Inspection on 13/11/06 for Arundel House

This inspection was carried out on 13th November 2006.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arundel House 01/09/05

Arundel House 27/01/05

Arundel House 05/08/04

Arundel House 26/03/04

Arundel House 08/12/03

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Arundel House Victoria Road Barnstaple Devon EX32 9HP Lead Inspector Susan Taylor Key Unannounced Inspection 13th November 2006 09:30 Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 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 Arundel House DS0000022089.V328625.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 and Care Homes for Adults 18 – 65*. 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. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arundel House Address Victoria Road Barnstaple Devon EX32 9HP 01271 343855 NO FAX 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) Mrs Barbara Tutt Mr David William Crick Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum no of placements will be 18 (Eighteen) The category of registration will be Mental Disorder The six service users named in the notice of proposal may continue to live at the home. On termination of their residency the home will revert to its registered categories and the Registered persons must notify the Commission of the fact. 1st September 2005 Date of last inspection Brief Description of the Service: Arundel House provides 24-hour care for 18 adults between 18 and 65 years of age with mental illness, some of who may have a learning disability. Conditions in place allow six service users who are over aged 65 years to continue residing at the home. The accommodation consists of two large, Victorian house linked to form one home. The home is within level walking distance of the local park and facilities in Barnstaple. Bedrooms are single and spacious, with the exception of one which is small. The bedrooms have views of the adjacent road and gardens. Several of the bedrooms contain a sitting area. To the rear is a large walled garden. The current range of fees at the home is £340 – £450 per week. There are no additional charges. Residents have the opportunity to go on holiday to Spain every year at a discounted rate. Arundel House DS0000022089.V328625.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 unannounced inspection of Arundel House, carried out on the 24th November 2006 beginning at 9:30 a.m. lasting approximately 8.5 hours. The inspection included a full tour of the home and discussion with staff including the manager and care staff. The Inspector also spoke to seven residents who gave their opinions on the food, the environment and staff who work at the home. At the same time, the Inspector observed care being delivered to residents by staff. Surveys were sent to sixteen residents. five staff and six health and social care professionals. Comments from one member of staff, a relative and ten residents are incorporated within the report. In summary, residents wrote: Arundel House is perfect in every way. The manager and staff do their work well. I wouldnt want to live anywhere else. The staff are very thorough in their cleaning routine so no complaints here at all. Im looked after very well here. I have been extremely contented with everything at Arundel (the team) have gone out of their way-no resident could wish for more. I havent got a complaint form but I know how to get one. Arundel House is very well run. This staff are exceedingly efficient and help is always available. The accommodation is very clean and tidy and meals are all varied and healthy. I am very happy here. The staff are very caring. Relatives wrote: Every effort was made to make sure he was consulted. We all feel its a pleasure to visit... His accommodation is always clean. All staff have been more than the courteous to us all, nothing is too much trouble. We as a family are so very impressed by the staff at Arundel House”. Staff wrote [Arundel] “makes residents feel grounded and also taken notice of.” What the service does well: Arundel House is a homely place to live. The home obtains important information about residents prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet resident’s needs. At the same time, residents are treated as individuals who have diverse needs, interests and different backgrounds. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 6 Care plans are well structured and care is delivered in a clean and comfortable environment. Residents say that they are involved in the planning and reviewing of their own care. The team of staff maintain good links with other healthcare professionals that are of benefit to residents. The home has an open feel. A monthly meeting is held and everyone is made welcome to attend. Residents say that they have the freedom to do what they want to. At the same time, they are confident about the way that staff protect their property and money that is kept securely for them. Contact with families and friends is encouraged and people who need support to do this get it. There is a good choice of appetising and well-balanced meals at Arundel House. Residents said that the staff had listened to their suggestions and had made changes to the menu. At the same time, they were satisfied with the level of choice at mealtimes. Medication is given, stored and recorded in a way that protects residents by ensuring that the right medication is given, at the right time, by competent staff. There are policies and procedures that protect vulnerable people, including dealing with complaints. Residents say that they can voice their concerns and feel that staff listens them to. Residents said that staff were kind and very caring. The manager encourages staff to do training so that they all keep up to date and understand how to care for people with mental health problems. In terms of health and safety, residents say that they feel safe at Arundel House. The home is clean, comfortable and well maintained. The home provides a good level of planned and spontaneous activities that are appropriate both in choice and structure for older people, some of whom have dementia or other mental health problems. What has improved since the last inspection? The application form had been reviewed. This has ensured that prospective staff provide full details about their current and previous employment and has meant that the home can check out any gaps. In making these changes, the home has taken steps towards ensuring that they have the right people to care for residents’. Further action is necessary and is explained below. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 (Adults) and 3, 6 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: The inspector read the ‘Service user’s guide’, which outlines the admission procedure. In comment cards ten residents verified that they received Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 10 sufficient information about the home that enabled them to decide that it was the right place for them. Two resident files were inspected. Comprehensive assessments had been completed and regularly reviewed with individual people. Additionally, the home had obtained important information from the agency placing the resident at Arundel House and referred to this in planning care with the resident. A resident told the inspector, I was taken around every area” and a relative said, Every effort was made to make sure he was consulted. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 (Adults) and 7,14,33 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Residents at Arundel are encouraged to engage in the planning and reviewing of their own care wherever possible. Residents are enabled to make day-today decisions and choose how they wish to spend their lives. Good financial systems are in place to protect the interests of the most vulnerable residents who need help to manage their money. Risks are managed so as to ensure that residents have few restrictions in their lives except those that accepted in this type of care setting and made known to them admission. Good risk management was seen, however this needs to be underpinned by written policies and procedures. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 12 EVIDENCE: Two care files were inspected. Needs and risks that had been identified at admission were always reflected in care plans. These gave sufficient detail about the needs of each service user and it was evident that wherever possible the individual had been fully involved in the process. Additionally, care plans had been regularly reviewed. Daily records reflect the outcomes for residents in relation to the care planned. Care delivered to the individuals whose records had been inspected was observed as being good. A resident told the inspector “They treat me like a Lord. They are very thorough and caring”. Residents in comment cards wrote, Im looked after very well here and Arundel House is very well run. The staff are exceedingly efficient and help is always available at times”. A relative wrote, The staff are very caring and with regard to care planning wrote, Every effort was made to make sure he was consulted. Four residents told the inspector that they are encouraged to make decisions on a day-to-day basis about their lives. At the same time, decision-making is also group based and community meetings are held monthly. According to the pre-inspection questionnaire, the manager had verified that the provider acts as appointee for eight residents who have lived at the home for many years. The inspector tracked how this is managed for three residents. Receipts for purchases had been obtained and balances tallied with records kept. Of the three, two service users also had their own building society savings accounts. The manager told the inspector that there is a designated key holder for the safe every day. Individuals who choose to do so keep a small amount of money in safekeeping and are able to access this whenever they wish to. At the same time, the inspector saw that care plans were in place outlining the level of support individuals need with regard to managing their own finances. The home did not have policies or procedures about risk assessment and management. However, in practice comprehensive risk assessments had been completed and were seen in three files inspected. Each one clearly laid down action to be taken to minimise identified risks and hazards. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 14 12,13,15,16 & 17 (Adults) and 10,12,13 & 15 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Individual service users preferences are encouraged in respect of hobbies, meals and activities. However, opportunities for residents to be involved in vocational training and employment support schemes are currently minimal. Such opportunities need further development to enable service users to reintegrate into community living and improve social inclusion for people with mental health problems. Residents are encouraged to maintain family networks and relationships within the home. Users are provided with a choice of appetising and well-balanced meals at Arundel. EVIDENCE: Three care files were inspected. Needs had been assessed and care plans produced that covered individual social networks, hobbies and interests. A programme of group activities was seen and included swimming, gardening, craft and cooking sessions and trips out to the local pub or bowling alley. None of the residents were involved in rehabilitation work schemes, vocational training or further education. Residents said that they had the “choice to join in if they wanted to, but not forced to” and that they were satisfied with the level of activities available. Additionally, they felt that the home’s location gave them a lot of freedom and that they could go into the town centre to use the facilities either on their own or accompanied by staff if needed. A resident said, “They asked me what I wanted to do and found out about my hobbies and interests. We’re going out for a meal at Christmas and I’m looking forward to that. Some residents said that they had ‘therapeutic jobs’, such as changing toilet rolls and emptying bins, for which they received payment. The inspector was shown photographs depicting previous holidays to Spain that were on display in the dining room. Residents told the inspector that they chose to visit the same place every year because the facilities were so good. In the pre-inspection questionnaire the manager had verified that residents pay for their holiday at a discounted rate. When spoken to residents who were interested in going on holiday felt that this was reasonable and were only expected to pay a small contribution towards the cost and their entertainment. The manager told the inspector that opportunity for meaningful activities, employment and rehabilitation was an area that could be improved upon and that there was a commitment to do this amongst the team. It was evident in care records, the visitor’s book and from comments from residents and relatives that opportunities to develop and maintain friendships and family relationships are encouraged at the home. Residents told the Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 15 inspector that some people who need extra support are accompanied and enabled to visit their relatives at home. A visitor wrote in a survey All staff have been more than the courteous to us all, nothing is too much trouble. In a survey, ten residents verified that they felt staff treated them well and that they were listened to. The inspector observed kind, caring and respectful interactions between staff and residents. A four-week rolling menu was inspected, which demonstrated that alternatives are planned for every meal. The inspector joined residents for lunch, which was appetising and served in a relaxed and unhurried manner. The dining room was inviting, laid out with fresh flowers on every table. Residents told the inspector that the menu had been discussed at the community meeting and changes made as a result of comments given. No record of meals provided had been kept and is a requirement. The lunchtime menu was displayed in the kitchen and there was a vegetarian alternative. In a comment card a resident wrote Sometimes we are taken for a meal in a restaurant usually chosen by resident. You can choose whether you go or not Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 (Adults) and 8,9 & 10 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Care is delivered to service users in a sensitive way that promotes their dignity and privacy. The team works in partnership with other professionals to ensure that the healthcare needs of service users are met. Medication is administered, stored and recorded in a manner that protects service users by ensuring that they are given the right medication, at the right time by competent staff. EVIDENCE: Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 17 Cultural, religious and ethnic needs had been clearly identified in the two care files that were examined. Two residents who required assistance with personal care verified that staff did this in a way that promoted their dignity and privacy at all times. The inspector examined the care files for two residents, which demonstrated that both had been registered with a local GP. Correspondence on the files verified that other health and social care professionals e.g. Psychiatrist, social worker, continence advisor and occupational therapist were involved in the care of these individuals. Seven residents who were spoken to felt that the staff were well qualified to monitor their healthcare needs and that prompt referrals were made to the appropriate specialist when needed. One person in a survey wrote, “the staff are exceedingly efficient and help is always available”. The inspector observed the manager administering midday medication from a monitored dosage system. Good practice was seen. . Records of ordered drugs and a register of controlled drugs were seen. The system was easy to audit Medication charts had been completed appropriately. The inspector saw that medication was administered as prescribed. All medication was kept in a secure place. Staff administering medication told the inspector that they are shown the procedures during induction and assessed as being competent. The manager had undertaken a formal ongoing review of competence and review policies and procedures. The inspector tracked medication administered to two service users. Three residents were ‘self medicating’. One of the individuals concerned showed the inspector the lockable cabinet they had in their bedroom that they used to store medicines in. A risk assessment and care plan seen in the same individual’s care file made reference to the fact that the service user was self medicating and a strategy for minimising risks was highlighted within the documents. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 (Adults) and 16,18 & 35 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Arundel House’s arrangements for the protection of vulnerable adults, including dealing with complaints ensures that service users are protected and able to voice their concerns. EVIDENCE: Ten residents in surveys verified that they were clear about who to complain to should the need arise. Additionally, the inspector met seven residents throughout the course of the inspection and established that all were content living at Arundel House and were satisfied with most aspects of living there. The complaints procedure was displayed on the notice board in the dining room. Residents felt that it is clearly written and easy to understand. The inspector examined the complaints file and saw that none had been received or investigated in the past 12 months. In surveys residents wrote comments like Arundel House is perfect in every way”, The staff are very thorough in their Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 19 cleaning routine so no complaints here at all”, Im looked after very well here, I have been extremely contented with everything at Arundel (the team) have gone out of their way-no resident could wish for more, I havent got a complaint form but I know how to get one, “…. I am very happy here; Ive had no reason to (complain). In a survey a relative wrote, We as a family are so very impressed by the staff at Arundel House”. Arundel House had a clearly written adult protection procedure that made reference to the ‘Alerter’s guide’ and the local authority led adult protection procedure. The pre-inspection questionnaire completed by the manager verified that no POVA referrals had been made in the last 12 months. Additionally, certificates seen in training records and minutes of a staff meeting demonstrated that POVA training had been provided for all staff. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 (Adults) and 19 & 26 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Residents at Arundel House have a homely, comfortable and safe environment in which to live. Measures are in place that minimise the risk of cross infection to residents and staff. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 21 EVIDENCE: A tour of the premises was carried out. The Commission had received notification of a serious flood that had caused considerable damage to the lower ground floor. The manager told the inspector that flash flooding had caused problems for a number of local properties and that negotiations were still underway with the local water company and council to improve mains drainage in the area. The inspector saw that these rooms had been dried out, decorated; new carpets and furniture purchased and were ready to be occupied again. Bedrooms varied in size and layout. All were personalised, clean and free from any unpleasant odours. The inspector met seven residents throughout the course of the inspection and was told that some people did domestic chores such as cleaning toilets and restocking toilet rolls for ‘therapeutic earnings’. Staff verified that domestic duties were part of their role and that they did this with residents. All other areas of the home were nicely decorated, homely and well maintained. Certificates were examined for the gas, electrical and fire installations and verified that external contractors had recently carried out maintenance. In surveys residents wrote The staff of very thorough in their cleaning routine so no complaints here at all, ….The accommodation is very clean …”. Relatives wrote, We all feel its a pleasure to visit... His accommodation is always clean. The laundry was clean. Good systems were observed in practice in respect of infection control. Soiled linen and everyday clothing had been separated for washing. Clean clothing had been placed into individual shelves that staff told the inspector would be delivered to service users later that day. Two residents were using commodes at night and staff told the inspector that these were emptied in the nearest WC, before being taken to the laundry to be cleaned and scrubbed with bleach in the Belfast sink. This practice was discussed with the manager who verified that the infection control nurse specialist had been contacted for advice and guidance to minimise the risk of cross infection and this had been implemented. A member of staff verified that the infection control nurse specialist had visited the home and had done a training session for the team. When asked about protective equipment such as gloves and aprons he same person said that there were “always plenty of them” for staff to use. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 (Adults) and 27, 28, 29 & 30 (Older People) Quality in this outcome are is poor This judgement has been made using available evidence including a visit to this service. Since the last inspection, the home has improved the application form for new employees. However, recruitment practices at Arundel House are not consistently followed and therefore fail to protect residents by ensuring that the right people are employed. Care workers receive regular supervision and are encouraged to undertake further training to ensure that they are capable and consistent in their professional practice when working with people with mental health needs. The training programme prioritises important skills that staff require to care for residents. However, shortfalls do exist with regard to specialist areas such as conflict resolution and particular disorders and training should be provided for all staff. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 23 EVIDENCE: Copies of the rotas were provided prior to inspection and discussed with residents. Residents told the inspector that there was always sufficient staff on duty to help them when needed. Additionally, in surveys ten residents wrote ….The manager and staff do their work well”, Im looked after very well here, “….. the staff are exceedingly efficient and help is always available”. In a survey, a member of staff verified that they felt well supported and informed about developments in the home. Minutes of staff meetings verified that these had been held regularly with a wide range of issues having been discussed. At the point of registration (six months earlier), the Commission had access to the registered manager’s portfolio that demonstrated that he had attained the ‘Registered Manager’s Award’ and National Vocational Qualification – Level 4 in Care. According to the pre-inspection questionnaire, three out of twelve care staff had completed the NVQ level 2 in care and a further five staff were in the process of doing it. The inspector spoke to one member of staff who felt that the recruitment process was “good”. The application form had been reviewed to ensure that prospective staff provide explicit details about current and previous employment. Three staff files were examined. Two written references had been obtained for two out of three staff. None of the files contained a statement of health. All other checks, including CRB and POVA, had been carried out. Care staff told the inspector that the induction training lasted two weeks. Every member of staff had a training and development portfolio. Certificates seen in staff files examined, demonstrated that training is readily accessible and relevant to the current needs of residents residing at the home. However, there were shortfalls in the training programme when audited against current needs. Care files contained a lot of information about triggers, behaviour patterns and management strategies but did not highlight the need for staff to receive conflict resolution training. Additionally, staff had not had any recent training about Parkinson’s disease, schizophrenia, depression, bipolar disorders or multiple sclerosis and this would benefit residents receiving care. On all the files examined there was written evidence that the staff had received one-to-one supervision since their employment. Seven residents verified that they had confidence in the skills, knowledge and experience that staff had who were working with them. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 24 Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 26 37,39 & 42 (Adults) and 31,33,35 & 38 (Older People) Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and qualified to run the home and do so effectively for the people who live there. Quality assurance systems tend to be informal and it is evident that resident’s, staff and visitor’s views are respected in this home. However, this is an area that needs further development so that outcomes for people who use the service are collated and reported upon to meet the current legal requirements and good practice. Health and safety issues are managed effectively and do not leave residents, staff and visitors at risk. EVIDENCE: Since the last inspection, the Commission had registered the manager who holds the NVQ level 4 – Registered Manager’s Award (Adults). Residents told the inspector that monthly community meetings were held with them. Minutes of these meetings were seen and demonstrated that a range of topics had been discussed and that residents have an active role in decision making within the home. Additionally, all of those who were spoken to verified that they had completed a survey about the home. Following the last inspection a survey had been conducted. A report was seen, which clearly identified areas of good practice and improvements needed in the home. In a survey a member of staff wrote about what the home does really well: “makes residents feel grounded and also taken notice of.” In surveys residents wrote: Arundel House is perfect in every way. The manager and staff do their work well. I wouldnt want to live anywhere else. The staff are very thorough in their cleaning routine so no complaints here at all. Im looked after very well here. I have been extremely contented with everything at Arundel (the team) have gone out of their way-no resident could wish for more. I havent got a complaint form but I know how to get one. Arundel House is very well run. This staff are exceedingly efficient and help is always available. The accommodation is very clean and tidy and meals are all varied and healthy. I am very happy here. The staff are very caring. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 27 In a survey relatives wrote: Every effort was made to make sure he was consulted. We all feel its a pleasure to visit... His accommodation is always clean. All staff have been more than the courteous to us all, nothing is too much trouble. We as a family are so very impressed by the staff at Arundel House”. Comprehensive Health & Safety policies and procedures were seen; including a poster displayed outlining who was responsible for implementing and reviewing these. The manager verified that they were responsible for overseeing Health and Safety in the home. Certificates seen on files examined verified that staff had attended infection control and manual handling training in the past 12 months. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. Residents and staff told the inspector that the alarm was regularly checked. First aid equipment was clearly labelled. Some of the staff on duty verified that they held a current first aid qualification. Electrical appliance checks and risk assessments had been reviewed since the last inspection. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Maintenance certificates were seen for the hoist, electrical installation, and central heating and fire alarm systems. Records seen verified that the Arjo hoist was last maintained on 12/4/05. This was discussed with the manager who was aware that a qualified engineer should maintain such equipment every six months. The manager showed the inspector the diary, which verified that an appointment had been made for this to be done on 30/11/06. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 1 35 3 36 x CONDUCT AND MANAGEMENT Standard No Score 37 3 38 x 39 3 40 x 41 x 42 3 43 x 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Arundel House Score 3 x 3 3 DS0000022089.V328625.R01.S.doc Version 5.2 Page 29 NO 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 YA17 Regulation 17(2) Sch 4(13) Requirement The registered person shall maintain in the care home the records specified in Schedule 4 Records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. 2 YA34 19 (1)(b)(i) The registered person shall not employ a person to work at the care home unless - subject to paragraph (6), (8), (9) her has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2. This relates to three files that were examined and discussed with the registered manager and with regard to future practice forthwith. Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 30 Timescale for action 30/04/07 31/05/07 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 YA9 YA12 Good Practice Recommendations Develop a written policy and procedure about risk assessment and management of hazards and risks. Seek out opportunities for residents to be involved in vocational training and employment support schemes to enable them to re-integrate into community living and improve social inclusion for people with mental health problems. All staff who are directly involved in resident care should receive education and training on the subject of conflict resolution. Additionally, staff would benefit from training about parkinson’s disease, schizophrenia, depression, bipolar disorders or multiple sclerosis and this would improve care for residents with these disorders. Equipment such as hoists should receive maintainence from a qualified engineer every six months. 3. YA35 4. YA42 Arundel House DS0000022089.V328625.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI. 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