Inspection on 31/07/07 for Arthur Roberts House

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Arthur Roberts House 09/06/06

Arthur Roberts House 24/11/05

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 121 Burnthouse Lane Exeter Devon EX2 6NB Lead Inspector Vivien Stephens Key Unannounced Inspection 31st July 2007 9:30 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.V307759.R01.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. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arthur Roberts House Address 121 Burnthouse Lane Exeter Devon EX2 6NB 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) 01392 274388 01392 210251 http/www.devon.gov.uk/adoption.htm Devon County Council Mrs 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.V307759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th June 2006 Brief Description of the Service: Arthur Roberts House provides personal care and accommodation for up to 23 older people who live with 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 secure 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. There is a small car parking area. The Home also offers short-term respite care. The Home now has a no smoking policy for all new admissions. Those residents who are smokers are still able to continue to smoke in designated areas. Within the building there is also a day centre for people living in the Exeter area, run by Age Concern. People using this centre use a separate entrance and therefore do not disturb the people living in the home, although, with prior agreement, some people who live in the home may attend the day centre if they wish. Fee levels are assessed according to the financial circumstances of each individual. The maximum cost of care was £570.50 per week at the time of inspection. Additional costs not covered in the fees include some transport, private chiropody, hairdressing and personal items such as toiletries and newspapers. A copy of the most recent inspection report can normally be seen in the entrance hallway, or alternatively the home will provide a copy on request. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Several weeks before this inspection took place the manager completed a selfassessment form with a range of information about the home and the way it is managed. This was submitted to the Commission. On receipt of this document survey forms were sent to the people who live in the home and/or their relatives or representatives, and also to care workers. Responses were received from 8 relatives and 2 care workers. The information received from these surveys has helped to form the judgements made within this report. This unannounced inspection began at approximately 9.30am and finished at approximately 6.30pm. On the day of this inspection there were 20 people living in the home. During the day we checked all of the communal areas, and most of the bedrooms, toilets and laundry. Discussions took place with the manager, Pauline Lake, and with 6 staff and 4 people living in the home. The storage and administration of medicines was checked and an assistant manager was observed administering medicines. Four care plan files were seen and the care of those people was ‘tracked’ to see how the home met all of their care needs from admission to the time of this visit. Records of four care workers recruited in the last year were seen along with records of the training staff have received. Records relating to the health and safety of staff and the people living in the home were also checked. What the service does well: Most of the people we spoke to or heard from during this inspection spoke highly of the care provided to the people living in the home. Comments included – “The staff are very caring and helpful.” “I feel Arthur Roberts is a very good example of how such homes are run. They have my confidence.” “They provide a calm, friendly and sympathetic environment. Ensure their residents are warm, well fed and comfortable at all times. The care staff are well-trained and provide an efficient service cheerfully and patiently at all times.” We saw evidence to show that staff have taken good care to ensure the home is suitable for people who are thinking about moving in. The records we saw showed that sufficient information has been gathered to assess the person’s needs. People have been given written information about the home and encouraged to visit either for the day or for a short stay before any final Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 6 decision is made to move in permanently, helping them to make an informed choice about where they want to live. People told us the meals provided by the home are good. The menus have recently been adjusted and now provide choices to suit all tastes and dietary needs. Satisfactory procedures have been followed before new staff begin work to ensure that they are suitable for the job. References and criminal record checks have been carried out and staff have been given good induction training to ensure the people living in the home are in safe hands. Staff have received training on a range of topics including all relevant health and safety related topics. The majority of the staff have achieved a nationally recognised qualification in care (known as NVQ). The home is well managed. The manager and team of assistant managers have had many years of experience and are well qualified. Records have generally been well maintained. We saw records to show that the care, health and safety of the people living in the home have been considered and acted upon. Good risk assessments are in place for the environment, and all equipment has been regularly serviced and maintained. All areas of the home were found to be clean and free from any odours. What has improved since the last inspection? The care plans have been improved in the last year. Each person living in the home has a folder in which all of their current health and personal care needs are set out. These plans provide good basic information to the care staff about how the person wants to be assisted each day. They showed us that the home has liaised closely with all relevant health and social care professionals to ensure that people receive appropriate advice and treatment with any health problems they may experience. Systems have been put in place in the last year to ensure that any concerns about the safety or welfare of the people living in the home are recognised and addressed. A member of staff has been trained by Devon County Council to be a ‘key trainer’ on moving and handling and the protection of vulnerable adults. Records seen during this inspection showed that the home have taken seriously all complaints and concerns and have taken appropriate steps to address all matters raised and have acted to prevent similar problems happening again. In the last year many areas of the home have been redecorated and upgraded. The communal areas appeared bright, clean and homely. Attractive lighting in the corridors and interesting framed photographs of Exeter and surrounding areas have helped to create a bright and welcoming atmosphere. The back Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 7 garden has been laid out with paths, raised flower beds, patio areas and seating. Good systems have been put in place review and improve the quality of the care and services provided. Devon Social Services have recently carried out a quality audit on the home. Their report on the outcome was seen during this inspection. What they could do better: Medicines are generally stored and administered safely. However, records of medicines received into the home in one case did not show the name or amounts of medicines received, and instead the record stated ‘as blister pack’. In addition the records had not been completed to show that some medicines had been administered at the midday medicines round on the day of this inspection. As a result it would not have been possible to check easily if the medicines had been given correctly. The written procedure for addressing a possible incident of incorrect or missed medication was unclear. It is recommended that all staff who have responsibility for administering medicines receive training to a nationally recognised standard in this topic, and that their competency is checked. While most relatives told us they are completely satisfied with the care and services provided by the home, some said that communication could be improved. One person said they have found it difficult to speak to a member of the management team if they want to know about the health or welfare of their relative. Another person said the home never rings them to keep them informed or involved – it is always left to the relative to instigate phone calls. Pauline Lake agreed the home could do more to encourage relatives to keep in touch and be involved in the care of their loved-ones. The method of recording the training staff have been given could be improved to provide an overview of all of the training staff have received, and to help identify those staff who may have missed vital training or updates. The home has experienced problems attracting new staff to the home and as a result a number of vacancies exist. Vacant shifts are covered each day by agency staff. While some of the agency staff have visited the home on a regular basis for some time and therefore have come to know the people living in the home well, the use of agency staff is not ideal and can lead to inconsistent care practice. Some relatives raised concerns about the use of agency staff, particularly at times when the only agency staff available are male, resulting in a higher ratio of male staff to female residents. Inability to recruit permanent staff to posts, and failure to provide regular one-to-one supervision sessions may contribute towards dissatisfaction among some of the permanent staff team. The home needs to develop it’s activity programme so that there is a wide range of activities available for people living at the home throughout the week. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 8 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. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 9 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.V307759.R01.S.doc Version 5.2 Page 10 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, 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a good exchange of information before people move into the home that enables people to decide if the home is right for them and that the home can meet their needs. EVIDENCE: Pauline Lake, Home Manager, explained the normal process for admission to Arthur Roberts House. She said people are usually assessed by a care manager in the first instance. The care manager will provide the home with a copy of their assessment, and the person will be invited to visit the home either for the day, or for a short stay. During this visit the person is given a copy of the Statement of Purpose and a copy of the inspection report if requested. If the person is unable to visit the home a member of the management team will visit them in their own home, or in hospital. The home carries out their own assessment of the person’s needs in order that they are Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 11 certain that they can meet the person’s needs. Some of the people we talked to could not remember how they chose the home, but others said they visited several homes with their families before they chose Arthur Roberts House. At previous inspections it has been recommended that the Home’s terms and conditions should be discussed with residents if they have capacity and if not with their representatives. The contract is usually sent out from County Hall direct to the individual and Pauline Lake explained that this has caused difficulties meeting this recommendation. However, she agreed that they will find ways of ensuring that people understand this document when it is sent to them. During this inspection the care of four people was ‘tracked’ by checking their care files to see what information was gathered before they moved in, checking their care plans and other routine records relating to their care, and by meeting the people to find out if the records were accurate. In the last year new assessment and care planning forms have been used, and these provided a clear picture of each person’s basic needs. The home has sent a ‘draft care plan form’ to the person and/or their family or carers in order to gather as much information as possible about how the person wants to be assisted. The information gathered during the assessment process was found to be wide ranging and has enabled the home to draw up and agree a comprehensive plan of how they will assist the person on a daily basis. The home does not provide intermediate care. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 12 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, 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People can be confident that their personal and health care needs will be met by staff who understand how they want to be assisted. Medicines are generally stored and administered safely, although some areas of recording were found to be poor and may lead to people not receiving the correct medication. EVIDENCE: Four care plan files were seen during this inspection. The plans included detailed risk assessments covering all health and personal care needs, including skin care, nutrition, moving and handling, medication, fluid intake, and continence. Information gathered during the assessment process has been used to draw up a list of tasks the person wants to be helped with throughout the day. The plans have been regularly reviewed and updated. While the plans seen were accurate and provided a good picture of each person’s basic care needs ways of improving them further were discussed with Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 13 Pauline Lake. It was agreed they could be developed in consultation with the person (and/or their family or representatives where appropriate) and with key members of the care team to provide greater detail about how the person wants to be assisted with each task. It was also agreed that the person could be given a copy of their care plan. The people we spoke to, or received a survey form from, during the inspection said they were very happy with the care they have received. They praised the staff team and confirmed that they are always treated with respect and in a dignified manner. Comments from relatives included – “I can only say that I have always found the staff most co-operative and helpful. Recently my mum has been poorly and the staff have looked after her.” The care plan files provided good evidence of how the home has liaised with health and social care professionals to ensure that the person’s health needs are met. Visits and treatment from GP’s and district nurses have been requested when needed. The home has followed advice given, and this has been clearly documented. Regular healthcare checks and treatment has been provided by opticians, dentists, and chiropodists. Discussions with the staff and manager provided examples of how the home has helped people who have previously been very agitated and distressed become calm and settled, without the need for sedative medication. They explained how they have used reassurance and explanation to help people feel safe. There were also examples of how people have become more independent by enabling them to carry out some tasks for themselves. All bedrooms are single and personal care tasks are normally carried out in the privacy of their rooms or in a bathroom. All bedroom doors have locks. Staff were seen knocking on doors before entering. One relative said they had complained about the ratio of male care workers to female residents and felt that men and women should always be cared for by a carer of the same sex if they request. Pauline Lake said she had discussed this with the person and said they always strive to achieve this if they can. However, they have a number of staff vacancies and therefore have to use agency staff regularly, and sometimes they are forced to accept more male carers that they would choose. The home has two separate medicines trolley (one for each floor) and both are kept locked when not in use, and are kept in locked rooms. Creams and lotions are normally left in the person’s bedroom when opened, and spare supplies are kept in a locked cupboard. The home uses a monitored dosage system of administering tablets. Medicines are only administered by a senior member of staff who has received training on the safe administration of medicines. Further training was due to be provided a few weeks ago but this was cancelled and the home is waiting for a new date for the training. It was Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 14 unclear whether this training will meet the standards laid down by a national organisation known as Skills for Care – Pauline Lake agreed to check this. She also agreed to ensure that the training will provide evidence of the person’s competence. The evening drugs round was observed. The record of administration had normally been completed as soon as each person has received their medication. However, on the day of this inspection the midday medicines had not been signed for. The staff seemed uncertain of the steps they should follow to check that the medicines had actually been administered. Some handwritten ‘do and don’ts’ were placed at the front of the medicine administration charts but these were brief and did not explain the actions to be taken in these circumstances. As soon as this was pointed out to Pauline Lake she agreed to place a copy of the Devon Social Services policy on the safe administration of medicines in the front of this folder. She also confirmed that they would take steps to contact the person who had been responsible for administering the midday medicines and to check if they had actually been given. She also agreed to contact GP’s and/or the pharmacist for advice if vital medicines have been missed. One person had been admitted to the home the previous day. Some medicines were in a monthly blister pack while others were in bottles and packets. Instead of listing each medicine separately the records simply stated “In blister pack”. This was not in line with good practice guidance, or in line with Devon Social Services policy on the safe administration of medicines. No controlled drugs were held by the home at the time of this inspection, although safe storage and recording systems were available if these drugs are administered in the future. The care of people who are close to death was described by Pauline Lake and some of the staff team. They confirmed that they take great care to work closely with GP’s and district nurses to ensure the person receives exactly the right care and pain relief. They were proud of their record of preventing pressure sores, and talked about the checks they follow to ensure the person receives the right fluids and nutrition, and the close attention to personal hygiene and comfort. They encourage family and friends to visit, and to be with their loved ones at the end of their life. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 15 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 adequate This judgement has been made using available evidence including a visit to this service. The home provides a good standard of service to meet the overall social and nutritional needs of the people who live at Arthur Roberts House. The level of choice and control for individuals could be improved by greater involvement and consultation with them, and with their relatives or representatives, about all aspects of daily life at the home. EVIDENCE: At the time of this inspection there was no clear plan of regular organised activities. Some relatives said they were unaware of any regular activities provided by the home. This was discussed with the manager and staff and they talked about their plans to draw up a regular programme of activities and how the programme will be displayed around the home so that everyone knows what is going on. The staff were enthusiastic about providing activities to suit individual needs, and they talked about how they want to look at each person’s interests and how these can be included in an activities programme. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 16 On the day of this inspection one member of staff was seen walking with a person along the corridors, helping to improve their mobility and confidence. Another member of staff escorted a person around the garden. A member of staff was seen helping a resident who was tending to the tomato plants in the garden. Several people were sat outside in the garden, while another group enjoyed some music and singing in one of the lounges. All of these activities were ‘ad hoc’. One person went out on a planned outing with a relative. In the afternoon the staff had planned to do some painting and drawing with some of the residents in the upstairs lounge but this didn’t go ahead as most of the residents fell asleep after lunch. The wife of one of the men living in the home told us “He very much enjoys visiting a nearby shop (with a member of staff, not on his own!) He likes to spend money there, which usually involves returning with chocolates/etc. and sometimes with a magazine. “ The home has access to a minibus at weekends, but due to lack of trained drivers they have been unable to provide any outings for several months. Some residents are able to go out unaided, and staff will escort others for shopping trips to local shops if they request. Some of the people we spoke to talked about how their friends and family come and visit them and said they are always made welcome and are offered refreshments. Relatives who completed a survey form said they are made welcome, but some said they thought the staff were too busy to keep in touch with them regularly. One person said “I am the one who has to ring the home to glean any information and I am usually greeted with “We are just doing medication!” I feel to avoid this, a time for enquiries, unless really urgent, should be designated to us and a suggested phone number should be available, therefore ensure we get officers in charge, not care assistants.” Another relative said “ I keep in touch with cards and flowers but I am sure they are far too busy to let people know how their relative is.” This was discussed with Pauline Lake and she agreed they need to look at how they encourage and enable families and friends to keep in touch and be involved in the care of their loved-ones. Examples were seen during the day of how people are offered choices each day. A member of staff was seen talking to residents about the meals planned for the next day and asking them what food they would prefer. People talked about how they are able to choose the things they want to do, and how the staff respect their wishes. The care plan gave some examples of how staff have been instructed to offer choices, although these could be expanded (see standard 7 – individual plan of care) to include such choices as times of rising and going to bed. There is a four weekly rota for menus. These have recently been adjusted to provide at least three alternatives for each main meal, plus special meals to meet individual dietary needs. The menus were balanced and varied. All of Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 17 the people we spoke to said they always enjoy the meals and said they is always something on offer to suit their tastes. The staff we spoke to also confirmed that the new menus have raised the standard of the meals, although they said that the menus still need some further adjustment for the evening meals. Pauline Lake said they have realised that on some days there is insufficient balance of sweet or savoury foods and they have already taken steps to address this. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 18 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 good This judgement has been made using available evidence including a visit to this service. People can feel confident that the home has taken appropriate steps to minimise the risk of abuse, and any complaints or concerns will be investigated and addressed in order to reach a satisfactory outcome. EVIDENCE: People have been given a copy of the complaints procedure in the Statement of Purpose before they move in. A copy of the complaints procedure is normally displayed in the entrance hallway but this had recently been removed when the home was redecorated and has not yet been replaced. Pauline Lake gave assurances that this would be carried out in the very near future. Most of the relatives who completed survey forms said they felt confident they knew who to approach if they wanted to make a complaint. In the last year the home has recorded four complaints, all of which have been upheld. Records seen during this inspection showed that the home took the complaints seriously and acted promptly and appropriately to address the matters. However, in one instance the home failed to notify the Commission within the correct timescales of a serious complaint. Pauline Lake explained the circumstances and said she had taken action to ensure notifications are made correctly. Despite this mistake documents seen during the inspection Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 19 showed that the matter had been investigated fully and all relevant professionals had been involved and agreed with the outcome. Since the last inspection one of the management team has become a key trainer for Devon Social Services on the protection of vulnerable adults. He has responsibility within the home for ensuring all staff are fully trained in this subject and are fully aware of the policies and procedures on recognising and reporting any suspicion of abuse. We spoke to agency staff on the inspection who had also joined in with adult protection training, who knew that they would speak to a senior member of staff if they had any concerns about the care of people living at the home. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 20 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in comfortable, clean, safe and homely surroundings that meets their needs EVIDENCE: In the last year a number of improvements have been made to the house and gardens. The communal areas have been redecorated and now appear bright, modern and comfortable. Attractive lighting has been provided in the corridors and lounges, and some eye-catching large framed photographs of Exeter and surrounding areas have been displayed around the home in the last year. The back garden is safe and secluded, and has recently been landscaped with raised flower beds, paths and patio areas, and benches and chairs where people can sit and enjoy the warmer weather. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 21 The home employs a maintenance person 1 day per week. On the day of this inspection contract gardeners were visiting the home to mow the lawns. The corridors are wide with handrails along each side. There is level or gently sloped ramps and a shaft lift between ground and first floors providing safe and easy access around the home for people who may have mobility problems. All bedrooms are single- occupancy providing people with privacy and dignity. Bedroom doors have ‘swing free’ devices connected to the fire detection system that allow people to leave their doors open safely if they wish. Alternatively, people can lock their doors if they want security and privacy. In a tour of the home all areas were found to be clean and free from any odours. Comments from relatives include “Arthur Roberts is always clean and tidy.” The laundry was tidy and in good working order. Most people we spoke to said they were satisfied with the laundry service, although one relative said that the amount of storage space in the bedroom is poor and this causes problems with the storage of clothing and continence pads. This was discussed with Pauline Lake who agreed that many of the bedrooms are small and therefore have limited space for cupboards and furniture. The home employs a person whose main duties are dealing with the laundry and the staff do their best to try to ensure that laundry is returned to the correct person and is stored in a tidy manner. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The home provides competent and well trained staff to meet the needs of the people they care for. Recruitment procedures are good meaning that people are safeguarded. Problems with not being able to recruit new staff leads to a heavy reliance on agency staff and a lack of continuity of care for people living at the home. EVIDENCE: On the day of this inspection the manager and an assistant manager were on duty, plus sufficient care assistants, cooks and domestic assistants to provide a safe level of support to meet the needs of the people living in the home. Staff were seen sitting with people in the lounges, taking them for walks in the garden or corridors, or discretely providing them support for personal care by escorting them to the privacy of their bedrooms or bathrooms. The atmosphere was calm and relaxed. Only two members of staff responded to this inspection by completing survey forms. Both said the staffing levels are low. Pauline Lake said they have had difficulties recruiting new staff over the last year and therefore vacant shifts have been covered by agency staff. Some relatives told us they were concerned about the number of agency staff used by the home, especially at times when a the ratio of male agency staff to female residents is high. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 23 During this visit we spoke to three members of agency staff. They said they have been visiting Arthur Roberts on a fairly regular basis for some time (one person said she had been visiting the home for several years) and have found in the last year the staffing levels have improved. The files of four staff who have been recruited in the last year were seen. These showed that application forms have been completed, and satisfactory references and criminal records checks have been received before a new person has been confirmed in post. Records showed that staff have received good induction training at the start of their work. Information provided by the home before this inspection began showed that 19 permanent care staff were employed. Three staff have been trained as assessors for nationally recognised qualifications known as National Vocational Qualifications (NVQ’s). Sixteen staff have already achieved an NVQ and two more staff are working towards this qualification. Copies of training certificates for each member of staff were seen during the inspection. These showed that a good range of training on specific topics including health and safety related topics has been provided. Individual lists of the training each member of staff has received have been drawn up but these did not appear to have been kept up-to-date. Pauline Lake agreed that a ‘matrix’ of all of the training provided to each member of staff would help the home to identify those staff who may have missed important training or updates. One care assistant holds Moving and Handling and Protection of Vulnerable Adults ‘key trainer’ qualifications that enables him to provide this training to other Devon Social Services staff and ensures that all Arthur Roberts House staff are trained and regularly updated in these subjects. Ten staff have received training on dementia awareness. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 24 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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Good systems are in place to seek the views of everyone involved in the home, and to ensure people are in safe hands. EVIDENCE: Pauline Lake has been the registered manager for a number of years. She holds a nationally recognised qualification known as the Registered Managers’ Award, also NVQ level 4 and qualifications that enable her to assess staff who are completing NVQ’s. The home also employs three Assistant Managers, all of whom hold NVQ level 3. All managers have attended Dementia Awareness courses as well as all mandatory health and safety training topics. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 25 The home is currently in the process of introducing the Devon County Council corporate Quality Management System. They have sent questionnaires to residents, relatives and other professionals and were in the process of gathering the results and acting on the results. Records of cash held by the home on behalf of some of the people living there were seen. The home encourages people to handle their own cash wherever possible. If people are unable to handle their own finances the home encourages people to arrange help from their family or representatives. At the time of this inspection the home did not have responsibility for handling bank or building society books. The home holds sums of cash for those people who were unable or unwilling to look after their own cash. The bulk of this money is kept in a bank account that has specifically been opened for the residents of the home. Records seen during this inspection showed that interest gathered by this account is regularly shared between the people using the account. The home holds a small ‘float’ that ensures that people can always have daily access to their money if they request. The records have been well maintained and regularly checked by a second member of staff to check balances. The records have also been audited by Devon County Council auditors. A copy of the most recent audit was seen and found to be satisfactory. In the last year some individual staff supervision sessions have taken place, although these have not been as frequent as the recommended level of six sessions a year. Staff have not received an annual appraisal. The two people who responded to this inspection by completing survey forms indicated that low staffing levels and issues relating to the management of the home may be affecting staff morale. However, the staff we spoke to during our visit to the home indicated that the improvements that have made to the home generally in the last year has helped to improve the morale and commitment of the staff team recently. Training records were not very well organised so it would be difficult to monitor who needed what type of training. Records seen during this inspection showed that moving and handling plans have been completed as required. Risk assessments have been carried out on all likely risks, both to staff and the people living in the home, and measures put in place to reduce or eliminate risks where possible. Records of regular equipment maintenance checks were available for inspection. The fire log book showed that all fire alarms and equipment have been regularly checked and maintained and staff have received regular training on this subject. The accident book has been well maintained. The manager said that this was an area they knew they had to improve on following the last inspection and had worked hard to ensure accidents are monitored effectively.Staff have received training and updates on all health and safety related topics. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 26 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 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 X x Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement The registered person must ensure that all medicines received into the home are correctly recorded giving the name, dosage, and amount. The home must ensure that there are clear and safe procedures in place when it is discovered that medicines may have been missed or incorrectly administered. Timescale for action 01/09/07 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 OP2 Good Practice Recommendations It is recommended that the Home’s terms and conditions are discussed with residents if they have capacity and if not with their representatives and that this is recorded. This is carried over from the previous inspection. Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 28 2 OP9 3. OP12 All staff who are responsible for administering medicines should receive training that meets the standards laid down by Skills for Care, and there is evidence to show that their competence has been checked. It is recommended that consideration be given to providing leisure/social opportunities for residents outside the Home. The home should consider how they can improve communication with families and friends in order to encourage and enable people to be more closely involved in the care of their loved-ones. Recruitment procedures should be reviewed in order to increase the number of permanently employed staff and to reduce the home’s reliance on agency staff to fill vacant shifts. The home should develop a method of recording the training all staff have received in order to provide a clear and easy method of checking those staff who may have missed any essential training topics. It is recommended that all staff receive at least six supervision sessions per year. 4 OP13 5 OP29 6. OP30 6. OP36 Arthur Roberts House DS0000039616.V307759.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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