Inspection on 01/07/05 for Arthur Roberts House

This inspection was carried out on 1st July 2005.

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

Arthur Roberts House 31/07/07

Arthur Roberts House 09/06/06

Arthur Roberts House 24/11/05

Arthur Roberts House 28/10/04

Arthur Roberts House 07/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Arthur Roberts House 121 Burnthouse Lane Exeter Devon EX2 6NB Lead Inspector Stephen Spratling Unannounced 01 July 2005 09:30hrs 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. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Arthur Roberts House Address 121 Burnthouse Lane Exeter Devon EX2 6NB 01392 274388 01392 210251 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) Devon County Council Pauline May Lake Care Home 23 Category(ies) of DE(E) Dementia - over 65 (23) registration, with number MD(E) Mental Disorder - over 65 (23) of places Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28 October 2004 Brief Description of the Service: Arthur Roberts House provides personal care and accommodation for up to 23 older people who have dementia or mental health related problems. The home does not employ registered nurses.The home is situated in the Wonford area of Exeter within close walking distance from local shops and on a regularly served bus route into the centre of the city. The building provides level access with a large lawned garden. Accommodation is provided on 2 floors with a shaft lift allowing easy access to both. Bedrooms are all single occupancy and there are four shared living areas, two on each floor.The Home is owned and managed by Devon County Council. The Registered manager is Mrs P Lake. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector (Stephen Spratling) from 10.45am until 3.35pm on Friday 1st July 2005. The inspector focused on 10 National Minimum Standards. Other standards will be looked at during inspections planned for later in the year. On the day of the inspection there were 22 residents living at the home, the inspector met with nine of them. Residents who met with the inspector had variable degrees of difficulty understanding questions and/or communicating their experiences of living at the home. The inspector also spoke with two of the assistant managers, five of the care staff (2 were agency staff) and one of the domestic staff. He looked some of the records kept in the home. What the service does well: What has improved since the last inspection? What they could do better: Staff must make sure that medicines are taken by the person for whom they are prescribed. Residents should always be treated with respect. The home should help residents get involved in more activities and outings. Staff need to be helped to develop a better understanding of what is abuse and what they should do if they suspect abuse is occurring. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 6 Evidence that proper recruitment procedures are being followed must be kept in the home. Staff should be provided with more training particularly training about how to care for people with Dementia and mental health problems. All staff need to have receive regular formal supervision. 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. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 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 Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 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) None of these standards were assessed during this inspection. EVIDENCE: Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.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) 9 & 10 Failure to properly administer medication puts residents at risk. Most staff treat residents with dignity and respect at all times, there are however occasions when some staff are not sufficiently respectful towards residents. EVIDENCE: The standard about medication was not assessed as a whole, though the inspector did see one instance when a resident was left with medication while in the dining room but the staff member did not stay to ensure the medication was taken, as they should. Five residents able to respond confirmed that staff speak to them politely and are gentle when providing personal care. Four of five residents said that they hear staff being pleasant and polite to other residents; one resident indicated that they are sometimes worried by the way in which some staff speak to other residents but was unable to describe what they saw or heard. Four confirmed that they choose what to wear, one person was unsure. Five care staff were asked what they would do if a resident refused help to change if they had soiled clothing and all responded appropriately. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 10 Five of eight staff spoken with said that they believe residents are always treated with respect, one carer said they think some staff can be “brisk”, two commented that staff are recently better with one of them saying that a practice of removing residents to their rooms as form of behaviour control had recently stopped. During lunch the inspector observed one care assist a resident with their food in a brisk, though not unkind, manner. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.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, 14 & 15 Residents are encouraged and helped to exercise control and choice over some parts of their lives, though the limited social activities provided mean there is little daily variation or stimulation. A varied balanced diet is provided and served in a pleasant atmosphere, which helps promote residents wellbeing. EVIDENCE: Four residents asked confirmed that they choose what time they get up and go to bed; one person said that they “always like to sit up late” indicating that this is fine with the staff. Residents were seen taking meals in the dining areas or in their easy chairs depending on their preferences. All residents asked said that they like the food and that a choice of main meal is available. One person said that they had fish and chips, which was “beautifully cooked and hot”. A carer was seen sitting with one resident who needed help to eat, taking time and paying attention to that individual. Residents were mostly offered condiments and assistance politely by staff (see standard 10). No plan of activities was available; a staff member previously employed to plan and do activities with residents is no longer in that post. Residents said sometimes they play games, or sit in the garden but were not aware of any other activities; one person said that the vicar visits every 3 weeks. The patio door to the garden was locked and staff said they would open it if asked, though as the garden is enclosed this seemed unnecessary. There had been no outings from the home in recent weeks. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 12 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 Arrangements for responding to complaints are satisfactory and help to improve the quality of care for residents. Lack of staff understanding of what is abuse and how to report it is putting residents at risk. EVIDENCE: The homes complaints procedure is on display in the entrance hall of the home, it provides all the information required but should be updated to refer to the CSCI. The inspector was shown the homes system for recording complaints and the outcomes of complaints. Three residents were asked if they knew what to do if they had a complaint, two said that they would speak to the managers indicating they had confidence in the managers, the third did not know what they would do and added that they never had cause to complain. A recent allegation about the behaviour of one carer was not initially managed in line with adult protection procedures, as it should have been. Subsequent investigation of the allegations were done in line with adult protection procedures and the allegations were found to be have been true. The staff member concerned is no longer working at the home. During the inspection of six permanent care/management staff asked four had attended training regarding the recognition and report of abuse and only three demonstrated a reasonable understanding of what is abuse and what they should do if they suspect a resident is being abused. Devon County Council has written to assure CSCI that more training and other actions are being put in place to improve this situation. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 13 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) None of these standards were assessed during this inspection. EVIDENCE: Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 14 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, 29 & 30 Staffing numbers are generally sufficient to ensure that residents needs can be met. Residents cannot be reassured that recruitment procedures are robust and protect residents from staff not suitable to work with vulnerable people. Staff have not had the training to ensure they can meet the specialist needs of the residents at this home. EVIDENCE: Duty rotas show and staff report that the numbers of care staff on duty meet or at times exceed the numbers recommended by Devon County Council. An agency carer new to the home said that she felt she had time to do her job without rushing. Other staff indicated that there are generally enough staff on duty but that that they feel there are too many agency staff and the home needs more permanent staff to provide more continuity of care. Since the inspection Devon County Council managers have confirmed that they are actively trying to recruit more permanent care staff. Two care staff said they do not feel they have the time to spend socialising or doing activities with residents as they think they should (see standard 12). There were three domestic staff on duty the day of the inspection, one spoken with indicated that she receives the supported needed to do her job. Three residents said that they think there are always enough staff around and that they get help quickly when they need it. One resident said that they think the staff are “very good and that they always know what they are doing”. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 15 The inspector looked at the staff files for three care staff, only one contained all the required recruitment information, proofs of identity/ references etc. Training records in these staff files where present did not provided evidence of comprehensive ongoing training. A chart summarising training attended by all staff indicated that some staff had not had any training in the last year, though the administrator said she believed it was not up to date. Of the five permanent care staff spoken with only one person could remember doing manual handling training in the last year, another thought they may have done some training regarding incontinence in the past year; none of them, including the two assistant managers had at any time received formal training about how to care for older people with dementia or mental health problems. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 16 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) 36 Lack of adequate staff supervision has contributed to residents being subject to some poor care practices. EVIDENCE: Recent inquiry at the home by Devon County Council highlighted some unacceptable care practices; the investigation indicated that some of these practices were known to senior staff who did not challenge them. This was bourn out by comments of two staff members to the inspector during this visit. Staff supervision records were not available to be seen by the inspector. Of the five permanent care staff spoken with all but one said they had attended one formal one to one supervision session in past months, though a regular pattern of formal supervision had not yet been established. Devon County Council managers have confirmed that all care staff will have received at least one formal supervision session by September 2005 leading into a regular pattern of formal supervision for all care staff thereafter. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 17 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x x x x 1 x x Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 18 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. Standard op 18 Regulation 13 (6) Requirement Timescale for action 01/10/05 2. OP 29 17 (2) 3. OP 30 18 (1) The registered person must make suitable arrangements, by training staff or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 01/10/05 The registered person must maintain in the care home the records specified in Schedule 4 (6); (a) full name, address, date of birth, qualifications and experience (b) a copy of his birth certificate and passport (c) a copy of each reference obtained in respect pf him (d) the dates on which he commences to be employed and ceases to be so employed (e) the position held at the care home, the work that he performs and the number of hours for which he is employed each week (f) correspondance, reports, records of disciplinary action and any other records in relation to his employment. The registered person must, 01/01/06 having regard to the size of the care home, the of purpose and the number and needs of the service users ensure that the Version 1.30 Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Page 19 4. op 36 18 (2) 5. op 7 15 persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. (In addition to statutory training, staff should recive training to develop their understanding of Dementia and Mental disorder) The registered person should ensure that all persons working at the care home are suitably supervised. Unless impractical to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service user plan/care plan) as to how the service user’s needs in respect of his health and welfare are to be met. (requirement made following the last inspection not examined on this inspection but will be assessed at the next) 01/10/05 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 OP 9 Good Practice Recommendations Medicines should be handled according to the requierments of the medicines act 1968 and from the the Royal Parmaceutical Society. (When administering medications stafe should observe to ensure it is taken by the person it is intended for) Service users should have to exercise choice in relation to leisure and social activities. Up-to-date information about activities should be avaialble. (Service users need help to access stimulating activities which suit their interests and abilities) All staff must be able to recognise abuse and should know what to do if they are concerned that abuse may be taking D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 20 2. OP 12 3. OP 18 Arthur Roberts House place within the home. Concerns about abuse must be reported promptly and in line with the Devon Protection of Vulnerable Adults Policy. Arthur Roberts House D54 D06_s39616_arthurroberts_v231599_010705 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. 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