Inspection on 02/05/06 for Beech Tree Care Home

This inspection was carried out on 2nd May 2006.

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

Beech Tree Care Home 10/08/09

Beech Tree Care Home 26/09/08

Beech Tree Care Home 26/03/08

Beech Tree Care Home 26/09/07

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arkle Lodge Nursing Home Sprents Lane Overton Hampshire RG25 3HX Lead Inspector Mr Ian Craig Unannounced Inspection 2nd May 2006 10:30 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 Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 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. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Arkle Lodge Nursing Home Address Sprents Lane Overton Hampshire RG25 3HX 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) 01325 351100 Southern Cross Operations Limited Mrs Sharon Jane Griffin Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61), Physical disability (12) of places Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 25 beds may be used for service users in need of personal care. 20th. October 2006 Date of last inspection Brief Description of the Service: Arkle Lodge is a care home providing personal and nursing care for 61 service users in the older persons category. The home is situated near to Basingstoke in the village of Overton. The home consists of a two storey building which was purpose built. There are forty-seven single rooms and seven shared rooms most of the single rooms have en-suite facilities. There is a passenger lift and a small-enclosed garden with easy access for wheelchair users. The range of fees for the home is £430.00 to £650.00 per week. There are no additional charges to residents. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the service since the Southern Cross Operations Limited have taken over the ownership of the home. The home also has a new manager. Four staff members were interviewed during the inspection. Several residents were spoken to and one resident was interviewed in private. Relatives of residents were also interviewed. What the service does well: What has improved since the last inspection? The majority of requirements made in the previous report have been completed. Redecoration of the home’s interior was evident. In the view of the inspector, the home’s management are taking steps to improve the service provided. Staff reported that after an initial period of change that the home’s operation was now improving. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 7 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 Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Additional measures need to be taken to ensure that the home only admits those persons whose needs it can meet by obtaining copies of social services care management assessments before agreeing to admit someone. EVIDENCE: The process of assessing the needs of those referred for possible admission was examined. This involved discussion with the manager and staff, as well as examination of records. Following referral for admission, a full assessment of need is carried out by the home and recorded on a pro forma. Copies of these assessments were held with each resident’s records. Copies of hospital discharge summaries were also held with resident’s records. The home had not, however, obtained copies of the referring care manager’s assessment. This information should form part of the admission assessment process so that the home admits only those residents whose needs it can meet. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Whilst each resident has a care plan setting out how personal and health care is to be provided by staff, these were not recorded in sufficient detail, resulting a lack of clarity regarding monitoring and recording. Procedures for the administration and handling of medication meet the needs of the residents. Residents are not always treated with dignity and respect. EVIDENCE: Case records were examined for 4 residents and the inspector was able to discuss the assessment and care plan system with the manager and staff. At the time of the inspection the home was introducing revised assessment and care plan documentation, as well as an allocated keyworker system. Staff were able to describe the revised procedures for recording care needs. Each person has a file containing numerous pro formas relating to the assessment of needs and how care is to be provided. These include: nutrition, continence, moving and handling, pressure area risk assessments, falls risk assessment etc. There are also several monitoring sheets, which are used to record and monitor when Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 10 specific care intervention is provided. The use of these monitoring forms was unclear. Care plans did not refer to the use of the forms and completion of the forms was inconsistent. For instance, for one person who was described as ‘bed bound’ the care plan did not refer to the need to regularly ‘turn’ the person to prevent the possibility of pressure sores, but a monitoring sheet had been completed showing that the person was regularly turned for four days and then the records ceased. The manager was unaware of why this had occurred, as the person’s needs had not changed. This was also the case for another resident. Also, food and fluid intake charts were being completed for some residents but not others, without reference to the need for this in the care plans. For one resident the following documentation was recorded to a good standard: pressure area risk assessments, moving and handling risk assessment, malnutrition screening tool, continence assessment, falls risk assessment and weight record. Procedures for the handling of medication were assessed. Staff were observed administering medication and recording a signature in the administration recording sheets. Records were also examined for the handling of controlled medication and these were of a good standard. A resident, and relatives’ of residents, described the care staff as polite, kind and friendly. Staff were said to address residents in a respectful manner. The inspector observed staff on several occasions failing to respond to the assistance call point. This included staff failing to respond to the call point on both settings: emergency and a request for assistance. As stated in the summary this has also been a repeated complaint made to the Commission. Staff also reported that the assistance call point frequently requires repair. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from stimulation and activities provided by the home and are able to maintain contact with friends and family. Nutritious and wholesome food is provided, although improvements are needed in the way the home communicates with the residents regarding meals. Residents are able to exercise control and choice in a variety of ways. EVIDENCE: The home employs a full time activities co-ordinator who organises activities at the home; these include arts & crafts, gentle exercise, bingo, skittles, quizzes, board games, reminiscence sessions, outside entertainers and shopping trips. The mobile library leaves a number of books, including listening books at the home and these are changed regularly. A resident stated “there is always something going on every afternoon,” and described how he enjoys the quizzes. One resident stated that there had been few opportunities to go out. This was discussed with the manager who stated that this resident was frequently taken out by staff. However, recent daily records failed to confirm this highlighting that this needs to be looked into. Choice is promoted in a number of ways. Staff asked each individual resident what they would like to eat for the midday meal from a choice of two main Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 12 dishes. Residents also confirmed that they have a choice at each mealtime. Staff are aware of the individual needs, preferences and wishes of each person. Numerous visitors were observed coming and going from the home. Several of these people were interviewed all of whom confirmed that they could visit at any reasonable time and how they are always made to feel welcome. The inspector observed the serving of the midday meal. A notice board is used to display the day’s meals and the choices. However, this had not been changed for 4 days, which is potentially confusing for residents. The meal was three courses. The staff serving the first course of soup were unaware of what type/flavour the soup was. Residents stated that they did not know what they would be getting for the lunch meal. Residents and relatives’ of residents described the meals as good and that there was always a choice available. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Concerns and complaints are listened to and investigated. Residents are protected from abuse. EVIDENCE: Relatives stated that they are of how to make a complaint. The complaints procedure is available in the Statement of Purpose. A relative described how he was satisfied how the home dealt with his complaint. Records were maintained detailing how the complaint had been handled, which included correspondence to the complainant. Staff confirmed that they have received training in adult protection and abuse. Records and details of this training were not freely available. The new manager described that when she started work at the home she found limited documents relating to staff training, and would be taking steps to address this. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from a generally clean and well maintained environment, although odours caused by incontinence were noticeable. EVIDENCE: The home was found to be generally clean with the exception that dirty washing had been left in a bag in a bathroom rather than being taken to the laundry. Decoration was in a variable condition, but generally satisfactory. Where redecoration is needed the manager explained that this scheduled to take place in the near future. Communal areas and bedrooms were comfortable although one lounge was being used as a store. The manager explained that this lounge was not used. A resident described his bedroom as comfortable and it was noted that it contained numerous items related to his interests. The home has a separate laundry containing washers and driers. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 15 Odours caused by incontinence were evident and two relatives’ also commented on this. The manager explained that this is being addressed by the systematic washing of carpets. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Sufficient staff are not always deployed to meet the needs of the residents. Residents are protected by the home’s staff recruitment procedures. Staff are trained, but additional measures are needed to ensure that staff are supervised so that residents’ needs are met. EVIDENCE: The home’s manger has recently written to the Commission explaining that due to unforeseen circumstances that for one week the home would not be able to deploy sufficient staff to meet the needs of the residents. This was due to sickness and previously agreed leave. Examination of the staff rotas also showed that the home had not been able to provide sufficient staffing at other times due to sickness. The shortfall in staffing was of only one staff member and the home’s manager had taken steps to try and resolve the problem. Several staff described how the home was frequently short of staff in the recent past resulting in the regular use of agency staff, but that this has also improved with the appointment of new catering and cleaning staff. Where the home had not been able to provide agency staff to cover a shortfall this was the result of staff telephoning the home to say they were taking sick leave immediately prior to a shift commencing. The manager had taken steps to rectify any shortfalls in staffing. Staff confirmed that they received induction, training and supervision after starting work at the home. Records of induction and training were available for Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 17 only some of the staff. The manager explained that staff training records will be compiled in the near future. One staff member stated that she has not received supervision since the new owners assumed responsibility for the home, whereas three other workers stated they had. Supervision records were not available for any of the staff. The manager stated that the area of staff supervision, appraisal and training will be addressed in the near future. It was not possible to assess the numbers of staff qualified to NVQ level 2 and above due to the lack of records. Registered nurses are deployed at all times. Staff confirmed that they have completed NVQ 2, NVQ 3, NVQ assessor’s award and nurse conversion training as well as courses in food hygiene, moving and handling and medication procedures. Recruitment procedures were found to be satisfactory with checks, references and interviews being carried out. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Management of the home is undergoing a period of change in recognition that the home needs to improve many of its practices. Procedures are in place to safeguard residents’ finances. Storage of records compromises residents’ privacy and confidentiality. Improvements are needed to ensure the health and safety of residents. EVIDENCE: The home is in a period of transition with a new manager and revised working procedures. The manager acknowledged that many aspects of the home’s operation and management need to be improved, such as introducing a system of staff supervision. The manager is a registered nurse and will be applying for registration with the Commission. Care and nursing staff described the manager as supportive. Regular audits are carried out and reports compiled. Residents and relatives are able to complete ‘comment cards’ about the service. At the time of the Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 19 inspection it was unclear if a more systematic method of obtaining the views of residents, and their relatives, is to be introduced as part of a quality assurance system. This will be revisited at the next inspection in order for the service to implement any planned quality assurance system. Procedures for the handling, safekeeping and recording of residents’ valuables and finances were checked and found to be of a good standard. Residents’ personal care and medication records were not securely stored when not in use. These were left on ‘work stations’ and medication trolleys for the duration of the inspection. The office was left open with residents’ records not securely stored even after this was pointed out by the inspector. Details of the servicing of appliances, passenger lift, etc were not readily available. The manager agreed to include these details by returning the Commission inspection questionnaire, which had recently been received by the home. Also, details of how many staff were trained in first aid, moving and handling, food hygiene were not available, although staff confirmed that they had received training in these areas. These details should also be included with the inspection questionnaire. The fire logbook showed that the fire safety equipment was being regularly tested. It was clear that staff had received training in fire safety and notice displayed a forthcoming fire training session. Records of staff fire training and fire drills were poorly maintained and showed no drills or training since 17/05/05. Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 20 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 2 Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 21 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 Requirement A copy of the care manager’s assessment must be obtained prior to agreeing to admit a resident. This must form part of the home’s assessment to determine whether or not the persons needs can be met by the home. Care plans must be recorded to show the details of the care that staff are to provide and whether or not monitoring sheets need to be completed regarding ‘turning,’ fluid and food intake etc. This requirement is outstanding from the previous inspection report. Staff must respond to residents activating the call point when requesting assistance and in emergencies. Information provided to residents regarding the daily food must be accurate and up to date. This must not confuse residents. A record must be maintained of individual staff training completed. DS0000066182.V289488.R01.S.doc Timescale for action 03/06/06 2 OP7 15 30/06/06 3 OP8 12 03/05/06 4 OP15 12 02/06/06 5 OP28 18 (1) 02/07/06 Arkle Lodge Nursing Home Version 5.1 Page 22 6 7 8 OP36 OP37 OP38 18 (1) 17 23(4) Staff must receive formal supervision at least 6 times a year and a record made of this. Residents’ records must be securely stored when not in use. Records must be maintained to show that each staff member has received training in fire safety at least twice annually, every 3 months for night staff, and that fire drills are carried out twice a year. 02/07/06 02/06/06 02/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Arkle Lodge Nursing Home DS0000066182.V289488.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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