Inspection on 09/06/09 for Arundel Lodge

This inspection was carried out on 9th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arundel Lodge 26/04/10

Arundel Lodge 05/02/10

Arundel Lodge 14/09/09

Arundel Lodge 17/07/09

Arundel Lodge 10/06/08

Arundel Lodge 12/06/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Dale     Date: 0 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 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): Hexagon Healthcare (UK) Ltd Name of registered manager (if applicable) 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 Additional conditions: 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 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 Care Homes for Older People Page 4 of 26 Brief description of the care home 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 enabling access throughout the home. Information about Fees can be obtained from the acting manager of the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and and focused mainly on key standards and how the home was currently being managed. Various persons were spoken with including the acting manager and care staff and several persons being cared for who were able to express their opinions about the care received. Surveys were sent out prior to the site visit and 5 were returned from staff and one from a person residing at the home; the responses and comments were included in the report. The last key inspection was on the 10th June 2008. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: A signature should be obtained on the care plan where possible from the individual concerned or a friend or family member to show that the way the care to be delivered is acceptable and appropriate. There should be more opportunities for stimulation through activities and outings in line with their capabilities and wishes. Care Homes for Older People Page 7 of 26 Fresh fruit and vegetables should be made available on a daily basis for the promotion of healthy nutrition to the individuals cared for. All staff must receive training on the safeguarding of adults from any abuse. The weigh scales need to be repaired and calibrated to ensure that the persons cared for can be weighed safely. There is a need to improve the environment with regard to furniture and fittings particularly in the bedrooms belonging to the persons with dementia to ensure a comfortable and welcoming environment. The worn and threadbare towels in the bathroom should be replaced. Assurance should be provided that the television will be able to receive digital broadcasts in the future. Some evidence of security checks such as with the Criminal Records Bureau (CRB) were missing and some of the references obtained were inappropriate. There was no evidence of written reports undertaken by the registered provider about the conduct of the home as detailed under Regulation 26 of the Care Home Regulations. A suitably experienced and qualified manager must be employed and registered with the commission. All staff should receive regular one to one formal supervision at least six times a year to ensure they are supported and competent. The registered provider is required to produce an improvement plan on the issues raised paying particular attention to the environment, fixtures and fittings with time scales for action. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process ensures that the services provided by the home are suitable. The home does not provide Intermediate Care. Evidence: Information is available about the services provided by the home. An assessment is carried out currently by the acting manager for any new person considering living at the home. There are 8 persons accommodated who require Dementia Care and 2 persons within the category of Older Person who have lived at the home for a number of years. The assessment process is comprehensive and looks at every aspect of care requirements both socially and physically. The acting manager spoken with is aware of the Mental Capacity Act and the Deprivation of Liberty and is going to attend some training on the subject. Care Homes for Older People Page 10 of 26 Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate records are maintained with regard to care planning, health and medication. The persons cared for are treated with privacy, dignity and respect by staff. Evidence: A key worker system is in operation. The care records for 4 persons residing in the home were examined and observation took place of staff interaction. The care records have all been put in order by the acting manager and those seen were in good order and were up to date. Risk assessments are undertaken and aims and objectives put into place with various strategies according to the individual. Where possible a recording had been made of the previous background and social history of the person concerned and any hobbies and interests. Recordings are kept of weight and food intake as well as personal care and bathing. There was evidence that GPs have been contacted as required as well as other health professionals such as Opticians and the Memory Clinic. Care Homes for Older People Page 12 of 26 Evidence: The majority of people cared for do not have the mental capacity to understand the care records and liaison has taken place with family or friends in the compilation of the care plans. There were no signatures seen on the care records examined and it was recommended that where appropriate a signature was obtained from a friend or family member as to the appropriateness of the care plan as well as a signature of the staff member recording the information. Family or friends could be invited to a review of the care plan from time to time. The two persons in the category of older person are happy with the care provided and have been supported as necessary with any changes to their physical requirements. The medication is stored in a dedicated room and has its own fridge for any medication that requires such storage. The acting manager has changed the supplier to Boots who have supplied blister packs and have provided training to staff. There are currently 7 staff trained in medication. The medication administration record was examined and found to contain no errors and was up to date, original prescriptions were seen to be in place. The acting manager is providing oversight and checking the medication records on a regular basis. The home subscribes to the UKQCS which is a Care Quality Management System based on equality and diversity principles. Staff are provided with the principles at induction training and they are available to read at all times. Staff were observed to treat the persons cared for with dignity and gentleness and were all very familiar with their individual needs and wants. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no formal activities programme and no outings take place. Meals are provided that offer choice but there should be more availability of fresh fruit and vegetables. Evidence: There does not appear to be any activities or outings taking place within the home. Staff do there best with music and dancing where possible. The acting manager states that she is planning an Autumn Fair to raise funds. Most of the persons cared for lack concentration and it requires some skill to motivate them. The outside space is still dangerous for escorting the persons cared for to the garden area. Work has begun to make safe the uneven crazy paving that has to be traversed and work has recently begun on the garden to make it more attractive. One of the persons cared for in the category of Older Person is taken out by her family on a regular basis. The other person is unable to go out and has only a friend who visits her. There is some worry about the TV in the lounge as it is not digital. There are regular visitors from one of the local churches but a local church minister Care Homes for Older People Page 14 of 26 Evidence: who visited the home has now moved away. There have been several changes of staff with regard to the provision of meals within the home. The person cooking the food on the day of the visit was employed as a carer but has the necessary qualification for cooking and another member of staff is to be the main cook. The menu is varied and choice is provided; soup and sandwiches are provided at tea time. There was no fresh fruit available on the day of the visit and according to one of the persons cared for the vegetables are all frozen although the meat provided is fresh. Staff were seen to assist with meals in a sensitive and caring manner. Staff now offer refreshments to any visitor to the home. Comments received from the persons cared for included: It could arrange more outing or indoor activities and also indicated that she would be happy to pay. Another comment when asked what the home does well was Most things. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place that ensures any concerns are investigated. All staff require specific training on the safeguarding of vulnerable adults. Evidence: There is an appropriate complaints procedure that is made available to all interested parties. The surveys indicated that both the persons living at the home, staff and relatives know how to raise any concerns. The persons cared for with dementia are able to show their dissatisfaction through body language and staff are quick to pick up any concerns. Staff have received some training on safeguarding at induction training but the staff spoken with had not received any further specific training on the protection of adults from abuse. The acting manager stated that all staff receive security checks before they commence duties at the home including the Protection of Vulnerable Adults (POVA) Register. All staff are provided with Health and Safety training at induction. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Parts of the home and outside area are still in need of refurbishment and decoration. Evidence: Some work has begun to improve the environment but there is still a lot of work outstanding. The home was clean and tidy in all areas and there were no unpleasant smells. Tables and chairs have been replaced in the dining room as the ones previously purchased were unsafe. The bedrooms belonging to the persons who have dementia are still sparse and unwelcoming. The acting manager states that she has provided some duvets but some of the bedding seen was in need of replacing. The furniture is minimal and old and contrasts unfavorably with furniture brought in and belonging to some of the persons cared for. One of the bedrooms has new carpet. As previously mentioned, the TV in the upstairs lounge is not digital and small for a person with poor eyesight. One of the persons spoken with is worried about the forthcoming changeover to digital as TV is one of her few pleasures. The acting manager said that she would speak to her about the concern and take action. Towels seen in the bathroom were threadbare and cut in half; the acting manager said Care Homes for Older People Page 17 of 26 Evidence: that there was some money allocated for new towels and would investigate. Some work has begun on the outside area to make it safe for transferring persons from the downstairs lounge to the lower garden area. The crazy paving is still in place but work has begun to level it out. Staff spoken with are still concerned that it could be dangerous for them to assist persons to the garden area. The weigh scales are out of action and need calibrating, currently the persons cared for are not being weighed as the other scales are unsafe. Staff have received training in Infection Control and the home employs domestic help and a maintenance person. There were several comments from staff about the environment: Improve the homes environment. Needs a lot of work in the home, eg - new furniture, painting and decorating. The rickety telephone stand that was in place at the last inspection has gone and it was confirmed that the one person who made use of the public telephone is able to use a mobile phone belonging to the home as required. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained in order to provide care to the current persons cared for in the home. There is a need to tighten up the recruitment procedures in order to ensure the safety of the persons living at the home. Evidence: Staffing levels are suitable for the number and needs of the current persons cared for. A key worker system is in place and staff spoken with had been trained and feel confident in their approach to caring for the persons living in the home. Three staff files were examined and found to be lacking some detail with regard to the security checks necessary before staff commence at the home. The acting manager has found it difficult to obtain all the necessary paperwork when she took over the home. One of the missing documents was a Criminal Records Bureau check although the acting manager has managed to obtain a copy of the applicants copy. Some of the references seen are inappropriate as they are from family members. There were also telephone, verbal references which are not acceptable. One of the health declarations had not been completed. There is a need to record and date each step of the recruitment process for ease of use and to ensure that all checks have been completed prior to commencement at the home. Care Homes for Older People Page 19 of 26 Evidence: Staff have been trained in Equality and Diversity at induction and the staff spoken with confirmed that they had received manual handling training and some dementia training in the past. There are currently 12 care staff and 11 have a National Vocational Qualification (NVQ) at level 2 or above. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being managed well with the current management arrangements. There is a need for an experienced and competent manager to be appointed and registered with the Commission. Evidence: The manager left the home suddenly in January 2009. Currently there is an acting manager who is overseeing the management of the home but whos primary responsibility is as manager of another care home belonging to Hexagon Healthcare (UK) Ltd. The acting manager is supported by a supervisor who works at the home and has NVQ 3. This is not an ideal situation but the staff and persons cared for at the home spoken with appeared happy with the current arrangements and staff feel well supported. A meeting has taken place with the owners of the home because of concerns over the lack of a registered manager since ownership was taken over by Hexagon Healthcare. Care Homes for Older People Page 21 of 26 Evidence: The acting manager has made improvements to the care records and done her best to obtain staffing documents relating to their recruitment. Staff appraisals have taken place. There have been no formal staff meetings or one to one supervisions but the staff confirmed that they have regular meetings with the acting manager and feel well supported and guided. There was no evidence of any formal reports under Regulation 26 of the Care Homes Regulations. Regulation 26 requires that a report should be completed by the owners of the home once a month about the conduct and performance of the home. At the last inspection the registered provider provided a pro-forma that was to be used for Regulation 26 reports but the acting manager is unaware of any such document. The acting manager confirmed that the owners of the home do visit the home and are available for advice as necessary. A staff comments was made that there could be: Better communication with directors. The general feeling amongst the staff is that there should be more money spent on the home and that when they raise any issues they are not listened to. The registered provider will be asked to produce an improvement plan paying particular attention to the environment, furniture and fittings with timescales for action following receipt of this report. The acting manager confirmed that personal allowances belonging to the persons cared for are placed in separate envelopes and receipts are kept. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 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, Care Homes 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 18 13 All staff must receive training on the safeguarding of adults from any abuse. To prevent the persons cared for in the home from harm. 27/11/2009 2 31 9 A suitably experienced and qualified manager must be employed and registered with the Commission. To ensure the efficient and smooth running of the home. 16/10/2009 3 33 26 There was no evidence of written reports undertaken by the registered provider about the conduct of the home as detailed under Regulation 26 of the Care Home Regulations. To ensure that the services provided by the home are meeting the needs of the persons cared for. 14/08/2009 Care Homes for Older People Page 24 of 26 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 7 A signature should be obtained on the care plan where possible from the individual concerned or a friend or family member to show that the way the care is to be delivered is acceptable and appropriate. There should be more opportunities for stimulation through activities and outings in line with their capabilities and wishes. Fresh fruit and vegetables should be made available on a daily basis for the promotion of healthy nutrition to the individuals cared for. There is still a need to improve the environment with regard to decoration, furniture and fittings for the majority of bedrooms belonging to the persons with dementia. This would ensure the persons cared for are more comfortable and provide a welcoming environment. Work should continue on the outside space to ensure that staff are able to assist the persons cared for safely to the garden area. There is a need to improve the environment with regard to furniture and fittings particularly in the bedrooms belonging to the persons with dementia to ensure a comfortable and welcoming environment. Re-assurance should be provided that the TV will be able to receive digital broadcasts in the future. The towels in the bathroom are worn and threadbare and should be replaced for the comfort of the persons being bathed. The weigh scales need to be repaired and calibrated to ensure that the persons cared for can be weighed safely. All staff should receive regular one to one formal supervision at least six times a year to ensure they are supported and competent. 2 12 3 15 4 19 5 19 6 19 7 8 20 21 9 10 22 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. 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