Inspection on 15/07/08 for Arrowsmith Lodge Rest Home

This inspection was carried out on 15th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Arrowsmith Lodge Rest Home 06/07/06

Arrowsmith Lodge Rest Home 04/10/05

Arrowsmith Lodge Rest Home 25/04/05

Arrowsmith Lodge Rest Home 06/01/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Arrowsmith Lodge Rest Home Arrowsmith Lodge Bournes Row Hoghton Lancashire PR5 0DR Lead Inspector Mrs Pat White Unannounced Inspection 10:30 15 & 16th July 2008 th 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 Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.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. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arrowsmith Lodge Rest Home Address Arrowsmith Lodge Bournes Row Hoghton Lancashire PR5 0DR 01254 854311 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) Mrs Kesavamalar Rajaratnam vacant post Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Dementia - Code DE. The maximum number of people who can be accommodated is: 16 Date of last inspection 6th July 2006 Brief Description of the Service: Arrowsmith Lodge is a purpose built home, of two floors, set in a quiet residential area of Hoghton. The home provides services for up to 16 older people, it does not provide nursing care, but provides social and personal care in a small, homely environment. At the time of this site visit a two storey extension was almost completed which comprised of 5 new en suite bedrooms, a lounge/dining area and a new conservatory. In addition there was the existing lounge and conservatory and bedrooms. The two floors were linked by a passenger lift. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide is issued to all residents and their relatives/representatives on admission. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 Star. This means that people who use the service experience poor outcomes. This inspection site visit to Arrowsmith Lodge was carried out on the 15th & 16th July 2008. The site visit was part of an inspection to determine an overall assessment on the quality of the services provided by the home (see above). This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People. The previous inspection report indicated that there were no issues that needed to be followed up from the previous inspection. The inspection included: talking to residents and relatives, touring the premises, observation of life in the home, looking at residents’ care records and other documents and discussion with the new manager and the owner. Six residents and 3 relatives spoken with gave their views on the home. In addition survey questionnaires from the Commission were sent to residents, relatives and staff asking them for their opinion of the home. At the time of writing this report only some (8) residents had returned completed questionnaires. Some of the views expressed in these questionnaires are included in the report. In addition the home provided the Commission with written information about the residents, staff and services provided, and their own assessment of the quality of the care and facilities provided. Some of this information is also included in the report. What the service does well: Residents said they were happy living in the home and felt that they received the care that they needed. Comments included, “the staff are brilliant, I don’t know where they get their patience from”, and “the staff are always so kind”. The questionnaires also showed that people were satisfied will all aspects of the care at Arrowsmith Lodge Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 6 Relatives spoken with also felt that people were well looked after. One said that he visited the home a lot and would know if things weren’t right. Two other relatives said that staff were kind and caring and that there was a good staff team at Melrose. One said, “They have been extremely kind to mum”. The medication procedures were safe and helped ensure that residents received the correct information at the right time. Residents said they were happy with the meals served and were able to have some say in food provided. There was a choice of main meals served each day. Usually there is a wide range of activities provided in the home to keep residents occupied. The old part of the home where the residents were living was clean and there were no unpleasant odours and this helped to make a pleasant environment for the residents. What has improved since the last inspection? What they could do better: All people should have their needs properly assessed and written down before they are admitted to the home so that a decision can be made about whether or not the home can meet their needs and staff have some information to help them understand these needs. This assessment should include a mental health assessment so that the needs of people with dementia are clearly identified and understood. The written care plans did not contain enough information. They should include all the details of the care and support people need in all aspects of health, personal and social care. This is to assist staff to provide all the assistance required and in the way that people prefer. The care plans could be Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 7 further improved by being properly updated when the care needs of people change to give staff up dated, accurate written information. The assessment of the risk associated with some aspects of care needs to be improved, such as assessing and eliminating the risk associated with the use of bedrails to help protect people from injuries. The risk assessments should show that bed rails are needed and that they are safe for individuals. Also people should not be transported in wheelchairs without foot tests unless there is written evidence to show that this is safer for individuals and why. The fire precautions in the home must be improved to ensure residents’ safety at all times. The requirements of the Fire Service must be complied with throughout the period of the construction work and constantly revised as the fire safety issues change. The staff training programme in the home, including the Induction training, should be in accordance with Government guidance to ensure a well trained and qualified staff team. More staff should undertake NVQ training and other training should be updated. The staff recruitment procedures must be improved to help ensure that unsuitable staff are not employed and which potentially puts residents at risk. Staff must not commence work in the home until all the necessary checks, and suitable references have been obtained. Residents’ finances must be managed safely, and records monitored and audited so that all residents’ money is accounted for. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.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 Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. Standard 6 was not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission procedures were satisfactory and people’s needs were met in the home. However this was not supported by written information to help staff understand these needs on admission. EVIDENCE: The written information about the home, the Statement of Purpose and the Service User Guide, will be updated when the extension is completed. In the questionnaire surveys most of the residents said that they had enough information about the home before moving in to help them make a decision, and also that they had a contract. Talking to people, and the information on the questionnaires, indicated that people’s needs were being met in the home. However this was not supported Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 10 by pre admission assessments to help staff understand people’s needs on admission. The viewing of the records and information from the manager showed that some residents had been admitted to the home without having their needs assessed. The manager said that if possible she visited people at the place where they were living to carry out an assessment. However details of this assessment were not written down and the social work assessment was not always obtained prior to admission. This meant that staff did not have written information about people’s needs to assist them at the time of admission and it was not clear how the home could meet these needs. Some of the assessments viewed that were undertaken after admission were not sufficiently detailed in all matters, for example one resident was assessed as being “heavily dependent” but there were no further details about this or what it meant. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans did not contain sufficient up to date information on all aspects of health and personal and social care required, especially with respect to the management of risks. Residents’ health was monitored and the medication management and procedures were satisfactory and in general safeguarded residents’ health. EVIDENCE: The care plans of three residents were viewed. These care plans did not contain sufficient detail in all matters of health, personal and social care. There was no up to date information about continence, pressure areas, assistance required with feeding, mental health or the personal care needed by residents and how this should be given. Therefore staff had insufficient written instructions to guide them and the care plans did not fully support the care Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 12 provided. Though there was evidence that residents’ care had been reviewed there were no written up dates on most aspects of care. There were written assessments of the risks associated with moving and handling, nutrition and pressure areas and though a level of risk was defined there were no instructions as to how the risk should be managed and accurate information was therefore not available to assist staff. There was insufficient written information to support the use of bedrails and how they should be fitted, and the risk assessments in place did not demonstrate that these were safe for individuals. People were seen in wheelchairs without foot rests and there was insufficient supporting written information to demonstrate that this was necessary or safe. The residents concerned may have been at risk from their feet and legs being caught underneath. According to the records kept the residents’ physical and mental health care was monitored and promoted. The records showed that residents had access to GP services and specialist medical services, including chiropody. District nurses were involved as required. They advised about pressure area care and supplied the necessary equipment for the relief of pressure areas. Those residents who completed questionnaires said they “always” received the care and support and medical attention they needed and that staff were “always” available when needed. The home had satisfactory policies and procedures for the safe administration of medicines, though advice was given on the development of a few procedures that were still outstanding. There were some good practices and medication appeared to be given safely. Areas of good practice included: safe storage of medicines and accurate records kept of all medication received into the home and leaving the home. However the following was noted. Not all staff administering medication had accredited training and staff were not checking the prescriptions before they went to the Chemist for dispensing. Whilst the Medication Administration Record sheets (MARs) viewed were generally well kept and signed accurately they did not always include enough information and instructions to guide staff. For example two creams were listed on one person’s MAR and the instruction for administration was “as directed”. There was no further information and the creams were not being applied. The manager said that these were not needed at the moment. There were no clear instructions regarding the administration of “when required” medication and when this was needed, and on another MAR sheet the instructions regarding when to give one medicine in relation to food was unclear. Residents told the inspector they are happy with the care they received and everyone spoken to said that staff were kind and respectful to them. We observed good interaction between residents and staff. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides residents with suitable activities and sufficient choice and flexible routines in their everyday lives. The food served suited the needs and preferences of the residents. EVIDENCE: Prior to the building work commencing Arrowsmith Lodge provided a wide range of activities for residents. The activity folder recorded a variety of activities to suit individual residents needs, such as playing dominoes and cards, singing, storytelling, bingo, trips out and church services. There were specific activities listed for people with dementia. Residents had completed questionnaires about their past interests and what they would like to do at present. As a result individual activities had been encouraged, such as knitting and painting. Those completing the questionnaire surveys for the Commission were satisfied with the activities. However those residents spoken with said that there had not been much going on whilst the building work was in Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 14 progress as staff had not got as much time or space to organise things. Also at the time of the site visit staff were not able to take the residents out as much as they would like, and the grounds were not suitable for people to sit out. Residents felt that the daily routines were sufficiently flexible. People said they could get up and go to bed at a time of their choosing, could stay in bed if they “were off colour” and that there was a satisfactory choice of meals. Some residents who were able were encouraged to manage their spending money. Bedrooms were personalised and residents were able to bring items of furniture, pictures and ornaments with them when they are admitted to the home. Visitors were seen in the home throughout the site visit and those spoken with said that they were made welcome in the home at any time and that staff were friendly and open. They felt informed of all the important matters concerning their relatives and were encouraged to remain part of their lives. Menus showed that there was a good variety of traditional food available and that there was a choice of the main meals served. The cook asked the residents which option they would like each day. Meals could be taken in resident’s own rooms if they preferred to eat in private. The meals served at the time of the site visit appeared appetising and residents spoken with said they had enjoyed the lunch - time meal. One said, “The food is very good”. Most of the residents who completed the questionnaires for the Commission said that they “always” enjoyed the food and the rest said “usually”. The cook said that she offered a cooked breakfast 2 days a week and that residents appreciated this. However no records were kept of the breakfasts and suppers served so this could not be confirmed. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate arrangements in place for residents to raise concerns, and the homes policies and procedures should help to protect residents from harm or abuse. EVIDENCE: The home had a complaints procedure, which was accessible to residents and their families. Copies were on the homes notice board and contained in the service users guide. There were no complaints recorded in the home and one issue that had been brought to the attention of the Commission since the previous inspection was resolved immediately. Residents and relatives spoken with at the time of the site visit said that they had no complaints and knew who to speak to if they had. The eight service users who completed the questionnaires said that they knew how to make a complaint and who to speak to if they were not happy with anything. The home had a protection of vulnerable adults procedure including a whistle blowing policy that would help protect residents. An alteration was advised which the manager agreed to rectify before the end of the site visit. Some staff had received training in the protection of vulnerable adults, but records showed that this was a number of years ago and that people, including the Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 16 manager, may benefit from updated training in this topic in order to ensure that the correct procedures would be followed in the event of an allegation or suspicion of abuse. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. At the time of the site visit the home’s fire precautions were inadequate and emergency measures were taken to ensure residents’ safety. The home was adequately decorated, furnished and clean but the hot water supply to some bedrooms was inadequate. EVIDENCE: The home is a relatively modern two - storey property situated in a rural village in the Hoghton area of Lancashire. At the time of the site visit a large extension was nearing completion, consisting of 5 new en suite bedrooms on the first floor and a lounge/dining area, conservatory and adapted toilet on the ground floor. Whilst this building work was in progress residents had temporarily lost some of the former communal space and were confined to two existing parts of the home. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 18 There were serious concerns about the interim fire precautions, and for which the Fire Service took emergency action to ensure the residents’ safety. In addition the fire risk assessment was inadequate for the risk posed by the building work. At the time of writing this report the Fire Service was monitoring the necessary ongoing changes in the fire precautions. In addition some access areas of the home had to be cleared of builders’ materials and old items of furniture as residents staff and visitors could have been at risk from accidents. The outside areas of the home were also regarded as unsafe for the residents to sit or walk at this, so they were more restricted and confined than usual. Some of the existing bedrooms had been recently redecorated and two other bed rooms were being decorated at the time of the site visit. Some of the bedrooms were shared with privacy screens. There was evidence that people had brought small personal items with them to personalise their rooms. Radiators were of the low surface temperature type to protect people from the hazards of hot surfaces. However in some bedrooms there was no hot water and in one room the hot tap was broken and water was unable to run. Most of the 9 shared bedrooms and 4 single bedrooms were adequately furnished and personalised. Residents spoken with were satisfied with their bedrooms. Taking into account the building work in progress, all parts of the home seen were sufficiently clean and a free from unpleasant odours. All eight residents who completed the questionnaires stated that the home was “always” clean and fresh. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty and the fire training was insufficient to ensure residents’ safety in the event of a fire. Staff recruitment processes were not sufficiently thorough to prevent the employment of unsuitable staff. EVIDENCE: At the time of the site visit the manager the owner and two care staff were working in the home. A cook was also working in the home. This was sufficient for meeting the personal care needs of the residents but according to the Fire Service there were sufficient staff on duty with the correct fire safety training to ensure residents’ safety in the event of a fire, and in particular during the night. The owner immediately rectified this, and a third member of staff was rostered over night until such a time that the risk is reduced. However staff appeared caring and patient towards the residents. Residents spoken with said they got on well with staff and one said staff were “brilliant” and that she “didn’t know where they got their patience from”. The information supplied by the home prior to the site visit indicated that about 56 of care staff had a relevant National Vocational Qualification. Staff had also recently undertaken training in dementia. However other records Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 20 seen indicated that the Induction training undertaken by new staff was not in accordance with Government guidance and was not as comprehensive as this guidance recommends. It also showed that other training needed updating, such as first aid, infection control and the Protection of Vulnerable Adults. A member of staff spoken with confirmed the training undertaken whilst working at Arrowsmith Lodge, but none of the staff returned survey questionnaires so a wider staff view of training and support was not obtained. Staff recruitment procedures were not in accordance with the Care Homes Regulations 2001 and may result in unsuitable staff being employed. The records of a recently recruited member of staff indicated that they were working in the home without a Criminal Records Bureau Disclosure or a Protection Of Vulnerable Adults check having been obtained. The references sought were also not the most appropriate. One was from a friend and the other, though from a previous employer, was not from the care service that they had listed in the employment history. Important and useful information about this person’s performance in a care service had therefore not been sought. These references had also been obtained after the person had commenced work. For another member of staff the records regarding the date starting work in the home were unclear, and there was no record of a past conviction having been thoroughly explored and subject to an assessment of risk to residents. There was no “Declaration of Criminal Convictions” section on the application form so convictions may not be picked up and explored at an early stage. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s management had not ensured the safety of the residents and staff, or managed residents’ finances competently or safely. EVIDENCE: There was a new manager in the home who was not yet registered with the Commission and did not yet have the qualifications required of the “Registered Manager”. She had however worked in the home for a number of years and been the deputy manager prior to her appointment as manager. She had also undertaken other relevant courses, such as NVQ level 3 in Business Management, medication management and dementia. The owner (and Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 22 previous manager) worked in the home several days per week overseeing the building work and supporting the manager. The management had systems in place for finding out the views of the residents about the home. Approximately every 6 months residents were asked to complete questionnaires and it was clear the management listened to residents’ views. Residents meetings are normally held but these have been put on hold whilst the building work has been in progress. The records kept of residents’ spending money held on behalf of the residents checked against the balance remaining of the home raised concerns about the way the cash amounts were handled and managed in the home. Three residents had less amounts of money stored than the records showed and this could not be accounted for at the time of the site visit. The owner was required to carry out an investigation and to inform the Commission about the outcome of this. Information on the serious concerns about the inadequate Fire Safety precautions have been outlined above in the “Environment” section, and the need for ongoing fire training specific to the home’s changing circumstances and fire risk have been high lighted. Therefore at the time of the site visit there were concerns that the management of the home had not properly ensured the safety of the residents and the staff throughout this period. With respect to other health and safety related training some up dated training was necessary, such as moving and handling, first aid and food hygiene According to the information supplied to the Commission prior to the site visit and the records viewed at this time appliances and equipment had been appropriately maintained and serviced. Because of the building work being undertaken the electrical wiring and gas installations in the home were undergoing changes and development and safety certificates will be issued when the work is completed. Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 23 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 2 3 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 2 1 2 x x 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 2 x x 2 Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 (1) Requirement People must not be admitted to the home without a comprehensive assessment of their needs so that there is written information to assist staff. The care plans must contain sufficient up to date detail and information on all matters regarding health, personal and social care in order to guide staff in how people’s care should be carried out. There must be comprehensive and up to date assessments of risk associated with pressure areas, the use of bedrails, wheelchairs without foot rests and nutrition which are individual to particular residents and which direct staff in the action they need to take to protect people. All the requirements made by the Fire Service for the duration of the building works must be complied with to ensure the safety of the residents. All residents must have hot running water in their bedrooms DS0000061375.V360164.R03.S.doc Timescale for action 08/08/08 2 OP7 15 31/08/08 3 OP8 13 31/08/08 4 OP19 OP38 23 (4) 21/08/08 5 OP25 23 (2) (j) 15/08/08 Arrowsmith Lodge Rest Home Version 5.2 Page 25 6 OP27 18 7 OP29 19 (Revised schedule 2) 8 OP35 17(2), sch 4, 9. (a) Staffing levels and fire safety 21/08/08 training in the home must be constantly reviewed and adjusted as necessary to ensure they are sufficient for the fire safety precautions whilst the building work is in progress and ensure the safety of residents in the event of a fire Recruitment procedures must be 08/08/08 in accordance with the Care Homes Regulations and staff must not commence work without supervision until the CRB disclosure and POVA check are received and employment references must be sought from previous employers in care services if possible. Residents’ money kept in the 08/08/08 home must be managed safely and accurate records maintained so that all the money is accounted for and none goes missing. 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 OP9 Good Practice Recommendations Their should be sufficient instructions on the Medication Administration Records to direct staff in matters such as the meaning of “As directed” and when to administer “when required” medication. All staff who administer medication should have suitable training and the manager should formally assess their competence. Staff should check the prescriptions before they go to the chemist for dispensing, in order to check for and rectify any errors made. 2 3 OP9 OP9 Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 26 4 5 OP15 OP29 6 7 OP30 OP31 Records should be kept of all the meals served including breakfasts and suppers. When members of staff apply for posts they should be asked to sign a “declaration of criminal convictions”. If people are employed with “convictions” the risk posed to residents should be assessed and documented. The Induction training undertaken by new members of staff should be in accordance with Government Guidance and Skills for Care. The manager should gain the appropriate qualifications for the post of manager of a care home as soon as possible Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Arrowsmith Lodge Rest Home DS0000061375.V360164.R03.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!