen, she felt the staff team worked with the residents toward the same goals. The kitchen and meal preparation area was very well equipped and the budget allowed for meals was sufficient so that a variety of meals could be offered. The home also maintained good communication with the families of residents, to ensure that relationships are maintained. The relationships between the residents and staff are good and create supportive and caring environment, which promotes the security and well being of the residents. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 6 The residents appeared to be well groomed, with coordinated clothing. The general atmosphere of the home was calm, with residents engaging positively with staff. In order to meet residents’ needs, staff recruitment has been undertaken and the home is able to offer a settled and experienced staff team. All the residents have an allocated key worker who has a responsibility to review care plans and to meet specific personal needs of their resident such as ensuring clothing is well maintained. The occupancy at the home is good, reflecting the reputation of the home in the local community. 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. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 standard(s) 1,3,4,5 There is clear information available about the service for potential service users and verifiable admission proceedures for service users. EVIDENCE: The individual care files for residents indicated that a pre-admission assessment had been undertaken which ensured that the home was able to meet identified need. The residents and carers are given the brochure and service user guide to use to enable them to make an informed choice about the home and the services it offers. The pre-admission assessments were undertaken in either the resident’s own home or in a hospital setting and were supported by information from the care manager and/or nursing staff. When potential residents are unable to visit the home prior to admission, the management invite relatives or carers to visit the home in order to see the facilities offered. One resident was able to confirm this, they stated that their daughter had chosen the home, however, the resident felt it was a very good choice. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 standard(s) 7,8,9,10 There is a clear and consistent care planning system in place to identify residents’ individual health and social care needs. EVIDENCE: The case tracking through the case files indicated that the health, personal and social care needs were fully identified and the home use various assessment tools. The home use the Braden assessment for the residents at high risk of developing pressure areas and where a risk was indicated a subsequent plan of action to reduce/eliminate the risk was required. The inspector observed these plans in action for example two residents in bed at the time of inspection had pressure relieving mattresses, manual handling risk assessments and turn charts. Within the care files the inspector was able to observe that care plans were regularly reviewed and changed with a change in need. The daily records are completed by trained staff and the carer giving the care. They were objective and informative. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 10 The manager also maintains a Chronic Disease Register as requested by Sarah Dunn, the project nurse for the Clevedon area. This involves ensuring that residents have regular clinical monitoring e.g. blood tests, which is additional work for the home. The physical appearance of the residents was that they were well dressed with clean coordinated clothing, well groomed and observed to be treated with respect. The manager recently undertook a clinical audit in hand washing. The home was able to demonstrate awareness of the infection control measures required and evidence of learning undertaken by the staff team to develop their skills and knowledge in this area. There are no residents at the home with MRSA. The system for the recording and administration of medication was found to be in good order. The clinical room is cited in the cellar of the house, which is damp. The Commission’s pharmacist will be able to advise the home on the effect this will have on the storage of dressings etc. New regulation on the disposal of medicines has come into effect and the home should follow these procedures, using Pharmacy Plus as the licensed waste disposal company. It is good practice for CDs to be denatured prior to disposal, this would include injectables. They should be signed out of the CD register by a registered nurse and witnessed by a second nurse. Monthly collection of the denaturing pot should be sufficient. Oramorph 10mg in 5mls would not be in this category and Fentanyl patches have instructions in the pack for safe disposal of used patches. Non CDs can go in a burn bin, the home must have a record of all medications disposed of in this way, it is important to have a second member of staff checking disposal. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 standard(s) 12,13,15 Activities at the home promote the health and well being of the residents. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets individual residents tastes and choices. EVIDENCE: As part of the care planning process the recreational and social preferences for the residents at the home are identified. To stimulate the residents, there was an activity organiser whose role was to organise the recreational activities preferred by the residents and which provide mental and physical stimulation for the residents. There were also books, games and audiovisual equipment available to the residents. The staff are able on occasion to take residents out of the home to access the local community. During the inspection several of the residents had visitors. The visitors who spoke with the inspector were very positive about the standard of care at the home. The relatives of one resident who has a considerable amount of personal furniture in her room, were very pleased that such a homely environment could be created within the care home. There is a menu planned for the residents, which is available for the residents. The residents complimented the quality of food and stated that although there Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 12 is no printed choice, Paula never gave them anything they disliked. The inspector observes the cook talking with the residents individually and discussing the type of food they would prefer. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 standard(s) 16,18 Complaints and concerns relating to the protection of vulnerable adults are acted upon appropriately. EVIDENCE: Arrigadeen has a rigorous complaints procedure; one complaint has been received since the last inspection, but was unsubstantiated. Most of the staff at home have undertaken training to enable them to recognise abusive practice and the action taken to report any concerns. The manager will be organising further training through North Somerset Council. There have been no adult protection issues at the home. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 standard(s) 19,20,25,26 Recent investment has improved the appearance of the home creating a comfortable environment for those living there. The home was clean and free from any offensive odours. EVIDENCE: The tour of the building indicated that some work on the environment had been completed since the last inspection. The manager and inspector identified that the ramp to the rear of the building presents a trip hazard and should be repaired. Carpeting in one double room was damaged and needed replacing. The inspector recommended the removal of floor covering on the bottom step leading to the cellar. The handyman has redecorated several of the bedrooms and refurbishment of further areas should be planned. The decoration and detail in the communal areas is of a good standard; the bedrooms, which have been refurbished, are also pleasant and welcoming. The home provides a wide choice of accommodation. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Resident’s benefit from a settled and familiar staff team who are experienced in meeting the resident’s identified needs. EVIDENCE: Use of agency staff is minimal; the staffing rota indicated that minimum staffing levels were met. Staff turnover at the home is low. All of the residents have an allocated key worker. Several of the care staff at the home are overseas staff, however, the residents expressed their satisfaction with the service and support of the staff team. It is noted that the majority of the overseas staff have appropriate qualifications and experience for the job they are doing at Arrigadeen. For example two of the carers have nursing qualifications obtained in their own country, but which are not recognised by the UK Nursing and Midwifery Council. The home have not met the minimum ratio of 50 trained care staff having NVQ 2 or equivalent, although the home can access NVQ training through North Somerset Council. At present one staff member has the NVQ 2 qualification and one NVQ 3. Two other members of the staff team had expressed interest in completing the NVQ two qualification. Training for staff is available and there is an expectation that staff will attend statutory training updates as required. All staff have some induction training and have a shadow Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 16 shifts before being counted as part of the staff rota. The management of the home are accessing TOPPS induction through North Somerset Council, although places on this course are limited. Staff were able to list the topics covered on induction and spoke about the supervision available to them and commented that the manager has introduced a positive training culture to the home. The individual files for several staff were sampled reviewed; all staff had two references and CRB checks. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 37, 38 The manager has successfully provided leadership for the staff at the home and has also provided a safe environment for the residents. The home is financially viable. EVIDENCE: The manager, Linda De’ath, has continued to implement good practice at the home, in respect of the implementation of the new care planning formats for residents, staff training, recruitment and providing a safe and stimulating environment for the residents. The manager is undertaking NVQ 4 and is a tutor for adaptation students. In addition to this she provides some of the in-house statutory training for staff and is an NVQ assessor. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 18 The manager has also demonstrated leadership skills in the administration of the home, staff management i.e. regular staff meetings and has the confidence of the staff team. Staff stated they felt the manager was approachable and listened to them. The comments received from the staff were very positive and included the team is very strong and trustworthy and the manager has introduced new initiatives. There is regular staff supervision and the staff are involved in daily handover of information directly relating to the care of the residents. There was documentary evidence of three monthly formal supervision and appraisal of staff; this was confirmed by staff members as being a useful practice to promote self-development. The quality assurance currently is a yearly visitor/relative questionnaire that has been distributed and the results collated. The residents were consulted on a one-to-one basis by staff. The result of the questionnaire has been collated, the outcomes communicated to residents and this has influenced the day-today running of the home. The manager is keen to undertake clinical audits of the home, she has already completed a hand washing and a documentation audit and will be covering further areas such as communication. Further quality audits of specific areas of the home will be introduced, such as health and safety, care planning etc. The accountant working on behalf of the home has provided evidence of financial viability. Evidence for the insurance cover for the business was available and on display on the wall. The implementation of health and safety at the home was reviewed in respect of accidents to residents. There have been 17 falls since the beginning of the year and the manager will be undertaking a falls audit to identify any common causes. The fire safety procedures at the home are implemented as the recommendations. There was evidence of regular maintenance of the electrical system, alarm system and portable electrical appliance testing was planned for 20th July 2005. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 3 x 3 3 3 Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 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 19 Regulation 23 Requirement A planned programme of redecoration and refurbishment of the home should be produced in order that continual improvement is maintained. Timescale for action 30/9/05 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 9 Good Practice Recommendations Stock numbers for when required medication are carried forward on a monthly basis to provide a clear audit trail. Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Arrigadeen D53_D02 S20294 Arrigadeen V223033 140605 Stage4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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