Inspection on 25/04/05 for Arrowsmith Lodge Rest Home

This inspection was carried out on 25th April 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arrowsmith Lodge Rest Home 15/07/08

Arrowsmith Lodge Rest Home 06/07/06

Arrowsmith Lodge Rest Home 04/10/05

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arrowsmith Lodge Rest Home Bournes Row Hoghton Lancashire PR5 0DR Lead Inspector Della Lovell Unannounced 25 April 2005 09:30 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. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Arrowsmith Lodge Rest Home Address Bournes Row Hoghton Lancashire PR5 0DR 01254 854311 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) Mes Kesavamalar Rajaratnam Care Home 16 Category(ies) of LD - Learning disability (1) registration, with number OP - Old age (16) of places PD - Physical disability (1) Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 16 service users to include: Up to 16 service users in the category of OP (Older People) Up to 1 named female service user in the category LD (Learning Disability) Up to 1 named female service user in the category PD (Physical Disability) This condition will no longer apply should the service user no longer reside at Arrowsmith Lodge Care Home or, due to advancing age, fall into the category OP (Older People). 2. Staffing should be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. Date of last inspection 6 January 2005 Brief Description of the Service: Arrowsmith Lodge is a purpose built home, 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 present, the home offers accommodation in single or shared rooms. The sizes of the rooms vary greatly and there are two rooms with en suite facilities.There are three lounge areas, one of which is a conservatory, leading via a ramp to a large garden area, and another includes the dining area.The service users have access to the first floor by a passenger lift. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This un-announced inspection took place over one day in April 2005. Information regarding standards not assessed at this inspection can be located in the previous inspection report. During the inspection discussions took place with the manager, staff members, service users and one family member. A number of records and documents were examined as part of the inspection process. Arrowsmith Lodge change ownership and management in August 2004, very little refurbishment or development had taken place previously and the home had a number of requirements and recommendations. What the service does well: What has improved since the last inspection? There have been a number of improvements to the environment at the home since the last inspection. Two small bedrooms have been made into one providing a good size room for a service user. A refurbishment programme is on going with improvements being made to decoration and furnishings and work has also been undertaken to improve the kitchen. All this has improved the condition of the home providing a comfortable place for the service users to live. A number of staff at the home have been there for many years and are experienced carers. However for many years formal training has not been provided. Since the last inspection a training programme has been put in place and all staff members are currently under going both mandatory and specialised training. This will ensure that the service users needs can be met by the skills and competencies of the staff team. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 6 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. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.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 Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.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 and 4 The homes Statement of Purpose does not provide sufficient information for prospective service users to be clear about the service the home provides to meet their needs. The assessment and care planning system does not provide information which demonstrates that the home can meet the indivdual needs. EVIDENCE: A Statement of Purpose had been produced but did not contain the information required by the Care Homes Regulation. This was identified at the last inspection and remains outstanding. Assessments of needs were seen on some files, however one privately funded service user had recently been admitted to the home, there was no assessment or care plan undertaken or in place for this person. Another care plan did not provide written instruction for staff on how the needs of the service users are to be met. On the day of the visit the inspector noted that one service user had deteriorated physically since the last inspection. There Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 9 was no evidence that a reassessment of needs had taken place for this service user and the care plan had not been updated. Since the last inspection staff training had commenced and a number of staff were in receipt of training. One relative told the inspector that she felt her mum was well cared for and was happy with the level of care given. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 Limited progress has been made on improving the care plan process to ensure that the assessed needs were being met. The homes policy and procedure for dealing with medication was not clear and did not provide adequate information for staff to administer medication safely. . EVIDENCE: Individual care plans are available but little progress has been made to ensure that care plans are developed from the assessment and provide written instructions for staff on how the identified needs are to be met. Not all care plans were up to date and not all had been reviewed. Discussion with staff suggested that needs were being addressed even though there was a lack of information on the service users care plan. Senior care staff communicate verbally to other carers and daily diary entries provide some information on care provision. Service users would be at risk of not having their needs met if these informal systems break down or if senior experienced staff leave. Senior carers administer medication but have not had any formal training. Although care was provided when administering medication one Mar sheet had incorrect dates on and medication was held in the cupboard for one service user but this was not recorded on the service users individual MAR sheet. One Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 11 service user was receiving anti-diarrhoea medication at the same time as receiving laxative medication. It was also unclear whether or not the home administers homely remedies, senior care staff told the inspector that they only administer prescribed medication. However there was a medication protocol in the drugs book, which provided a list of homely remedies and instructions to follow. The registered person must review the home’s policy and procedure for the administration of medication in accordance with Royal Pharmaceutical Society of Great Britain. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 12 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) 15 Dietary needs of the service users are well managed and catered for with a balanced and varied selection of food available for service users to choose from. EVIDENCE: Service users spoken too said that they enjoyed the food and that a choice was offered to them if they did not want what was on the menu. Meals were seen to provide a wholesome balanced diet. Service users requiring assistance were served once other service users had their lunch, which ensured that all service users were unhurried, and enough time was given to service users requiring full assistance. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.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) 16,17 and18 The home had a satisfactory complaints procedure which ensured that all complaints would be acknowleded and investigated. Arrangements for potecting service users is not satisfactory and does not ensure the safety of service users. EVIDENCE: There was a complaints policy and procedure in place in the home and available for all to see. Since the last inspection the registered person had developed a separate proforma for recording all details including the actions and outcomes to be taken by the home. One complaint had been received by CSCI, which had been investigated appropriately by the provider. Service users spoken to said that they had no complaints. The home had information on how to contact the local advocacy service and service users were supported in exercising their rights to vote through the postal system or family support. A policy was available for protecting vulnerable adults from abuse, however there was no clear procedure for reporting and recording allegations and it was not clear who had the responsibility for reporting incidents. Not all staff have had a checks with the Criminal Record Bureau. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.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) 19,20,21,22 and 25, Since the last inspection a refurbishment plan has been put in place and there was evidence of improvements throughout the home which has created a homely and comfortable place for the service users live. Further work is on going to ensure that the facilites in the home are made suitable for the service users. EVIDENCE: Arrowsmith Lodge was in need of extensive refurbishment and re-decoration. Since the change of ownership in August 2004 a clear action plan for refurbishment and decoration has been implemented and is on going. The registered person had sought advise from the occupational therapist with regards to the refurbishments of the bathrooms which is due to commence. Although a number of bedrooms were still in need of refurbishment, much progress had been made. Service users were able to bring into the home small pieces of furniture and personal processions. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 15 Water temperatures are monitored on a weekly basis and were seen to fluctuate and there was no evidence that the water is stored at a temperature to prevent the risk of legionella The registered person informed the inspector that a heating engineer had been contacted with regards to these matters. These matters remain outstanding from the last inspection. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 16 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 and 29 The procedures for the recruitment of staff are inadequate and do not safeguard service users. Staffing numbers are sufficient to meet the services users needs and the registered person has put in place a training programme for all staff to ensure that they are competent to do the job. EVIDENCE: On the day of the inspection there was a rota, which showed who was on duty and in what capacity. Staffing numbers were sufficient to meet the service users needs. Two new members of staff were working in the home. The home had not undertaken the necessary checks including a POVA or Criminal Records Bureau check. There was no record that an induction process had taken place and checks on existing staff were not yet completed despite this being made a requirement following the last inspection. One new staff member was under the age of 18 years. There was no evidence that this staff member had been registered on a TOPSS-certified training programme. Since the last inspection the registered person had introduced a training programme. A number of staff had completed training in moving and handling and food hygiene, other specialised training was also being provided. The training matrix identified two members of staff with an NVQ qualification and two staff members working towards the qualification. No staff are left in charge of the home under the age of 21 years. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.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) 35 and 36 The current system for recording personal allowances does not ensure safekeeping for service users monies. Although informal supervision takes place, staff were not clear with regards to their roles and responsibility to ensure that documentation is in place and up to date. EVIDENCE: The home provides written records of all service users financial transactions, receipts and records were maintained. However at the time of the inspection service users personal allowances were not in the home for examination. There was also one personal allowance payment being paid directly into the homes business account. The inspector discussed alternative options available with regards this payment. Formal supervision session for the staff had not yet commenced. In the past 9 months the home had gone through a change of ownership and management. Staff spoken too were positive about the change and recognised that it would Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 18 take time to implement the changes required. Formal supervision sessions would be an ideal opportunity for the new manager / owner to communicate the changes. A requirement from the last inspection remains outstanding with regards to the registered person must ensure an environmental risk assessment is undertaken which covers unprotected radiators, hot water pipes and the provision of handrails. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.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 2 x x 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 2 2 x x 2 x STAFFING Standard No Score 27 2 28 2 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 x x x x 2 2 x x Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. OP1 Standard Regulation 4 (1)(c)Sch edule 1 Requirement The statement of purpose must be amended to meet the requirements of Regulation 4 and Schedule 1 of the Care Homes Regulations 2001. A copy of the amended document must be supplied to the Commission for Social Care Inspection. (Timescale 31/3/05 not met) The registered person must ensure that all service user have an assessment of needs and this is kept under review and revised at any time when it is necessary to do so. The registered person must ensure that service users and or their relatives are provided with the opportunity to be involved in the care planning and reviewing process. (Timescale of 31/3/05 not met.) The registered person must ensure that the care plan provides written instruction on how the assessed need including health care needs are to be met. (Timescale of 31/3/05 not met.) The registered person must ensure staff who administer Timescale for action 27/6/05 2. 14(2)(a)(b) OP4 27/6/05 3. 12(2)15(2) (c) OP7 27/6/05 4. 15(1) OP7 OP8 27/6/05 5. 18(1)(i) OP9 31/8/05 Page 21 Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 6. 12(1)13(6) OP18 7. 13(6) OP18 8. 13(4)(a) OP25 9. 10. 13(4)(a) 19(1) Shedule 2 OP25 OP29 11. 19(1) Shedule 2 OP29 medication are provided with acredited training. The registered person must develop further the homes procedure for reporting allegations of abuse in accordance with the Lanacshire documents no secrets in Lancashire.(Timescale of 31/3/05 not met) The registered person must ensure that staff left in charge are provided with training on the Protection of Vulnerable Adults. The registered person must ensure that water is stored at a temperature to prevent risks from legionella. (Time scale of 31/3/05 not met) The registered person must ensure that water temperatures are provided close to 43oC The registered person must ensure that all exisiting staff have a satisfactory check with the Criminal Record Bureau. (Timescale of 31/3/05 not met) The registered person must ensure that information and documentation listed in Schedule 2 of the Care Homes Regulation 2001 in respect of persons working in the care home must be obtained.(Timescale of 31/3/05 not met) The registered person must not have service users personal allowance paid into Arrowsmith business account The registered person must ensure that staff recieve supervision. The registered must ensure that an environmental risk assessment is undertaken which covers; 31/8/05 31/8/05 31/8/05 31/8/05 27/6/05 27/6/05 12. 13. 20(1)(a)(b) OP35 31/8/05 14. 15. 18(2) 13(4)(a) OP36 OP38 31/8/05 31/8/05 Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 22 ·Unguarded radiators and hot water pipes throughout the home. ·The provision of handrails. (Timescale of 31/3/05 not met) 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. 2. 3. 4. Refer to Standard OP12 OP18 OP28 OP35 Good Practice Recommendations The registered person should consider developing individual time for each service user who are no longer able to participate in planned group activities The registered person should develop a proforma for recording all allegations of abuse. The registered person should make approprate arrangements to ensure staff are appropraitely qualified to NVQ Level 2 in Care The registered person must ensure that service users monies are not removed from the home and are available at all times. Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Levens House Ackhurst Business Park Foxhole Road Chorley, PR7 1NW 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 Arrowsmith Lodge Rest Home F57 F08 S61375 Arrowsmith Lodge V223186 250405 Stage 4.doc Version 1.30 Page 24 - 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!