CARE HOMES FOR OLDER PEOPLE
Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA Lead Inspector
Ms Susan Dale Key Unannounced Inspection 10:00 12th June 2007 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 Arundel House DS0000069503.V338164.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. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Arundel Lodge Address 1 Station Road Wesham Kirkham Lancashire PR4 3AA 01772686343 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) Hexagon Healthcare (UK) Ltd Care Home 22 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (2) of places Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP.(maximum number of places: 2) Dementia over 65 years of age - Code DE (E) (maximum number of places: 20) The maximum number of service users who can be accommodated is: 22 Date of last inspection 6th June 2006 Brief Description of the Service: Arundel Lodge is registered with the Commission for Social Care Inspection to provide personal care for 19 service users of either sex who are elderly mentally disordered (DE category) and 3 service users who are elderly (OP category). Since the last inspection the home has changed ownership and is now owned by Hexagon Healthcare (UK) Ltd. There is currently no registered manager and two acting managers are overseeing the day-to-day running of the home. The Home is situated on the main road in a residential area of Kirkham and is within easy reach of community resources and facilities and is located on a bus route. Service users accommodation is arranged over three floors. There are fourteen single and four double bedrooms. There is a passenger lift to each floor of the Home, and ramped access to the garden and patio area affording service users access throughout the Home. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and the focused mainly on key standards. The inspector was able to speak to service users and staff and examine various records. Comment cards were provided to service users, relatives/friends and health professionals prior to the inspection. There were no comments returned before the site visit took place. There is currently no manager at the home and two acting managers from other homes owned by Hexagon and senior staff provide oversight. During the site visit the inspector was able to speak to the acting managers and the registered provider and a director of Hexagon. What the service does well: What has improved since the last inspection?
There have been changes to the medication with a new pharmacist and medication now kept in blister packs. The patient information leaflets are now kept in a loose-leaf file. The assessment and care plans are in the process of being reviewed and the details transferred to new improved paperwork in line with other homes owned by Hexagon. A communications log is in operation that is used by all staff over the care of service users and any issues connected with the home. The two acting managers are providing oversight in the absence of a manager and holding two weekly meetings to ensure that staff feel well supported. The process has begun for decorating the home and carpet has been purchased to replace the worn carpet in the hall and stairs. The new owners have increased the food budget. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 6 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 DS0000069503.V338164.R01.S.doc Version 5.2 Page 7 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 Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 8 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 good, prospective service users have an assessment that ensures their needs will be met by the services provided by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Documentation was examined that included an initial assessment. A comprehensive assessment is undertaken at the service user’s own home or in hospital prior to admittance to the home. There was also evidence of an assessment by social services where funding is provided by the local authority. As the home has changed ownership the assessment documentation is to be changed to that used by other homes owned by Hexagon Healthcare (UK) Ltd. A blank format was made available and the documentation appears suitable for the assessment process. On the current documentation, where possible, the details include the background and history of individual service users and this is valuable information particularly with regard to service users who have dementia. The assessment process also examines any potential risks with regard to the room and environment or being taken outside the home.
Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 9 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 good; appropriate records are maintained with regard to care planning, health and medication. Service users are treated with respect and their privacy respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A key worker system has been operating but currently has stopped until a new manager has been appointed and new management control established. A key worker system ensures a member of staff takes responsibility for individual service users and becomes more familiar with their needs. The care plan documentation is to be transferred to new documentation and is being reviewed at the same time. The documents seen did not show evidence of review by the staff at the home but there was evidence of regular reviews at the Memory Clinic for the service user with dementia. The current documentation includes separate sections for any visits by health professionals such as district nurses or General Practitioner and there was evidence of a good relationship maintained with health professionals. The majority of service users have continence problems and a toileting regime is in operation. The toilets are some way from the main lounge and there was
Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 10 evidence through wet floors that service users were finding it difficult to get to a toilet in time. The storage and documentation of medication is appropriate with medication stored within a dedicated room. Since the last inspection the patient information leaflets have been obtained detailing any possible side effects caused by the provision of medication. The pharmacist who currently provides medication to the home is to be changed to another pharmacist who will also provide free training to the staff. Currently eight staff have received training and are responsible for providing medication. The two acting managers provide audit/oversight of the provision of medication. From service users spoken with and observation during the site visit, evidence was provided to show that staff treat service users with dignity and their privacy is respected. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 11 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; service users are provided with social activities that are suitable for their individual abilities. Meals are provided that offer choice at times suited to individual requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently there does not appear to be very much happening with regard to activities other than a soft ball in the afternoon and TV. Staff spoken with confirmed that they had tried to interest the service users to become involved in other activities and that some of the service users enjoyed dancing. The service users generally looked well cared for and the ladies had their hair and nails done. Service users spoken with appeared resigned to sitting and watching TV and expressed no interest in any other activity. There does not appear to be a programme of activities happening as there was at the last inspection and it is hoped that any new manager will look at the training needs of staff looking after service users with dementia and help them to devise an appropriate activities programme. A relative spoken with confirmed that were no restrictions on visiting times and they were always made to feel welcome by the staff. The chef was unavailable on the day of the site visit but according to the service users spoken with and staff, as at the last inspection encouragement to
Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 12 eat is still provided by showing service users a sample of the meals with a choice of protein and asking them to choose which they prefer. Service users spoken with confirmed that the meals are very good although one service user commented that the meat could be cut up a little smaller. Another relative was unhappy about the quality of the meals but the service user she had come to see had no complaints and stated he had no complaints. Meals for the service users in the category of older person (OP) have their own dining room and a microwave for re-heating when necessary. The service users in the category of dementia have a separate large dining room/lounge and are served at individual tables. The new owners have increased the food budget. Service users spoken with said staff were ‘very helpful and kind’ and meals were ‘excellent’. It was difficult to communicate with the majority of service users with dementia but there was no obvious negative behaviour and one service user who has resided within the home for a number of years expressed her satisfaction with all the services provided by the home and the kindness of the staff. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 13 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; policies and procedures are in place that ensures any complaints are investigated and service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an appropriate complaints procedure that is made available to all interested parties. There have been no complaints received since the last inspection apart from one that was sent to the Commission for Social Care Inspection; the complaint was investigated by the original owners of the home and found to be unsubstantiated. The new owners have devised a new format for the recording of any problems within the home that includes concerns/complaints. The format includes the date, subsequent investigation and when the problem has been resolved. The majority of staff have received training in Adult Abuse and are able to recognise the symptoms and what to do in the event of any abuse. A couple of staff spoken with had not been provided with training on the subject of Adult Abuse and it appears that staff who have been on fast track National Vocational Training level 2, do not receive training on Abuse. A recommendation was made that a check should be undertaken to identify staff that have not received any training on the subject. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 14 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 adequate; parts of the home are in need of refurbishment and decoration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been undergoing gradual refurbishment by the previous owners but still needs a lot doing in order to make it an attractive place to live and work. The carpet in the entrance hall has a worn patch and needs to be replaced. According to the new owner of the home, new carpet has already been purchased for the hallway and stairs and will be fitted once the painting of walls and staircase has taken place. Service users complained that they are unable to take personal phone calls as the public phone line was not working and one of the service users was unable to use the phone as she is unable to stand and the phone is situated on a rickety phone trolley that cannot be wheeled into her bedroom. The tumble drier was not working on the day of the visit and staff were struggling to dry bedding and clothes etc. The issues were discussed with the new owner who is aware of some of the problems that
Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 15 have occurred within the home and is dealing with them along with other priorities. The downstairs lounge could be made more attractive and better use made of the outside facilities to encourage service users with dementia to go outside. Bedrooms belonging to service users with dementia have been improved and now look more homely with a re-arrangement of furniture and new counterpanes on the beds. Pictorial signs have been placed on toilet and bathroom doors to help distinguish them from other facilities. There was a strong smell of urine in the corridors and bedrooms. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 16 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 good; there are suitably recruited staff on duty at all times and there is a commitment to staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are sufficient staff on duty according to the number and needs of the service users. Staff and service users spoken with, confirmed that there was enough time for them to carry out their duties and cover the physical and emotional needs of the service users. Staff have been recruited appropriately. Some of the Criminal Records Bureau checks are missing and are thought to be retained by the previous owner of the home. The new owner and registered responsible individual for the home are in the process of obtaining the missing documents. Those staff recruited since the last inspection had evidence of a Criminal Records Bureau check. Advice was provided on how to tighten up the existing procedure for recording the progress of each application with a signature and date for each stage. The majority of staff have received suitable foundation training including induction training and half a day training in Dementia. There are 16 care staff and 11 have completed NVQ level 2. One staff member spoken with had not received any training other than induction training. All staff must agree to foundation training in line with National Training Organisation specifications. A recommendation was made that staff should not be employed if they are unwilling to attend foundation training. According to the staff the new owners
Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 17 have a commitment to staff training and the acting managers are currently having a one to one with all staff to clarify the training already received and devise a future training plan. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 18 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 adequate; the management of the home could be improved by the appointment of a competent manager familiar with the care of service users with dementia who registers with the Commission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently the home is without a manager and two acting managers from other homes owned by Hexagon and Directors of Hexagon are overseeing the dayto-day running of the home. According to the registered owner, a manager has been appointed and is undergoing clearance and will be put forward for registration. Staff confirmed that they feel supported by the current management arrangements are the new owners of the home are very approachable. Staff meetings are held every two weeks to ensure staff feel supported and the two acting managers are carrying out one to one supervision.
Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 19 Financial records are maintained on behalf of service users and an inventory is now being maintained of personal possessions brought into the home; a safe is available for any valuables. Policies and procedures are in place that ensure the health and safety of staff and service users including risk assessments and accident and incident reporting. There is a need for regulation 37 of the Care Home Regulations to be re-instated and provided to the Commission. Regulation notices provide details about any deaths, serious illnesses and any event that could adversely affect the well-being or safety of service users. Reports should also be made once a month under regulation 26 of the Care Home Regulations. The registered provider must visit the home and write a report about the conduct of the home, a copy should be provided to any new manager and copies made available to the Commission as required. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 2 Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1 OP31 8(1)(a) A manager must be appointed 03/08/07 and apply to be registered with the Commission. 2 OP38 37 The details of any deaths, 01/07/07 serious illnesses, serious accidents and any event that could adversely affect the wellbeing or safety of service users must be sent to the Commission. 3 OP38 26 A visit must be undertaken by 01/07/07 the registered provider and a report made once a month under regulation 26 of the Care Home Regulations about the conduct of the home and copies made available to the Commission as required. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 2 OP18 OP19 All staff must be provided with Adult Abuse training and be familiar with how to report any abuse. A programme of decoration and refurbishment should be put into place and arrangements made to ensure that any problems with equipment are corrected within defined timescales.
DS0000069503.V338164.R01.S.doc Version 5.2 Page 22 Arundel House 3 3 OP27 OP36 All staff on duty should have foundation training in line with National Training Organisation specifications. Any new manager should reinstate formal, individual supervision for staff at least 6 times a year. Arundel House DS0000069503.V338164.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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