CARE HOMES FOR OLDER PEOPLE
Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG Lead Inspector
Teresa Anderson Unannounced Inspection 13:00 31 January 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.V259750.R01.S.doc Version 5.0 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.V259750.R01.S.doc Version 5.0 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 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.V259750.R01.S.doc Version 5.0 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 nusing 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 14th June 2005 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. Arthurs Court is owned by European Care Ltd, a private company, which owns other care homes across the country. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. As it is the second inspection, this report should be read in conjunction with the inspection report dated June 2005. The inspector spent 3 hours in the home speaking with residents and staff and looking at records in relation to assessment, care planning, medication and recruitment. All of the communal areas were seen, together with some of the bedrooms. The manager completed a pre-inspection questionnaire and 10 comments cards were received, 6 from residents and 4 from visitors. What the service does well: What has improved since the last inspection? What they could do better: 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. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 6 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.V259750.R01.S.doc Version 5.0 Page 7 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): (3) The systems and practices in relation to pre-admission assessment are good with care needs being clearly identified. EVIDENCE: The manager carries out all pre-admission assessments using a standard format. These are completed comprehensively and the information gained ensures that a plan of care can be devised. Residents are invited to visit the home prior to moving in. Residents said that their needs are well met. Questions noted on assessments include ‘which side of the bed do you like to get in and out of’? The answer determines the position of the bed in the bedroom which is arranged before the resident moves in. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 8 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, 9) There is a clear and consistent care planning system in place but the information within this system does not provide staff with the information they need to meet needs. Two omissions in relation to the systems for the administration of medication potentially place residents at risk EVIDENCE: The care planning system used at Arthur’s Court is comprehensive, clear and well organised. The Registered Nurses plan all care given to residents and a summary of the care plan is provided in the bedroom of each resident for quick reference by staff. Vulnerable residents have their food and fluid intake documented to help promote good nutrition and hydration. Position changes of those nursed in bed are documented which helps to promote tissue viability. However, the care plans do not provide care staff with enough instruction to ensure that residents’ needs are met consistently and appropriately. Care plans included phrases such as ‘encourage fluids’ and ‘turn regularly’. Care staff are then having to make decisions regarding how much fluid a resident should receive and how often ‘regular’ is. The manager was advised to seek guidance from the Nursing and Midwifery Councils (NMC) publication in relation to records and record keeping.
Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 9 It was noted at the last inspection that two people were not signing some hand written medications, as is good practice. Upon inspection of medication records at this inspection, this is being carried out. However, it was noted that not all residents have a photograph accompanying their medication record, as is good practice for identification purposes. In addition not all residents who are prescribed medication on an ‘as needed’ basis have the reasons for administration or omission recorded on their medication records or in their plans of care. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 10 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): These standards were inspected and met at the inspection in June 2005. EVIDENCE: Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 11 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): These standards were inspected at the inspection in June 2005. Standard 18 is now met because of improvements in relation to Standard 29. EVIDENCE: Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 12 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): (26) Infection control practices ensure residents are protected from infection. EVIDENCE: At the last inspection the inspector noted that bar soap was being left in communal areas and that some bin lids were broken. At this inspection these issues had been dealt with. The home was clean and hygienic throughout. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 13 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): (29) Since the last inspection the standard for vetting and recruiting staff has improved ensuring residents are not put at risk. EVIDENCE: At the last inspection it was noted that two references were not being obtained for all staff. Three staff files were inspected and all contained two references and other information required for vetting purposes. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 14 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): (35 and 38) Systems for managing residents’ monies ensure their safekeeping and appropriate handling. One omission in relation to safe working practices may be putting some residents at risk of scalding. EVIDENCE: It is a requirement that water is distributed through pipe work at close to 500C to control for Legionella. This is being achieved. However, this does mean that water is delivered into hand basins at a very high temperature presenting a potential scalding risk. The manager has not carried out risk assessments on these basins and has therefore not decided what action, if any, would be appropriate to deal with identified risks. The manager was advised to take guidance from the Health and Safety Executive. Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x X 3 x x 2 No Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 16 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 OP7 Regulation 15 (1) Requirement The registered person must ensure that each resident has a written plan of care as to how the service users needs in respect of health and welfare are to be met. The registered person must make suitable arrangements for the administration of medications. (This refers to the need to have photographs of all residents for the purpose of identification and the need to always record when ‘as needed’ medication is omitted or given, including the reasons why). The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety and any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This relates to the need to ensure risk assessments and appropriate actions are taken in relation to hot water and hand washbasins). Timescale for action 30/03/06 2. OP9 13(2) 28/02/06 3 OP38 13 (4) 28/02/06 Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 17 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 Each care plan should contain the details of the actions which need to be taken for care staff to ensure that all aspects of the health, personal and social care needs of residents are met. The care plan referred to above should meet relevant guidelines produced by the relevant professional body – in this case the Nursing and Midwifery Council (NMC) guidance in relation to records and record keeping. 2. OP7 Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. Extracts may not be used or reproduced without the express permission of CSCI Arthur`s Court DS0000045674.V259750.R01.S.doc Version 5.0 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
