Inspection on 24/11/09 for The Arches

This inspection was carried out on 24th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Arches 04/12/08

The Arches 04/12/07

The Arches 11/12/06

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Arches The Arches 11 Priory Road Cottingham East Riding of Yorks HU16 4RR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: George Skinn     Date: 2 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Arches The Arches 11 Priory Road Cottingham East Riding of Yorks HU16 4RR 01482842222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): samantha@the-arches.net Mrs Lota Hopewell,Mr Derrol Paul Hopewell Name of registered manager (if applicable) Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Arches is located in Cottingham, close to Hull and not far from local amenities, transport and shops. The home is currently registered to care for thirty nine (39) older people who may or may not have dementia. The accommodation is situated on two floors. A passenger lift provides access to the first floor, as well as two staircases. One double room is available, and the rest are Care Homes for Older People Page 4 of 25 Over 65 39 39 0 0 0 4 1 2 2 0 0 8 Brief description of the care home single, including eighteen which have en suite toilet facilities. The home has three lounges and a separate dining room. There is a car park to the front and pleasant secure garden to the rear of the home with paved pathways, seating areas, lawn and pond. Some rooms have patio doors leading directly onto the garden, where people can sit out if they wish. People pay extra for hairdressing, clothing, toiletries and dry cleaning. They also pay for their own newspapers and magazines, although the home does provide some for everyone to read. People are give information about the home before they move in, and they have their own copy of the service users guide to refer to in their room for when they arrive. People can also have a copy of the report written by the Commission for Quality Care (CQC). Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people experience adequate quality outcomes. The key inspection has used information from different sources to provide evidence. These sources include, reviewing information that has been received about the home since the last inspection, information provided by the registered person on an Annual Quality Assurance Assessment (AQAA), comment cards returned from ten (10) people who live at the home, nine (9) staff and three (3) health care professionals. A visit to the home was carried out by one inspector which lasted 7 hours. We spoke with the people who live at the home, their relatives and staff. We looked at records relating to the people who live at the home, staff and the general management activities of the home. Care Homes for Older People Page 6 of 25 During the visit we looked at care practices where appropriate, and time was also spent watching the general activity within the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Date of last inspection 14/12/08. The acting managers were available to assist throughout the day. Currently weekly charges range from 362 GBP to 426 GBP inclusive of any top up charges. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: The home keep detailed records about peoples needs and these instruct the staff on how best to care for people. These records needs to contain evidence that those people who have been assessed as lacking the capacity to make an informed choice are fully protected and their emotional need are being met. Sometimes people have to use special equipment like bedrails to make sure they are safe and not at risk of harming themselves if they fall out of bed. There needs to be full risk assessments in place for these and the risk assessment must be based on guidance issued by the Department of Health. Peoples mediation must be handled safely and there must be systems in place for ensuring people are safe and not at risk of receiving the wrong medication or the Care Homes for Older People Page 8 of 25 wrong dosage. Some people told us that there is a lack of activities and outings, the acting manager needs to establish if the level of activity or the choices offered are what people want. Some people told us they did not know who they would speak to if they had a complaint. People need to be aware that the home has got a compliant policy and who they make a complaint to. Currently the home is being managed jointly by two (2) deputies, there needs to be decision made as to who is going to take overall responsibility and what the registration arrangements are going to be so the home is complying with the law. An application for registration should be made to the CQC. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to moving into the home. Evidence: We looked at a sample of files which belonged to the people who live at the home and we saw that these contained copies of assessments undertaken by the placing authority and the home. This assessment information is then used to write a care or support plan describing what staff need to do to look after each person. The home does not provide intermediate care, which is a specialist service aimed at maximising peoples independence and return home after a hospital admission. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the people who live at the home have a plan of care but this does not always fully protect those people who do not have the capacity to make an informed choice. People who use bedrails are not fully protected. People are not protected by the way the staff handle their medication. Evidence: We looked at a selection of files which belonged to the people who live at the home. We chose files which demonstrated the range needs the home caters for; this included the file of some who was dependent on the staff for all their needs, a newly admitted person, someone who has dementia and someone who was independent. We saw that all of the files contained a care plan which described how the staff were to care for the person and risk assessments about falls, tissue viability, nutrition and diet. We saw that these are updated on a monthly basis and any changes in needs are recorded. We saw that two (2) people who live at the home have formed a platonic relationship, Care Homes for Older People Page 12 of 25 Evidence: however on some occasions one person spends the night in the other persons bedroom. Both people have been assessed as not having the capacity to make an informed choice, but we saw no risk assessments or best of interest meeting about the relationship and how to keep the people safe from harm. This means that people could be vulnerable due to their inability to make an informed decision and are not protected. We saw that some of the people who live at the home have bedrails fitted to their beds for their safety, the acting managers could not show us any risk assessment for the use of bedrail based on the Department of Health Guidelines. This means that people are not protected and could be put at risk of harm. We saw that people have access to health care professionals when needed and social care professionals are involved in peoples reviews as are families were appropriate. When we spoke with the staff they were clear about how to maintain someones dignity and uphold their rights. We saw that the staff were sensitive to peoples needs when undertaking any personal tasks and were sensitive and patient when dealing with those people who have dementia. We looked at the way the medication is handled by the staff. We found that the medication is stored safely in a locked cabinet anchored to the wall. Staff records showed us that they had received medication training. We found that there were a lot of discrepancies in the staffs administration of medication; for example one persons medication records showed that they had been given their medication and the staff had signed to this effect but the medication was still in the blister pack. Another persons medication records showed gaps in the records but when we looked at the blister packs the medication was missing. There was no indication on the records if the medication had been refused, destroyed or administered. We could not establish a clear audit trail as the records did not correlate with what had been administered. This means that people are at risk of receiving the wrong dosage of medication at the wrong times. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can lead a life style of their own choosing, however people may not have access to as many activities as they would like. People are provided with a choice of food which is wholesome and nutritious. Evidence: When we spoke with the people who live at the home they said they could make choices about activities, food, how to spend their time and when to get up and go to bed. The home encourages contact with relatives and friends. We saw that visitors were made welcome to the home and had good relationships with the staff. They told us they could visit at any time and were always made welcome We saw that a selection of activities are arranged for the people who live at the home to take part in if they wish these included reminiscence, one to one discussions, bingo, quizzes, table games, dominoes, crosswords and nail care. We saw some of the staff playing board games with the people who live at the home. Some of the surveys returned told us that people, and staff, felt there should be more Care Homes for Older People Page 14 of 25 Evidence: time for social interaction, to play games and undertake activities. People told us they would like to see more outings on offer to the local community or further in summer months. People told us they enjoyed the food and there was plenty of choice. We saw that staff ask people what they would like for lunch and tea. There is always a choice at each meal time. The meal on the day of the site visit looked well presented and wholesome. One person told us that they get too much food and would like the staff not put so much food on their plate as they did not like to think of it going to waste. This was discussed with the acting manager at the time of the visit and amicable agreement was reached. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the way the home handles complaints and staff are trained about how to protect people from abuse, however some people are not sure about how to report a compliant. Evidence: Three (3) complaints have been received at the home since the last inspection, all have been dealt with and none are outstanding. There have no investigations by the local Authority safeguarding team and no one has raised any concerns with the CQC. We saw that all complaints are recorded; the record shows what the complaint was, how this was investigated and what the outcome was, the satisfaction of the complainant is also recorded. We saw that staff have received training about how to recognise abuse and how to report this to the proper authorities. When we spoke with staff they were able to tell us what they would do if they witnessed any abuse at to whom this should be reported. A couple of the surveys we received back from the people who live at the home told that they were not sure who they would report any concerns of complaints to. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean well maintained environment. Evidence: The home is situated in Cottingham on the outskirts of Hull. There is parking to the front of the property, and a pleasant garden area at the back, which many of the rooms overlook. The home smelt fresh and looked clean and tidy on the day of the site visit. People said they liked their private accommodation. They had been able to bring in their own belongings to make their rooms more personal and individual. This helps people to feel more at home. There is a main communal lounge with a large television for people to enjoy. A second smaller lounge provides a quiet area for people. They sometimes take their visitors there for some privacy, there is also a third smaller sitting room. Minor maintenance jobs continue to be carried out by the owner when needed. Grab rails have now been fitted round the corridors on the ground floor. This makes it easier for people to walk round the building independently, and with more confidence. People have a choice of bath or shower facilities, both of which are assisted. The laundry is separate from the main building. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are provided in enough numbers and trained to meet their needs. People are protected by the home recruitment and selection procedures. Evidence: There is a satisfactory staff rota in place that records the role of each member of staff. The staffing levels are based on the needs of the people who live at the home. There is a cook on duty each day as well as a kitchen assistant and other ancillary staff. This enables care staff to concentrate on assisting people with personal and social care activities. We saw training records which indicated that that more than 50 of the staff are trained to NVQ level 2 which includes training on equality and diversity and an awareness of abuse. The recruitment and selection procedures remain robust and all checks are undertaken prior to staff commencing work at the home. We looked at staff recruitment files and saw that these contained references from previous employers an application form which identified gaps in employment and a completed enhanced Criminal Record Bureau (CRB) check. We saw a training and development plan which shows that all staff have undertaken Care Homes for Older People Page 18 of 25 Evidence: core training and some staff undertake more specialised training. We saw that staff records include information about individual training achievements and a copy of training certificates is kept on their file. We saw that staff have refresher training as appropriate to ensure that their skills and knowledge are kept up to date. All staff have received mandatory training in Health and safety, Manual handling, Basic Food Hygiene, First Aid and Fire. We saw that staff receive regular supervision and developmental opportunities to attend further training. When we spoke with staff they said they found the training excellent and where pleased that they were encouraged to attend lots of training. They felt this gave them the skills needed to care for the people who live at the home. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which well managed and run in their best interests. The home is not managed by someone who is register with the CQC. Evidence: The home is currently being managed by two (2) deputy managers and neither is registered with the CQC. They are planning to either be jointly registered or one is applying to be registered. The decision needs to be made quickly as the home has been without a registered manager for over six (6) months. People who live at the home told us that the management team is approachable and they have confidence in them. Staff told us that the management team is supportive and provides them with good leadership We saw that there continues to be a well developed Quality Assurance (QA) system that involves the people who live at the home, family, staff and health care professionals giving their views about the home. Surveys are completed throughout Care Homes for Older People Page 20 of 25 Evidence: the year and an annual report is produced explaining the outcome of the surveys and any relevant action to be taken. People who live at the home and or their families continue to manage their own financial affairs. The home has a fire policy and a fire risk assessment and the fire alarm is tested weekly. We saw that tests on equipment are undertaken as per the manufactures recommendations and fire drills are carried out on a monthly basis. The home has a nurse call system fitted to ensure that all the people who live at the home are able to request assistance when needed. All the equipment in the home is tested at the appropriate intervals and all maintenance certificates are up to date. The AQAA which was returned by the home prior to the site visit was well completed and told us about areas for improvement. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People who use bedrails 31/03/2010 must have a full risk assessment in place based on the Department of Health Guidelines. This will ensure the person is kept safe and not put at risk of harm. 2 7 15 Those people who have been 31/03/2010 assessed as lacking the capacity to make an informed choice must always be fully protected by assessments and the use of best of interest meetings. This will ensure people are not put at risk and their welfare is ensured. 3 9 13 People must be protected by 01/02/2010 the way staff handle their medication and good clear records must be kept. Care Homes for Older People Page 23 of 25 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure people receive medication safely and as prescribed. 4 16 22 People must be fully 01/02/2010 informed about their right to make a complaint and who this should be directed to. This will ensure there is clear and accessible complaint procedure for people to access and use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 People should be consulted about what activities they would like to pursue and a review of staff practice should be undertaken to ensure staff have time to undertake activities with people. An application should be submitted to the CQC for the registration of a manager to comply with Section 11 of the Care Standards Act 2000. 2 31 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!