CARE HOMES FOR OLDER PEOPLE
Seven Arches Lea Rigg Cornsland Brentwood Essex CM14 4JN Lead Inspector
Carolyn Delaney Unannounced Inspection 29th March 2006 14:00 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.V267999.R01.S.doc Version 5.0 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.V267999.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Seven Arches Address Lea Rigg Cornsland Brentwood Essex CM14 4JN 01277 263076 01277 216692 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), Terminally ill (4) of places Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Nursing and personal care to be provided for up to 30 Older People. Nursing care for up to 4 Older People with a Terminal Illness. Maximum number to be cared for shall not exceed 30. Date of last inspection 13th December 2005 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, including up to a maximum of four people who have a diagnosed terminal illness. Residents have access to extensive well maintained external grounds and the home is decorated and maintained to a high standard. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out on 29th March 2006 between the hours of 14.00 and 17.00. Carolyn Delaney, Lead Inspector for the home, carried out the inspection. Records including care plans and assessments in respect of residents’ needs and risks to health, safety and welfare were examined. Three residents and two relatives were spoken with during the course of the inspection. The relatives of five residents at the home were contacted by post so as to offer them the opportunity to make comments about the services provided by the home. A summary of the comments made will be included in the final version of the report. Three members of staff, including the homes manager were spoken with during the course of this inspection so as to determine their awareness of the needs and wishes of the people living at the home and the homes policies and procedures. Key standards as identified in the intended outcomes sections of this report are inspected at least once every twelve months. Where key standards have not been inspected on this occasion they will have been inspected at the previous inspection. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk What the service does well:
Seven Arches provides a safe, comfortable and homely environment for older people with a variety of nursing needs. Staff are well trained and supported and employed in appropriate numbers so that residents needs are met. Residents and relatives who were spoken with during the inspection all said that they were happy with the home. Information about residents such as care and treatment, risks to their health and wellbeing is recorded in a detailed way and kept up to date so that all staff are aware of these needs and how to assist residents to carry out daily activities. Residents receive appropriate care and treatment and from other qualified healthcare professionals including doctors, speech and language therapists. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 6 Staff are well trained and supported and employed in appropriate numbers so that residents needs are met. The home is well managed and residents and their relatives are consulted regularly about the care and services provided. What has improved since the last inspection? What they could do better: Nursing staff must ensure that records kept in relation to the medicines brought into the home and administered to residents are well maintained and that people receive medicines as prescribed for them. The opportunities for stimulating activities, which are provided for the people living at the home, should be reviewed and residents should be consulted so as to find out how they would like to spend their days including how they would like to spend free time. Where activities are provided records could be better maintained. Records should be kept regarding any complaints made or concerns raised verbally or informally. These records should clearly indicate whether the complaint was upheld and what action was taken to address the issues raised. The manager must ensure that people are only employed at the home after all of the checks have been carried out so as to determine that the person is suitable to care for older people. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 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. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 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.V267999.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Staff working at the home ensure that people are only offered a place following an assessment of the individuals nursing and care needs. EVIDENCE: The homes manager generally carries out pre- admission assessments and following this assessment a decision is made as to whether the home can meet these needs. Once people are admitted to the home a more detailed assessment is recorded from which care plans are developed. It was noted that wherever it is possible that residents or their relatives were involved in the assessment process. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 10 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 Information in respect of each person’s nursing needs and activities of daily living including assessments of potential risks to individual’s health, safety and welfare is well recorded. Nursing staff do not consistently maintain records in respect of medicines received into the home and administered to residents in accordance with the homes policies and procedures and current relevant legislation. EVIDENCE: Care plans were developed for each nursing and general care needs as identified in the preadmission assessment. Care plans are kept under regular review according to each person’s individual needs and any changes in their condition. There were detailed assessments in relation to risks to resident’s health, safety and welfare including risks of developing pressure sores, falls, and injuries sustained through use of equipment such as bedrails etc. Where risks were identified there were plans in place so as to minimise these risks and their impact on the lives of residents living at the home.
Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 11 It was disappointing to note that nursing staff do not consistently maintain records in respect of the medicines received into the home and administered to people who live there. For example staff do not consistently record the amount of tablets brought into the home by residents when they are admitted. It was also noted that a number of residents were prescribed medicines, which were not administered. The senior nurse on duty advised that these medicines were not required and should be prescribed on an as required basis. Two residents required oxygen therapy at the time of this inspection. The dose and frequency of this therapy was not clearly recorded. The senior nurse undertook to contact the pharmacist and to address these issues. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 12 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 & 14 More could be done in respect of the social and leisure activities provided by the home. Information about resident’s choices and preferences for activities of living are not consistently recorded for the people living at the home. EVIDENCE: There is information recorded for some but not all of the people who live at the home about how they wish to spend their days including their preferences for leisure. There are some activities provided such as entertainers, games and music. It is accepted that a number of people living at the home may not wish to or be capable of participating in activities. However records in respect of meaningful occupational and stimulating activities are not consistently recorded and it was not clear what activities are planned on a day-to-day basis. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 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 Staff working at the home do not record and monitor complaints made informally in a consistent manner. EVIDENCE: The home has a detailed complaints policy and procedure and people may raise concerns formally or discuss any issues in a more informal way with the homes manager. It was reported by the homes manager that there has been no complaints made since the previous inspection. It was noted that informal and verbal complaints were not logged in a manner which recorded the outcomes and would facilitate and recurring issues or areas where services could be improved. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 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): 0 These standards were assessed at the previous inspection. EVIDENCE: Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 15 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 & 29 Staff are employed in sufficient numbers and skill mix to meet the needs of the people who live at the home. Staff are not recruited in a consistently robust manner so as to best protect the interests and welfare of the people who live at the home. EVIDENCE: The staff duty rota provided evidence that staff are employed in sufficient numbers to meet the needs of the people who live at the home. Staff do not work excessive hours without appropriate off duty time. Care staff are supported by experienced nursing staff some of whom provide regular in house training, supervision and support which covers how to manage illnesses and conditions associated with the aging process, terminal illness etc. Staff training records were not assessed on this occasion and the recommendation as identified at the last inspection will be carried forward for assessment at the next inspection. There had been one new member of staff recruited to work at the home since the last inspection. While the way in which records and information about newly recruited staff had improved it was disappointing to note that it was not clear that all of the required checks had been carried out robustly. For example
Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 16 there was evidence that A Criminal Records Bureau (CRB) disclosure had been obtained it was not clear that this had been obtained prior to the individual commencing work at the home. It was not clear that references had been sought from this person’s previous employer and there were no records available in respect of any interview so as to further determine the persons suitability to work providing care for older people. The induction for this member of staff had not been tailored to meet ay specific training or skills needs, taking into account that this person had not previously worked in a care setting. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 17 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, & 38 Seven Arches is well managed with clear lines of accountability and residents and / or their relatives meet regularly with the manager and are consulted and kept up to date with changes to the day to day running of the home. There is a system in place for obtaining views about the services provided by the home so as to monitor and improve quality. Seven Arches is well maintained so as to provide a safe environment for the people who live at, work in and visit the home. EVIDENCE: The manager works at the home most days in a supernumerary capacity and oversees the day-to-day running and provision of care and treatment. Residents and their relatives can discuss care and any issues with the manager informally or formally when they visit.
Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 18 Very competent and skilled nursing staff supports the manager. Care staff are supervised and supported on a regular basis. Since the last inspection the manager had contacted residents relatives for their views about the nursing care and services provided by the home. Following on from this, relatives have been invited to meet so as to discuss the findings of the survey. People living at the home are discouraged from keeping monies and valuables however there is a safe should residents wish for their valuables to be kept on their behalf. The manager said that this arrangement suits residents and relatives. The manager was advised to include the homes arrangements for the safe keeping of valuable and monies in information provided to current and prospective residents. Since the last inspection all staff including those who work at night had participated in a fire safety exercise so as to ensure that all staff were aware of the correct action to take in the event of outbreak of fire at the home. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 19 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13(2) Requirement The registered persons must ensure that all staff adhere to the homes policies and procedures in respect of the administration of medicines in the home. This is outstanding from the previous inspection The registered persons must ensure that all complaints, however made are recorded in line with the homes policy and procedure. The registered persons must ensure that people are only admitted to the home after all of the necessary checks have been carried out in respect of their fitness to work with older people. This must be addressed with immediate effect. Timescale for action 01/04/06 2 OP16 22 10/04/06 3 OP29 19 01/04/06 Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 21 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 2 3 4 5 6 7 8 9 Refer to Standard OP1 OP35 OP3 OP9 OP9 OP12 OP14 OP30 OP35 Good Practice Recommendations Clear information with regards to the provisions for safe keeping of valuables and monies should be provided to all current and prospective residents Clear information with regards to the provisions for safe keeping of valuables and monies should be provided to all current and prospective residents The way in which information is recorded when pre admission assessments are carried out could be more clear and ordered. Where MAR are handwritten by staff these records should be checked and countersigned so as to minimise the risk of errors Where residents receive oxygen therapy the dose and frequency should be recorded as part of the care and treatment plan and kept under regular review. Records to evidnece the social, leisure and occupational activity oppportunities provided for people living at the home should be maintained. Information about how people living at the home wish to spend their days and how staff can assist and support them in this should be recorded consistently The records maintained in respect of staff training and supervison of staff would benefit from reorganisation so as to better evidence good pratcices at the home. Information in respect of the homes arrangements for safe keeping of valuables should be provided to prospective residents. Seven Arches DS0000015560.V267999.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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