CARE HOMES FOR OLDER PEOPLE
Arundel Park Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 0WN Lead Inspector
Daniel Hamilton Key Unannounced Inspection 09:45 1 , 2 and 3rd April 2008
st nd 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 Park DS0000059311.V358472.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 Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Arundel Park Address Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 0WN 0151 291 7840 0151 726 1999 arundelpark@europeanwellcare.com 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) European Wellcare Homes Ltd Janet Margaret Burns Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N 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 The maximum number of service users who can be accommodated is: 50 Date of last inspection Brief Description of the Service: Arundel Park Care Home is part of the Sefton Care village complex. It is situated in the middle of two other care homes in a residential area, close to the city centre. The home is part of the European Wellcare group who have several homes within the Merseyside Area. Arundel Park is purpose built and is registered to provide care for fifty older people who require either nursing or personal care. It is accessible by public transport (mainly bus) and is close to spacious green areas such as Sefton Park. The home provides accommodation in single bedrooms, all with en-suite facilities. There are several lounges and two dining rooms over two floors. There is a passenger lift and two stairways to give access to all areas of the home. The building is centrally heated and individual thermostatically controlled radiators are available in all of the bedrooms. The complex has one main kitchen providing meals for the 3 care homes on the site with small satellite kitchens in each home. There is one laundry unit providing a service for the 3 homes on the site. Fees range from £315.50 to £447.56 per week for residential care and from £398.75 to £534.19 per week for nursing care. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced site visit was carried out over a period of three days. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were viewed and the Programme Manager, Registered Manager, residents, relatives and staff were spoken with during the visit. Survey forms were also distributed to a number of staff, residents and / or their relatives prior to the inspection to obtain additional feedback about the home. All the key standards were assessed and progress / action taken in response to the previous requirements and recommendations from the last key inspection in October 2007 was reviewed. Full feedback was given to the management team during and on conclusion of this inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well:
The general atmosphere of the home was warm and friendly. Staff were observed to be attentive to the needs and support requirements of the people living in the home and residents were generally positive about the standard of care provided. Comments included; “The staff are very good. Nothing seems to much trouble for them”; “All the staff are alright. They treat me OK and I have no concerns” and “The staff are very attentive and patient.” The people using the service confirmed they were able to follow their preferred routines and were treated with respect. Visitors were seen to visit their relatives at various times of the day and rooms viewed were comfortable and personalised. Staff spoken with demonstrated a commitment to meeting the diverse needs of the people using the service and a basic awareness of the need to promote social care values into practice. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection?
The Statement of Purpose had been updated to include accurate information on the current range of fees, the arrangements for the management of finances and the correct contact details of the Commission for Social Care Inspection. This ensures that prospective and current residents have access to correct information on Arundel Park. The majority of the staff team had received training on the protection of vulnerable adults from abuse so that staff understand how to recognise and / or respond to suspicion or evidence of abuse. The management team had organised for staff to complete medication training and introduced a ‘Medications Competence Assessment’, revised drug count system and a drug calculation test following an error in the administration of medication. This action will help to safeguard the health and welfare of residents and reduce the risk of further medication administration errors. Two new hoists had been purchased and a comfortable armchair supplied for a resident, to ensure the safety and comfort of residents was maintained. Risk assessments had been completed to address a number of hazards / risks identified at the last visit to minimise and control potential areas of risk. Action had been taken to improve care plans, staff training and the management of resident’s personal monies however further work is needed in these areas to fully safeguard the welfare of the people using the service. Duvet covers and pillowcases had been purchased and new sheets and valances had been ordered as the previous linen was worn. Furthermore, the corridors had been repainted, three ground floor windows had been replaced, the radiator in the corridor had been repaired, the outside security lighting had been replaced and the frayed carpet on the upstairs landing had been made safe. New Kardene Flooring had been fitted in the lounge and new tables and chairs had been bought and placed in the upstairs bar area. Furthermore, some new side tables had been purchased for the lounge areas. A new activities coordinator had commenced employment at the home and an additional twelve hours a week had been allocated to the post. Residents reported that they had started to have day trips in the home’s mini bus however more work is needed in this area to ensure the social and recreational needs of residents is met. Feedback received from the majority of residents indicated that the standard of catering had improved. Comments included; “The home has a new chef and the food is improving”; “I think it is difficult to cater for so many tastes but it
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 7 has been pleasant and varied so far” and “The food is OK. I don’t get hungry. Sometimes I get a choice but not all the time.” The management team had introduced a system to monitor the dependency and occupancy levels of residents since the last visit to ensure staffing levels reflected the changing needs of the people using the service at all times of the day and night. A review of the staffing levels in the home had also been undertaken by the Programme Manager to ensure residents’ needs were met by appropriate numbers and skill mix of staff. Examination of records and discussion with staff confirmed that staff had received formal supervision from their line manager to ensure they were supported in all aspects of their role. Arrangements had been made for the manager’s designated hours (36 per week) to be supernumerary in order for her to undertake management duties and develop the service provided at Arundel Park. What they could do better:
An assessment and care planning system had been developed however records showed that one resident had moved into the home before their needs had been fully assessed. Furthermore, some care plans and associated documentation did not identify how all the assessed needs of residents were to be met. These issues must be addressed to ensure the health, personal and social care needs of residents are identified and planned for. Some Medication Administration Records (MAR) viewed did not account for the Administration of some medication and the dates on some MAR were out of sequence. Furthermore, there was no audit trail to account for the discontinuation of one type of medication for a resident. Concerns were also noted regarding the safe storage of medication as a member of staff left a tub of medication (eye drops) unsupervised on the top of a medication trolley for a short time whilst administering medication. Suitable arrangements must be made for the recording, safekeeping and administration of all medication to ensure the health and welfare of residents is safeguarded. Although progress had been made in providing training for staff there is still further work required in this area. Some staff had not completed induction training, less than 50 of the home’s care staff had a National Vocational Qualification in Care at level 2 or above and a number of staff had not completed training in all safe working practice areas. Furthermore, a number of staff had not completed training in areas specific to their role as noted at the last visit. Staff must complete training appropriate to the work they perform to ensure they are competent in their roles. The Commission for Social Care Inspection had not received notification of adverse incidents in the home as required under the Care Home Regulations
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 8 2001. This matter should be addressed as a matter of priority so that the Commission is kept up-to-date on any actions occurring at the home. Some residents did not have a copy of a contract on file from the Registered Provider (European Wellcare) or the local authority (where applicable). The people using the service should be provided with a Contract / Statement of Terms and Conditions so that they are aware of their rights and obligations. Some residents continued to express concerns about the range and frequency of activities provided. Comments included; “There is little in the way of entertainment”; “Activities have improved since Warren [Activity Coordinator] started but it would be nice to have more group activities” and “I have not been here very long but there appear to be days when nothing much is organised.” A programme of activities should be developed in consultation with the people living in the home so that residents are aware of the activities on offer. Activities should also be offered on a daily basis so that the social and recreational needs of residents are met. Feedback received from some residents revealed continued concerns regarding the laundry service, the choice of food and entertainment. For example, comments included; “Laundry can sometimes go missing and I find it frustrating”; “I am happy with the home but I have to complain about the laundry service”; “I am satisfied with the food but I don’t always get a choice” and “Some days we have no entertainment.” Action should be taken to ensure reoccurring concerns and complaints regarding meal choices, activities and the laundry service are acted upon to provide evidence that the views of residents are listened to and taken seriously. The Complaints record for Arundel Park should be updated to clearly identify: the date and time of the complaint; the name and contact details of the complainant; the details of the person receiving the complaint; the nature of the complaint; the action taken and date and finally the outcome - to provide a clear audit trail for all complaints / concerns received. The ongoing maintenance tasks identified to the management team during the inspection should be addressed to ensure the environment is maintained and homely. Priority attention should be given to repairing / replacing the external windows and dining room furniture, attaching curtains that have become detached from curtain tracks and the cleaning of stained / dirty carpets. Staff should refrain from being directly involved in assisting residents to complete survey information and advocates, friends and / or family members should be involved in order for the process to remain objective and impartial. Records showed that the fire alarm system had not always been tested on a weekly basis and there were occasions when the system had not been tested for approximately three weeks. This matter should be reviewed as a matter of priority so that the health and safety of the people living in the home is safeguarded.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 9 The administrative systems in the home should be kept under review and further developed in order for information to be easily accessed. 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 Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 10 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 Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 11 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): 1, 2 and 3. Standard 6 is not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on the needs and rights of the people using the service is not always obtained and / or supplied. Unless a full assessment of need is undertaken and contracts issued, there is no assurance that the care needs of the people using the service will be met and residents will be unsure of their rights and obligations. EVIDENCE: A sign was displayed on a notice board in the reception area advising that a Statement of Purpose was located in the office and available upon request. The Statement of Purpose had been developed to provide key information on the service provided at Arundel Park and a large print version of this document had been produced to ensure the information was more accessible. Residents spoken with during the inspection confirmed they had also received a Service User Guide, which contained information about the facilities and procedures within the home. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 12 Since the last inspection the Statement of Purpose had been updated to include information on the fees charged by the home, the arrangements for the management of pocket money and personal allowances and the contact details of the Commission for Social Care Inspection. This enabled the people using the service to make informed choices about the home prior to moving in. The manager was advised to display copies of the Statement of Purpose and the current inspection report in the reception area of the home so that the documents are easily accessible to prospective and current residents and / or their representatives. This advice was acted upon by the manager during the site visit. The care plan records of five residents were viewed during the visit. Four of the files were for people who had moved into the home since the last inspection and one was for a resident who had lived in the home for over three years. Only four of the five records examined contained a copy of a pre-admission assessment. Overall, the pre-admission assessments contained brief information on the needs of prospective residents however one assessment had not been fully completed and some information was missing e.g. footcare, oral health, weight and height. The manager reported that ‘Admission Assessments’ were completed to review the needs of new residents following admission to the home and copies of the documentation were available on files viewed. Likewise, a range of risk assessments had been completed for each resident and kept under monthly review. The manager was recommended to update one risk assessment for the use of bedrails and to refer to guidance from the Medical Devices Agency for information on best practice. Only one of the five files contained a Contract from the Registered Provider (European Wellcare). Likewise, only three of the five files contained a Contract from Liverpool City Council. The Programme Manager provided evidence that the management team had undertaken an audit of all contracts that should be in place and were in the process of trying to obtain copies of outstanding contracts from Liverpool City Council. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 13 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): 7, 8. 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and medication practices are in need of review to ensure the health and personal care needs of residents are fully promoted and safeguarded. EVIDENCE: The care plan records of five residents were randomly selected to view during the visit. Four of the files were for people who had moved into the home since the last inspection and one was for a resident who had lived in the home for over three years. Records showed that the Registered Provider (European Wellcare) had developed a range of corporate documentation to record the needs and support requirements of the people using the service. Each file contained a ‘Person Centred Care Plan’ that outlined information on “My life leading up to admission”; “What you need to know to Support Me” and “Help me stay Healthy.” A Person Centred and standard Care Plan together with a range of personal information including risk assessments, daily report sheets, personal care, accident and health care records was also in place.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 14 Some accident records viewed were vague and examples were discussed with the management team during the visit, to improve recording practices. Care Plans were based upon a model of care called ‘Activities of daily living’. This model provides a framework for staff to assess and plan care around routine daily activities. Staff spoken with during the visit were able to give examples of how they provide person-centred care to the people using the service. Overall, care plans described the action required by staff to meet the individual needs of residents, however some shortfalls were noted. For example, one resident had a diagnosis of dementia and a care plan had not been developed in sufficient detail to adequately address the support requirements of the resident. Discussion with residents and / or examination of health care records confirmed a number of residents had attended appointments with doctors, district nurses and chiropodists since admission. Some care plans viewed did not provide evidence that the general health care needs of the people using the service were being fully promoted. Likewise, the individual wishes of residents concerning routine healthcare had not been documented. Examples were discussed with the management team during the visit. A range of Policies and Procedures had been developed to provide guidance for staff responsible for managing medication. A record of staff designated with responsibility for administering medication was in place and a resident identification system had been established. Staff had been asked to read and sign the medication procedures to ensure best practice. The Commission for Social Care Inspection had received notification of a medication administration error during March 2008. Since the incident, the management team had introduced a number of initiatives to improve future practice. This included; the development of a ‘Medications Competence Assessment’, the completion of medication training, the introduction of a revised drug count system and a drug calculation test. The manager reported that two residents self-administered medication at the time of the visit. Medication risk assessments had been completed however the manager was advised to confirm and record on the risk assessment that each resident understood the times of administration and the maximum permissible dose. Furthermore, the manager was advised to ensure that residents and / or their representatives complete medication consent forms to confirm individual wishes concerning the administration of medication have been taken into consideration. An example template was given to the manager for reference. A sample of Medication Administration Records (MAR) were viewed during the inspection and some issues were noted. For example, one MAR had not been
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 15 signed to confirm whether Hypromellose eye drops 0.3 and Paracetamol 500m/g had been administered on one separate occasion for each form of medication. Likewise, the dates on a MAR were not clear and out of sequence. Upon checking the Controlled Drugs register it was noted that Tamazepam 10m/g had been discontinued for a resident from 5/04/2007 and there was no audit trail to account for the change. It was also noted that a member of staff left a tub of medication (eye drops) unsupervised on the top of a medication trolley for a short time whilst administering medication. The issues were brought to the attention of the management team during the visit. Residents were observed to be clean and appropriately dressed on the day of the visit and staff were seen to be attentive to their needs and support requirements. The people using the service confirmed they were able to exercise control over their day-to-day lives, were treated with respect and that they were generally satisfied with the care provided in the home. Staff spoken with demonstrated a commitment to meeting the diverse needs of the people using the service and a basic awareness of the need to promote social care values into practice. Since the last inspection the home had purchased four new footstools and arranged for five to be recovered. A recliner chair had also been provided for a resident to improve the safety, comfort and wellbeing of the people using the service. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range and frequency of social activities are in need of review to ensure they satisfy the needs and expectations of the people using the service. EVIDENCE: Since the last inspection the manager had recruited a new Activity Coordinator who was employed to work 24 hours per week over three days a week. This is an increase of 12 hours per week. A programme of activities for residents was not in place at the time of the visit and some residents spoken with were unsure as to what activities were on offer. Likewise, feedback from residents revealed that activities were only sometimes provided. The activities coordinator was on annual leave at the time of the inspection. On the first day of the inspection, a member of staff was observed to organise a number of activities for residents including; darts, cards, musical DVD and 1:1 time. On the second date an outside entertainer visited to facilitate musical entertainment and a notice had been displayed on the notice board to advertise the event.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 17 A number of activity records were viewed during the inspection and these showed little evidence of planned activities with the exception of trips to different destinations in the mini-bus. e.g. New Brighton and Eastham Wood Bird Sanctuary. Records revealed that a significant amount of the Activity Coordinator’s time had been used to spend 1:1 time with residents and many residents spoken with wanted to see more entertainment. Representatives from two denominations also visited the home to provide services and / or meet with residents subject to their individual religious beliefs. Some residents were of the opinion that activities could be further developed to provide more stimulation for the people living in the home. For example, comments received from three residents included: “There is little in the way of entertainment”; “Activities have improved since Warren [Activity Coordinator] started but it would be nice to have more group activities” and “I have not been here very long but there appear to be days when nothing much is organised.” The Annual Quality Assurance (AQAA) for the service detailed that policies and procedures were in place that acknowledged the rights of residents to exercise choice and control over their lives and to maintain contact with family and friends. Residents spoken with confirmed they could follow their preferred routines and receive visitors whenever they wished. Friends and relatives were observed to visit people in the home during the visit and one relative reported; “I visit daily and overall I am quite satisfied with the service provided.” The home has two dining rooms on each floor. Menus were displayed on each table, for residents to view and large print menus were available subject to individual need. Menus viewed offered residents a range of wholesome and nutritious meals. Specialised diets e.g. diabetic, puree and low fat were catered for subject to individual need. The tables were nicely laid with condiments on each table however the curtains were hanging off the track in one dining room and various tables and chairs were scraped and worn on the wooden bases as noted at the last inspection. Since the last visit, ‘Catering Information sheets’ had been completed for each resident. The forms contained key information on each resident’s dietary needs and preferences. A copy of ‘Halaal guidelines’ for a Muslim Diet had also been obtained for catering staff to reference. The Head Chef was spoken to during the inspection. Records showed that the kitchen had been recently inspected by the Environmental Health Department and that there had been no contraventions or recommendations.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 18 Since the last inspection a new deep fat fryer and plate warmer had been purchased and the preferred brand of bread had been repurchased following concerns from residents. The Programme Manager reported that the service had continued to use the same suppliers of food for approximately three years and the chef advised that the brands of food had not changed to cheaper alternatives as previously reported. The minutes of residents meetings during February and March 2008 confirmed that the people using the service had been consulted about proposed changes to the menu plans and the meals provided. Minutes also detailed that the majority of residents felt the meals had improved. Some residents spoken with reported that they had not always been offered a choice of meals and there was no record of the meals served to individual residents. The Programme manager requested the Chef to establish a system to record this information during the inspection. Comments received from residents included; “The home has a new chef and the food is improving”; “I think it is difficult to cater for so many tastes but it has been pleasant and varied so far” and “The food is OK. I don’t get hungry. Sometimes I get a choice but not all the time.” Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 19 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable the people using the service to express their concerns however some continuing issues have not been adequately addressed to confirm all complaints are taken seriously and acted upon. EVIDENCE: A Complaints Procedure had been developed by the Registered Provider (European Wellcare Ltd). A large print version of the procedure had been developed and a copy of the procedure was included within the Statement of Purpose and Service User Guide. Since the last inspection, the documentation had been updated to include the correct contact details of the Commission for Social Care Inspection. The Complaints Procedure outlined the processes and timescales the company would follow in response to complaints. A separate leaflet entitled “Let us Know” had been produced for people to record any complaints, comments and suggestions. The Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the inspection detailed that there had been two complaints within the last 12 months. The complaints record for Arundell Lodge was viewed, as no information on the outcome of the complaints had been recorded in the AQAA documentation. The
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 20 complaints record detailed that three complaints had been received by the home since the last inspection. Two of the complaints had been received from relatives of people living in Arundel Park. One complaint concerned a stained carpet in a resident’s bedroom and the other concerned the acceptance of gifts by staff from a resident. The Commission for Social Care Inspection had also received one anonymous complaint regarding low staffing levels. Examination of records and discussion with the management team confirmed that all three complaints had been upheld and action taken in response. Advice was given on how to improve the recording of complaint information as records viewed were vague and lacked information on the outcomes. Furthermore, the complaints record book had been inappropriately used to record incidents. Feedback received from residents via survey forms and via discussion confirmed the people using the service were generally satisfied with the service. Some concerns were expressed regarding meal choices, the laundry service and the frequency of social activities. Similar concerns were noted at the last visit. For example, comments included: “Laundry can sometimes go missing and I find it frustrating”; “I am happy with the home but I have to complain about the laundry service”; “I am satisfied with the food but I don’t always get a choice” and “Some days we have no entertainment.” The relatives of one resident also expressed concerns regarding social stimulation and the personal care needs of a resident. The manager was observed to speak to the family and confirmed that arrangements would be made to act on their concerns during the inspection. Policies and procedures were in place at Arundel Park to provide guidance to staff on how to protect vulnerable adults from abuse. The policies included a ‘Safeguarding Adults Policy and Procedure’ and a ‘Whistleblowing’ procedure. A copy of the local authority adult protection procedures for the City of Liverpool and Borough of Sefton was also available for staff to reference. Training records showed that the majority of the staff team had completed training in ‘Recognising Adult Abuse’ since the last inspection and staff spoken with demonstrated awareness of how to recognise and respond to suspicion and / or evidence of abuse. Further training dates had been planned for April 2008. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 21 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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment continues to receive investment however some parts of the home remain in need of attention to ensure residents benefit from a safe, comfortable and homely environment in which to live. EVIDENCE: Arundel Park had access to a full-time maintenance man and a decorator who worked between three homes owned by European Wellcare Homes Ltd. The Programme Manager reported that the maintenance man worked on average between 16 to 24 hours per week in Arundel Park and the decorator generally worked block periods in each home, subject to decorating schedules. Contractors were hired for major and specialised work as and when required. A maintenance / renewals schedule had been developed for 2008 and advice was given on how this could be further improved. A decorating schedule / plan had also been produced for reference. A maintenance book had also been established were staff could record a repair in need attention.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 22 Since the last visit new duvet covers and pillow cases had been purchased and new sheets and valances had been ordered. Furthermore, the corridors had been repainted, three ground floor windows had been replaced, the radiator in the corridor had been repaired, the outside security lighting had been replaced and the frayed carpet on the upstairs landing had been made safe. New Kardene Flooring had been fitted in the lounge and new tables and chairs had been bought and placed in the upstairs bar area. Furthermore, some new side tables had been purchased for the lounge areas and a new Standaid Hoist and an Oxford mini hoist had also been obtained to ensure staff had the necessary equipment to safely meet the needs of the people living in the home. A number of the outside window frames were in need of maintenance as the window locks were not operating effectively and / or the frames were in need of painting. Similar issues were noted at the last visit. The manager provided evidence that she had completed a ‘Capital Expenditure Request’ and was awaiting approval to replace 43 external windows. A partial tour of the premises was undertaken during the inspection. Overall, areas viewed appeared clean and maintained to a satisfactory standard and the external grounds were tidy. Residents spoken with confirmed they were generally satisfied with the standard of accommodation provided and rooms viewed were attractive and had been personalised with photographs, ornaments and various memorabilia. Some bathrooms viewed were full of clutter and examples of minor maintenance were brought to the attention of the manager during the visit. For example, the curtains were hanging off the tracks in the dining room, some carpets viewed were in need of cleaning and some dining room furniture was scraped and worn on the legs. Similar issues were noted at the previous inspection. The laundry room was seen during this visit. A laundry supervisor and laundry assistant were working in the laundry on the day of the visit. Staff reported that another full-time laundry assistant had recently been recruited and was due to commence duties in the near future. The laundry provided a centralised service for approximately 123 residents across the three homes on the site and three designated areas had been established for the laundry of each home. The Annual Quality Assurance Assessment (AQAA) detailed that a policy on preventing infection and managing infection control was available for staff to reference and that four staff had completed training in infection control. The home’s training matrix did not include details of which staff had completed
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 23 infection control training however laundry staff spoken with confirmed they had received training in infection control and demonstrated a satisfactory understanding of infection control practice when questioned. The laundry appeared well organised on the day of the visit. A resident meeting for February 2008 detailed that overall residents felt the laundry service had improved however some residents continue to express concerns regarding the efficiency of the service during the inspection. This matter should therefore be kept under review. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 24 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some staff have not received induction and / or key training opportunities to provide evidence that they are trained and competent to do their jobs. EVIDENCE: The management team reported that they had introduced a system to monitor the dependency and occupancy levels of residents since the last visit to ensure staffing levels reflected the changing needs of the people using the service at all times of the day and night. A review of the staffing levels in the home had been undertaken by the Programme Manager following an anonymous complaint regarding staffing levels. This review included seeking the views of residents and staff. Additional staff had been recruited to the organisation’s float team to cover staff holidays and absence and other contingency plans were in place to ensure adequate staffing levels were maintained. The home was accommodating 41 residents during the period of the inspection. Residents spoken with during the visit confirmed the people living in the home were generally happy with the support provided by staff. Comments included; “The staff are very good. Nothing seems to much trouble for them”; “All the staff are alright. They treat me OK and I have no concerns” and “The staff are very attentive and patient.”
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 25 One resident stated; “Sometimes I have to wait longer than ten minutes for staff to answer the call bell” and another reported; Sometimes the staff don’t act on messages but they are very good natured”. These issues were brought to the attention of the manager during the site visit. Feedback received from staff via surveys and discussions confirmed the staffing levels in the home were generally adequate and sufficient to meet the needs of the people using the service providing staff absences were covered. Two staff spoken with reported that staffing levels had improved although one was of the opinion that more staff were still needed. The Registered Provider (European Wellcare Ltd) had developed a Recruitment, Selection and Appointment policy. The Manager reported that only one member of staff had commenced employment at the Arundel Park since the last inspection and the personnel file of the new employee was viewed during the visit. The Personnel file contained all the necessary records required under the Care Home Regulations 2001 and provided evidence that the employee had been correctly recruited. Feedback received from some staff via surveys and discussion revealed that they had not consistently been supported to complete inductions in accordance with guidance issued by Skills for Care (National Training Organisation). No evidence of a ‘Skills for Care’ Induction was available on the new employee’s file. It was also noted that induction records were incomplete for two other staff who had been working at Arundel Park for over 6 months. The home did not have a training and development programme in place at the time of the visit as noted at the previous inspection. A training matrix had been developed which provided information on which staff had completed Abuse, Moving and Handling, Food Hygiene and First Aid training only. The manager was advised to also include information on Induction, Health and Safety, Fire Awareness, Infection Control and role specific training as this would help to provide an overview of the outstanding learning needs of staff. The Programme Manager was able to provide evidence of training that had taken place since the last visit and the names / numbers of staff who had completed the training. Since the last visit, Safe Food Handling; Recognising Adult Abuse; Person Centred Planning; Listening Skills; Communication Skills; Emergency Procedures; Nutrition; Activities Management; Pressure Area Care; Understanding Loss and Bereavement; Moving and Handling and Dementia training had been organised. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 26 Training files were in place at Arundel Park, which contained a record of the training completed by staff, together with documentary evidence. Significant gaps were noted for some core and role specific training areas despite the range of training completed by staff since the last visit. Examples were discussed with the management team during the inspection. The manager reported that the home employed 15 care staff to work day shifts and 8 care staff to work night shifts. The Annual Quality Assurance Assessment (AQAA) for the service detailed that 9 staff (39 ) had a National Vocational Qualification (NVQ) in Care at level 2 or above and that a further 4 staff (17 ) were working towards the award. Once the outstanding staff have completed their awards, 13 (56 ) of the non-nursing staff will be qualified to NVQ level 2 or above. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 27 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the service is in need of ongoing development to ensure the home operates efficiently and delivers good outcomes for the people using the service. EVIDENCE: The manager (Janet Green) is registered with the Commission for Social Care Inspection and has managed Arundel Park since December 2002. Since the last inspection arrangements had been made for the manager’s designated hours (36 per week) to be supernumerary for management duties. Records showed that the manager had completed the National Vocational Qualification Registered Manager’s Award and was a qualified Registered General Nurse with live registration.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 28 Feedback received from residents and staff confirmed the manager was generally approachable and supportive. Two staff reported they felt there was a lack of management support via staff survey forms and this information was brought to the attention of the manager. A number of positive comments were received. For example; “Good working relationships with manager. Always available for discussions and regular staff / service users meetings” and “Our manager is very supportive and helpful in all matters.” The manager was observed to interact positively with staff, residents and visitors during the inspection and demonstrated a commitment to developing the service. The administrative systems in the home were in need of review as the inspection process was prolonged, as the manager could not easily locate some information requested during the inspection. Furthermore, the Annual Quality Assurance Assessment received from the manager was not the correct version for the Registered Service and provided brief information about the service. The Programme Manager reported that she undertook visits in accordance with Regulation 26 of the Care Home Regulations 2001 and records were available to confirm these visits had taken place each month. At the time of the visit, the Registered Provider did not commission an external consultant to undertake a quality assurance assessment for Arundel Park. The manager reported that she was responsible for undertaking a self-assessment quality assurance system, which had been developed by the Registered Provider. The system consisted of 4 modules, which were to be completed during each year. Records viewed revealed that section 2 of the system had been completed since the last visit. This section was entitled ‘Information and Care Development’ and covered: ‘Brochure and Service User Guide’; ‘Enquiries and Referrals’; ‘Service User Pre-admission Assessment and Information’; ‘Admission of Service Users to the Home’; ‘Handling Service Users’ Personal Property’; ‘The Keyworker / Primary nurse’ and ‘Development and Review of Service User Plans of Care.’ A ‘Bi-Annual Service User Questionnaire’ had also been completed since the last visit and the results of the survey had been displayed on the notice board for people to view. Advice was given for staff to be excluded from assisting residents to complete questionnaires in the future and for advocates, friends and / or family members to be involved in order for the process to remain objective and impartial. An annual development plan had been developed. The Manager reported that a three-year business plan had also been produced however this could not be located at the time of the visit.
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 29 Minutes of Resident Meetings were available for January February and March 2008. The manager reported that meetings had also been coordinated during November and December 2007 however no minutes could be located. Minutes of meetings for domestic, kitchen. laundry, general and Registered General Nurse staff were also viewed however the meetings were not always regular and some minutes were missing. Similar issues were noted at the last visit. Staff spoken with confirmed they had received appraisals and supervisions and a sample of records was viewed during the visit. The Annual Quality Assurance Assessment received from the manager prior to the inspection detailed that there had been 13 deaths at the home and 10 in hospital. Only three Regulation 37 forms [a mandatory form used to report all adverse incidents that occur in a registered service] had been received by the Commission since the last visit. Similar concerns were noted at the last visit. The management team reported that they had sent the forms to the local office of the Commission for Social Care Inspection instead of the Regional Contact Team. No record of the forms was available at the local office. Residents living in Arundel Park were encouraged to manage their own financial affairs either independently or with support from their family. Systems had been established to handle the personal allowances and items of expenditure for residents, who did not wish and/or were unable to manage their own financial affairs. Since the last visit, the Registered Provider had revised the system for the management of personal finances and the Statement of Purpose had been updated to reflect these changes. Arrangements had been made for interest on residents’ personal monies to be apportioned on a monthly basis per resident, dependent upon their individual balances. Statements for each resident’s pocket money were received on a monthly basis for each resident and stored in individual files. Representatives from European Wellcare are expected to report back to the Commission on the current practice of depositing Department of Work and Pensions money in the Company’s bank account, prior to being paid into the joint resident account. The Annual Quality Assurance Assessment for the service detailed that Health and Safety policies and procedures were in place and that test, maintenance and / or associated records were up-to-date for all key areas. Fire records were checked during the visit. Records of the fire alarm tests revealed that the system was generally tested on a weekly basis however there were occasions when the system had not been tested each week. For
Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 30 example, one record detailed that the system had not been tested from 7/03/2008 to 26/03/2008. Service / test certificate records were viewed for the fire alarm system, fire extinguishers and emergency lighting and these were found to be in good order. The manager had also maintained records of 3-monthly fire lecture training for staff. Advice was given on how to improve the record keeping. Risk assessments had been produced to address the risks identified at the last inspection and records confirmed that health and safety audits were undertaken by the maintenance man and manager to monitor the equipment and environment. Training records showed that some staff had not completed training in all Safe Working Practice topics. Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 31 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 3 1 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 3 X 2 Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 (1) Requirement Residents must not move into the home before their needs have been fully assessed. This will ensure best practice and safeguard the welfare of people who wish to access the service. Up to date care plans must be in place for all people living at Arundel Park to make sure that care practices are carried out according to individual need. Care plans must give enough information to show how each resident’s needs will be met. (Previous timescale of 2/07/07 not met.) 3. OP9 13 (1) Suitable arrangements must be made for the recording, safekeeping and safe administration of medication to ensure the health and welfare of residents is safeguarded. Staff must receive training to ensure they fulfil the aims of the
DS0000059311.V358472.R01.S.doc Timescale for action 04/05/08 2. OP7 15 (1) 04/06/08 04/05/08 4. OP30 18 (1) 04/07/08 Arundel Park Version 5.2 Page 33 home and are able to meet the current and changing needs of people who reside at the home. (Previous timescale of 2/07/07 not met). 5. OP31 37 (1) Regulation 37 reports must be sent to the Commission for Social Care Inspection as soon as there are any adverse incidents as detailed in the Care Home Regulations 2001, so they can be kept up to date of any incidents occurring at the home. (Previous timescale of 29/11/07 not met.) 6. OP35 20 (1) The management of finances must be clear and accurate and show that they are managed in the best interest of residents. Resident’s monies must not be stored in a company-pooled account. This will ensure resident’s money is managed as safely and openly as possible. (Previous timescale of 29/12/07 not met.) 04/06/08 04/05/08 Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations Residents should have copies of Contracts / Statement of Terms and Conditions in place to provide evidence that residents and / or their representatives are aware of their rights and obligations. Care Plans should promote the general healthcare needs of residents and the details of all routine health care appointments should be recorded to confirm the general healthcare of residents is maintained. A programme of activities should be developed in consultation with the people using the service to ensure the provision of daily activities that meet residents’ recreational needs and expectations. Residents should be offered a choice of daily meals and a record of the meals provided for individual residents should be maintained to provide information on dietary intake. Action should be taken to ensure reoccurring concerns and complaints regarding meal choices, activities and the laundry service are acted upon to provide evidence that the views of residents are listened to and taken seriously. The Complaints record for Arundel Park should clearly identify: the date and time of the complaint; the name and contact details of the complainant; the details of the person receiving the complaint; the nature of the complaint; the action taken and date and finally the outcome - to provide a clear audit trail for all complaints / concerns received. The ongoing maintenance tasks identified to the management team during the inspection should be given priority attention to ensure the environment is maintained and homely. 2. OP8 3. OP12 4. OP15 5. OP16 6. OP16 7. OP19 Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 35 8. OP26 The laundry service should be kept under review to ensure the dignity of residents is safeguarded and an efficient service is provided. 50 of the care staff team should have obtained a National Vocational Qualification in Care at level 2 by 31st December 2005. This matter should receive priority attention to ensure compliance with National Training Targets and to ensure residents are supported by competent staff Staff should be inducted in accordance with the ‘Skills for Care’ - Common Induction Standards to ensure they are correctly inducted in accordance with National Occupational Standards and are “Safe to Leave.” All staff should complete mandatory training in Safe Working Practice topics and training specific to their job e.g. principles of care, equality and diversity, dementia training, specialised diets, complaints procedure, mental health needs, management of pain, catheter care, care plans, communication, activities etc to ensure they are trained and competent to undertake their roles. Administrative systems in the home should be further developed so that key information is easily accessible. Staff should be excluded from assisting residents to complete questionnaires and advocates, friends and / or family members should be involved in order for the survey process to remain objective and impartial. Arrangements should be made for the fire alarm system to be tested on a weekly basis at all times to safeguard the health and safety of staff, residents and visitors. 9. OP28 10. OP30 11. OP30 12. 13. OP33 OP33 14. OP38 Arundel Park DS0000059311.V358472.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Northwest Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2QY National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@csci.gsi.gov.uk Web: www.csci.org.uk
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