Inspection on 09/10/07 for Arundel Park

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arundel Park 17/03/09

Arundel Park 01/04/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arundel Park Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 0WN Lead Inspector Miss Diane Sharrock Key Unannounced Inspection 10:00 9 /10th October 2007 th 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.V353077.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.V353077.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.V353077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 50 Nursing for older people Date of last inspection 10th November 2006 Brief Description of the Service: Arundel Park Care Home is part of the Sefton Care village complex situated 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. It 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. Arundle Park is situate in the middle of 2 other homes. 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 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. The staff have provided the minimum and maximum levels of fees for the home, stating from £447.56 per week up to £534.19 per week. Arundel Park DS0000059311.V353077.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 two days. During this time discussions took place with six of the people living there and six members of staff. Prior to the site visit comment cards were sent out to some of the people living there, their relatives and staff. Four of the people living there and four of the staff returned these and their views were taken into account in compiling this report. A selection of comment cards were also left at Arundel Park to offer people further opportunity to give their opinions. The manager was given the opportunity to contribute to the inspection process by completing a questionnaire about the service provided, prior to the site visit. We completed the site visit by looking at a selection of records and undertaking a tour of the building. Feedback was given to the manager at the end of the site visit. What the service does well: What has improved since the last inspection? During discussions some staff explained that they were generally happy and loyal to the company and felt it was a good place to work Staff comments included, “In my eyes there are no problems to me with the service its enjoyable working in this care home.” “Training is an ongoing thing and we are always encouraged to take up training programmes which are always on the notice board.” Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 6 Resident’s views in their comment cards were mixed with two residents saying that staff were “usually” available when needed, and two said that activities were “sometimes “ provided. One resident explained that, the staff are “….ok……” whilst another said, “it’s the best thing I did coming here, the staff are lovely….” What they could do better: Full feedback was given to the manager and regional manager during and on conclusion of this inspection. Some areas were noted to need action taken to improve facilities and services for the people living there. Due to areas of concerns and continued repeated requirements made the company will be asked to provide an improvement plan to explain what actions they will be taking to improve the standards at the home. Information about how residents’ money is managed needs to be clearer and accurate and the use of a pooled company account to store residents money in must stop. Everyone living at Arundel Park should have a contract with the service and a copy of the terms and conditions for living there. This will help to ensure residents’ money is managed safely and in their best interests. Continued use of organised audits and management tools will help to show consistent evidence in how the home is being managed to meet the needs and choices of the people living there and ensure they are supported safely. Care practices within the service should be reviewed to ensure that resident’s privacy and dignity, rights and choice are promoted at all times. The complaints procedure and management of residents comments must be reviewed and improved so that evidence is in place to show their concerns are valued and appropriately looked into to provide a better service. Consistent and continued meetings should ensure that staff members and residents and representatives have a regular forum to discuss issues that may affect their home and the service provided. The CSCI should be notified in writing as soon as there are any adverse incidents as detailed in the care home regulations, so the commission can be kept up to date of any actions occurring at the home. When staff start work at Arundel Park thy should have a full induction to the home that provide them with the information they need to support people safely and meet their needs and choices. Training for all staff should be planned and delivered in areas of basic care practices, abuse awareness and more specialist areas such as supporting Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 7 people with catheter care, and with their mental health. This will help to ensure staff have the skills to support people safely and in line with current good practices. Staffing levels should be kept under review in order to make sure that there are enough staff to meet the needs of the residents. These reviews should take into account staff and resident’s opinions and experiences. A review of staffing levels and resources invested currently into management hours, activities, maintenance and laundry personnel should be reviewed to achieve better outcomes in these areas. Work should continue in developing some areas of the environment to ensure that the people living there have a comfortable and homely place to live. The views of the people, who live there regarding improvements they would like to see, should be obtained. All hazards and risks within the environment or for the people living there must have updated risks assessments in place to say what actions will be taken to eliminate risks at the home. This will help to ensure the safety of the people living there and the building. This must include, eg. Wide opening of windows on top floor, frayed carpets, broken radiator guards, inappropriate armchairs, bedroom doors left open. Procedures must be clear in what actions to take to reduce risks and appropriate resources must be in place to eliminate any identified risks Activities must be developed so they can meet all of the resident’s social needs and steps should be taken in respecting resident’s opinions and including them in the developments of their home. The statement of purpose must be updated and accurate and easily available to everyone at the home to keep them informed and updated regarding services available. 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.V353077.R01.S.doc Version 5.2 Page 8 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.V353077.R01.S.doc Version 5.2 Page 9 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 & 3 and standard 6 is not applicable. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s needs are not always assessed before they move into the home. Therefore staff cannot accurately make sure that the service provided can meet that person’s needs and choices. EVIDENCE: The homes statement of purpose was located in the manager’s office and not easily accessible to everyone. This document did give details as to how residents could organise and have their own phones and sky TV in their bedrooms at their own expense. It also gave good practice advice on trial visits being encouraged before any new residents chose to come and stay at the home. An example of good practice showed that they also had a large print version of this document to make it easier for some people to understand. We found this document to have information regarding the management of finances to be incorrect. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 10 It did not have the actual fees charged for the home. It gave inaccurate information about how the company manage their personal allowance account as staff explained they no longer pay the interest from resident’s monies into a residents social fund account. Staff explained that this account was closed last year. The address for the Commission for Social Care Inspection office wasn’t accurate and needed to be updated in case anyone wanted to contact us. Residents need updated information so that they can make decisions about the home and make informed choices especially prior to moving in. Each bedroom we saw had a copy of the, “service user guide” which was easily accessible and available to residents at the home within the privacy of their own bedroom. This provided them with information about facilities and procedures within the home. We looked at six care plans during this visit and two included recently admitted residents to the home. Care plans had some pre admission assessments in their file. We reviewed one residents record which showed a partially completed assessment carried out by staff prior to their admission whilst another had not been completed at all. If these documents had been completed they would have helped the staff to assess if they could meet the residents needs. There was not enough information or detail for staff to show they could support the residents with their needs. This document also showed that they were not always admitting residents correctly within the homes current registered categories of older people. Some care records showed that a resident was admitted outside the category of registration for the home and showed that their needs were not always being met. The company’s assessment records are detailed and if used correctly by staff should be able to evidence whether they can successfully support the person. In discussions residents said that they are generally happy living there. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 11 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): 7/8/9/10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s staff did not always show they were adequately managing residents health and personal care needs. EVIDENCE: The company have produced various records that if used correctly should identify and address peoples individual support needs and choices and show an overall assessment and plan of care necessary for all residents supported at the home. However some of the care records we saw for residents hadn’t always been completed in full nor were they able to show they were meeting the residents, health, personal and social needs. Six care plans were reviewed as part of the site visit. Some plans were completed in parts and staff tried to personalise them and included the resident’s choices and involved them in the review of their care plan. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 12 Some plans didn’t give enough information to show how staff would support the persons social care and personal care. Assessments covering social support were very basic with little detail regarding how the person would be supported. Records also gave little information as to when residents were supported with bathing. One care plan that we looked at gave no details regarding residents nursing needs with their pain relief and could not show that it was being managed appropriately. One residents care plan had a financial risk assessment in place but it hadn’t been filled in. One care file had a risk assessment in place for the person’s bedroom door to be left open. However there was no evidence from the company to show whether they were offering enough protection to other people, as they were allowing residents to keep doors open that are not linked to any type of fire system and potentially putting other people at risk. The company had developed body charts to help staff support residents with any type of injury sustained. One care plan had a blank chart and it was noted that staff had not used this chart, which could lead to issues not being fully noted and addressed as this person had been identified at risk of having skin suscepiable of marking. Most staff appeared to have a good rapport with residents, helping and supporting them throughout the day. We saw two staff patiently reassuring one person who was confused and unsettled throughout the day. One resident explained that, the staff are “….ok……, ” another said, “it’s the best thing I did coming here, the staff are lovely….” Two residents felt they had to get up and go to bed when the staff say so. They didn’t feel they could choose the times they wanted. Most of the residents that we saw and met during this visit were noted to be appropriately dressed and well presented. One person explained that she goes to the hairdresser each week. The staff arrange for the hairdresser to call in weekly and she was in the home during our visit. However some interactions and observations of some staff were discussed with the manager, as they did not show good practice in respecting the resident’s rights, privacy and dignity. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 13 For example two residents were seen with food over their clothes late in the afternoon and care had not been taken by staff to change their clothes to assist them in their dignity and pride of wearing suitably clean clothes. One resident had a catheter bag lying on the floor with no thought to this person’s dignity and showed a potential infection control issue. Some of the residents were seen sat in static armchairs and their feet did not reach the floor, nor where they supported whilst sat in these chairs. One staff member explained that they do not use footstools for one of these residents and didn’t seem to understand why it was important to have the right equipment to safely support residents in a comfortable position. Continued use of not providing appropriate support could lead to discomfort for the resident and potential problems with their limbs. Some staff seemed comfortable in communicating with residents however other staff sat on their own and didn’t interact or take the opportunity to chat with the residents. A sample of medications, records and storage of medicines were looked at. The management of medications appeared tidy and organised showing a wellmanaged area. Staff explained that they try to carry out regular audits and checks on medications to help maintain good practice. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 14 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): 12/13/14/15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home did not always provide adequate support to residents to meet their social needs and requests. EVIDENCE: Arundel Park has an activities organiser who is also a carer at the home and is employed for 12 hours a week to arrange an activities programme. The activities programme was seen displayed in the reception area for each week but no details were given for each day of what event was planned. During day one, no activities were in place as staff explained that due to sickness the activities organiser had to go as an escort with one resident to the hospital. The plan advertised was not accurate and didn’t reflect what was offered during this visit. One activity file seen, showed very limited information for activities being provided for the month of October 07. Every resident’s records had an entry for the 9th October, day one of our visit in which we observed no activities. The record stated that most people had a chat on that day, 9/10/07. There were no other records of activity for October 07. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 15 September records showed just 8 written entries on resident’s files, again the majority of most entries described that they had had a chat. Staff generally did not feel it was part of their role to organise activities and felt they had no time during their role as carers to organise activities. Some comments from residents explained that, “…There’s not much activities going on sometimes an entertainer comes in…” “…There’s not much activities anymore but a long time ago they used to have quite a bit.” A residents meeting dated 28th May 07 recorded residents stated they didn’t like the food, they felt it wasn’t always cooked very well, and clothes were going missing in the laundry. Residents asked for trips out and also asked the question, “When are we getting a minibus.” Another residents meeting dated 28th July 07 discussed comments and complaints about the food. A staff member advised residents to speak to the chef individually…….” . There was no evidence to show what staff had done to support residents in their continued concerns to improve the quality of meals and activities provided. There was little evidence to show how the company were meeting the resident’s social needs. A lack of investment into resources and no plans to improve these areas highlight concerns around the companies’ ability to satisfy resident’s needs and requests and value their opinions and comments. The staff generally felt the ongoing concerns and complaints raised by the residents covered the laundry with clothes continually going missing and the complaints about food being of poor quality at times, being cold and menus being changed without them knowing at very short notice. The home has 2 dining rooms on each floor. The dining tables had menus displayed on each table, which were easily accessible to all residents and staff had also made large print menus. The tables were nicely laid with condiments on each table however the curtains were hanging off the curtain track, and various tables and chairs were scraped and worn on the wooden bases, which affected the overall standard in these areas regarding the presentation of the dining rooms. Some comments from residents explained that, the food was “ok”, but there was no choice for meals and if they didn’t like certain things then they would just not have anything as their family brought food in. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 16 One person explained that they had breakfast mostly served at 9 am then staff call with lunch at 12 noon but they felt this was too soon and they were never feeling hungry at this time. “the food is ok…..mostly warm….” “….the food is awful …” they explained they had previously told people but they felt it didn’t make any difference…”. Resident comment cards were sent to us, one suggested improvements were needed to the food, “the cooking could be better and the bread and sandwiches are not very nice at all and also I would like more fresh fruit and vegetables and meat and fresh turkey for Christmas dinner.” One staff comment card suggested, “The service could do better by having its own kitchen ……… and the time could go into making the meals nicer and prepared better instead of the food being cold or half cooked and no love put into the food.” There was no evidence of any recent discussion or choices explored with residents regarding the planning and review of meals or input to the development of menus to meet their needs. The only minuted resident meetings seen were for May and July 07, no further meetings were seen following questions and concerns raised at those meetings. The Cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals and has worked at the home for over 5 years. The kitchen area was clean and tidy, well organised and well stocked with food, especially a large stock of dry stores. Staff explained that the catering staff were all up to date with basic food hygiene however they said they would like specialised training on “special diets”. There were no menus plans for any specialised diets eg low fat diets, Muslim diets or, high protein meals or details about residents likes and dislikes in food. The kitchen staff and senior management were aware of various discontents with resident’s opinions about the food over the last 6 months. Most residents and staff described ongoing problems and discontent with the quality of food served. Discussion took place with staff during my visit regarding any changes in the routines of the kitchen over the last 6 months. It was openly acknowledged that they had changed a lot of supplies of foods to cheaper brands and the bread had changed from one popular brand to an unpopular make that residents did not like. Oven chips had been served to residents as the deep fat fryer had been brokne for over 2 months and staff were unsure when it would be fixed or replaced. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 17 The changes to the food supply and poor management of arranging repairs to necessary equipment have resulted in continued poor outcomes for residents who have repeatedly complained about their meals. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 18 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): 16/18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems are not always robust enough to ensure the safety and protection of residents. EVIDENCE: Residents who chatted to us said they were generally happy and “ok” One person said she, “…likes the carer” and would always tell her things especially if she was “unhappy about something.” The home have a complaints procedure that is accessible for residents which states the length of time the company will take to respond to complaints. A copy of the complaints procedure is also available in the homes statement of purpose. This policy was noted to be in need of updating and the address of the Commission for Social Care Inspection needed to be up to date as the statement of purpose still had reference to an old address in Liverpool. The commission are now situated in Crosby at Burlington House. The pre inspection questionnaire completed by the manager, gave details of some complaints over the past 12 months and the homes complaints records were seen during this inspection. Not all of these records or complaints were seen during this visit and the manager acknowledged that she did not have records or outcomes for any recent and previous adult protection investigations. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 19 There were repeated complaints from residents and staff regarding the laundry and meals and yet there was no evidence to show that these concerns were taken seriously or valued enough to give improvements and better outcomes to the residents. One person suggested, “they could deal with service users complaints or concerns better ……………….” The company have developed good records in the use of body mapping which can be useful in helping staff identify unexplained injuries. However some records showed this hadn’t been implemented by staff. Which could lead to issues not being fully noted and addressed. In reviewing staff training records, some staff had not attended various basic training including abuse awareness training, which is necessary to make sure everyone is aware of how to keep residents safe. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 20 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. Residents are offered an adequate standard to their environment. EVIDENCE: Arundel Park offers a friendly environment and all the staff were welcoming during our unannounced visit to the home. We looked at various areas throughout the home during this visit. A sample of bedrooms seen showed personalised rooms with various personal belongings. This helps residents feel more at home and to maintain links with their previous lifestyle. One resident said she had a lock for her door and that she likes her bedroom especially having her own en-suite. However the curtains and bedding within the home were noted to be old, worn and faded, which spoiled the overall effect of the décor achieved in these areas. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 21 One person stated, “ I would love to see an update on bedding I feel at the moment what we have is clean but very washed out.” All corridors looked bright attractive and pleasant, however some parts had wallpaper peeling in parts and scrapes seen to skirting boards, door frames and walls. A radiator guard was loose on a corridor wall. The carpet between one corridor and one door was frayed and offered a potential trip hazard. The outside window frames had signs of wood falling and flaking from the frames. There was no evidence to show when they would be replaced. No risk assessments were seen to say what actions were being taken to eliminate any of these potential risks. Some windows were observed to have metal fixed restrictors, however we noted that the windows opened right out and were much wider than the health and safety recommendations. The manager made arrangements immediately during this visit with the maintenance person to review all windows and take action to make them safe and started to put in new window restrictors. One member of staff comment stated, “I feel the overall security of the home isn’t very good ie broken window locks, windows not closing properly, and poorly lit back garden…. these factors make me feel unsafe they also make me feel concerned for the safety and well being of the service users.” General discussion with staff identified that some had worked at the home for many years and discussed how they felt about the home. They said they needed another hoist as they only have one manual host for 50 residents. Staff felt they needed another 2 hoists to safely meet the needs of the residents The large communal lounge on the ground floor had a worn stained carpet, the manager explained she had already obtained quotes to replace this. This room had a large amount of old, upright armchairs some worn and faded with scrapes to the wooden frames. The side tables next to each resident were old worn stained and scraped. The staff hoped to get them replaced but they had no evidence of when they were to be replaced. Some of the smaller quieter lounges were clean tidy and nicely decorated but not really used much by the residents during the site visit These points showed that some areas still need further improvement to give an overall better standard of living to the resident’s home. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 22 The manager explained that every 6 months they have access to a decorator, to carry out decoration in the home for a month. This home did not have any type of redecoration, maintenance or refurbishment programme. There was no evidence of what was planned or any information able to be shared with residents to let them know, when or if their room was to be decorated. The laundry room was seen during this visit. The laundry area was very busy at 4pm. Just one staff member was working in this very busy environment because they had been asked that afternoon to do the laundry due to staff sickness. It was noted the laundry had 3 sections for the laundry of each home, however there was a large amount of laundry to get through. Staff explained they only usually have 2 staff in the laundry each day to carry out laundry for 123 residents across the 3 homes on this site. Staffing levels and the management of staff cover could offer a possible reason why laundry continually goes missing on a regular basis and generates continued complaints from both staff and residents. The homes pre inspection questionnaire gave details of all maintenance checks Carried out. A sample of these were seen during this visit and most were up to date and showed that parts of the home are safely maintained. Health and safety checks around the home showed evidence of weekly inhouse checks on fire alarm system, emergency lighting, bed rail, bed and bath checks and hot water checks done by the maintenance person. They also had a maintenance book were all staff could record a repair noted to need attention. Repairs are then reviewed and done by the maintenance person who on average only gets to work at Arundel Park for approximately 12 hours per week. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 23 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): 27/28/29/30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are not always adequately met by all the staff team. EVIDENCE: One staff member explained that they were happy at the home and tried to do their best, they explained that they loved working with the residents and felt the only issues were the complaints about the food and the laundry. One person stated, “in my eyes there are no problems to me with the service its enjoyable working in this care home.” Four staff comment cards, said staff “ sometimes” felt positive about their employment at the home. One staff member felt, “Training is an ongoing thing and we are always encourage to take up training programmes which are always on the notice board.” Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 24 During our visit, it was acknowledged that approximately 6 comments cards had been given in to the office by staff so they could be sent to the commission with their opinions about the home. The manager was advised that the commission had not received these comment cards so further blank cards were given out to staff/ manager with freepost envelopes so they could freely send them in to CSCI following visit. Case tracking of six staff files took place and these files showed good recruitment procedures, which helps to safeguard residents at the home. However these staff files showed limited information in showing evidence of updates to training or detailed induction training for recently employed staff. Some staff records showed they had not yet received abuse awareness training or regular supervisions, which are necessary to help support staff in their role and help them to protect and support residents. Staff training file enclosed details of some certificates for training. However most of those seen showed out of date records, some with no evidence of any training for staff for 07 and since 05 for another staff member. Individual training records had not been updated and there was no training development programme for the home. Which would help develop training necessary for all staff and help to keep them updated in all basic and specialist training that would ensure thy can support residents safely and meet their individual needs. A residents meeting dated 28th July and chaired by staff at the home, discussed comments by residents who wanted to know, “why they were always down on staff numbers….” The staff response was brief and said, that they are trying their best. There was no evidence of any further response or reassurance to resident’s views on staffing at the home. Two resident comment cards said that staff were “usually” available when needed. One staff comment card said that staff were “usually” available, two said “sometimes” available and one said “always” available. During day one of this visit it was noted there was a staff absence due to sickness and they did not get a replacement so they arranged for the activity organiser to go to the hospital to assist a resident, which resulted in no activities taking place that day. The laundry staff also had staff absence due to sickness, which resulted in lower numbers of hours provided in the laundry to try and carryout a large amount of outstanding laundry late in the afternoon. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 25 There was no evidence of a regular review of staffing levels and whether they can meet the resident’s needs, and there was no evidence of any review of staffing hours for activities, maintenance, and laundry and whether they were suitable for the needs within the home. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 26 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): 31/33/35/38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not always consistently well managed or run in the best interests of residents. EVIDENCE: The manager works as part of the care team for all but eighteen hours a week. These eighteen hours are set-aside for her to carry out managerial duties. However as there are fifty people living at Arundel Park, this may not be sufficient to manage the home efficiently. Previously the home had a manager whose full time hours were designated for managerial duties. During this visit we were able to see how the manager offers an open door policy and makes herself accessible to everyone. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 27 When we reviewed care records we also noticed that some areas of risk and investigations carried out by the local authority for adult protection had not been reported to our offices. These reports are mandatory and are called regulation 37 reports, which helps the company keep the commission informed or all adverse incidents that may occur at the home. The manager had organised various quality assurance systems as per company protocols. Some were consistently completed but some were not. For example the accident recording had not been reviewed since July 07, which could lead to an increase in accident or patterns of accidents not being noted or acted upon. Various audits were also seen, some covered medications, which showed regular checks on the storage and management of medications. This helps to ensure medication is managed safely and any issues can be quickly noted and addressed. Despite these audits being in place it has to be pointed out that various health and safety risks noticed during the inspection had not been identified by the staff. There was no evidence to show what plans were in place to make the home safer and well maintained at all times. (as detailed in the environment section of this report The Manager had not continued with regular consistent staff or resident meetings. However minutes were seen of the most recent meetings, which covered various topics in the home. Although some notes were very brief with quite small agendas for discussion. There were some records that showed that residents and representatives did not always have a regular effective forum to discuss issues that may affect their home and the service provided to residents. A review of resident finances with the finance administrators based at the main office took place during this visit. We looked at bank statements for the company-pooled accounts used to store and manage resident’s personal allowances. Staff explained that they stored all residents’ monies in these accounts for all of the homes owned by the company, with the administrators operating individual statements on their own computers, which helped divide the residents monies. Another company-pooled bank account was seen. Staff explained that resident’s money was transferred over to this high interest account when they got up to £200 pounds in their company account. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 28 A further account was also used for the fees to be paid into and they stated that personal allowances were only paid into the pooled account on a monthly basis. This meant that residents personal allowance monies was stored in the company account for a month after payment from the authorities before it was transferred over to the company pooled account. The homes statement of purpose advertised that when resident monies got to £1000 then it was transferred into a high interest account. Arundle Park’s statement of purpose advertised that interest on money managed on behalf of residents, was transferred into a resident social fund account. The administrators explained that this social fund account had been disbanded last year and that there was no money to distribute as they felt it was usually in the negative balance. Staff described different procedures for managing residents finances to what was advertised in the homes statement of purpose. This concern highlighted that inaccurate information was stored in a legal document, the statement of purpose and that the current management of residents monies was not appropriate and in line with best practice. The practice of storing residents monies in company accounts means that their money may not be safe. The maintenance person carries out regular health and safety check on the home and tries to ensure that equipment such as wheelchairs and bedrails are functioning correctly. There was no evidence to show that the broken deep fat fryer was to be replaced. Staff acknowledge that he is only able to get to the home approximately 12 hours a week as he works within other homes and is limited to the time he is able to spend at Arundel Park. The company have various procedures in place to show how the home is being managed, a sample of maintenance certificates showed what actions were mainly taken to ensure the safety of everyone at the home. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 29 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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 2 Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 30 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)2) Requirement People should not be admitted to the home until a full assessment of their needs has been carried out Residents must not be admitted to the home if they are not within the homes registered category. This will ensure that the service can meet all of the persons support needs. (This is a repeated requirement following the 2/7/07 random visit.) 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. (This is a repeated requirement following the 2/7/07 random visit.) All people living in the home should be safeguarded from harm. Staff should be trained DS0000059311.V353077.R01.S.doc Timescale for action 29/11/07 2. OP7 15 1)2) 29/11/07 3. OP18 13 6) 29/11/07 Arundel Park Version 5.2 Page 31 and have full understanding of abuse awareness policies and practices to ensure that all people living in the home are safe and well cared for. (This is a repeated requirement following the 2/7/07 random visit.) 4. OP22 23 1)2)n Residents must be provided with 29/11/07 any necessary equipment once they are admitted to the home. It is the companies’ responsibility to make sure residents are supplied with suitable comfortable armchairs which safely support them. Any necessary lifting equipment must be in place to help the safety of moving and handling of residents. Staff should receive training to ensure that they fulfil the aims of the home and meet the current and changing needs of people who reside at the home. 29/11/07 5. OP30 18 1)2) 6 OP38 13 4)a b c 7 OP31 37 1)2) (This is a repeated requirement following the 2/7/07 random visit.) 29/11/07 All hazards and risks must have updated risks assessments in place to say what actions will be taken to eliminate risks at the home. Risk assessments must be in place for all highlighted risks seen during this visit, eg. Wide opening of windows on top floor, frayed carpets, broken radiator guards, inappropriate armchairs, bedroom doors left open. Regulation 37 reports must be 29/11/07 sent to the commission Social Care Inspection as soon as there are any adverse incidents as detailed in the care home regulations, so they can be kept DS0000059311.V353077.R01.S.doc Version 5.2 Page 32 Arundel Park up to date of any incidents occurring at the home. 8 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. 29/12/07 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 OP1 Good Practice Recommendations The statement of purpose should be developed further to include accurate services offered at the home including. Fees, the management of finances and updates to the Commission for Social Care Inspection address. Residents must have contracts/terms and conditions in place so their placement at the home is clear in what to expect. 2 OP10 To review care practices and audit current standards so that residents privacy and dignity is promoted at all times, including the provision of clean clothes after meal times, To look at general routines in the home and ensure practices are promoted in giving residents as much choice as possible especially in going to bed when they want to. To include residents in the development of their home and include plans to promote dignity and choice over their living areas. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 33 To make sure that staff are updated and trained in the basic principles of care so that residents are supported with choice, rights privacy and dignity and to stop any practice by staff that do not respect these basic principles. 3 OP19 To take all necessary actions to make sure a consistent standard of service is given in the laundry of all clothing and linen. To make sure enough staff are in place to offer a decent standard of laundry. To replace all worn linen so that bedding offered to residents is of a good standard. 4 Activities and records must be planned and developed to meet residents social needs and should be clear in including residents opinions in the development of an activities programme accessible to everyone. Staffing levels should be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should include staff and residents opinions. Staff must act in accordance with company policy and show evidence of how they have covered any staff absence. Appropriate staffing levels must be in place for all aspects of safely managing the home. A review of staffing levels and resources invested currently into management hours, activities, maintenance and laundry personnel should be reviewed to achieve better outcomes in these areas. 6 OP30 All staff must be supported with an appropriate induction that covers all their training needs and assists them in supporting all residents at the home. Training records should be updated for all staff so evidence is in place that staff have at least 3 days paid training and are given the right training to meet both the residents and staff needs. All staff should be supplied with all identified training specific to their job eg dementia training, specialised diets, food hygiene, moving and handling, complaints procedure, mental health needs, health and safety, management of pain, catheter care, care plans, communication, activities, basic care practices. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 34 5 OP27 7 OP33 8 OP36 Effective management of quality audits should be consistently applied to promote best practice in all areas and evidence consistent performance Including regular care plan audits, health ands safety checks and updates to risk assessments and hazards, regular and consistent staff, resident and relative meetings and ways of including their opinions regarding the development of the home. All staff should be regularly supported with supervision and given regular opportunities to discuss their training needs and suggestions and views about the home. Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Arundel Park DS0000059311.V353077.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!