Inspection on 18/07/06 for Arthur`s Court

This inspection was carried out on 18th July 2006.

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

The inspector 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`s Court 29/12/09

Arthur`s Court 28/03/09

Arthur`s Court 13/02/08

Arthur`s Court 21/08/07

Arthur`s Court 21/11/06

Arthur`s Court 31/01/06

Arthur`s Court 14/06/05

Arthur`s Court 25/02/05

Arthur`s Court 14/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG Lead Inspector Stephen Humphreys Key Unannounced Inspection 18 & 19th July 2006 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.V297113.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.V297113.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 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.V297113.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 31st January 2006 Brief Description of the Service: Arthurs Court is a care home for up to 40 service users, with a maximum of 30 receiving general nursing care and a maximum of 10 receiving personal care. It was purpose built in 1992 as a nursing home on two floors. It is situated on the outskirts of the town of Street, within walking distance of some shops. The majority of rooms are for single occupancy and 14 have en-suite facilities. There are seven baths available at the service and two shower rooms. In addition to the en-suite facilities there are an additional ten toilet facilities. There are a number of communal spaces including a large lounge and dining area on the ground floor and a smaller lounge/diner on the upper floor. There is a small kitchen area also on this floor. The main commercial kitchen is on the lower floor. There is an in house laundry service. The upper floor is accessible by a passenger lift. The home has small gardens, which are well maintained and accessible with help. European Care Ltd, a private company, which owns other care homes across the country, owns Arthur’s Court. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of Arthur’s Court Nursing Home using the Inspecting for Better Lives methodology introduced by Commission for Social Care Inspection in April 2006. The inspection was carried out over two days. On day one there were two inspectors and one on day two. All of the key national minimum standards for older persons were assessed based on the outcomes fro the residents. The inspection process involved detailed discussions with residents, staff, relatives and the homes manager. On day one the inspector was able to discuss issues relating to Arthur’s Court with the organisations programme manager, who was visiting the home. During the two days the inspector observed staff in the delivery of care. The inspection methodology used by the Commission for Social Care Inspection enables the inspector to make a judgement on the quality of the service delivery based on the outcomes for residents. Prior to the site visit the inspector sent out a pre-inspection questionnaire for the registered manager to complete and return. Fourteen resident survey forms were sent to a random selection of residents. Comment cards were also sent to visiting GP’s. The results from the satisfaction surveys were fairly positive from all respondents although some comments indicated some residents were concerned at the availability of staff at times. Comments from the surveys will be included in the body of the report. The outcome of the discussions with residents and relatives during the site visit was positive and satisfactory. What the service does well: All the residents spoken too said that they felt their care needs were being met. All staff members were observed to be polite and respectful to residents and other visitors to the home. The provider has introduced a quality audit system that includes management and clinical audits to measure the quality of service delivery. The organisations programme manager and the homes registered manager carry out monthly audits, in a twelve monthly cycle of planned audits. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The information provided by the registered provider in the form of a statement of purpose and service user guide could be kept up to date. The standard of towels and face cloths at the time of this inspection was very poor. The registered manager expressed difficulties in obtaining authorisation from senior managers to replace worn and broken items. The organisation should consider providing the registered manager with a budget for day-to-day items. The service is task orientated and is not flexible to the individual’s lifestyle. The rigid practices in the home should be reviewed to introduce a flexible lifestyle that meets the residents wishes and feelings.The care plan must be developed with resident / relative involvement and be person centred to ensure a flexible approach to meeting the residents care needs. The registered person should introduce a social care programme that enables residents to maintain their independence through stimulating activities. The registered manager could improve on the present methods used to ask residents their preferences for meals. Menus should be displayed in areas where residents can see them. The quality audit system should be more robust to provide a correct picture of service quality. Please contact the provider for advice of actions taken in response to this Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 8 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.V297113.R01.S.doc Version 5.2 Page 9 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): 1,2,3.5 The quality in this outcome group is adequate. Prospective residents are provided with information about the care home and its services however the statement of purpose and service user guide are in need of updating. EVIDENCE: 5 residents spoken to during the visit said that they were not able to visit the care home before admission because they were in hospital. This is true of many other residents in the home. Only two resident’s said that they had visited the home before entering permanently. Eleven of the fourteen respondents to the satisfaction survey said that they felt they had received enough information to make a choice. Relatives spoken to said the registered manager told them everything about the home when they had a look around. The statement of purpose is available at the main entrance for visitors to read. It is detailed and informative however the copy is in need of up dating to include an updated complaints procedure and other changes to the home. The service user guide is included in the resident’s welcome pack. This document contains inspection guidelines and does not entirely meet the requirements of regulation 5 of Care Homes Regulations 2001. Only one Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 10 resident could recall reading the welcome pack shortly after they entered the home. All residents and relatives confirmed that the registered manager had visited them prior to admission to carryout a needs based assessment. One relative said the matron visited them at home. Each resident has a care plan fronted by the pre-admission assessment based on the activities of daily living model of care. The registered manager is aware of the skills and experiences of her staff in relation to caring for the older person and excepts residents who se care needs can be meet in the home. All fourteen respondents to the survey said they had received a contract. The inspector reviewed the terms & conditions in the residents files. The terms & conditions included all the items to meet this standard except the issue of what constitutes a breach of the contract. Contracts of private and social service funded residents were reviewed. Arthur`s Court DS0000045674.V297113.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The quality in this outcome group is adequate. Residents receive nursing and personal care from trained and experienced nurses and carers who are experienced and respectful at all times although the care is task orientated and specific or complex care needs may not always be met. EVIDENCE: Each resident has a care plan that is detailed and includes all the information to be held on each resident. The care plan includes risk assessments and nursing / personal care interventions. The daily report is completed and dated, however the record does not identify the specific care carried out to meet the care needs of the individual. The daily record identifies “all care given” however there is no evidence to show what care is given in relation to meeting the care needs. The following residents were part of the case tracking exercise. In one resident’s care plan there was a continence plan that required daily interventions to ensure the resident does not develop further problems the daily record did not identify whether this intervention was carried out or whether there was progress or regress in meeting the desired resident outcomes. Another resident’s care plan identified the need for regular Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 12 monitoring to ensure the diabetes remained controlled. There was no record of the residents normal blood sugar range to use as a measure. The care plan of another resident recorded visual disabilities, but there was no recorded interventions or outcomes identified that supported the resident to maintain independence as much as possible with the disability. The evidence from the case tracking exercise confirmed that in the main only basic care and nursing needs are being met due to the task-orientated regime in the home. None of the residents spoken to could recall being involved in the development or seeing their care plan. The care plans in general are similar containing the basic information necessary to plan the individual’s care. Further evidence of rigid practices is the bath rota and confirmed by residents who said they have a bath on specific days only. One resident appeared quite put out when they said “we only get one bath a week”. The care plan complies with clinical guidelines however the registered manager is encouraged to make it into a working record and involve the resident in its development and to promote person centred care. The nurses undertaking assessment using the activities of daily living model of care need to identify the specific care and nursing needs of residents including the psychological and social needs. Staff were observed carrying out personal care to residents respectfully and sensitively. Comments received from residents included “ …I’m happy with the standard of care but sometimes it takes them a long time to arrive”. Another resident commented “You press the call bell ……and they arrive half an hour later”. During the inspection the inspector observed that residents call bells were being activated and responded to within a reasonable time. The registered manager has a recording of the response times and audits them monthly. One resident said they had informed the Commission for Social Care Inspection inspector in the past they had a concern regarding the length of time staff take to respond to call bells. The registered manager investigated and a system of recording the call bell times was introduced. Five of the residents spoken too during the inspection who needed to be in their rooms commented on the length of time staff take to respond to the call bell. Two residents felt that the staff respond within a reasonable time when called. Other comments received from residents included “they look after me very well”. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 13 Question five of the resident survey asked: Are staff available when you need them? 5 answered – always, 7 – sometimes and 3 – Never. Comments received to this question were: I have to wait a long time sometimes. Staff not available when attending meetings. Occasionally have to wait at mealtimes or when they are busy. The registered manager is encouraged to monitor this situation closely as there appears to be a concern from residents. Residents are visited as required by the GP, optician, chiropodist and other health care professionals. A professional visitors record is maintained in each care plan. Nutritional screening is recorded along with the need for a special diet. Weight monitoring is carried out monthly. Three comment cards were received from visiting GP’s. All the comments were positive and none had any concerns about the service delivery. The medication procedure followed by the nursing staff is the Nursing & Midwifery Council standard. The receipt, storage, administration and disposal of medicines were reviewed. The receipt of medicines is recorded on the medicine administration record. The majority of the prescriptions are produced in type form on the medicine administration record. The hand transcribed prescription only had one signature. To prevent any errors the registered manager must ensure all hand transcribed prescriptions have two signatures on the medicine administration record. One resident who was case tracked during the inspection was self administering her inhaler, however there was no evidence of a self – medication administration assessment in the care plan. No errors were found with the controlled drugs procedure. Security and storage of oxygen cylinders was satisfactory. Residents said that staff treat them with respect and dignity is preserved at all times. Staff were observed to knock on doors before entering and speaking politely to residents. Evidence of the gold standards framework (Liverpool pathway) method of care planning was seen being used on very frail residents and residents who have palliative care needs. This method ensures that resident’s wishes at end of life are carried out and respected. The registered manager is encouraged to develop this method of care planning through out as this method is holistic and person centred. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 The quality of this outcome group is poor. The routines in the home are task orientated and do not allow any flexibility for residents to make choices or to have control over their lives. EVIDENCE: Comments received from residents included “Other than the TV there is nothing else to life here. We used to have a lady who does the dominoes from 2pm – 4pm but she left – no activities now”. “I attend the residents meetings monthly. We ask for things, but we don’t get them”. Minutes of the June 2006 residents meeting were displayed on the notice board at the main entrance to the home. Item 8-tuck box – recorded residents would like crisps at teatime with their sandwiches. Matron was looking into this request. On food the resident said, “generally the meals are good and you get what you want provided you ask the day before”. Another resident said, “I have been here a long time, I choose to stay in my room, I like doing crosswords and go to church on Sunday, my friends take me”. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 15 With regards to food the comment was “ you get what is given to you”. One resident said “ I have a nice comfortable room, plenty big enough. I came and looked around. They get me my meals, always respectful and very kind” With regards to activities the comment was “those that is in charge tell you what is going on”. Another resident commented, “My wheelchair is well looked after so I can get around the home easily”. This resident knew what was for lunch. “They come round with the menu the day before and ask you” I get breakfast in bed, lunch and evening meal is about 5pm.”My relatives don’t visit very often”. “I join in the activities – people play music on the piano”. Comments received from staff included “No activities at present but many do not want to do activities”. Residents are got up at 07:30am for breakfast at 08:00am. Night staff go into residents with a cup of tea at 06:00am. The cook who knows the residents very well prepares the meals. She caters for their likes and dislikes. The menu of the day is not displayed in the dining room however there is a four-week cycle menu that she works to. The inspectors observed the lunch being served in the dining room. It was well presented and liked by all the residents. Carers assisted those residents who needed help in a sensitive manner. One carer was observed to be standing over the resident, good practice is to sit along side. Observable practices such as this were not identified in the homes self audit record. Observations made by the inspectors included carers assisting immobile residents to have a drink regularly, carers always acknowledged the residents in passing. Relatives were observed to come and go during the day of the inspection. Comments from one relative included: We take mum up to street in her wheelchair. During the two-day inspection no activities were observed, in the lounge the TV was on but no one was watching it. One resident spoken to said she did like to watch the TV but was not able to watch the programmes of her choice because the remote control was broken. The registered manager said that many of the resident’s televisions remote controls were broken, but she was unable to get approval from the company to buy replacements. During the inspection residents were observed to be just sitting in their rooms and three residents were sat outside in the sunshine. The evidence collected suggests that residents would like the opportunity to engage in stimulating social activities of their choice. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 16 The inspector observed that residents were being assisted to get out of bed during the morning. The last residents to get out of bed were arriving in the lounge at lunchtime. There was no record in any care plan to indicate resident’s wishes on when they liked to get up or go to bed. Observation suggested that there is no choice due to the rigid practices in the home. The registered manager is encouraged to review this situation to take into account resident’s wishes and feelings. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 17 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): 16,17,18. The quality in this outcome group is adequate. Recruitment policies and procedures are in place to protect residents from abuse. Residents can be assured that the registered person will take any concerns or complaints seriously. EVIDENCE: None of the residents or relatives spoken to had any complaints regarding the care service. A copy of the complaints procedure was displayed in the main entrance to the home, however the procedure is in need of updating to include a statement that informs complainants they can contact the Commission for Social Care Inspection directly if they so choose. The local office address of the Commission for Social Care Inspection needs to be included. Although all the staff spoken to knew what constituted abuse to residents some of the overseas staff were not able to convincingly show an understanding of the procedure they needed to take to report an incident. The nurses spoken to confirmed they had received abuse training and would be able to take appropriate action if an incident occurred. The policy and procedure for reporting an incident to a vulnerable adult is in need of up dating to link it to the Somerset County Council Adult Protection procedure. The complaints audit section of the quality assurance system recorded one complaint between January 2006 and the date of the inspection. All concerns are taken seriously and investigated by the registered manager. Two relatives voiced minor concerns that they said were not complaints but dealt with by the nurses at the time. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 18 Information on advocacy agencies was displayed at the reception. A statement as to how the home protects resident’s rights was included in the statement of purpose. The registered manager should review the ethos in the home to introduce a more flexible lifestyle and enable residents to live as independently as possible in exercising their rights to choice. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 19 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): 19,26 The quality in this outcome group is good. Residents can be assured of a safe and well-maintained environment. EVIDENCE: The maintenance person works four hours a day doing routine and small maintenance jobs. All necessary records were being kept except the flowing hot water temperatures. The inspector did a tour of the home and visited residents in their rooms. The main communal areas were visited as well as the laundry and kitchen. The communal rooms including the conservatory were clean and had sufficient and comfortable seating. The resident’s bedrooms were all clean and the furniture was in good condition. There appeared to be adequate and suitable pressure relief equipment for those who needed it the only exception was the poor quality of the towels and the face cloths. This was brought to the attention of the laundress and the programme manager who agreed to replace all the stocks. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 20 The home includes assisted shower and baths and toilets were within close proximity to communal rooms. Generally all the rooms and areas through out the home were clean and in good repair. Marks were noticeable on some walls on the ground floor and minor scuffs on the woodwork. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 The quality in this outcome group is good. The registered manager ensures the agreed staffing levels are maintained and that the recruitment and selection procedure is robust. EVIDENCE: The daily staffing complement is made up of: 1 RGN and 5 carers from 07:00am until 14:00pm then 1 RGN and 4 carers until 20:00 and a night staff of 1 RGN and 2 carers until 08:00am. This allows for a slight overlap in the morning. The home also has catering domestic, maintenance and administration staff. The staff rotas were checked and found to be correct. Recruitment of overseas staff has enabled the registered manager to maintain a full staffing complement. Recruitment of local staff is proving difficult. Several of the overseas staff are qualified nurses who do not meet the registration requirements for registration in this country and are working as experienced carers. The staff are experienced in caring for older persons and also receive in-house training. There is a staff room that contains resources for training and updating knowledge in health and social care. Staff spoken to recalled the training events they had attended and the training records contained certificates of training events confirming attendance. Cate Peet, European Care’s programme manager, said that the company was developing a culture of learning for life. It is planned that training and learning Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 22 events will be available via the Internet for staff in the home, based on their personal development plans. There is a key worker system and a buddy system for new staff in place. Two resident’s said they knew who their key worker was. As stated in section three above, there is no specific activities person employed, and very few social activities. The registered person is encouraged to provide extra staff in the home to enable residents to receive social care that is stimulating and therapeutic. Six staff files were checked during the inspection including those staff that had recently been employed. All the staff files are kept securely in the registered manager’s office. The files reviewed contained all the required checks and information to meet the Care Homes Regulations 2001. European care has the services of a recruitment agency for overseas staff. The agency carries out all the necessary security checks and translates application forms and references into English copies. Comments from residents about staff were positive and complimentary. All said the staff were respectful. Observation of staff during the inspection recorded staff knocking on doors before entering and helping to feed residents in a none hurried and sensitive manner. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 23 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): 31,33,35,38 The quality in this outcome group is adequate. Residents can be assured of strong leadership however they cannot be fully assured the home is run in their best interests. There is a quality assurance system in place however the audit information collected does not always reflect the standard in the home. EVIDENCE: The home has an experienced Registered Nurse Manager. The residents and relatives spoke highly of the Manager, reflecting on her approachability and kindness. There is administrative support to assist the Manager with contracting and staff recruitment. Residents contracts and personal finances were seen at this inspection and were correct, appropriately stored and with restricted access for security. The inspector checked three of the files and monies held for residents. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 24 The general policies and procedures are in need of review and up dating. It is acknowledged that this is a company issue as all the policies and procedures are generic. European Care has introduced a quality assurance system into their care homes that is based on a system of monthly clinical and management audits. Medication audits are carried out weekly, accident & falls, wound analysis, homes self-audit including catering facilities are carried out monthly and recorded. The whole system is planned to be completed over a twelve-month period. The inspector reviewed the homes self audit. Several of the areas in the records had scored quite high however this did not reflect the current standard. There was no evidence in the audits other than a tick in the box to say that the standard had been met. An example being health & safety, the audit indicated the standard had been met however the inspector found that maintenance records were not being kept regarding the temperature of flowing hot water, other indicators in the audits did not correspond to the current standard of practice such as activities, and care plans. These scored high on the audit but in reality need a lot to be addressed. Resident satisfaction surveys are carried out and actions identified from the results are carried out. Residents meetings are held, but not well attended. The organisation is planning to introduce a culture of learning for life by introducing Internet based training modules for staff to access. The registered manager is aware of the shortcomings related to creating a person centred care culture, she feels that the task orientated methods predominate due to the differences in the staff cultures and staff prefer to be told what to do. Staff are supervised in their daily work and regular staff meetings are held with minutes being displayed. Staff supervision is carried out on a one to one basis with the registered manager and notes of the meeting recorded and kept on file. Staff spoken to confirmed supervision takes place. The standard of record keeping by the administrator and the registered manager is generally very good. Maintenance records that were available were checked and found to be satisfactory. Fire logbook was correct. Hoist and lifting equipment are being maintained at correct intervals. Electrical portable equipment is being tested as required. Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 12 (1)(a) Requirement The registered manager must ensure that all residents care needs are identified including those with visual and sensory disabilities and appropriate interventions are recorded to meet those needs. The registered manager must ensure staff respond to resident’s needing assistance within a reasonable time. The registered manager must ensure all residents who choose to self-administer their medicines are assessed as being competent to do so and the assessment must be recorded in the residents care plan. The registered manager must ensure that all hand transcribed prescriptions are witnessed by recording two signatures on the medicine administration record. The registered manager must ensure the complaints procedure contains up to date information about contacting the Commission for Social Care Inspection. The registered manager must DS0000045674.V297113.R01.S.doc Timescale for action 30/09/06 2 OP8 12(3) 30/08/06 3 OP9 13(2) 30/08/06 4 OP9 13(2) 30/08/06 5 OP16 22 30/09/06 6 OP33 24(1)(b) 30/09/06 Page 27 Arthur`s Court Version 5.2 7 OP38 13(4) (c) ensure the quality assurance audits are representative of the standards in the home. The registered manager must ensure that the temperature of flowing hot water is recorded monthly in all areas where total body emersion occurs and at wash hand basins used by residents. 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP2 OP7 OP7 Good Practice Recommendations The registered manager should ensure the statement of purpose and service user guide are up to date and available to visitors and prospective residents. The registered provider should review the terms & conditions to include all information as described in the Older Persons national minimum standards 2.2. The registered manager should ensure that residents or their representatives are involved in the development of the care plan. . The registered manager should develop the gold standard framework method of care planning for residents who require palliative care and roll it out to include residents with complex needs. The registered manager should have an agreed homely remedies list available in the home. The registered manager should review current care practices to take into account residents wishes and feelings. The registered manager should encourage staff to sit next to residents when assisting them to eat their meals. The registered person is encouraged to provide extra staff in the home to enable residents to receive social care that is stimulating and therapeutic. The registered manager should ensure the quality audit system is transparent with current practice outcomes. 5 6 7 8 9 OP9 OP14 OP15 OP27 OP33 Arthur`s Court DS0000045674.V297113.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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