Inspection on 24/11/05 for Arthur Roberts House

This inspection was carried out on 24th November 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 01/07/05

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 Arthur Roberts House 121 Burnthouse Lane Exeter Devon EX2 6NB Lead Inspector Rachel Doyle Unannounced Inspection 24th November 2005 11:00 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 Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Arthur Roberts House Address Arthur Roberts House 121 Burnthouse Lane Exeter Devon EX2 6NB 01392 274388 01392 210251 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) Devon County Council Pauline May Lake Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (23) Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st July 2005 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. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place at 11.00 until 15.00 on Thursday 24th November 2005. The inspector was welcomed by the Duty Manager, as the Manager was not on duty. They were able to move freely around the Home and look at any relevant documents. Some residents were relaxing in the lounge and others were in their rooms. There were 23 residents living at the Home at the time of the inspection, including one short stay resident. 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 spoke to 8 residents in depth, (time was also spent in the communal areas and rooms with other residents who were less able to engage in conversation), 4 staff and the duty manager. The inspection focussed on key National Minimum Standards, which had not been inspected at the previous inspection or those, which were the subject of previous requirements and/or recommendations. There have been serious concerns following an Adult Protection issue to which Devon County Council have made a Service Improvement Action Plan in July 2005. This has had limited effect on the quality of the service. CSCI has requested a formal meeting with the providers to discuss the findings from this inspection. What the service does well: What has improved since the last inspection? A new care plan system has been devised and is about to be introduced. If this is used correctly then holistic care may improve. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 the following standard(s): 3, 4 Residents benefit from good admission and assessment practice but this does not ensure that the Home then consistently meets their needs. EVIDENCE: Four pre-admission assessments were looked at. These appeared to be comprehensive using an assessment tool. The duty manager said that the manager goes out to visit all prospective residents and liaises with the multidisciplinary team and family and/or representatives. Staff practice and training records do not indicate that the Home are able to provide a specialist service regarding mental health and dementia care. Few staff have had any training in this topic and there was a marked lack of engagement and communication with residents throughout the inspection. Care records did not show clear histories, actions or goals relating to mental health needs and some health care needs such as mobility and medical conditions. (See standard 7 and 8). Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 The staff do not show that they have a good understanding of the health and personal care needs of residents nor are their needs clearly documented in care plans, which does not ensure that these needs are met. Medication which is not stored safely could put residents at risk. Residents’ privacy and dignity is not always met or promoted by staff. EVIDENCE: The Home is in the process of implementing a new care plan system. These have a comprehensive format and will be used in conjunction with key-worker input. At present any identified issues in the assessment lack detailed action plans and goals, such as diabetic care, mobility, painful hands etc. Mental health care need records are very brief and there are no social histories relating to residents, which could aid communication. Bowel and fluid charts are used as a blanket policy with little rationale. Interaction between staff and residents did not show that residents’ health care needs were being met or that challenging behaviour was being managed such as one resident’s destructive behaviour or when a resident was clearly displaying different behaviour than usual which staff commented on. Carers had little knowledge of Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 10 formalised plans of care saying most knowledge was ‘in their heads’ or from the recent handover. Some issues flowing from risk assessments such as poor mobility did not outline the need for further planning. There was evidence of residents being neglected by staff- carers were not pro-active in ensuring that residents’ needs were met, especially those who had limited capacity. Staff tended to work in pairs, often talking amongst themselves, watching television or reading magazines. Some residents were being left for long periods such as one resident who did not change their position for the entire inspection and another resident who was unable to ask for assistance shouted for over 2 hours during the inspection, with no engagement or assistance with wet clothes and unable to drink. Seven residents sat around the upstairs lounge in silence for much of the afternoon with the television on, which no-one appeared to be watching or understanding when asked. Interaction between residents and staff was consistently poor and brief with little eye contact and often in an environment, which did not aid communication such as noise. One resident was fed their lunch by a carer in complete silence. Most of these residents would be unable to ask for assistance. One resident said that it was ‘do it yourself here’. When residents received health care from the external health care professionals such as the District Nurse this was clearly documented and followed up and the optician was visiting the Home that day. The inspector observed that staff did not promote privacy and dignity or independence, and one resident voiced their concerns to the inspector, as they had told the staff but said that nothing had been done. Medication records were good and staff were seen to wait for residents to take their tablets before recording but there were tablets left on the office table, which is accessible to residents. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 On the whole residents are not encouraged and helped to exercise control and choice over a large part of their lives and the limited social activities and appropriate communication by staff mean there is little daily variation or stimulation, especially for those residents who have difficulties communicating. EVIDENCE: It is noted that one staff member was very knowledgeable about the residents including details of their social histories, which was used by them to give individualised care. This staff member also used photographs of residents’ activities to jog their memories and encourage families to be involved and aid conversation with the resident. This is commendable. There were no records to indicate that all the residents had their social and leisure needs met. Activities were not individualised or resident focussed. Five out of 23 residents joined in the offered activity of threading beads with two carers, who often talked over residents and did most of the bead threading and decision-making. One resident said that ‘it was better than nothing but that they liked more active things.’ There are no outdoor outings, which staff and residents confirmed. There are activities offered such as gardening, bowls, card making, dominoes and computing but mostly with the same more able residents. The duty manager said that the domestics do try to get residents to help with chores, which the residents enjoy. Four residents said that they did as they were told and that they couldn’t choose when to do things. Staff did not facilitate Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 12 residents’ choice and four residents when asked said that they did as they were told and that they couldn’t choose when to do things. Staff relied on residents asking for what they wanted such as going into the garden. There were no consents recorded for identification photos of residents. Two residents said that there was nothing to do and said that they would like to go to the shop sometimes. They said they only do anything if their family facilitated it. One staff member agreed that the Home had made little effort to build a rapport with one resident as their family took them out. The resident said that they hated it at the Home, which staff acknowledged but the resident’s views had not been addressed. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 the following standard(s): 18 Current practices and procedures at the Home do not protect residents from harm or abuse. EVIDENCE: Nearly all the staff have attended a Protection of Vulnerable Adults training day. The manager was able to discuss this following the inspection and said that this had been successful with staff being vocal and motivated to learn. The Home have a copy of the No Secrets video and the POVA Alerters’ Guide. However, not all residents, especially those who are unable to use a call bell are checked on a regular basis and staff are not visible within areas of the Home other than the communal lounges. One resident did not move their position in a recliner for the entire inspection- meaning their skin integrity was at risk. The majority of residents spoken to did not feel that they were listened to and especially if their views were negative. At the time of the inspection there were also issues relating to the procedure undertaken by the Home about a vulnerable adults situation, which had not been followed correctly. This is being followed up with Strategy Meetings. The lack of appropriate training in mental health care means that not all staff treat residents as individuals with specific needs relating to their dementia or mental disorders. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 the following standard(s): 19, 24, 26 The environment, although dated, is clean and provides a comfortable living space but not all rooms suit residents’ needs or are personalised. EVIDENCE: Some rooms were quite sparse and were not very personalised. Those residents who were vocal had more personalised rooms with photographs. Some rooms did not have bedside lamps or an easy chair. Records did not include risk assessments as to why. There are gloves, paper towels and liquid soap around the Home although one carer was walking around wearing the same pair of gloves. The sluice and laundry areas were clean and the Home in general was hygienic. The Home has a Health and Safety representative. The Home were having a new tumble dryer fitted during the inspection. The Home has plenty of communal space with a large downstairs lounge and a smaller television lounge. There is another lounge upstairs and wide hall and landing areas. The back garden has a large lawned area and the front has some car parking and a green frontage. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 Staffing numbers are generally sufficient to ensure that residents’ needs could be met. Staff have not had the training to ensure they can meet the specialist needs of the residents at this home. EVIDENCE: The staff rota was looked at and appeared to have sufficient numbers of staff on duty. On duty were the duty manager, clerk, 5 carers, 2 domestics, 2 kitchen staff and a laundry person. One staff member should be commended for their individualised care and attention to residents. Staff commented that there had been an unsettled time within the staff team recently but that the atmosphere was improving with staff being nicer, more relaxed and calm with each other. (See standards 7, 8, 12). The staff member responsible for staff training had been away for some months and there has been minimal training at the Home other than POVA. Most staff had done one training day this year and there was no evidence of any relevant mental health or dementia training or competency monitoring. Staff training files were not up to date. The Home had made a start in listing which staff needed training. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Residents receive care in a safe, physical environment. EVIDENCE: Manual handling training is delegated to one staff member who is ensuring that all staff are up to date. There will be manual handling assessments done by the assessor in the new care plan format including wheelchair use. These were seen. The Home has started regular supervision sessions for staff. The inspector was unable to view these as the manager was not on duty and they will be inspected fully at the next inspection. The duty manager said that most staff had had one session and that assistant managers were going to be getting supervision training. This does not contain competency discussions at present. Accidents are well recorded and tracked. Quality assurance will be looked at during the next inspection as the information was difficult to obtain without the manager being present. Fire checks were being done and the equipment was checked correctly. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 1 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4OP8 Regulation 12 (1) Requirement The registered person shall ensure that the Home is conducted so as to promote and make proper provision for the health and welfare of service users and to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. This refers to the Home ensuring that they can provide a specialist service and that all residents’ needs are met. Unless it is practicable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service users’ needs in respect of his health and welfare are to be met, make it available to the service user, keep under review, revise and notify the service user of any revision. Timescale for action 24/02/06 2. OP7 15 (1) 24/02/06 Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 19 3. OP9 13 (2) 4. OP10 12 (4) 5. OP12 16 (m) (n) 6. OP14 12 (3) (4) 7. OP18 13 (6) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the Home. (this refers to medicines being left accessible in the office). The registered person shall make suitable arrangements to ensure that the Home is conducted in a manner which respects the privacy and dignity of service users with due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of service users. The registered person shall consult residents/representatives about their social interests and make arrangements to enable them to engage in local, social and community activities and consult with them about the programme of activities arranged by the Home and provide facilities for recreation, having regard to their needs. The registered person shall so far as is practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare and ascertain and take into account their wishes and feelings. 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. This is a requirement from the previous inspection and must be a priority. 24/12/05 24/12/05 24/02/06 24/02/05 24/12/05 Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 20 8. OP29 17 (2) 9. OP30 18 (1) The registered person must 24/03/06 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) correspondence, reports, records of disciplinary action and any other records in relation to his employment. This is carried forward from the previous inspection but was unable to be inspected, as the manager was not on duty at the time of the unannounced inspection. 01/01/06 The registered person must, having regard to the size of the care home, the purpose and the number and needs of the service users ensure that the 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 receive training to develop their understanding of Dementia and Mental disorder) The Home still has not dates for this training in order to meet the previous timescale. Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 21 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. Refer to Standard OP24 OP36 Good Practice Recommendations It is recommended that the Home provides rooms which are furnished to the stated minimum and are personalised. It is recommended that all staff receive regular supervision including competency monitoring. (carried over from the last inspection). Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter 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. Extracts may not be used or reproduced without the express permission of CSCI Arthur Roberts House DS0000039616.V264857.R01.S.doc Version 5.0 Page 23 - 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!