CARE HOMES FOR OLDER PEOPLE
Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG Lead Inspector
Shelagh Laver Unannounced Inspection 13th February 2008 09:30 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`s Court DS0000045674.V357261.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`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Arthur`s Court Address 27 Highfield Road Street Somerset BA16 0JG 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) 01458 442319 01458 447254 AC1Europeancare@aol.com www.europeancare.net European Care (UK) Limited Mrs Barbara Alice Waymont Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40) of places Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, not less than 60 years, who require general nursing care Places for up to ten clients for personal care Up to four persons in the age range 18-59 years who require general nursing care Places for up to 30 clients for nursing care Registered for a total of 40 places in categories OP and PD Date of last inspection Brief Description of the Service: Arthurs Court is an established care home providing nursing and personal care for up to 40 service users. The care home can be found near to the centre of Street and within walking distance of the shops. The care home is in an area surrounded by domestic housing. Highfield Road is a major road with very little parking. Arthur’s Court can be found midway along Highfield Road. There are only six car parking spaces to the rear of the home. The care home can provide accommodation in single and shared rooms over two floors. The bedrooms and communal rooms can be reached by stairs from the reception area or by passenger lift from the reception area. There are seven bathrooms including assisted baths and two shower rooms. There are ten communal toilet facilities around the home. The communal areas include a large lounge / dining area on the ground floor and a smaller lounge/diner on the upper floor. There is also a conservatory to the rear of the home. The main lounge on the ground floor can accommodate residents who wish to watch television. There is a small section to the rear with a selection of books for those who wish to read. The care home provides twenty four hour nursing and personal care services to older persons and can offer general nursing services for up to four persons between the ages of eighteen and fifty nine years. The care home aims to provide nutritious meals to suit peoples’ wishes.
Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 5 The current fees charged are £487 - £640 for nursing care £ 361 - £530 for personal care Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The previous Key inspection of the home took place on 24/07/07 and was followed by a Random Inspection on 1/11/07. These reports should be read to gain a full picture of the developments in the home over the previous months. The home has had a change of manager and there have been concerns about the continuity of management and nursing care. At this second key inspection the newly appointed manager Mrs Pauline Purnell had been in post since January. She was on duty during the inspection and was able to provide all information required by the inspectors. On the day of the inspection there were 37 people in the home. There were two vacancies. Two inspectors met with people in the home, viewed the environment and reviewed care and recruitment documents. We met with one person who had been in the home a few months. She said “Everything is very nice here. …lovely girls. The food is very good.” A visitor confirmed that she was pleased with her relative’s care. What the service does well:
There were many comments from people that lived in the home that staff are “kind” and that “you can always talk to the staff.” The home appeared clean and comfortable. There are planned and comprehensive maintenance systems in place. The food provided in the home is wholesome and enjoyed by people. People knew who to speak to if they were not happy and felt confident that the complaint would be listened to. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
There has been an appointment of a senior nurse to support the manager. If it is intended that this post is effective in delegating some of the manager’s work load there should be a clear job description with specific targets. An allowance of hours when the nurse is not responsible for nursing care in the home must be made. Whilst there is a recruitment system in place and this had been devised with reference to meeting NMS the records in files were not clear. There are currently two care planning systems in the home. Both contain many forms. The plans reviewed by the inspectors contained many empty forms. Information was not easily accessible and it was clear what care was required by the person.
Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 8 Whilst there is a lot of progress in the provision of activities in the home some people are well enough to want to go outside the home. As one person said “This place is very good but I don’t want to be here seeing the same scenery every day.” 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`s Court DS0000045674.V357261.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`s Court DS0000045674.V357261.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): 2 Quality in this outcome area is good. People are assessed prior to admission to the home. The manager ensures that the home can meet the needs of the people admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessment for the last person to come to the home in a planned manner was seen. The manger also described the processes undertaken to ensure that a person admitted under emergency procedures had been deemed suitable for the home. Documentation was comprehensive. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. There are detailed care plans that show evidence of review. The current care needs of people were not always easily accessible and the progress of short-term care needs could not be tracked clearly. The recording of fluids and pressure relief has improved. Medication systems in the home are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People have their health needs met by staff in the home and through access to a range of professionals including GPs, Community Nurses and hospital clinics. Whilst it was clear that there was care being delivered the care planning system needs attention. The manager confirmed that this was the area of the home she planned to address in the near future. There are currently two care planning systems in the home. Both are extensive and contain many pieces of paper. We looked at four care plans. The plans
Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 12 contained many empty forms. Information was not easily accessible and it was clear what care was required by the person. People observed in the home appeared clean and looked comfortable. There was evidence that care staff were charting the provision of fluids and changes of position. There is a safe system of medication administration in the home and charts were accurately completed. There are plans for staff to undertake further medication training. Throughout the inspection we heard staff speaking to people kindly and with respect. It is important that staff are aware of the impact of their comments regarding peoples’ dignity at all times. The inspectors overheard one member of staff telling someone that he “had to be supervised” if he wanted to smoke outside. There was a risk assessment regarding smoking in the care plan that did not demand total supervision. It is also important that staff note that it is not appropriate to make such comments. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. People are able to make some choices about how they spend their day. Opportunities for social activities to meet people’s needs have improved however there is scope for further development. . The food provided in the home is wholesome and adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke to people in the communal rooms and in their own bedrooms. People confirmed that they were able to choose how they spent their day and that there was now “a lot more going on.” People spoke of afternoon activities and some trips but as they said “we could do with more.” One person said “I have breakfast in my room. Go down for lunch and have tea in my room. That is my choice.” In the sitting room some people were talking to each other, one lady was knitting. There was music playing. Visitors to the home are welcome and trips out with families were very important.
Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 14 One lady chooses to stay in her bed all day. This wish is respected although she is now being actively encouraged to leave her room for short periods. The food was considered to be “O.K” and there were “ no grumbles.” Other people were more enthusiastic. “The food is excellent. We get too much that is all.” The menu seen indicated a variety of home cooked food with a clear alternative for lunch. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is adequate. People in the home are protected by the policies and procedures in the home but some amendments are required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to during the inspection knew who to speak to of they had any complaints. The “Whistle Blowing” policy contains detailed guidance as to how issues of concern can be dealt with within the company. Whilst this is usually sufficient the essence of a Whistle Blowing policy is that concerns can be raised outside the company when necessary. Addresses and telephone numbers should be included in the policy and staff made aware of the policy changes. The home Safeguarding Adults Policy and Procedure states that is important to know the established procedures for dealing with adult protection in local areas. The home must access local guidance and ensure all staff are aware of the action to be taken. Recruitment files contained evidence that all staff are appropriately screened before they are employed at the home. Staff have received training in protection of vulnerable adults. People told the inspector that staff were kind. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 16 Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. People live in a safe and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home appeared clean and well maintained. There is evidence of a programme of re-decoration. The manager was able to tell us of the plans to improve the bathrooms. One lady said that some of her clothes regularly went astray and this was discussed with the manager. We visited the laundry. It was organised and clean. There were individual boxes in order to return peoples’ clothes. One person said it was difficult to access some toilets in her wheelchair and access should be considered in all plans to renovate bathrooms and toilets. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 18 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 adequate. Recruitment practices in the home are basically sound but attention is needed to ensure full records are available Staff have received thorough induction and training in the past year. Staff numbers have been reviewed and increased. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that additional staffing had been arranged. In the mornings there is now one nurse and eight carers. The organisation of the staffing into nursing and residential teams is alleviating pressure on the nursing staff. Additional staff have been recruited. Staff confirmed that they had had recent training. A training plan for the coming year is being prepared by the manager. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 19 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 38 Quality in this outcome area is good. The home is managed by a competent person who puts the interests of people in the home first. There are systems in place to protect the health and safety of people in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently appointed Mrs Pauline Purnell who has appropriate qualifications and management experience. People in the home spoke positively of Mrs Purnell’s arrival in the home and were pleased to have a manager in post again. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 20 The inspectors discussed with Mrs Purnell the need to ensure clear allocation of responsibilities within the home to ensure all tasks were completed. In particular the role of the senior nurse and administrator were discussed. Maintenance records were up-to-date and indicated a comprehensive system that promoted peoples’ health and safety. Bedrail checks are undertaken weekly but should indicate the person using the rails and be signed. Records confirmed that hoists are serviced according to requirements and measures are taken to ensure fire prevention measures are effective. Wheelchairs should be reviewed to ensure all have footplates and all staff are aware of the need to use them. Minutes of a recent staff meeting indicated issues of care and refurbishment were being addressed. Quality assurance surveys are due to be distributed and will be reviewed at the next inspection. Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 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 2 X X X X 3 Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) 12(1) Requirement Timescale for action 01/05/08 2. OP29 19(1) 3. OP18 13 (6) 4. OP18 12 (1) The care planning system must be reviewed and effective staff training provided so that the home has a robust and usable care planning system that gives easily accessible instructions to care staff and meets NMS. There must be evidence that 01/04/08 recruitment practices in the home are sufficiently robust to protect people. The records relating to recruitment must be clear including dates when information is received. A system of checking documents and auditing files must be in place. 01/05/08 The Safeguarding Adults Policy and Procedure states that is important to know the established procedures for dealing with adult protection in local areas. The home must access local guidance and ensure all staff are aware of the action to be taken. The “Whistle Blowing” policy 01/05/08 contains detailed guidance as to how issues of concern can be
DS0000045674.V357261.R01.S.doc Version 5.2 Arthur`s Court Page 23 dealt with within the company. Whilst this is usually sufficient the essence of a Whistleblowing policy is that concerns can be raised outside the company when necessary. Addresses and telephone numbers should be included in the policy and staff made aware of the policy changes. 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 OP7 Good Practice Recommendations Care plans should be audited and excess paperwork archived so that the care plan accurately reflects peoples’ current needs and information is easily accessible. Wheelchairs should be reviewed to ensure all have footplates and all staff are aware of the need to use them The home should ensure wherever possible the accessibility of toilets for people in wheelchairs. Access should be considered in all planned refurbishment. 2. 3. OP38 OP22 Arthur`s Court DS0000045674.V357261.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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