Inspection on 24/07/08 for Seven Arches

This inspection was carried out on 24th July 2008.

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

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

Seven Arches 07/08/07

Seven Arches 06/09/06

Seven Arches 29/03/06

Seven Arches 13/12/05

Seven Arches 22/03/05

Seven Arches 12/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Seven Arches Lea Rigg Cornsland Brentwood Essex CM14 4JN Lead Inspector Mrs Bernadette Little Unannounced Inspection 24th July 2008 10:45 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 Seven Arches DS0000015560.V368934.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. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seven Arches Address Lea Rigg Cornsland Brentwood Essex CM14 4JN 01277 263076 01277 216692 sevenarches@brookvalehealthcare.co.uk 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) Brentwood Homes Limited Mr Lochan Kunkun Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care Home with Nursing - Code N to service users of the following gender: Either, whose primary care needs on admission to the home are within the following catergories: `Old age, not falling within any other category - Code OP` The maximum number of service users who can be accommodated is: 30 7th August 2007 2. Date of last inspection Brief Description of the Service: Seven Arches is a large purpose built two-storey property situated in a quiet residential area close to Brentwood town centre and within approximately one mile from Brentwood rail station. The home provides single bedroom accommodation for up to a maximum of thirty older people. Communal areas and service facilities i.e. laundry and kitchen, are on the ground floor. Residents have access to extensive well maintained external grounds and the home is decorated and maintained to a reasonable standard. The manager said that the current scale of charges at the home ranges between £542.00 - £665.00 per week. The actual fee depends on the source of funding, assessed nursing needs and /or type of accommodation available i.e. with or without an ensuite. The home’s current Statement of Purpose and Service User’s Guide are available upon request. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The site visit was undertaken over a nine hour period on two days as part of the routine key inspection of Seven Arches. There were twenty three people living at Seven Arches. Time was spent with residents, visitors and staff and information gathered from these conversations, as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is required to detail their assessment of what they do well, what could be done better and what needs improving. This information was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, relatives, staff, care managers and healthcare professionals. Completed surveys were received from three residents supported by relatives, (although none from relatives directly) four staff, a care manager and three health professionals. The information they contained as well as comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back in detail and discussed with the manager and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection was greatly appreciated. What the service does well: Seven Arches has a core group of staff that have worked at the home for some time. This gives residents familiar faces, allows staff to get to know peoples needs and supports consistency of care. A resident said, the staff are nice and I get on well with them. One person commented in a survey my (relative) is having excellent care and has no complaints, I could not wish for more. In a survey, a health professional Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 6 commented on what the service does well as gives a high level of care to very high dependency patients requiring nursing. The grounds at Seven Arches are extensive and beautiful. A resident explained how they really enjoy going around the accessible grounds and they love watching the squirrels outside their window. What has improved since the last inspection? What they could do better: Each person’s care plan needs to include all their care needs and preferences, for example their social care needs or how their dementia impacts on their daily lives. This needs to show staff in a way that is easy to read and understand how these are to be meet on a day to day basis. People living at the home need to have better support and opportunity to make real choices and this needs to take into account the particular needs of residents, for example those with dementia or communication difficulties. The decoration of the home needs to be better managed to keep it looking good and a nice environment for people living there. In a survey, a professional said on what they could do better the lounge could be made a bit more welcoming. Some safety practices in the home need to be changed such as keeping the laundry and front door secured to safeguard residents. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 7 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. Seven Arches DS0000015560.V368934.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 Seven Arches DS0000015560.V368934.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 and 3. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of living at Seven Arches can expect a full assessment of their needs to make sure that the service can meet them and they will have enough information on which to base their decision. EVIDENCE: A copy of the statement of purpose and service user guide were provided. These documents are required to be available so that people thinking of using the service have all available information about it on which to make a judgement. A copy of the last inspection report was seen to be readily available in the main entrance hall, which is good practice. The statement of purpose had been reviewed as required following the last inspection to make sure it contained the required information. The service user guide was undated. The documents should contain more information on how to obtain a copy of the last inspection report, comments from people who use the Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 10 service, how residents will be consulted with and information on current fees. They also need to be reviewed, as the information they contained was not accurate, for example in relation to social activities and outings. Information from surveys and discussions with residents and visitors confirmed that people felt they had received enough information about the home before they moved in. One comment was and after looking at several other local homes, decided Seven Arches was the best, which has proved to be true. People spoken with also confirmed that they or their relatives had been able to visit the home prior to choosing a placement at the home. Assessment documentation was reviewed for three more recently admitted residents to ensure the home had obtained all information necessary before admission to make sure they could meet these peoples needs. The service user guide said that Seven Arches had a strict policy on assessing all residents prior to acceptance into the home. Emergency admissions only to be accepted upon prior assessment by a qualified nurse from the nursing home. Assessments were available on all three files and contained good detail. Two had been completed prior to admission. One was completed on the day of admission and the manager advised that this had been an emergency situation. It is recommended that in this situation the manager shows clearly that the assessment was undertaken prior to a decision being made on accepting the person. There was no evidence on the files reviewed that the home had written to the person as required, to confirm to them that based on the homes assessment, the home could meet their needs. Advice was also given to the manager on ensuring that he does not breach his conditions of registration and admit people whose prime care need is based on their diagnosis of dementia. Seven Arches is not registered to provide dementia care and the majority of staff had not attended training on this condition. Seven Arches does not provide intermediate care. Seven Arches DS0000015560.V368934.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there are generally positive care outcomes for residents, some shortfalls in care planning and aspects of medication management means that residents cannot be assured that all of their needs would be met. EVIDENCE: Care plans requested for review for three residents and were readily available. Two did not contain photographs of the resident to support identification and ensure that the right care was given to the right person. Some contained relevant information on the persons life history and preferences, such as they were “not really a morning person”. In the AQAA, the manager referred to a new care planning system and that they could do better to try to make their care plan documents more personalised and detailed so they are a true reflection of the care they deliver. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 12 Care plans sampled of the newer format were a pre-printed list of headings that included problem/need, desired outcome and an action plan. This read as a problem led approach that did not reflect positive approaches to maintaining skills and was not person centred. For each care need there was a pre-printed list of needs, outcomes and actions, with those not required being crossed out. There was limited opportunity to record additional information that was relevant for each persons individual needs and preferences or what a dental check “as appropriate” means for that person. Identified assessed care needs such as medication, dementia and social/leisure needs were not included as part of peoples’ care plans. Overall there were limited instructions for staff on how to support people in an individual way. The new format of care plan did have better links to screening tools and risk assessments to ensure that residents’ safety was promoted in an effective way. The manager agreed that where a score was reached. for example in relation to tissue viability, there should be an indication on the form of what that actually meant. Screening tools/risk assessments were in place relating to moving and handling, use of bed rails, falls, nutrition, tissue viability/pressure area care They were supported where appropriate by a care plan so that staff knew how to keep residents and themselves safe and to promote health and well-being. Care notes were written regularly and contained good information about the care provided to the person. Residents and visitors spoken with confirmed they were generally satisfied with the level of care provided and one person said “the care is superb”. In their Annual Quality Assurance Assessment the manager said that all residents are supported to access health services and within the home they have a team of nurses and carers allocated to them lead by a registered nurse. The manager and staff spoken with were able to demonstrate a good awareness of peoples’ health care needs. A visitor said that staff monitored the resident’ health carefully and took appropriate action as the person was unable to communicate their needs. Surveys confirmed that residents received the medical support that they needed. The manager advised that they have been recently reallocated to a different GP surgery. This was confirmed by one GP survey received. In the AQAA, the manager says that a robust medication policy is in place and he audits it on a monthly basis. The medication administration, storage and recording practice of the service was observed during the inspection visit. Medication administration record sheets were sampled for three residents. Signatures were recorded for all administrations, which showed that residents got their medication when they should. A record was also available for each person giving information about their ability to take their medication and any special conditions they may have to help staff to meet their needs more effectively. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 13 This was seen as good practice. While spaces were available for photographs to help staff identify the person the medication was being given to, it was disappointing that very few photographs were available. Medication that does not need to be taken regularly, such as painkillers or laxatives, may be prescribed on an ‘as required’ basis (sometimes referred to as PRN medication). Care plans did not contain any protocols to guide staff as to the circumstances when PRN medication should be administered. It was identified for one person that the number of tablets remaining did not tally with the records. The number of tablets received by the home on admission had not been checked and recorded to ensure that accurate information was available. A hand-written entry/change to a medication chart did not contain the signatures of any staff to confirm the accuracy of the change to the person’s medication regime. Controlled drugs were being stored in a separate cupboard within a locked medication room. Records of controlled drugs were satisfactory and tallied with medications remaining where sampled. The room where medicine was stored was secure and the medication trolley stored in the dining room during the day was secured to a wall. It was locked when unattended during the medication round. This is a noted improvement from the unsupervised access to medication noted at the last inspection. A record of temperatures in the dining room was not kept and no thermometer was available in this room. The temperature in the main medication storage room was above the recommended maximum of 25C, and a senior nurse confirmed the thermometer as showing 38°. Records had not been routinely maintained as required but there were other records showing the temperature of this room at or above 25C. Medication was administered only by qualified nursing staff. Observed medication administration was done with due regard to people’s dignity. One survey contained the comment it would be nice to have a female carer to wash and dress me, as I still have my dignity although I am old I like to maintain what I have left. Other residents spoken with said that they felt their privacy and dignity was respected by the staff. All relatives and residents spoken with confirmed that they were satisfied with the care provided at Seven Arches. Seven Arches DS0000015560.V368934.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While some residents can expect improving opportunities to have their social needs met, some may not receive the necessary consideration and support to operate choices and satisfy their recreational, religious or dietary preferences. EVIDENCE: In their AQAA the manager said that the newly appointed activities coordinator provides a wide range of activities and plans an individual activities program for each person. A member of the nursing staff is now allocated ten hours each week to provide social activities for residents, which is some improvement from previous inspections. There was no care plan to inform of and support peoples social and emotional needs or preferences on any of the files sampled. The staff member advised they plan one week ahead for daily activities and arrange quarterly outside entertainers. Their file recorded peoples interests although no information was maintained for residents on respite care. The activity coordinator confirmed that there are a number of residents at Seven Arches who are living with dementia. They confirmed that although they have not done any specific training on the provision of activities or dementia care they have done some reading on the subjects. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 15 Records of activities sampled showed that some people had more regular activities than others, including for example sitting in the garden listening to old time music, beanbag games, and visits by the pat-a-dog scheme and the hairdresser. The activity coordinator said they do group or one-to-one activities such as hand massage or manicures. Students from a local school visit one afternoon a week in term time to talk to residents or play musical instruments. Some residents go out with their family/friends or are taken out by a private carer arranged by their family. The activity coordinator said there are no religious services in the home because residents were asked but had no interest in this. The statement of purpose said the activity coordinator arranges activities on a monthly pre-advertised program and organise outings to places of interest for more able residents. The service user guide states “we take our more able residents on trips to the seaside, the local gardens, church outings and shopping centres. There was no evidence of this occurring at Seven Arches and the activities coordinator confirmed that they are unable to take people on outings. Surveys received varied in their views on the activities arranged by the home and one person said it would be nice just to be taken out on the garden on a nice day. Some residents were seen to be sitting in the garden at various times. Visitors spoken with said they come regularly and always feel welcome. Residents said they could get about because they were more able and so could go out in the garden, or read or watch television in their room, as they were able to make that choice independently. Residents spoken with said that they were able to exercise choice and control over their daily lives, such as what clothes to wear each day, where and what to eat, where or how to spend their time and bringing personal items to make their rooms nicer. Discussions with residents and observations indicated that it was not so easy for less able residents to make as many choices. The AQAA states that mealtimes are treated as a special occasion with all residents being encouraged to eat in the dining room. Tablecloths were removed from the tables before residents had their meals and replaced once the meals were over, which does not respect dignity. A very limited number of residents were seen to eat in the dining room, the garden or their room. The majority of residents ate in the lounge, sitting in the armchair that they had spent most time in. Some people needed assistance and staff sat with them and fed them in a respectful and patient way. A visitor spoken with said the resident’s food is nice and liquidised separately. This would maintain flavours and an appetising appearance. In surveys comments on the meals at the home show that people usually liked them. One had the comment a very good variety and another I have to eat it as I dont have any choice, staff make these decisions on the residents behalf. Its Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 16 nice to be consulted at times as I do have lucid moments. A resident spoken with said, the food is fine, I can have seconds and there is plenty. The only information available for residents on the four-week rotating menu was in small print and kept on the notice board by the kitchen and not in the main areas used by residents. This menu shows choices at breakfast, lunch and supper. Records show residents operating choice at breakfast and supper but that very few residents ‘chose’ anything other than the main dish at lunchtime, which was confirmed by the cook. There was evidence that staff operated choices for their meals. The manager said that if a resident had been “asked what they like and refused for example, salad before, they are likely not to want it again”. Records of food served indicated some days when no choice was offered at lunch and the meal served was clearly not appropriate for all residents as identified in the care plan. The cook said the records were inaccurate and that they had cooked them some rice instead for their main meal. To support more active choice for residents, information on activities available could be produced in a clearer format and be more readily available to them. This should also be considered in relation to menus on a daily basis so that residents know, or can be helped to understand in a suitable format, what choices they actually have. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While some documentation needed improving, residents can expect to be listened to and safeguarded by staff knowledge and competence. EVIDENCE: Information on how to make a complaint was displayed in the entrance foyer. It contained current contact details for the Commission. It did not explain that social services have a role in investigating complaints about the care provided. The complaints procedure was inaccurate and referred to the Commission’s predecessor. It also inaccurately stated that people could go to the Commission seven days after making a complaint to the home. A concern was raised with the Commission early this year that the lift had been out of order and that this had had an unsatisfactory impact on residents’ lifestyle and care outcomes. The information was passed to the manager to investigate and address. The manager had not notified the Commission that the lift was out of order as required. The Annual Quality Assurance Assessment identified that one complaint had been received since the last inspection and was upheld. The manager’s record on this was reviewed. While it identified the resident involved and stated that an apology had been extended to the family, the manager stated that no formal response had been sent to the family as he did not know who the complainant was. No formal outcome was recorded for the complaint. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 18 A survey from a health professional advised that a friend had made a complaint but that the manager’s response was to question the mental capacity of the resident involved. Other surveys, as well as residents and visitors spoken with at the time of the site visits indicated that people found the manager approachable and would be able to raise concerns with him. A care manager said families report that manager is always available to discuss any problems and resolve before becoming unmanageable The manager confirmed that no safeguarding referrals had been made since the last inspection. None had been raised with the Commission. The last inspection report identified that the manager did not have sufficient knowledge to safeguard residents in the event of an incident and that the manager or the staff had not had any training. It was noted positively that an outside trainer had been accessed to provide this training. In addition staff have also had DVD training sessions on this subject. Training records provided showed that 75 of staff at the home had been provided with safeguarding training to date. Staff spoken with were able to identify types of abuse and showed confidence in reporting it, either to the manager, or to the Commission if this was appropriate. The last inspection report identified that the home had local authority guidance issued in 2005 but with no evidence of review or update. No review or update was available at this site visit. The managers/organisations’ procedure on management of, for example physical abuse, instructs that the manager investigate, monitor and commence disciplinary procedures. It makes no reference to referring to the safeguarding team or to the police as current guidance requires. The manager’s response to a scenario given was generally satisfactory. Advice was given are not relying overly on his assessment of the person’s mental capacity, and on referring it promptly to the safeguarding team who would make a decision on whether an investigation was needed. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 19 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, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a pleasant environment that is clean and adequately maintained but may not meet their needs in terms of safety. EVIDENCE: Residents had use of a large communal lounge and a separate dining room. An additional quiet lounge/visitors room was also available. Residents were able to spend time in their room if that was their preference. Some residents sat in the garden and one person confirmed they really enjoy being able to use the “lovely grounds whenever the weather allows”. Carpets in some communal areas such as stairs and corridors were marked and stained, as were the walls in some areas. A member of the housekeeping staff advised that they regularly cleaned the carpets, and the lounge carpet was done in the evenings so as not to disrupt residents too much. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 20 Some new bedroom carpets had been fitted and others are recognised as needed. The manager said that at least three rooms were about to be decorated, as they were now vacant. A bath panel on one upstairs bathroom was chipped and in need of attention. The manager’s Annual Quality Assurance Assessment stated that a full-time handyman was employed and there was a rolling programme of decorating and maintenance. A plan of maintenance and decoration of the premises was not available when requested. As stated in the Annual Quality Assurance Assessment, the manager confirmed that the majority of residents now have profiling beds that are easily adjustable and there are plans to obtain some extending beds for taller people. Some health and safety issues were identified. Boxes of latex gloves were not safely stored and were easily available to residents. While staff need easy access to these, they presented a choking risk to confused people. The manager advised that there was no oxygen being used for any resident and regarding standard 38, there was no risk assessment done relating to this, as it wasn’t necessary. The treatment room had a sign warning of oxygen. There were three empty cylinders stored there which had been recently used by residents and were awaiting collection. Although no current residents required oxygen there was clearly a need to have a risk assessment in place and to ensure that this was included in the fire risk assessment and fire plan. Twice during the day, both laundry room doors and the outside door were found to be wide open presenting a potential risk to residents. This was identified at the last inspection as a concern and does not comply with the manager’s own risk assessment. On the second day, the front door was ‘locked’ open and having waited some time for a response to the bell, we were able to be in the home and with residents before a member of staff came and was advised that the door was not secure. The manager advised that the door is “ locked open at certain times to allow staff easy entry while the other staff were busy, but that it should have been locked by now”. This does not promote resident safety. Some resident’s bedrooms were really well personalised. Two residents confirmed that they found their rooms very comfortable and “nice”. A visitor confirmed that they had been able to provide the resident’s own armchair. A resident said they had their own ornaments and photographs, which was “very important as they were their life memories”. Call bells were sited near to resident’s beds/chairs so that they could access them. Two resident surveys said that the home was always clean and fresh while another thought that the room was very dusty and the carpet dirty. Most visitors spoken to said that the home was nicely kept and clean and one person commented there are “no smells here like other places”. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by adequate numbers of familiar and safely recruited staff, who would benefit from further training. EVIDENCE: In the AQAA, the manager said we have a good staffing to resident ratio, with a good skill mix of qualified/unqualified staff to meet the care requirements of all our service users. At the time of the site visit there was one qualified nurse plus four care staff providing care for twenty three residents. A resident survey said that staff were always available, another that they usually were and another that they sometimes were and added very rarely there is staff in the day room. Observations did show some periods of time when there was no staff in the lounge supervising residents. Residents spoken with confirmed that staff were available to them when they need them. Visitors were also satisfied that residents had the support they required from staff and that they were regularly monitored to ensure their well being. Staff surveys showed there are adequate staff to meet the individual needs of the people who use the service. One person added we always have enough staff on duty but extra would mean more time spent with residents. A staff survey advised that agency staff were not used and permanent staff cover for Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 22 each other. This was confirmed by the manager in the AQAA and provided consistency of care and familiar faces for people living at the home. The manager said in their AQAA that they had a higher than average number of staff trained to NVQ level 2 and that 66 of the staff had achieved this. This was not evident in the staff training records provided which showed that 10 of the staff had obtained this level of training. However, the registered provider subsequently advised that the information in the matrix was not up to date and that almost 50 of the staff had achieved this award. The last inspection report identified a haphazard approach to maintaining records showing robust staff recruitment procedures to safeguard residents. The manager now advised that recruitment had been delegated to the administrator. Three files selected on this occasion were well-organised. All demonstrated appropriate references and checks in place prior to employment commencing and were supported by photographs and other identification documents. This is a noted improvement from the last inspection. The manager said he will contact head office to discuss arranging updated criminal record bureau checks for staff that have been in post for some years. The AQAA stated that all new staff commenced on the Common Induction Standard program. The induction records were sampled for two care staff to review if they had had training to help them to understand all areas of their role in caring for people well and safely. These showed that staff had worked through the Common Induction Standards and had obtained a certificate of completion. This is a noted improvement from the last inspection. The format used did not provide opportunity for each section to be dated and signed by both people to confirm competence. A first-day induction record was available for a qualified nurse appointed since the last inspection. The manager stated that a full induction record should have been completed but as an oversight, this had not happened but they had worked with another nurse for one week. The manager stated that there is a combination of in-house trainers and external training provided for staff. Staff training files and training records were sampled. These showed that some staff had attended training since the last inspection as required, for example safeguarding vulnerable people, basic life support, dementia awareness, falls prevention, basic food safety and care of ageing skin. However there was no evidence for other staff that they had attended even basic training including moving and handling, fire or safeguarding. Two of the qualified nurses had undertaken training in 2003 so they could train other staff in moving and handling. The manager said it had recently been identified that their training had expired, perhaps some two years ago. It was stated that this had recently been identified, the staff had retrained recently and were awaiting certificates to evidence this. It was advised that all staff may require updated moving and handling training in light of this. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 23 Observed interaction between staff and residents was friendly and respectful. Discussion with staff and information from surveys indicated that staff felt well supported, inducted and trained and so able to promote quality care outcomes for residents. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 24 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, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to benefit from developing management systems that will listen to their views but may not always best promote their safety. EVIDENCE: In the Annual Quality Assurance Assessment, the manager states that he is a suitably qualified and experienced practitioner to run the home. The statement of purpose explains that the manager is a qualified registered general nurse who had managed care homes for the elderly for 19 years and had achieved NVQ level 4 in management. The manager said that he operates an open door policy always. Visitors, staff and residents spoken with during the site visits said they would be able to talk to the manager about any concerns. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 25 Reports were available that showed that registered provider regularly checked on how well the home was running. A director of the company was present for part of the site visit and is regularly in the home. The manager also had the support of a nursing officer from the company who visits on a monthly basis to provide support. There were some noted improvements from the last inspection including in the management and organisation of staff recruitment files, the implementation of a recognised induction process for care staff and in some aspects of quality monitoring. Other reviewed aspects of quality monitoring such as audits of medication or accident records, as well as some aspects of health and safety need further development. It was noted positively on this occasion that the manager had access to a copy of the national minimum standards so that he could be aware of the standards and requirements to be met. The manager confirmed that residents and relatives have been surveyed to get their views on the service and how it could be improved. A survey was ready to send to staff this month and other stakeholders such as the GP, nurses and pharmacist also to be asked their views. The outcomes of the surveys are to be feedback at the next resident/relative meeting that the manager said will be in September. Accident records were maintained. Advice was provided to the manager on keeping the individual people’s records separately on their own files to comply with data protection, as the accident book indicated was appropriate. An analysis of accidents was requested. This would review if there was any pattern of accidents to help prevent them occurring and form part of the quality monitoring audits. The manager advised that this was not undertaken and questioned what use it would be. The manager confirmed that no money is looked after for residents. Management of health and safety was reviewed. Evidence was available of inspection of the fire alarm, emergency lighting, call bell and fire equipment. A report confirmed a service of the lift took place in February 2008. Records were available of regular checks of the emergency lighting and fire alarm. Two sets of records were maintained relating to fire drills. These did not show that all staff had attended regular fire drills and practices to support the safety of all at the home. Information was available informing staff of forthcoming fire training and giving them opportunity to add their name. Some environmental risk assessments were available. They were undated and contained limited information as identified at the last inspection. The available assessments were not seen to be effective in promoting safety in everyday practice. An example was where the risk assessment said the laundry room was not to be accessible to residents yet both doors were held fully open at the time of the site visits. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 26 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 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X N/A X 2 2 Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 27 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)d Requirement The manager must confirm in writing to each prospective resident that, based on their assessment, they are able to meet the person’s needs in respect of their health and welfare so that people can be reassured their needs will be met. Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and give staff clear instructions on how to apply these in daily practice to ensure that residents get the care they need and in the way they prefer. Medication must be stored under suitable environmental conditions and in line with current legislation to ensure it remains effective to meet residents’ needs. Written protocols or guidance must be in place for medicines prescribed on a “when required” basis to ensure they are Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 28 Timescale for action 15/08/08 2. OP7 15 (1) 01/09/08 3. OP9 13 15/08/08 administered to residents in a consistent and agreed way. Records of medicines received must be accurate. This will show residents receive the medication prescribed for them. 4. OP12 16 (m) & (n) So that people living at Seven 01/09/08 Arches have their needs met, the current social/recreational/ occupational programme must be developed and extended and comply with the statement of purpose. The manager must demonstrate that all residents are consulted about their social needs in ways appropriate to their cognitive/communication abilities and that they are actively supported to express their views. Previous timescales set for the home to meet this requirement has not been fully achieved. To demonstrate respect for people’s diversity and right to exercise choice, all residents must be routinely supported to express their preferences in ways that meet their abilities and to have their choices respected in daily life. This includes for example choices of food, social activities or who provides their personal care. An accurate record of the food served to residents must be kept to demonstrate that their diet is satisfactory in terms of nutrition and diversity. To ensure a safe and pleasant living environment and to safeguard residents the manager DS0000015560.V368934.R01.S.doc 5. OP14 12 24/08/08 6. OP15 17(2) Sch. 4 24/08/08 7. OP19 OP38 23 13(4) 24/08/08 Seven Arches Version 5.2 Page 29 must implement a planned and effective programme of maintenance and refurbishment, undertake effective risk assessments and ensure that the safe working practices are carried out on a daily basis for example with the safe storage of latex gloves, the security of the front door and access to the laundry, ensure all staff participate routinely in fire drills, and ensure staff are provided with fire training. 8. OP30 18(1) Ensure there is evidence that that staff working at the care home receive appropriate training and updates to the work they perform so as to best meet residents needs and promote their safety. This refers specifically to ensuring all staff have current training in basic areas such as fire, protecting vulnerable people, health and safety, moving and handling and that this is provided by recognised trainers. Previous timescale of 30/09/07 not met. 24/08/08 Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 30 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 and service user guide should be extended to include information on the fees, residents’ views of the service provided, how residents are consulted with and how to access a copy of the last inspection report. They also need to have accurate information on social activities and outings. This will give people access to all the available information on which to assess Seven Arches as a suitable place for them. A photograph of residents should be held with their care plan and medication records to enable correct identification to ensure they receive the appropriate individual and medication. Hand-written changes or additions to instructions for prescribed medicines should be signed and dated by the person making the changes to ensure accuracy to safeguard residents. Residents’ preference for a same sex member of staff for personal care should be recorded in their care plan and provided in practice to promote their dignity. To ensure people have access to the most up to date information, information on the complaints procedure should be updated. A formal outcome should be recorded for all complaints received to show that they are fully investigated, actioned and concluded. To safeguard residents the managers/organisations’ procedure on management of abuse should be reviewed and brought into line and provide links to the current local safeguarding protocols and procedures. The manager should obtain a copy of these and keep them in an DS0000015560.V368934.R01.S.doc Version 5.2 Page 31 2. OP7 OP9 3. OP9 4. OP10 5. OP16 6. OP16 7. OP18 Seven Arches accessible place. 8. 9. 10 11. OP28 OP30 OP33 OP33 At least 50 of care staff should achieve NVQ Level 2 and evidence of this should be readily available. All qualified staff should have a formal recorded induction to the home. Manager should undertake and analysis of the accident records to identify any patterns as part of his quality audits of the service. The action plan and outcomes of the analysis of the quality assurance surveys and quality monitoring systems should be provided to all stakeholders and be readily available in the home. Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Seven Arches DS0000015560.V368934.R01.S.doc Version 5.2 Page 33 - 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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