Inspection on 21/11/06 for Arthur`s Court

This inspection was carried out on 21st November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arthur`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 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 Stephen Humphreys Unannounced Inspection 09:30 21 November 2006 st 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.V317862.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.V317862.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 Patricia Oliver ( Acting) 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.V317862.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 suite the resident’s wishes. Arthur`s Court DS0000045674.V317862.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.V317862.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection of Arthur’s Court Nursing Home using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection in April 2006. 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. The inspector visited the care home and assessed all of the key older persons national minimum standards and had detailed discussions with residents, staff and the homes manager, who had only been in the home for one week. No relatives were seen to have visited the home on this day. Since the last key inspection the care home has had no manager in position. The day-to-day running of the home has been shared between the administrator and the registered nurse in charge. The organisations regional programme manager has visited twice a week and Gill Galloway, a home manager from the BANES area, has provided managerial support to the registered nurse’s. Since the last inspection the Commission for Social Care Inspection has received notification of two complaints about the quality of care delivery in the home. Mr Chris Ashton the organisations programme manager investigated one complaint. The issues of the second complaint that was an anonymous call to the Commission for Social Care Inspection were investigated during the inspection. Following the last key inspection an action plan was received from European Care Ltd setting out how the requirements made would be met. A random inspection was made on October 12th 2006. This visit was to review the outcomes of the action plan. It was disappointing to find that the requirements pertaining to safe administration of medicines were not met and the procedure was not being carried out correctly. The care plans of residents with physical and sensory care needs had not been improved. The trigger for this key inspection were the concerns received about the quality of service delivery and the outstanding requirements indicating that residents were not being protected by safe practices. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The inspector had a detailed discussion with Mrs Oliver the homes manager about issues of care in the home. The manager needs to ensure that care staff follow personal care procedures at all times. Staff morale and motivation is low and needs to be improved. Care plans need to be improved to ensure person centred care is carried out. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 8 Communication amongst nursing and care staff needs to be improved to ensure residents care needs are met fully. Staff supervision needs to be increased to ensure personal care needs are met. 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.V317862.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.V317862.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): Quality in this outcome area is poor. Residents are admitted into the care home without adequate information or knowing whether their care needs will be met. This judgement has been made using available evidence including a visit to this service. 1,2,3,5 EVIDENCE: Information about the care home and its services are available and displayed in the homes reception area. It has not been a recognised practice to provide prospective residents with the information. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 11 A copy of the service user guide and statement of purpose was provided for the inspector however no evidence was found to show that a copy of the service user guide was given to the residents. Upon reviewing the statement of purpose the inspector found that the information was not up to date and not adequate to meet the required standard. The description of bedrooms was wrongly stated and there was no clear description of where the home is situated. The focus of the statement of purpose is clearly about European Care Ltd however to make this an information tool for prospective residents more emphasis on service description and how it is delivered should be included. 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. Four of the five residents said that their relatives chose the home. One resident said “they chose it because it was convenient and relatives could visit easily”. No person is admitted into the home without a care needs assessment usually carried out by social services and the homes manager. The registered provider does not confirm to the prospective resident that the care home can meet their care needs. The homes administrator confirmed that in the future each prospective resident would receive a welcome pack that includes a service user guide and a letter of admission. The admission letter will confirm that the home can meet the individual’s care needs and the fee agreed. A draft copy of the proposed letter was forwarded to the inspector after the site visit. The letter is detailed and explains the services offered. It does not clearly state the assessed care needs of the individual or the interventions planned to meet those needs. This could be included as an appendix in the form of a proposed care plan. None of the residents could recall any form of assessment being carried out either by a member of social services or the homes manager. Evidence from the last inspection showed that the manager did pre-admission care needs assessments. Each resident has a care plan fronted by the pre-admission assessment based on the activities of daily living model of care. All of the care plans reviewed of residents who had been in the home more than six months had a care needs assessment however this did not reflect the current state of the person. The inspector reviewed the terms & conditions in the residents files. The terms & conditions included all the items to meet this standard. Contracts of private and social service funded residents were reviewed. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 12 None of the residents spoken to could recall signing a contract or reading a copy of the terms & conditions. Only one of the contracts reviewed had the resident’s signature all the others were signed by the residents relative. . . Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is poor. Each resident has a detailed care plan however the care plan may not be reflective of the current care needs. Residents cannot be assured that staff will follow the homes procedures to meet personal care standards. Due to the inaccurate temperature control of the drug fridge medicines may become unsafe for administration. This judgement has been made using available evidence including a visit to this service. 7,8,9,10. EVIDENCE: Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 14 The care of four residents who were being nursed in bed was looked at in detail. The range of assessed care needs for each resident was recorded in their care plan. All four residents had been in the home for more than six months and their physical state had changed although the care plans did not fully reflect the resident’s current state of well-being. One resident had visual and sensory needs that were not being met fully. The resident was not able to summon staff because the call bell was out of reach. All four residents had food and fluid monitoring charts and position charts. The inspector monitored and observed the care of the four residents by visiting them in their rooms through out the day of the site visit. One resident’s monitoring chart recorded a drink at 08:15am, the inspector visited the room to check the chart at 11:30am, and no further drinks had been recorded. The jug of juice on the table had not been used. At 11:30am the resident was calling out for assistance unable to use the call bell. The inspector went to find a carer. The carer attended the resident and provided care. During the observation periods only one carer appeared to visit the residents and assist them to have a drink. There were four carers on duty however they were not easy to find in the home. In all four residents rooms visited between 10:15am and 12:30pm the bar soap was dry, with no residue to give the appearance it had been used and tooth brushes appeared unused. All residents looked cared for, they all had pressure relief mattresses, bed rails and covers. The bed tables had a jug of juice and a glass. The monitoring charts had entries at specific times. Two of the fluid charts had been totalled to give a twenty-four hour record. The care plans of the four residents were reviewed. All were detailed with appropriate records of assessment, doctor’s visits and daily statements. The daily records stated the personal care delivered however two members of the care staff stated that there were times when corners were cut. This would indicate that the daily records in the care plans are not a true account of the care delivered. The inspector had a discussion with one resident in their room. The jug of juice was on the table out of reach however the resident was mobile enough to help them self. The resident commented about the service delivery. On food the resident was aware the menu was on a board in the dining room. “You can’t grumble, it’s fair food”. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 15 On care they commented,“if you need them – they come and see what you want” “they’re always respectful, they don’t hurt you” The organisation has policies and procedures in place although there is evidence to suggest that the practice is not always consistent or well applied. During a discussion with one member of staff verbal evidence was given to suggest that the drop in the standard of care occurs when the skill mix is not right. The care plans are in the main basic with adequate information to plan care and includes risk assessments. There is no evidence of resident involvement. The plans are task orientated with no specific achievable outcomes identified. The care plans lack detailed evaluations of the care delivery with comments such as “no change” recorded in all the care plans reviewed. The care plans are not working tools and therefore it is not certain that residents care needs are being met. The medication policy is clear and specific. Only the registered nurse’s administer the medication. At the time of this visit the hand written prescriptions were signed by two signatures. The medicine administration records checked were completed satisfactorily. The receipt, storage and disposal records were completed satisfactorily. The community pharmacist visited the home on the 8th August 2006 to carry out an inspection. A requirement was for hand transcribed prescriptions to be signed by two persons. It is disappointing to note that it took the registered nurse’s so long to conform to the inspector’s requirement and ensure a safe working practice. The community pharmacist identified that the drug fridge was not working adequately to ensure controlled safe storage of medicines. The temperature records record the fridge temperatures between –5C and 23C. The fridge is not working efficiently to ensure the safe storage of medicines. The inspector discussed the pharmacy inspector’s findings with the registered nurse on duty, who was aware of the temperature readings but not aware of the procedure to follow to replace the fridge. The lack of action is evidence of poor practice and may put residents at risk. The lack of concern to improve safe practices with the medicine procedure is also seen as a contributory factor to poor management. At least four of the medicine administration records reviewed had prescriptions for paracetamol tablets to be given “as required”. To ensure safe practice of Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 16 analgesic medication a risk assessment should be developed for each resident as part of the administration practice. The manager should ensure that all residents prescribed “as required” pain relief medication have an analgesic management plan to identify the behaviour or expressions exhibited by the resident when they require the analgesics. This will benefit residents by ensuring good safe practice in medication administration. Controlled drugs were checked and found to be correct. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. Residents spoken to said that the staff speak to them respectfully and protect their dignity when assisting in their room or in the lounge. A telephone survey of visiting health professionals confirmed that there were no current concerns with care delivery. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. The routines in the home are task orientated therefore residents do not have flexibility in their daily lifestyle. This judgement has been made using available evidence including a visit to this service. 12,13,14,15 EVIDENCE: Shortly after the last inspection the registered manager left the home. There has been no marked improvement in these standards since then. On the day of this inspection the new manager was in her second week. During the first week she did arrange a residents meeting which she said was very fruitful. The residents provided her with some information on how to improve the life style in the home. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 18 What is very noticeable in the home is the length of time residents spend on their own without any visible staff supervision or interventions. The only time staff were seen was just before lunch when they all sat in the dining room having their break. The inspector observed that nine residents were sat in the lounge five seated in their wheel chairs. Three ladies were talking to each other and two were watching television. One lady was sat in a recliner chair. Four ladies had blankets over their knees. At 12:00 a carer entered the lounge and encouraged a resident to take a drink. Assisted with drink then left. A resident with a physical disability was trying to read the newspaper, but found it difficult only having the use of one hand. This resident would benefit from having a reading stand to place the news paper on. From 12:10 until 12:40pm no other members of staff entered the lounge. 12:40: The new activities person entered and asked each resident if they wished to participate in the afternoon games. Board games were played from 2:00pm – 3:00pm. The activities board is displayed in the main reception area. Mainly board games and bingo. There does not appear to be any other form of stimulation offered to the residents in this home. The home manager said that her objective is to develop a resident focussed ethos in the home. This will be reviewed at the next inspection. Comments received from residents included “Other than the TV there is nothing else to life here”. On food one resident said, “generally the meals are good and you get what you want provided you ask the day before”. 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 displayed in the dining room however there is a four-week cycle menu that she works to. The inspector observed the lunch being served in the dining room. It was well presented and liked by all the residents. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 19 Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area 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. This judgement has been made using available evidence including a visit to this service. 16,18 EVIDENCE: The Commission for Social Care Inspection has been notified of two complaints since the last inspection. The organisations programme manager investigated one complaint and Gill Galloway investigated the issues from an anonymous complaint. Her report was sent the Commission for Social Care Inspection. The inspector also looked into the complainants concerns during this inspection. The evidence found at this inspection has enabled the inspector to conclude the concerns are founded. Issues relating to poor personal care standards and low staff morale were discussed with the manager. The issue of staff is concerning as this may put Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 21 residents at risk of harm. A follow up visit will be carried out to monitor progress on these issues. The complaints procedure has been updated and is displayed in the reception with a copy in the service user guide. None of the residents spoken to had any complaints regarding the care service. 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. All concerns are taken seriously and investigated by the registered manager Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good Residents can be assured of a safe and well-maintained environment. This judgement has been made using available evidence including a visit to this service. 19,26 EVIDENCE: This area has not changed since the last inspection. 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 Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 23 furniture was in good condition. There appeared to be adequate and suitable pressure relief equipment for those who needed it. The bed rails on beds appeared secure and mobile hoists and lifts have been maintained as required. 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.V317862.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is poor. The agreed staffing levels are maintained and the recruitment and selection procedure is robust however residents may not be in safe hands at all times. This judgement has been made using available evidence including a visit to this service. 27, 28,29,30 EVIDENCE: Two staff files were checked during the inspection of those recently employed. All the staff files are kept securely in the manager’s office. The files reviewed contained all the required checks and information to meet the Care Homes Regulations 2001. The length of time the home has been without a manager has affected the teamwork and motivation off the staff. This has been recognised by visiting health professionals and by at least one relative, who contacted the Commission for Social Care Inspection anonymously. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 25 The manager is aware of the need to improve teamwork and to raise the staff morale. Although residents said they felt their individual care needs are being met the evidence of below par practices and low staff morale is concerning. Staff voiced concern at the differentials in the skill mix on various shifts. The manager will be monitoring the duty rotas to ensure the skill mix is adequate to meet the needs of the residents. Review of the staff training records showed that very little training has been done since the last inspection. Staff need to receive the mandatory training in lifting & handling and fire training. Discussion with the manager, care staff and visiting health professional about the service delivery, since the last inspection, enabled the inspector to conclude that staff morale is low and the service delivery may not be of a consistent standard. The Commission for Social Care Inspection will monitor the situation and review at the next inspection Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is poor Prior to the new manager taking up her position the home clearly lacked strong leadership, this is now expected to improve, however residents cannot be fully assured the home is run in their best interests. This judgement has been made using available evidence including a visit to this service. 31,32,33,35,38 Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 27 EVIDENCE: Mrs Tricia Oliver is an experienced Registered Nurse Manager who has been in the home for two weeks. During the period of time the organisation needed to appoint a manager the home has been overseen by Mr Chris Aston, the programme manager, and Gill Galloway a registered manager from another home. Both visited the home each week to assist the registered nurse who was in day-to-day charge. The registered nurse and the administrator shared the day-to-day running of the home. Evidence was found through discussions with staff to conclude that staff lacked leadership during this period. The training, supervision and development of staff were inconsistent during this period. The new manager identified that no statutory training had taken place in the home. The evidence supports the anonymous complainant’s concern about the lack of leadership in the home. 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. 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 over a twelve-month period. Mrs Oliver has had an opportunity during her first week to audit four care plans. The outcomes of which indicate a need for improvement to ensure a good standard of personal care and to ensure the residents care needs were met. At the time of this visit she has not taken any action to improve the standard of care plans. Residents meetings are held, but not well attended. Comments received from residents such as “we better not say too much – or we get told off”, are concerning and indicate that there are rigid protocols in the home which do not benefit the resident. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 28 The manager informed the inspector that she was aware of the areas that need to be addressed to promote a resident focused life style in the home. She therefore needs time to address the drop in standards of service delivery and staff morale. These areas will be reviewed at the next inspection. The inspector was informed at the last inspection that the organisation was planning to introduce a culture of learning for life by introducing Internet based training modules for staff to access. This has not been done at the time of this visit, which is further evidence that the training and development of staff has not taken place in this home. The standard of record keeping by the administrator 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.V317862.R01.S.doc Version 5.2 Page 29 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 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 1 1 X 3 X X 3 Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 5 Requirement Timescale for action 30/12/06 2 OP7 15 3 OP9 13 (2) 4 OP14 23 (2)(n) The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s guide”). The registered person shall supply a copy of the service user’s guide to the Commission and each service user. The registered person shall— 31/12/06 keep the service user’s plan under review (this refers to ensuring the care plan reflects the residents current state of well being) The registered person shall make 31/12/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (This refers to the safe storage of drugs in a controlled environment) The registered person must 31/12/06 ensure suitable adaptations are made, and such support, equipment and facilities, as may be required are provided, for service users who are old, infirm DS0000045674.V317862.R01.S.doc Version 5.2 Arthur`s Court Page 31 5 OP27 or physically disabled (this refers to meeting the needs of physically disabled residents to read the newspaper safely) 18 The registered person shall, (1)(a)(c)(i ensure that the persons ) employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training; (this refers to the skill mix issue and the lack of staff training) 12 (5)(b) The registered provider and registered manager (if any) shall, in relation to the conduct of the care home— Encourage and assist staff to maintain good personal and professional relationships with service users. (This refers to the need to develop strong leadership and increase staff morale) 31/12/06 6 OP32 31/12/06 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 Refer to Standard OP3 OP8 Good Practice Recommendations The registered person should review the proposed care needs acknowledgment letter to include the assessed care needs. The registered person should ensure that resident’s personal care needs are met by care staff following the organisations procedures at all times. Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 32 3 OP9 The manager should ensure that all residents prescribed “as required” pain relief medication have an analgesic management plan to identify the behaviour or expressions exhibited by the resident when they require the analgesics. The registered person should ensure the policy and procedure for reporting an incident to a vulnerable adult is up dated to link it to the Somerset County Council Adult Protection procedure. The registered person should ensure staff are properly supervised at all times. 4 OP18 5 OP28 Arthur`s Court DS0000045674.V317862.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Somerset Records Management Unit 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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