Inspection on 21/08/07 for Arthur`s Court

This inspection was carried out on 21st August 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`s Court 29/12/09

Arthur`s Court 28/03/09

Arthur`s Court 13/02/08

Arthur`s Court 21/11/06

Arthur`s Court 18/07/06

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 Shelagh Laver Unannounced Inspection 21 August 2007 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.V346806.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.V346806.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 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.V346806.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 21/11/07 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.V346806.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.V346806.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. 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. One inspector carried out the inspection making two visits to the home on 21/08/07 and 7/09/07. During this time the inspector was given unrestricted access to all areas of the home, was able to speak with staff and service users and observe care practices. All documentation requested was made available. The manager completed an Annual Quality Assurance Assessment (AQAA) before the inspection, which gave an overview of practices in the home since the last inspection and outlines plans for further improvement in the coming year. Fifteen people were spoken to individually during the inspection others were met in communal rooms or appeared to be sleeping. 13 Comment cards from people in the home were completed either by themselves or with assistance by relatives and carers. The last key inspection of Arthur’s Court took place on the 21st November 2006. Management reviews were undertaken in January and February 2007. On the first day of this inspection there were 39 people living at the home. At the time of the inspection Tricia Oliver had been in post as manager for ten months and there was evidence that a good deal of work had been undertaken to meet the requirements of previous key inspections. CSCI has been informed that Ms Oliver will be leaving the home. The home has had three managers in four years including a period without a registered manager. It is important that people in the home are not affected by a further period of change and uncertainty. What the service does well: It was clear from examining the care plans and talking to people in the home that some peoples’ health improves in the home. People spoken to told the inspector that staff were polite and respectful to them. Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 7 The home environment is clean, attractive and well maintained. Comment cards completed by people living in the home indicated that they “always” or “usually” received the care and support they needed and that staff are “always” or “usually” available when they are needed. (See also comments in what they could do better.) Medical support is available “always” or “usually” for the majority of people who returned comment cards. The manager has worked hard to improve the home and has made a substantial impact on the running of the home. People liked the meals provided in the home. People knew who to speak to if they were not happy and felt confident that the complaint would be listened to. The home was thought to be almost “always” fresh and clean. The recruitment process conducted by Tricia Oliver is robust and thorough. The induction and training programme in the home has been organised and thorough. What has improved since the last inspection? What they could do better: People in the home believe there is a shortage of staff. Comment cards sent to CSCI and people spoke with in the home expressed comments such as “They are short of staff…” and “they can only do what they can do…” Although the manager has provided some regular events there is little social provision in the home. The care plans did not reflect peoples’ interests or previous activities. There is currently no activities co-ordinator in the home. People in the home spoke of their wish to have outings and events “to liven life up a bit.” “They need an activities person…” The company should review the management structure in the home to try and improve the continuation of management. The access to the garden could be improved. Arthur`s Court DS0000045674.V346806.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`s Court DS0000045674.V346806.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.V346806.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 3 4 5 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: An up-dated Statement of Purpose was sent to CSCI in November 2006 following the last key inspection. People coming into the home receive an information pack. The four care plans reviewed showed evidence of professional and comprehensive assessments. People who returned comment cards confirmed that they had received information about the home before they arrived. Arthur`s Court DS0000045674.V346806.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 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 could be improved. Medication systems in the home are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were examined in detail. The home uses an Activities of Living model and there was detailed guidance to inform care of people. Care plans had been reviewed and up-dated although in some cases it was difficult to follow how peoples’ needs had changed. It would be helpful if nurses regularly audited and annexed records so that care plans were more manageable. The plans showed that some people’s condition improved at Arthur’s Court. People kept appointments at hospital for specialist care. There are plans to introduce a new 92-page care plan. The company should ensure that training is provided Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 12 to staff to use these plans and that the completed plans are used by all staff resulting in improved outcomes for people. The plan of a person who had recently died showed communication with family, attention to assessment of pain and its control. Records of fluids given to people and turns made were in place. In two rooms drinks had been recorded but were seen to be untouched and cold on the side of the bed. Other records showed people were drinking adequately. A review of medication documents showed nurses signed for medication given and noted variable doses. It is good practice to ensure all changes made on the Medication record sheets are signed and dated. For example when a GP stops a prescription or changes the dose. Some people self mediate and there is clear documentation to support this. Arthur`s Court DS0000045674.V346806.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 adequate. People are able to make some choices about how they spend their day. There is a need to provide more opportunities for social activities to meet people’s needs. 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: People were observed spending their time in different ways. Some people seemed to be in bed until quite late in the morning. People were spoken with in the communal rooms. One person enjoyed sitting in the conservatory. One person said, “Activities is a dead loss.” There has been no activities coordinator at the home for some time. The manager offers “Tea with Tricia” every Monday to meet people and enable them to express views. There is a “Sunday Spirit” when people can meet in the conservatory and enjoy a sherry before lunch. One person organises bingo and a painting group had just commenced. There are some people in the home who are able to organise their own outings including trips into town. Generally people would like more “going on” in the home. People do not go out on Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 14 outings organised by the home. One lady able to travel said she had not been out since her admission “You hear that other people in homes go out on little trips…Not here….” There is a menu displayed and people were mostly satisfied with the food provided. One person said “there is choice at lunch-time…if we don’t like the main choices we can have omelettes…. they try to make sure we are ok.” The daily menu is displayed on a board in the dining room. The majority of people eat lunch in the dining room. Arthur`s Court DS0000045674.V346806.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 good. People in the home are protected by the policies and procedures in the home. 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. 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.V346806.R01.S.doc Version 5.2 Page 16 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 environment is overall clean and well maintained. Some people have personalised rooms that are comfortable and attractive. There is a need to pay attention to details that promote peoples’ dignity such as ensuring toilet rolls are put away and incontinence pads are not on display. Toothbrushes should be stored appropriately in en-suites and not left on toilet cisterns. Communal rooms are attractive and well furnished. More people are now using them and at times they can be cramped. Outdoor space is clearly enjoyed by some people. The gardens could be developed to give a choice of current sitting area with more shade in hot weather. Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 17 Arthur`s Court DS0000045674.V346806.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. There is evidence of thorough recruitment practices in the home. Staff have received thorough induction and training in the past year. There is poor retention of staff in the home. The home uses agency staff to maintain adequate staffing levels in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five staff recruitment files were seen. All files demonstrated thorough recruitment practices. There were CRB checks, appropriate references and evidence of thorough induction training. It is unfortunate that a group of staff recruited together quickly left the home. In the past twelve months 9 full-time and 15 part-time staff have the home Whilst there is a core of long standing permanent staff others come and go quickly. The weekly rota sheet shows the use of agency staff to maintain numbers. Staff have received training in Moving and Handling, Fire training, Emergency First Aid, Infection Control and Prevention of Adult Abuse. Eight of the 19 staff have NVQ qualifications. A further 7 are working towards this. Arthur`s Court DS0000045674.V346806.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 35 38 Quality in this outcome area is good. At the time of the inspection the home was 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: This is a large home that has had problems reaching the National Minimum Standards in some areas at previous inspections. There was evidence at the inspection that the manager Tricia Oliver had addressed many issues raised in previous reports and had made substantial improvements in the running of the home and the outcomes to people in the home. Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 20 The home does not have a deputy post in the management structure. During the visits to the home it was clear that much work was undertaken by the manager personally and that a deputy post would facilitate further improvements in the home. Maintenance records were up-to-date and well organised. Arthur`s Court DS0000045674.V346806.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 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X 3 X 3 3 3 Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8 (1) Requirement There must be a registered manager that is qualified, competent and experienced to run the home. The registered provider must put in place suitable interim management arrangements to ensure clear direction and leadership in the home whilst there is no registered manager. Further training must be provided to staff to ensure all are aware of the need to record regular fluids and pressure relief care given to vulnerable people. The registered provider must ensure that there are appropriate opportunities for social activities and entertainment for people. Timescale for action 01/01/08 2. OP32 12 (5)(b) 01/01/08 3. OP8 12(1) 01/11/07 3. OP12 16 (2) m n 01/11/07 Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 23 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. Arthur`s Court DS0000045674.V346806.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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