Random inspection report
Care homes for older people
Name: Address: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA zero star poor service 05/02/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susan Dale Date: 2 6 0 4 2 0 1 0 Information about the care home
Name of care home: Address: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA 01772686343 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Hexagon Healthcare (UK) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 20 2 dementia old age, not falling within any other category Conditions of registration: 0 0 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 0 5 0 2 2 0 1 0 Care Homes for Older People Page 2 of 10 Brief description of the care home Arundel Lodge is registered with the Care Quality Commission to provide personal care for 20 older persons within the category of Dementia and 2 persons within the category of Old Age (OP). 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. 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. Currently the home is in need of renovation and some major work is required to the roof, inside and outside areas. There is a Statement of Purpose and Service User Guide that provides information about the services provided by the home available in the foyer. A manager has recently been employed who is in the process of registering with the Care Quality Commission. The current fees are £386:50 per week rising to £463:50 per week, further Information about fees can be obtained from the registered providers. Care Homes for Older People Page 3 of 10 What we found:
We carried out this random inspection to see what progress had been made with the requirements and recommendations made at the key inspection carried out on the 5th February 2010. There have been two enforcement notices sent to the registered providers since the last inspection. One enforcement notice was with regard to the roof and building defects, furniture and equipment which need to be addressed by the 19th June 2010. The other enforcement notice which expired on the 10th April 2010, was in relation to risk assessment, accidents and incidents and monitoring processes. The quality rating for the home is 0 star indicating poor quality outcomes to people living in the home. Since the last key inspection a new manager has been appointed and is in the process of obtaining necessary documents prior to applying for registration with the Care Quality Commission. The manager is aware of the legal requirements under the Care Standards 2001 that were unmet at the last key inspection and is gradually working her way through the requirements that are within her ability to meet. Other requirements can be met only by financial expenditure from the owners of the home. The Statement of Purpose and Service User Guide were under review. The manager had combined both documents on the computer and was making them user friendly by utilising pictures and large print in order to provide a clear understanding about the services provided and staff within the home. There was some additional information required in order to meet legal requirements and the manager has since submitted further information and included it within the Statement of Purpose. Care records were examined and also the accident book. At the last inspection there were a number of unexplained injuries and bruises recorded in the accident book. There is a need to cross reference the records to see any patterns or trends emerging that would help influence how the care is to be delivered and whether any measures could be put in place to reduce the amount of injuries occurring. The unexplained bruises and injuries were occurring mainly to the same persons and any accidents should be taken into account at each review of the care plan and a new risk assessment recorded as necessary. The manager has since confirmed that she has undertaken an audit of the care records and accidents. Additional measure have been taken to reduce the accidents including a discussion with a Social Worker and the purchase of a new chair to support a person prone to falling. New risk assessments have also been put in place to ensure correct procedures are being followed by staff for the safety of the individual concerned. The manager has introduced a system whereby if unexplained bruising is evident or if staff witness behaviour that may lead to bruising ie pinching or or self harming than a record sheet is completed together with a body map. There was evidence of these documents in the care records but none have yet been completed as they have just been introduced and she was still observing the residents and their behaviour at this time. There was evidence that equipment such as bath lifts and weigh scales have been serviced; One of the bath lifts has failed the inspection the manager stated that this will be replaced. Other bath lifts have passed but only for another year. There is a hoist but it
Care Homes for Older People Page 4 of 10 is not currently required or available as the sling is missing. Bed rails were in place for two persons cared for in the home; bed rails are generally in place because there is a risk that the person accommodated may fall out of bed and injure themselves. The care records did not include a full assessment for the suitability of the bed rails or a risk assessment for the compatibility of the bed rail bumpers and the bed or the safety of the equipment. The manager has since contacted the District Nurses, Occupational Therapists and Social Services as well as the manufacturers of the bed rails for advice. It is confirmed that the bed rails are suitable for the bed and mattress and relatives have been informed about what has been done. Bed rails have been removed for the other person as they are not necessary. The cook confirmed that she has an adequate budget for the purchasing of food and that consideration is being given to changing suppliers in order to reduce costs. At the last key inspection a complaint had not been recorded correctly and was lacking in information. At the current inspection, there had been one complaint recorded which included all the necessary details and the investigation that had taken place as far as was possible at that time. Staff were seen providing activities that included ball games and bubbles in the afternoon. The manager has established a seven day entertainment program and the details have been recorded within an activities log with photographs of some of the people concerned enjoying the activities. Staff have recorded details each day of the week for each person and when they have participated in an activity even if it was just watching TV. An activities cupboard has been established to contain the equipment and board games; the manager is hoping accumulate more items including CDs with music suitable for an older generation. A sign has been placed on the wall in the main lounge with pictures detailing the day, date and current weather. The manager has also obtained some money from the owners to pay for hairdressing and new clothes as previously certain items such as toiletries were being paid for by staff. The manager ia also establishing which individuals require money and talking to relatives who have control of their money. At the last inspection there was a temporary cook who did not have a Food Hygiene Certificate as necessary under Food Safety Legislation. The manager has obtained a video relating to basic food hygiene which is being used for care staff should they be involved in the kitchen preparing food. Staff complete a questionnaire which is then marked by the manager. Environmental Health have attended the home recently and confirmed that they are satisfied with this arrangement as there is a dedicated cook who is undertaking a National Vocational Qualification at level 2 in Food Safety and Presentation. The training room has been cleared of all redundant and old equipment, tables and chairs have been made available and the room is now being used for staff meetings and training. The manager has introduced a new shift pattern that has been welcomed by staff. Staff are now on duty 8:00 am to 3:00 pm, 3:00 pm to 10:00 pm and at night 10:00 pm to 8:00 am. Overnight one staff member is awake and one staff sleeping; the manager tries to ensure there is always a mixture of female and male staff on duty to ensure there is a
Care Homes for Older People Page 5 of 10 choice of gender when providing personal care. There have been issues raised by staff on duty at night unable to give medication because they have not been trained. By changing the staff rota there is now no need for night staff to provide medication which is done by day staff. The manager stated that she will review the number of staff on duty if there is a change of dependency needs and additional staff support is required. The records belonging to two new staff members were examined and found to contain all necessary pre-employment checks including references and checks with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) register. There was evidence of a Health declaration and induction training. Robust recruitment procedures ensure that staff of a suitable calibre are employed to look after vulnerable people. The new manager has begun one to one staff supervision and has all staff booked in month by month; staff meetings have also taken place. Good individual supervision of staff ensures they are supported to carry out their duties and review any training requirements in order to provide appropriate care. The new manager had been in post for only six weeks when the inspection took place and has made some very positive changes within her remit to address with regard to the issues found at the last key inspection on the 5th February 2010. These have included the review of the Statement of Purpose/Service User Guide, activities, staff deployment, training and recruitment, care plan documentation and supervision of staff. What the care home does well: What they could do better:
The medication is stored within a wooden cupboard and has a hasp lock halfway up the doors with a padlock. Additional measures should be taken to secure the door by the fitting of drop locks inside the door to ensure the protection of the medication within. Part of the building has been sealed off to prevent access by the people cared for in the home and staff. Repairs to the flat roof are stall outstanding as well as repairs to the
Care Homes for Older People Page 6 of 10 ceilings and external walls. Evidence has been provided that despite the damage to the roof and the surrounding areas, the electrical and fire systems within the home are safe. No assurances were given at the time of the inspection as to when it was anticipated that work would commence on the necessary repairs to the roof which requires financial expenditure on behalf of the owners of the home. The manager stated that she was not aware of any date for commencement on the repairs. The area was viewed, some of the old furniture has been removed, the state of the ceiling where there has been water penetration was the same as at last inspection; there was no evidence of water dripping through during the visit. The outside area at the front of the home is still being tidied up with bushes taken out and cut down. At the rear of the home there is a very uneven crazy paved path leading to the garden which has made it too hazardous for the people supported in the home to go outside. There is still no improvements to the path but a metal stump that was sticking out of the ground has been removed as required at the last inspection. The home is in major need of refurbishment and some decoration. In the bedrooms the furniture and fittings are old and of poor quality, commodes are rusty and the majority of fittings have become worn, broken and scratched over time due to general wear and tear, there did not appear to be any plans to review and replace the furniture and fittings. Some of the empty bedrooms have been re-decorated however there is a need to ensure that the rooms currently in use are upgraded so that they provide a pleasant place to live. Lockable facilities for the safekeeping of any valuables or medication should be provided within the bedrooms. The manager was not aware of any Regulation 26 visits or reports undertaken by the owners. Regulation 26 reports are necessary to show that the home is being managed effectively and the services and facilities within the home are suitable. Previously Regulation 26 visits have been provided to the Commission for January and February 2010 following the last key inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 19 23 The outside area must be made safe to allow safe exit by the persons cared for as well as staff. To ensure the health and safety of the persons cared for as well as staff. 19/06/2010 2 19 23 As at previous inspections, the bedrooms belonging to the persons with dementia require decoration and refurbishment. To ensure a welcoming environment. 30/09/2010 3 19 23 Repairs must be made to the 19/06/2010 roof where leakage is occurring, the bulging exterior wall and all necessary remedial work including the furnishings of the affected rooms. To ensure the health and safety of the persons cared for as well as staff. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 33 26 Evidence must be provided 25/06/2010 of written reports by the registered provider for March & April 2010 about the conduct of the home as detailed under regulation 26 of the Care Homes Regulations. To ensure the facilities and services provided meet expected standards of care. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 The wooden cupboard used to store medication should be fitted with additional locks to ensure the contents are secure. Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
