Inspection on 17/03/09 for Arundel Park

This inspection was carried out on 17th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arundel Park 01/04/08

Arundel Park 09/10/07

Arundel Park 15/08/06

Arundel Park 15/12/05

Arundel Park 17/05/05

Arundel Park 06/12/04

Arundel Park 28/05/04

Arundel Park 12/02/04

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 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arundel Park Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 0WN     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: Daniel Hamilton     Date: 1 8 0 3 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 34 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 34 Information about the care home Name of care home: Address: Arundel Park Sefton Park Road Sefton Park Care Village Liverpool Merseyside L8 0WN 01512917840 01517261999 arundelpark@europeanwellcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : European Wellcare Homes Ltd care home 50 Number of places (if applicable): Under 65 Over 65 50 old age, not falling within any other category Additional conditions: 0 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 care home 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 on the ground floor. There are two Care Homes for Older People Page 4 of 34 Brief description of the care home passenger lifts 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 Arundel Park and Greenheys Lodge (another home on the site). Parking facilities are available at the front of the premises. Information on Arundel Park is available in the form of a Statement of Purpose and Service User Guide, copies of which are available in the reception foyer. Fees range from 322.00 to 493.44 pounds per week for residential care and from 425.80 to 588.00 pounds per week for nursing care. Care Homes for Older People Page 5 of 34 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 quality rating for this service is one star. This means that the people who use the service experience adequate quality outcomes. This unannounced inspection took place over two days (17th and 18th March 2009). A partial tour of the premises took place and observations were made. A selection of care, staff and service records were viewed and the registered manager, residents and staff were spoken with during the visit. Survey forms were also distributed to a number of staff and residents prior to the inspection to obtain feedback about the service provided at Arundel Park. Only two surveys were received back from residents and one from a staff member. Care Homes for Older People Page 6 of 34 Reference was also made to an Annual Quality Assurance Assessment document which was completed by the manager. This document provided a framework for the manager to undertake a self-assessment and provide key information on Arundel Park prior to the inspection. All the key standards and previous requirements and recommendations from the last key inspection in April 2008 were also reviewed. Full feedback was given to the Registered Manager and the Programme Manager at the end of the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 Information on the medication needs and ethnicity of prospective residents should be obtained as part of the pre-admission assessment process. This will ensure an holistic assessment of needs and ensure equality and diversity needs are identified. Staff must record variable dosages clearly and consistently and provide an explanation for the use of unexplained codes on Medication Administration Records. This will ensure a clear audit trail and safeguard the welfare of the people using the service. Care plans should be revised to ensure they are person-centred and outline how the routine health care needs of the people using the service are to be met. This will help staff to deliver individualised care that is user focused. The programme of activities should be further developed to include more community based trips and activities. This will ensure the recreational needs and preferences of the people using the service are fully met. The daily record of meals provided for individual residents should be updated to include breakfast and desert choices to provide information on dietary intake. The Complaints record for Arundel Park should clearly identify the outcome of complaint investigations. This will help to provide evidence that complaints are appropriately investigated and the views of the people using the service are listened to and acted upon. Records of the outcomes of all safeguarding referrals should be maintained to confirm the welfare of vulnerable people has been safeguarded and to improve record keeping. 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. The laundry service should be kept under review and improved to ensure the dignity of residents is safeguarded and an efficient service is provided. Action should be taken to ensure the dates of previous employment are always recorded on application forms and gaps in employment history should always be explored and recorded as part of the recruitment process, to ensure best practice. All staff should complete mandatory training in Safe Working Practice topics and additional training specific to their role e.g. principles of care, equality and diversity, dementia training, complaints procedure, mental health needs, catheter care, care plans, communication etc to ensure they are trained and competent to undertake their roles. Action should be taken to ensure the second lift is repaired as a matter of urgency and a detailed risk assessment should be undertaken to control potential risks. All night staff should complete fire instruction refresher training at least every three months and all day staff at least every six months to ensure safe working practices. Care Homes for Older People Page 9 of 34 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 10 of 34 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 11 of 34 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. People are given information and have their needs assessed before deciding whether to move into Arundel Park. This enables prospective residents to determine whether the service is suitable and can meet their needs. Evidence: A Statement of Purpose and Service User Guide had been developed by the Registered Provider (European Care Homes Ltd) to provide key information for prospective service users on the service provided at Arundel Park. A large print version of this document had also been produced to ensure the information was more accessible. Copies of the documentation were located in the reception foyer and additional copies were available from the manager upon request. The manager reported that the document would be produced in alternative languages, subject to individual need. Residents spoken with during the inspection confirmed they had also received a Care Homes for Older People Page 12 of 34 Evidence: Service User Guide, which contained information about the facilities and procedures within the home and written confirmation that each resident had been provided with a guide had been retained in each file. The personal files 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 five years. Each file viewed contained a copy of a pre-admission assessment which contained brief information on the needs of prospective residents. Copies of letters welcoming new residents and confirming the service could meet their needs had also been retained on file. Two of the assessments viewed did not include any information on the needs of prospective residents in relation to medication and gaps in equality and diversity information were also noted. For example, it was not possible to determine the ethnic origin of the people using the service as this information was not recorded on the preadmission form. Files viewed included Admission Assessments which were used by the service to review the needs of new residents following admission to the home. A range of risk assessments had also been completed for each resident and these had been kept under regular review. The manager had been obtained copies of assessments for residents referred through care management arrangements for staff to reference. Records confirmed that each resident had been issued with a contract from the Registered Provider however two files did not contain copies of contracts from local authorities. Previous inspection records confirmed that the Programme Manager had previously undertaken an audit of all residents files in an attempt to obtain copies of outstanding contracts from local authorities. Care Homes for Older People Page 13 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and medication recording are in need of review to ensure the health and personal care needs of residents are fully promoted and safeguarded. Evidence: The Annual Quality Assurance Assessment (AQAA) for Arundel Park detailed that policies and procedures had been developed for individual planning and review and the control, storage, disposal, recording and administration of medicines. The files of five residents were viewed during the visit in order to review care planning processes. 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 five 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. A plan of care had been developed for each resident Care Homes for Older People Page 14 of 34 Evidence: 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. Care plans viewed were not person centred as plans written for other people had been used and the names changed. Furthermore, care plans lacked information on how the routine health care needs and wishes of the people using the service were to be met and three had not been signed by the individual residents or their representatives. Examples were discussed with the manager during the visit as a number of complaints had also been received since the last visit regarding the standard of care delivered. Supporting documentation including risk assessments, declaration of wishes in relation to medication, daily report sheets, personal care and weight, accident and health care records was also in place. Feedback received from residents via discussion and examination of health care records confirmed the people living in Arundel Park had access to a range of health care services. Records viewed confirmed that people had accessed general practitioners, chiropodists, opticians and dentists subject to individual need. Since the last inspection the medication policy had been updated to include information on self-administration and medication consent forms had been introduced to confirm each residents wishes in relation to the administration of medication. The manager reported that medication in Arundel Park was administered by Registered General Nurses who had undergone an assessment of competency. Capital expenditure records confirmed that medication refresher training had also been requested from the training department for all nurse trained staff. A record of staff designated with responsibility for administering medication was in place and a resident identification system had been established as noted at the previous inspection. Medication was dispensed by a local pharmacist and stored in a suitable room. Drug cabinets were bolted to the wall and records had been established to monitor the temperature in the fridge and room used to store medication. A sample of Medication Administration Records (MAR) were viewed during the inspection. Concern was noted regarding the use of codes which had been recorded on Medication Administration Records without an explanation. Furthermore, variable dosages were not recorded in a consistent manner and did not provide a clear audit trail. Other examples were brought to the attention of the manager during the visit. Care Homes for Older People Page 15 of 34 Evidence: Staff were observed to be attentive and respectful towards the needs of residents during the inspection process however a number of residents spoken with expressed concern regarding their privacy and dignity not always being upheld. Residents continued to express concern regarding the laundry service and the loss of articles of clothing. In many cases residents reported that they had received clothing and underwear which did not belong to them. Concern was also expressed by some residents regarding staff entering their rooms without knocking. Examples of the range of comments received included; Some staff burst into my room without knocking; I have lost a lot of clothes since moving here and I continue to have problems with the laundry service and have lost underwear. It should be noted that the Registered Provider had taken action to reduce the demand on the central laundry service since the last visit however further action should be taken to address outstanding concerns as a matter of priority. Care Homes for Older People Page 16 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of the people using the service have been sought in order to provide a more stimulating environment according to preference and need. Evidence: Since the last inspection a new Activity Coordinator had been employed who worked 24 hours per week over five days a week at Arundel Park. The majority of the activity coordinators time in Arundel Park was from Tuesday to Thursday as only one hours input was available to residents on a Monday and Friday. This should be reviewed. A weekly programme of activities had been developed for residents and information on daily activities had been displayed on notice boards around the home. An activities survey had also been circulated to residents or their representatives during March 2009 in order to seek the views of residents in relation to their preferred activities. The activity coordinator reported that an action plan would be developed once all the survey forms had been returned and reviewed. During the two days of the unannounced inspection a residents meeting was coordinated, a quiz organised and an entertainer visited. Examination of activity Care Homes for Older People Page 17 of 34 Evidence: records and discussion with residents confirmed they had participated in 1:1 chats, watching television, videos, DVDs, reminiscence, sing-a-longs, entertainment afternoons and other group activities. The manager reported that some residents had also participated in clothes parties, shopping trips and meals out. Residents spoken with continued to express mixed feedback regarding the range and frequency of activities provided. A number of residents spoken with requested more group entertainment and outings. This information was passed to the activity coordinator and the manager who agreed to address these concerns. Comments received from residents included; Id like to get out more; We have a new activities lady. Things are getting better but it would be nice if we could have more entertainment and Im not particularly interested in activities but they do organise things if people are interested. Representatives from two denominations continued to visit Arundel Park to provide services or meet with residents subject to their individual religious beliefs. One resident was also supported to visit a local mosque by his friends. 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. The home has two dining rooms on the ground 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. Previous inspection records confirmed that Catering Information sheets had been completed for each resident. The forms contained key information on each residents dietary needs and preferences. A copy of Halaal guidelines for a Muslim Diet had also been obtained for catering staff to reference. Tables viewed were nicely laid with condiments on each table however the dining tables and chairs were scraped and worn on the wooden bases as noted at the last inspection. The manager reported that the furniture had been re-varnished since the last inspection and that she was due to submit a capital expenditure request to obtain Care Homes for Older People Page 18 of 34 Evidence: new dining room furniture. Residents spoken with reported that they ordered their meals the day before the meal was served. Records of individual meals served were recorded however no information on the choice for breakfasts or deserts had been recorded. The manager agreed to address this matter as some residents reported that they had not always been offered a choice of meal. Feedback received from residents was generally positive. For example, comments included; The food is OK but Id like more meals with rice and chicken; The meals are generally fine. I get a choice for lunch and evening meal only and Its hard to please so many people but Im quite satisfied with the standard of catering overall. Care Homes for Older People Page 19 of 34 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. Records concerning complaints and safeguarding referrals are vague and do not always provide a clear audit trail to safeguard the welfare of the people using the service. Evidence: A Complaints Procedure had been developed by the Registered Provider (European Care Homes Ltd). A large print version of the procedure had also been produced and a copy of the procedure was included within the Statement of Purpose and displayed on notice boards within the home for people to reference. 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 eight complaints within the last 12 months, two of which had been upheld. The complaints record for Arundell Lodge was viewed. The complaints record detailed that five complaints had been received by the home since the last inspection. Three were received from relatives, one from the Royal Liverpool Hospital and one from a Care Homes for Older People Page 20 of 34 Evidence: visitor. The first complaint concerned standards of communication, the cleanliness of a residents bedroom and the general wellbeing of a resident. The second complaint was referred to the Commission and concerned the time taken to contact a general practitioner for a resident. This incident was referred to the provider to investigate. The third complaint concerned missing clothing, the standard of personal care given and a missing wheelchair cushion. The fourth complaint concerned the conduct of a member of staff whilst supporting a resident to hospital and the fifth complaint concerned a visitor to the home. One concern had also been brought to the attention of a social worker by a family and this concerned a resident wearing footwear belonging to another resident, the use of a wheelchair for which a care plan and risk assessment had not been developed and a fall whilst in Arundel Park. Advice was given to the manager on how to improve the record keeping for complaints as some records were difficult to decipher and the outcomes of four of the complaints were not clear. Similar issues were noted at the last inspection. Feedback received from residents via discussion confirmed the people using the service were generally aware of how to express their views on the service and confident to discuss issues of concern with the manager and senior staff. One person reported via a survey that they did not how to complain and some people spoken with continued to express concerns regarding meal choices and the laundry service as noted at the last visit. Please refer to the sections entitled Environment and Daily life and Social Activities for more information. 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 the protection of vulnerable adults from abuse and received refresher training periodically. The manager and staff spoken with demonstrated awareness of their duty of care, the different types of abuse and how to respond to suspicion or evidence of abuse. Records highlighted that there had been six safeguarding referrals in the last 12 months. The first referral concerned the standard of care provided to a resident which Care Homes for Older People Page 21 of 34 Evidence: resulted in a resident falling from bed and sustaining a fracture. The second referral concerned the care of a former resident who fell from a wheelchair during a period of respite care. The third referral concerned an allegation of sexual abuse by a former employee. This allegation was unfounded. The fourth referral concerned the loss of money from a residents purse. The fifth referral concerned a resident who claimed he had been left in a bathroom for over half an hour. Records detail that the resident retracted this allegation. The final referral concerned the inappropriate behaviour of a resident towards another resident. The outcome of four of the referral investigations was not known at the time of the inspection. Care Homes for Older People Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment continues to receive investment however some parts of the home and the laundry service remain in need of attention to ensure the comfort and dignity of the people using the service is not compromised. Evidence: Arundel Park had access to a full-time maintenance man who worked between two registered services owned by the Registered Provider (European Care Homes Ltd). A full-time decorator was also employed who worked between 5 registered services. Contractors were hired for major and specialised work as and when required. Since the last visit a new facilities management team had been established and a maintenance and renewals schedule had been developed for 2009. The schedule included information on re-decoration and was updated monthly. A maintenance book had also been established for staff to record work in need of attention. Records showed that approximately half of the windows at Arundel Park had been replaced with UPVC frames and the manager reported that she had applied to replace the outstanding units during 2009 to 2010. New sheets and valances had also been purchased. Care Homes for Older People Page 23 of 34 Evidence: A capital expenditure request for new dining room furniture and lounge chairs, 22 profiling beds, garden landscaping and new carpets and furniture for some bedrooms was in the process of being applied for. 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. One bathroom viewed was full of clutter and another was in need of cleaning. Action was taken to address these issues during the visit. Examples of minor maintenance were also brought to the attention of the manager during the visit. For example, a tap in a toilet used by visitors was leaking, a shower mixer connection was missing in a bathroom and some lounge and dining room furniture was scraped and worn on the legs. Similar issues were noted at the previous inspection. Residents spoken with confirmed they continued to have access to all areas of the home and were enabled to maximise their independence via a range of specialised equipment and relevant aids. Residents also reported that 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. (Please refer to the Brief Description of the Service section for more information on the premises). The manager reported that the on-site laundry had only been providing a centralised service for residents living at Arundel Park and Greenheyes since July 2008, following concerns and complaints from residents regarding the efficiency of the laundry service. The Annual Quality Assurance Assessment (AQAA) detailed that staff had access to a policy on communicable diseases and infection control. The training matrix for the service detailed that 19 staff had completed infection control training. The laundry appeared well organised on the day of the inspection however a number of residents reported ongoing concerns regarding the laundry service. Comments included; Ive had problems with the laundry service and keep getting the wrong underpants; Sometimes I end up with mens trunks in my drawers and I have lost over 30 pieces of clothing and Ive noticed no real improvement. These and other concerns were brough to the attention of the manager during the inspection. Care Homes for Older People Page 24 of 34 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. Systems for the induction and training of staff at Arundel Park are improving however outstanding gaps in core training may affect the ability of care staff to meet residents care needs fully. Evidence: At the time of the inspection 48 people were living at Arundel Park. Examination of rotas and discussion with the manager and staff confirmed there were 8 care staff and two registered general nurses on duty in the mornings and 6 care staff and one registered general nurse on duty in the afternoons. During the night the home was staffed with 4 care staff and a registered general nurse. Ancillary staff were also employed for catering, cleaning and maintenance duties and a float team was in place to cover staff sickness and annual leave. Since the last visit arrangements had been made by the Registered Provider (European Care Homes Ltd) for an administrator to be based on site. The manager reported that the administration systems in the home had improved and records were accessible throughout the inspection. Previous inspection records confirmed that the management team had established systems to monitor the dependency and occupancy levels of residents, in order to Care Homes for Older People Page 25 of 34 Evidence: ensure staffing levels reflected the changing needs of the people using the service at all times of the day and night. Residents spoken with during the visit confirmed the people living in the home were generally happy with the care provided by staff. Comments included; The staff are generally fine with me; The staff are good and The carers are OK. Some concerns were expressed regarding privacy and dignity and these are highlighted under the section Health and Personal Care. Only two surveys were received from residents prior to the inspection. One person reported that it was sometimes difficult to get assistance from staff during staff break times and another reported that staff were only available sometimes. Staff spoken with reported that staffing levels were generally being maintained however one employee expressed concern regarding the staffing arrangements for the afternoon and was of the opinion this should be reviewed. This information was relayed to the manager for action. The Registered Provider had developed a Recruitment, Selection and Appointment policy. The Manager reported that 10 new staff had commenced employment at the Arundel Park since the last inspection and the personnel files of the ten employees were viewed during the visit. Overall, each file viewed contained the necessary records required under the Care Home Regulations 2001. The manager was advised to always check that the dates of previous employment were always recorded on application forms and to explore and record gaps in employment history, as three records viewed did not provide a clear audit trail. It was also noted that one employee had commenced employment prior to the receipt of two written references and one application form had been mislaid. The Registered Manager reported that the Registered Provider had established a training department in February 2009, that was responsible for commissioning or delivering training for all employees. Feedback received from staff via discussion and surveys confirmed training opportunities were improving. The manager reported that the home employed 15 care staff to work day shifts and 10 care staff to work night shifts. The Annual Quality Assurance Assessment (AQAA) for the service detailed that 15 staff (60 ) had a National Vocational Qualification (NVQ) in Care at level 2 or above and that a further 3 staff (12 ) were working towards the award. Once the outstanding staff have completed their awards, 18 (72 ) of the non-nursing staff will be qualified Care Homes for Older People Page 26 of 34 Evidence: to NVQ level 2 or above. Staff files viewed provided evidence of in-house induction checklists. Arrangements had also been made for staff to undertake induction training that was compliant with the Skills for Care Common Induction standards via Social Care Information and Learning Services (SKILS). The manager was advised to ensure that all staff complete this training within the first 12 weeks of their employment, as this timescale had been exceeded for two employees. Training files were in place at Arundel Park, which contained a record of the training completed by staff, together with documentary evidence. A training and development programme had also been developed together with a training matrix which provided information on which staff had completed Induction, Fire Safety, First Aid, Moving and Handling, Health and Safety, Food Hygiene, Protection of Vulnerable Adults, Infection Control and National Vocational Qualification training. The manager was recommended to also include information on role specific training to assist in monitoring the outstanding training needs of staff. Although significant progress had been made in supporting staff to complete a range of mandatory and role specific training, some gaps were still evident. The manager demonstrated a commitment to ensuring all staff completed the full range of training and development opportunities available and provided evidence of recent capital expenditure and e-mail requests for a range of core training. Care Homes for Older People Page 27 of 34 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 management and delivery of person centred care remains in need of further development, to ensure positive outcomes for the people using the service. Evidence: Ms Janet Green (Manager) had managed Arundel Park since December 2002 and was registered with the Commission for Social Care Inspection. Previous inspection records confirmed that Ms Green had completed the National Vocational Qualification Registered Managers Award and examination of Nursing and Midwifery Council records confirmed Ms Green was a qualified Registered General Nurse with live registration. The Registered Provider (European Care Homes Ltd) did not commission an external consultant to undertake a quality assurance assessment for Arundel Park. Detailed records were in place which confirmed the Programme Manager continued to Care Homes for Older People Page 28 of 34 Evidence: undertake monthly visits to monitor standards of service and review progress in accordance with Regulation 26 of the Care Home Regulations 2001. Since the last visit the Registered Provider had introduced a new self-assessment quality assurance system based upon the Care Homes for Older People National Minimum Standards. The Annual Quality Assurance Assessment (AQAA) for the service detailed that bi-annual satisfaction surveys were undertaken and a summary of the results for the period September to November 2008 was also available for residents to reference. Some concerns highlighted by the people using the service were also identified during the inspection process and these should be addressed as a matter of priority. The manager reported that a quality assurance plan had been produced in order to respond to significant findings and to aid the ongoing development of the service. A three-year business plan was also available for reference dated 12/05/08 and records of meetings with residents and staff had been retained. Residents and staff spoken with during the visit confirmed the manager was approachable and supportive and staff reported they had received supervisions from the manager. Prior to the inspection the manager completed an AQAA for the Commission for Social Care Inspection in order to provide general information and statistical data on the service. Overall, most sections of the AQAA were completed to a satisfactory standard and the information received provided a reasonable picture of the service. Records confirmed that appropriate action had also been taken since the last visit to ensure notifiable incidents were reported to the Commission for Social Care Inspection in accordance with Regulation 37 of the Care Home Regulations 2001. 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 or were unable to manage their own financial affairs. At the time of the inspection the manager looked after the personal spending money for 31 residents and records of expenditure together with receipts had been retained and cash balances were not pooled. The manager was advised to obtain individual receipts for expenditure as there were instances where one receipt had been issued for a number of residents. Discussion with the manager and examination of the AQAA and the Statement of Purpose for Arundel Park confirmed there had been no changes regarding the arrangements in place for the management of residents finances. (Please refer to the Statement of Purpose for detailed information on this subject). Care Homes for Older People Page 29 of 34 Evidence: Examination of records confirmed systems were in place to ensure interest accrued from residents personal monies was apportioned on a monthly basis per resident, dependent upon their individual balances. Statements for each residents pocket money were received from the Registered Providers head office on a monthly basis for each resident and stored in individual files. The Annual Quality Assurance Assessment for the service detailed that Health and Safety policies and procedures were in place and that equipment within Arundel Park had been serviced and maintained. A selection of service certificates were randomly sampled during the visit. These included hoisting equipment, analysis of water quality, waste transfer, portable appliance testing and the passenger lifts. It was noted that one of the passenger lifts had been out of order for a pro-longed period of time due difficulties in sourcing parts. Some residents with mobility difficulties expressed concern regarding the lift being out of order as noted in the results of the Satisfaction Survey for the period September to November 2008. Fire records were also checked during the visit. Service or test certificates for the alarm system, emergency lighting and extinguishers were found to be up-to-date and examination of records confirmed that weekly tests of the fire alarm system and monthly tests of the emergency lights had been undertaken. It was noted that although fire instruction training was organised routinely, some staff had not received the training in accordance with the recommended timescales. Risk assessments had been completed to address environmental risks and health and safety audits were undertaken periodically by the maintenance man and manager to monitor the equipment and environment. Training records showed that progress was being made to ensure all staff completed safe working practice training however some staff had not completed training in all mandatory topics at the time the inspection was undertaken. Care Homes for Older People Page 30 of 34 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 31 of 34 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 9 13 Staff must record variable dosages and provide an explanation for the use of unexplained codes on Medication Administration Records. This will ensure a clear audit trail and safeguatd the welfare of the people using the service. 18/04/2009 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 3 Information on the medication needs and ethnicity of prospective residents should be obtained as part of the preadmission assessment process. This will ensure an holistic assessment of needs and ensure equality and diversity needs are identified. Care plans should be revised to ensure they are personcentred and outline how the routine health care needs of the people using the service are to be met. This will help staff to deliver individualised care that is user focussed. Action should be taken to further improve the laundry Page 32 of 34 2 7 3 10 Care Homes for Older People service in order to ensure the privacy and dignity of residents is maintained. 4 12 The programme of activities should be further developed to include more community based trips and activities. This will ensure the recreational needs and preferences of the people using the service are fully met. The daily record of meals provided for individual residents should be updated to include breakfast and desert choices to provide information on dietary intake. The Complaints record for Arundel Park should clearly identify the outcome of complaint investigations. This will help to provide evidence that complaints are appropriately investigated and the views of the people using the service are listened to and acted upon. Records of the outcomes of all safeguarding referrals should be maintained to confirm the welfare of vulnerable people has been safeguarded and to improve record keeping. 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. The laundry service should be kept under review to ensure the dignity of residents is safeguarded and an efficient service is provided. Action should be taken to ensure the second lift is repaired as a matter of urgency and a detailed risk assessment should be undertaken to control potential risks. All night staff should complete fire instruction refresher training at least every three months and all day staff at least every six months to ensure safe working practices. 5 15 6 16 7 18 8 19 9 26 10 38 11 38 Care Homes for Older People Page 33 of 34 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. 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