Inspection on 04/12/08 for The Arches

This inspection was carried out on 4th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Arches 24/11/09

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 17/02/2009.

Inspecting for better lives 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, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 0 4 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: The Arches 11 Priory Road The Arches Cottingham East Riding of Yorks HU16 4RR 01482842222 Telephone number: Fax number: Email address: Provider web address: samantha@the-arches.net Name of registered provider(s): Name of registered manager (if applicable) Mrs Samantha Sutcliffe Type of registration: Number of places registered: Mrs Lota Hopewell,Mr Derrol Paul Hopewell 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 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 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. On the day of the site visit, we Care Homes for Older People Page 4 of 38 Over 65 39 39 0 0 Brief description of the care home were told that the weekly fees range from 350 to 410 pounds. 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 Social Care Inspection if they wish. Care Homes for Older People Page 5 of 38 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 last key inspection at The Arches took place on 4 December 2007. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 38 Comment cards completed by eight people who live at the service, and two visiting health professionals who support them. A site visit to the home. This was carried out on 4 December 2008 by one inspector. The visit started at 10am, and lasted for approximately eight hours. During the visit to the home, several people who live there, some staff, the deputy manager and the registered provider were spoken with. Three peoples care plans were looked at in detail. A fourth persons plan was also looked at in specific areas. Also, two staff recruitment files, some policies and procedures and some records about health and safety were looked at. Care practices were observed, where appropriate. Time was also spent watching the general activity, and sitting with people, to get an idea about what it is like to live at The Arches. 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. What the care home does well: What has improved since the last inspection? What they could do better: Staff could make sure that they always get a copy of the care managers care plan to look at before any person referred by them is admitted. This would give staff more information about the persons needs, and to make a good decision about whether they can be successfully met. Risk assessments could be completed and kept under review for people who have risks associated with their health and wellbeing, so that these risks can be monitored and kept under control. Peoples social needs could be described in a more individual way in Care Homes for Older People Page 8 of 38 their care plan. This would help staff to understand better what they can do so that these needs can be met successfully. Weighing scales that people are able to sit on could be provided, so that those who are unable to stand are able to have their weight accurately monitored. Improvements could be made to the way medication is handled and audited so that it safer for people. People who have liquidised meals could have these served in separate portions on their plate. This would make the meal look more appealing, and would allow the person to experience different textures of food. A choice could be offered before each mealtime, rather than people having to ask for an alternative once the meal is served. This would allow people to look forward to a meal which they know they will enjoy, and which they can eat with others, because it would already be prepared for them. The homes abuse policy could be amended to reinforce that the local authority are lead investigators in safeguarding matters. Staff could all receive training which reinforces this procedure. This would help to make sure that any allegation or suspicion is referred to the right people for investigation without delay. Plans to fit a sink in the laundry could be pursued. This is so that staff have appropriate hand washing facilities to reduce the risk from cross infection. A ready supply of gloves, aprons and hand sanitiser could be readily available for the laundry staff to use to reduce the risk from cross infection. Staff working there could be provided with safety sheets which tell them what to do take in the case of spillages. A record could be kept to show who is responsible for the ongoing supervision of any new staff member who has started work before their full police check has been returned. This will help to protect people by ensuring that the person does not work alone until this is returned. New starters could complete the full Skills for Care inductions so that, from the start, they are working consistently, and to the current national minimum standards that are expected of them when they provide care. Staff given the responsibility to check hot water temperatures could make sure that they report when these are found to be wrong. This would help to protect people from scalds, and will also make sure that other peoples water is warm enough to be comfortable to use. The results from satisfaction surveys could be published, and available for people to look at, so they can see what everyone has said collectively about the quality of the service, and where the home does well. It would also allow them to see what is being done to address areas where people want to see improvements made. The advice of the fire officer could be considered. Automatic closers could be provided for the bedroom fire doors which people choose to have open during the day. This is a safer way to meet their wishes, because the closers would allow the door to shut automatically in the event of a fire. Care Homes for Older People Page 9 of 38 Risk assessments for those people occupying rooms with unrestricted windows, which open wide, should be kept under review. They should also be completed for future occupants who use the rooms to check that they too are safe. Enquiries could be made with the Environmental Health Officer to see whether it is necessary to obtain, and keep, a record of the temperature of chilled meats when they are delivered to the home. This check would provide reassurance that the meat has been kept at the right temperature to keep it fresh before arriving there. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 38 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 11 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are normally assessed properly before they are admitted. However, exceptions to this rule do increase the chance of these peoples assessments going wrong. Evidence: A member of the homes staff assesses people before they are admitted. This normally includes gathering information from the person themselves, their family, where appropriate, and other professionals, such as hospital staff and the persons care manager. This information is used when deciding whether the persons needs can be met, and before they are offered a place. During this period, the person is given information by the home which tells them what sort of care it offers, and what services they can expect to receive when they arrive. This helps the person to decide whether in fact they wish to live at the home, and whether it will be suitable to meet their overall needs. Care Homes for Older People Page 12 of 38 Evidence: When people are admitted in an emergency, the information staff get about the persons care needs is built upon when the person arrives. The pre admission assessments seen were satisfactory excepting one, where a pre planned admission from hospital had taken place before the care plan from the persons care manager had been received. There had been time for the staff to ask for a copy of the care managers care plan after the initial enquiry was made, but this had not been obtained. This care plan could have given staff additional information, which the home may not have been aware of, but which may have been important when making a decision about whether the persons needs could be met. The staff should always insist that this care plan is provided for the purpose of making a good decision using information from as many sources as possible. This reduces the risk of admissions going wrong. The deputy manager said she would chase up this care plan to make sure that staff had considered the persons current needs fully. Of the eight people who returned their surveys, six of these said they received enough information before they came into the home. Two said they did not, because they were admitted in an emergency. Staff said that they are given enough information about newly admitted people to make sure that they get the right care and attention when they arrive, according to their wishes. The home does not provide intermediate care. Therefore standard six is not applicable. Care Homes for Older People Page 13 of 38 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. People get care and support form staff and other professionals, and equipment where risk is identified. But they cannot be assured that the home is proactive when measuring risk to their health and welfare. Evidence: After someone has been admitted, the staff start to build up a more detailed picture about the persons needs, and how they can best be met. In addition, staff also assess the persons mental capacity. The outcome of this assessment is recorded, so staff know how and why people may need help when making important decisions in their daily lives. There was some evidence that this information is discussed with the person or their family, who sometimes help to review the care plans, when they can make suggested adjustments where necessary. A six monthly review is also held to review the persons overall needs, and to identify where changes to their care may be required or requested. There was some good information about these needs, and how they were to be met by staff. This helps to Care Homes for Older People Page 14 of 38 Evidence: keep the care right. Although the plans are reviewed regularly, risk to people is not always monitored effectively. For instance: Some people had been provided with equipment to reduce the risk from pressure sores. In one case the district nurse had asked staff to inform her if any further problems arose. Care provided by staff was not the same as the care described as needed in the care plan, because the person concerned was not comfortable when staff changed their position. However, in the absence of a risk assessment, any increased risk to this person was not properly measured. By having a formal tool in place, changes in the persons health may be noticed and acted upon earlier. A person who suffered from regular falls did not have a falls risk assessment completed to measure how risk to them might be minimised. One person who had nutritional problems, who was having support from the dietitian, and who could not be weighed, because they are unable to stand on the weighing scales, did not have a completed nutritional risk assessment. The registered provider is thinking about buying some weighing scales which people who are unable to stand can sit on. These should be obtained, so problems with peoples weight can be picked up and acted upon quickly. Risk assessments assist staff when making decisions about whether further advice is needed from professionals who may be able to support the person, such as district nurses, dietitians and falls assessors. They are therefore an important element of the persons care plan, and need to be carried out. However, there was evidence in peoples files to show that they do have regular contact from their doctor, chiropodist and other health professionals. The two health professionals who returned their surveys answered usually to each of the questions when asked questions about whether the home met their clients needs. It was agreed also that peoples social needs could be looked at and reported on in more detail, so that their wellbeing is properly understood and catered for. For instance, in one care plan, staff had recorded that the person has a visit once a week from their family. However, there was nothing to say what staff should do the remainder of the week to support the person. Concerns about social isolation had been recorded in another persons review. Although they stay in their room, their care plan said staff to inform about social activities and assist to participate if possible. This action neither identifies nor addresses the persons individual needs. However, out of Care Homes for Older People Page 15 of 38 Evidence: those who returned their surveys, seven people said they always get the care and support that they need. One of these commented Perfect. The eighth said this is usually the case. And seven out of eight said that that staff listen and act on what they say, with the eighth commenting that it Depends on staffing levels. On the day one person said Im fine here. People on the day said that generally they are respected, and that that staff acknowledge their right to privacy. One person said Some staff are better than others. They said they thought this was the same everywhere. However: One persons door was wedged open. We were told that this was their preference. However, this meant that anyone could look into the room as they walked past. The person was in a state of undress, and they were using the commode. Staff need to be mindful about protecting peoples dignity at all times. One person was dressed in their nightwear from 3.30pm onwards. Whilst we were told that this was their regular choice, it is this sort of information which should be recorded in their care plan to make it more individual, and to show that staff have considered how their dignity can be maintained. In another instance, a staff member spent the duration of the mealtime having a telephone discussion with the pharmacist whilst standing over the table where two people were eating. They discussed one persons medical details, and also someone who had recently died. This unsettled the person sitting at the table, and did not respect their right to have a pleasant and dignified mealtime. We were told that any staff who look after peoples medication complete training so they know how to do this safely. Medication arrives from the chemist in special packs from which staff remove the tablet from the appropriate blister at the time of day the medication has been prescribed. The records staff keep to show they have given the medication were kept up to date. The home does not have a separate room for the storage of medication. This is kept locked away in cabinets in the corner of the dining area. Controlled medication is safely stored, and two staff check that the medication has been dispensed correctly before it is given to the person concerned. This helps to keep the records correct, and to make sure the right medication is given. The following shortfalls were discussed with the deputy manager: One person manages their own medication entirely on their own. However, a risk Care Homes for Older People Page 16 of 38 Evidence: assessment had not been completed to show that this arrangement had been reviewed periodically with the person to make sure that it remained safe, appropriate, and acceptable for them. Neither was there a readily available list of medication prescribed for this person for staff to refer to in the case of an emergency. The deputy manager agreed to organise this so staff can speak on behalf of the person concerned should they not be well enough to pass on this information themselves at any time. One person has their tablets halved. It had not been checked with the doctor or the pharmacy whether halving the medication would change the way it worked. The deputy manager agreed to check this forthwith. The pill cutter had not been cleaned between doses, and there was a residue of powder remaining. This means that the next dose of medication chopped will not be accurate, because it could also have the remains of the previous dose included. This must be kept clean at all times. During the lunchtime medication round, the medication was left out unattended, in an area where people living at the home were sitting. This is not safe practice. Medication must never be left unattended. The deputy manager said this would not happen again. Staff need to carry forward the balance of non blistered medication, so that a check can be kept about how much medications should be remaining, and whether it has been given as prescribed. The date had passed by when one persons eye drops should have been disposed of. This means it may no longer work properly. It was taken out of circulation and replaced. There was a lot of medication in the stock room. This need to be better audited so that only the medication that is needed is ordered and so that medication belonging to people no longer living at the home is removed and returned to the pharmacy. Topical medication was stored in one of the bathrooms and was not locked away. This poses risk to people. In addition, some of the medication belonged to people no longer living at the home. The deputy manager arranged for this to be removed straight away. Care Homes for Older People Page 17 of 38 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. Although more thought could be given to how individual social needs can be met, people can maintain important links with family and friends who are important to them. Evidence: There is no longer an activities organiser at the home, although a volunteer has been visiting people once a week. We were told that the post will be advertised again after Christmas. In the meantime, the activities are currently provided ad hoc by staff when they have time. Because of this, there are no advertised daily activities. This means that people do not know what to expect, and makes it more difficult for them to plan their day. On the day of the site visit however, staff organised dominoes and some simple exercises for people. In the afternoon, a number of people enjoyed a game of Bingo. However, there have been some events organised for over the festive period, such as a Christmas Fayre. This event, a forthcoming Carol Service and a clothes party were all advertised, to remind people when these were due to take place. People said they Care Homes for Older People Page 18 of 38 Evidence: were looking forward to them. Regular visits from local church denominations were also advertised. These visits assist in meeting peoples spiritual needs. Four of the seven people who returned their surveys said that there are always activities for them to join. One said this was usually the case, with the remaining person answering sometimes, and adding many activities are arranged but not all to my liking. It was agreed that more could be done to be done to tailor the activities to peoples needs where they do not choose to attend group activities. Improving their care plans in this area will help to achieve this. This has already been discussed in Health and Personal Care. People spoken with thought that they were able to make decisions about what they did with their day, and when. Staff gave examples of ways in which they offer people choice. For instance, about rising and retiring times, where they eat, and what they wear. We were told that there are no restrictions to the visiting arrangements either, so people can maintain links with family and friends which are important to them. People are offered three meals each day, and we were told supper is also available. The cook told us that there are no limitations placed on her budget. She can cater for special diets, such as diabetic diets. We were told that people who have their meals blended have each component served separately on their plate. However, at lunch, one person with such needs had their meal blended into one. This made it look unattractive, and meant that the person could not experience each separate taste and texture. Breakfast is prepared by the kitchen assistant in the small kitchen area in the main part of the building, as people get up and are ready for it. There are two dining areas. People were assisted to the table before their main meal. Some did wait for up to twenty minutes between being assisted to the table, and being served their meal. However, some used this time for socialising with others. Those who could manage were served tea in individual pots so they could help themselves. This helps to maintain peoples independence. One area is reserved for people who are more dependent, and need help with their meal. Staff helped in a way which maintained their dignity. And everyone who needed help were assisted to tidy their hands and face after the meal. Of those who returned their surveys, all but one said that they always like the meals at Care Homes for Older People Page 19 of 38 Evidence: the home. One of these said Perfect. The remaining person said that they sometimes like the food. People on the day appeared to enjoy their meal. Most agreed they liked the food, although one person said the choice was not good, and that there was not always an alternative provided when requested. If people want an alternative from the main meal of the day, they do have to request this, although the cook said that she knows who has a special diet, and who has particular likes and dislikes. People could be offered a positive choice before this meal, so they do not have to ask for an alternative. A choice of menu is offered at tea time however, and the cook said that people can have hot or cold drinks whenever they want. People were seen to be offered drinks and biscuits between meals, and were offered help and encouragement when they could not manage alone. Care Homes for Older People Page 20 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints are listened to and investigated by the management. Evidence: Seven out of eight people who returned their surveys told us that they know how to make a complaint. One person did not. Six of these people knew who to speak to if they were not happy. One person said they usually do, and one answered not really. One person spoken with on the day said that they would have no problems reporting their concerns to the registered manager, and were sure that these would be addressed. There has been one complaint made to the Commission for Social Care Inspection about peoples continence care, access to fluids, staffing levels and shortfalls in the upkeep of the cleanliness of the environment. The complaint was passed to the registered provider to investigate, with the person remaining anonymous. The home gave us detailed feedback to tell us what they had done about each area of concern where they recognised shortfalls were upheld. There were four complaints recorded in the complaints file at the home which have been made over the last year. These were around personal care, continence care and staffing levels. In each case there were details of the action taken by the registered Care Homes for Older People Page 21 of 38 Evidence: manager following her investigation, and evidence that her findings had been fed back to the complainants. The deputy manager told us that staff have completed safeguarding, otherwise known as POVA (protection of vulnerable adults) training. She said that the registered manager delivered this training. After speaking to staff it was evident that some have not yet had this training. All knew they must report any suspicions they may have, or if they were told that a person was being abused. However, some, including a senior staff member who has received the recent training, said they would report to the commission, rather than to the local authority, who have the lead role in investigating. Although the management understood the role of the local authority as lead investigators, the policy at the home did not support this, and needs amendment. It also suggested that minor allegations can be investigated by the management of the home. This is not correct. All allegations must be referred to the local authority for consideration, although it remains the responsibility of the home to also report any incident to the Commission for Social Care Inspection. One person living at the home told us on the day of the site visit that they thought some valuables had gone missing from their room. This was discussed with the registered provider and the deputy manager, who were already aware of this concern. They were already looking at information they had requested, and had just received, from the persons representatives. They knew their responsibilities of alerting the local authority and the police should there be any discrepancies found. The management must also keep the commission informed of the outcome. Care Homes for Older People Page 22 of 38 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 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 warm, clean and comfortable environment. But the way that infection control is managed to keep the risk from infection to a minimum could be improved upon. Evidence: The home is situated in Cottingham. There is parking to the front of the property, and a pleasant garden area at the back, which many of the rooms overlook. Changes have been made to the way that the cleaning staff are organised. They are now available over seven days. The home smelt fresh and looked clean and tidy on the day of the site visit. In their surveys, seven people told us that the home is always fresh and clean. One of these said perfect. The eighth said this was usually the case. People said they liked their private accommodation. They had been able to bring in their own belongings to make their room 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, but otherwise, this and a third smaller sitting room, currently Care Homes for Older People Page 23 of 38 Evidence: used to store some equipment, are not really used by people, who prefer to sit in the main lounge with others. Since the last site visit, the home no longer employs a maintenance man. Minor jobs are now carried out by the owner when needed. He was at the home on the day of the site visit completing some work required by the fire officer on their last visit. There has been no changes made to the design of the toilets. Some are not big enough to accommodate wheelchairs. The deputy manager is aware that this is an issue, but is satisfied that there are enough facilities for people. Nobody told us the facilities were not adequate on the day of our visit. 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 normally have a choice of bath or shower facilities, both of which are assisted. However, the assisted baths were put out out of action the previous day, after the deputy manager received an alert that the hoists had been deemed no longer safe to use. She had let people know straight away that there was a problem, by putting up posters apologising for the inconvenience. The restricted arrangements had not yet affected people, but the deputy had anticipated that there may be some people with set routines who found this disruption difficult. The home intends to restore the facility as soon as possible, once they have enough information to know how to. The laundry is separate from the main building. Peoples clothes looked well looked after. There has been a recent outbreak of diarrhoea and vomiting at the home which affected people and staff. The registered manager reported this to the right people and sought advice from them to keep the risk to people to a minimum. However, the following points were discussed: The washers have a sluicing facility. Soiled linen is delivered in black bags by care staff, in order to distinguish it from other washing. The home used to have a supply of bags, which are specially designed to dissolve in the wash. They can be filled with soiled linen and placed straight into the washing machine, where the seal dissolves, allowing the clothes to wash. This reduces the need to handle the linen, and so reduces the risk from cross infection. Consideration should be given to getting a new supply of these. There were no gloves and aprons readily available for staff to use in the laundry area. Care Homes for Older People Page 24 of 38 Evidence: Nor was there any hand sanitiser, which was available in other areas of the home. This equipment should be provided. Neither is there a sink. This means that staff have nowhere to wash their hands should they need to. The registered provider is looking into this currently. As the laundry is separate from the main building, staff will sometimes work in isolation there. They should be provided with safety sheets, which tell them what to do in the case of spillages on their skin, or splashes in their eyes from hazardous chemicals. This will help them to keep safe, and take the right action, if a spillage occurs. Care Homes for Older People Page 25 of 38 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. Staff are satisfactorily recruited, and are encouraged to attain qualifications which confirm they are working to agreed standards in the provision of care for people. Evidence: Seven out of eight people who returned their surveys agreed that staff are always available when needed. The eighth stated that this was usually the case. Staff did not appear rushed on the day, and did have some time to spend socially with people. Although, one staff member said that should staffing levels ever drop, this is the area of peoples care which has to be left. A staff member said that there were usually enough staff to make sure that people got the care they needed when they wanted it. Another said that the numbers were sometimes difficult to maintain when people went off sick unexpectedly, but they knew that the registered manager does try to cover shifts wherever possible. This helps staff to have sufficient time to provide consistent care to people. There are only four care staff at the home who have not yet completed a National Vocational Qualification in Care at level 2 or 3. This is good. It means that staff should all be working to national minimum standards when providing care. Care Homes for Older People Page 26 of 38 Evidence: Before newly recruited staff are allowed to work with people, the registered manager asks them to complete an application form, interviews them, and gets two written references, one from the persons previous employer. In both recruitment files looked at, the registered manager had checked that the prospective staff member had not been barred from providing care, but they had allowed to begin working with people before the full police check had been returned. This arrangement is acceptable in exceptional circumstances, where the staff are needed quickly. We were told that this was the case, and that the staff concerned were supervised at all times. The arrangements for this should be made clearer on each shift, and recorded, so that everyone knows who is supervising who over the course of the shift. This helps to protect people until all the information about the employee is returned from the police. New staff get an induction into how the home runs. One staff member spoken with said they were not expected to carry out any new tasks until they felt confident to do so. The Skills for Care induction is not completed. This should be introduced. It would provide a good and thorough induction and foundation training for staff. Staff have completed training in dementia care. They said this was good, and gave them better insight into peoples needs. Some have also completed training about the Mental Capacity Act. This sort of training is good, because it focuses on peoples individual needs and rights, and how they can be upheld. Care Homes for Older People Page 27 of 38 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. The manager listens to peoples views, but some risks to their health and safety need further attention. Evidence: The registered manager was not available when we visited, because the visit was unannounced, and she was on annual leave. However, staff spoke well of her. One said I love it here. When asked if they could approach the management, we were told they were great. Another staff member was pleased that the registered manager listens, and that, in her absence, the deputy manager is always there to talk to. Another said they get lots of support from the management. The registered manager told us before we visited that she sends out surveys every six months to people, their families and professionals who support them, so she can gather their views about what the home does well, and where it could do better. We were told that the results of these were published, although staff were not aware of Care Homes for Older People Page 28 of 38 Evidence: the results, which were not seen on display on the day of the site visit. It is important that people can see the collective results from their comments so they know that these have been taken seriously and their views acted upon where appropriate. The home chooses not look after peoples money at all. This is managed by their representatives on their behalf. We were provided with information before the site visit, which showed that the major appliances at the premises are kept maintained. A sample of certificates looked at during the inspection where more information was needed showed that the relevant checks had been made. In house safety checks are also done. This includes a weekly check of the fire alarm, to make sure that it will still go off if a fire were to break out. The following shortfalls which affect peoples heath and safety were discussed on the day of the site visit: The records showed that the hot water temperatures had been checked each month. However, the staff member had failed to tell anyone that the water temperatures were not correct. This meant that in one area, the water was far too hot and could have scalded someone. And in another, it was not hot enough. Staff given this responsibility need to report when the temperatures are wrong, so that they can be put right, as they were on the day of the site visit. Two bedroom fire doors were held open by furniture on the day of the site visit. This means that they would not close automatically should a fire break out. This increases the risk from the spread of fire to those using the room. The deputy manager checked with the fire officer on the day of the site visit whether this was acceptable, as the commission cannot permit this practice. She informed us that the fire officer has allowed this practice during the day. However, he has recommended that automatic door closers are fitted to each of the doors, because this is safer practice. He also stressed that the doors must always be closed at night in any event. The deputy manager told us that this happens. The window to the top floor toilet would not close properly. This was repaired so that it would shut. This will make the room warmer for those who use it. There were some windows on this floor, including this one, which were not fitted with restrictors, which is normal practice. This meant that they opened widely. The deputy manager agreed to assess any risk to people from this arrangement. She has informed us that nobody is deemed at risk, and has decided therefore that no further action is needed at this Care Homes for Older People Page 29 of 38 Evidence: point. This assessment must be kept under review for those people living in these rooms, and for future admissions into them. Some people have bed rails. One person whose care was looked at did not have a risk assessment in place for the use of these. Therefore it had not been formally assessed whether the equipment was right for them. Neither was there evidence that the rails are checked periodically to make sure they remain safe and fit for use. The deputy manager agreed to organise for everyone with bed rails to have this assessment completed. The cook keeps records to show that she has kept the kitchen a safe area to prepare and store food. Although meat is delivered in a refrigerated van, the cook is not told at what temperature the meat has been stored until it arrives. We were told before the site visit that staff are up to date with compulsory training that they are required to attend, to make sure they work in a safe way. From the records seen, and from discussion with staff, it was identified that this was not the case, and there are a number of gaps which need to be filled. Care should be taken to make sure that this training, in areas such as moving and handling, fire safety, infection control and food hygiene, is delivered by staff who are trained as competent in each subject area. This makes sure that staff are given the right information. In the absence of a risk assessment, the home must also have a first aider on duty at all times, who knows what action to take in an emergency situation. As a starting point, the deputy manager is giving all staff an update in the fire procedure over the next week so they are refreshed. She has also agreed to contact the fire officer to see what level of training they expect staff to undertake. Care Homes for Older People Page 30 of 38 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 31 of 38 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 13 As discussed at the site visit, 30/12/2008 risk assessments must be completed and kept under review for people who are at risk from pressure sores, nutritional problems and falls. They must also be completed for people who choose to self medicate. This is so that risk to people can be monitored and kept under control. It also lets staff see when risk to people has changed, and where advice from the appropriate professional may be needed. 2 9 13 As discussed at the site visit, 16/12/2008 the pill cutters must be kept clean at all times. This will make sure that people always receive the correct dose of medication. 3 9 13 As stated at the site visit, medication must never be left unattended. 16/12/2008 Care Homes for Older People Page 32 of 38 This is to protect vulnerable people who may access it from harm. 4 10 12 As discussed at the site visit, 16/12/2008 peoples care must not be discussed publicly. This is so their right to privacy, dignity and confidentiality is maintained. 5 18 13 As discussed at the site visit, 31/12/2008 the homes abuse policy must be amended to reinforce the role of the local authority as lead investigators in safeguarding matters. The suggestion that staff can investigate minor allegations must also be removed. Staff must all receive training which reinforces this procedure. This will make sure that any allegation or suspicion is referred to the right people for investigation without delay. 6 26 16 Plans to fit a sink in the 31/01/2009 laundry must be pursued. As part of this plan the environmental health officer could be consulted to see what is required to meet regulation. This is so that staff have appropriate hand washing facilities to reduce the risk from cross infection. 7 37 13 In the absence of a risk assessment, there must be 28/02/2009 Care Homes for Older People Page 33 of 38 sufficient staff with a current first aid qualification to make sure that there is a first aider on duty at all times. This will help to make sure that people get the right attention in an emergency requiring first aid support. 8 38 13 Remaining gaps in 28/02/2009 compulsary training for staff must be filled. This must be provided by people assessed as being qualified and competent to do so, and covers fire safety, moving and handling, infection control and food hygiene. This will make sure that staff are refreshed in how to work competently and confidently in order to provide safe care for people. 9 38 13 As stated at the site visit, staff given the responsibility to check hot water temperatures must also report when these are not maintained within normal limits once they have completed the check. This will help to protect people from scalds, and will also make sure that their water is warm enough to be comfortable to use. 10 38 13 As discussed at the site visit, 31/12/2008 people with bed rails must have a formal risk assessment completed 31/12/2008 Care Homes for Older People Page 34 of 38 which must be reviewed periodially. The rails must also be checked periodically, and this check recorded. This will check that the rails are the most appropriate course of action for the person concerned, that they remain suitable and safe over time, and they are checked to make sure they are in safe working order and properly fitted. 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 3 The care plan written by the persons care manager should always be obtained before the person is admitted where this admission is planned. This makes sure that sufficient is known about them to make a good decision about whether their needs can be met. Peoples social needs should be described in a more individual way in their care plan. This will help staff to understand better what they can do so that these needs can be met successfully. Baseline risk assessments should be in place for everyone at the home, so that their care plans consider calculated risks from falls, nutritional problems, pressure sores, and moving and handling issues. 2 7 3 8 Weighing scales should be provided that people are able to sit on, so that those who are unable to stand are able to have their weight accurately monitored. The pharmacist should always be contacted where a decision has been made that specific medications need to be chopped up. This will make sure that the medication will still work in the same way, and that it is safe to do so. The way the medication system is audited should be reviewed, to include the following: 4 9 Care Homes for Older People Page 35 of 38 Checking that staff have carried forward the balance of non blistered medication, so that a check can be kept about how much medications should be remaining, and whether it has been given as prescribed. Making sure that staff do not use, and return to the pharmacy, medication which is out of date, or which belongs to people no longer living at the home. Making sure that topical medication is also kept safely locked away, and not stored in bathroom areas accessible to people. 5 10 Staff should always make sure that they support people to maintain their privacy and dignity when people are attending to their own personal needs. People who have liquidised meals should have these served in separate portions on their plate. This makes the meal look more appealing, and allows the person to experience different textures of food. A choice should be offered before each mealtime, rather than people having to ask for an alternative once the meal is served. This will allow people to look forward to a meal which they know they will enjoy, and which they can eat with others. 7 26 A ready supply of gloves, aprons and hand sanitiser should always be available in the laundry for staff to use to reduce the risk from cross infection. Staff working there should also be provided with safety sheets which refer to the products they use, and which tell them what action to take in the case of spillages. A record should be maintained to show who is responsible for the ongoing supervision of a new starter on each shift they work, until the full police check is returned. This will make sure that the staff member always works with someone until a firm decision can be made as to whether they are suitable to work with vulnerable people. Staff should complete the full Skills for Care inductions so that from the start they are working consistently to current national minimum standards that are expected when they provide care. The results from satisfaction surveys should be published, and available for people to look at. This will mean that they can see peoples collective views about the quality of the service, where the home does well, and what is being done to address areas that people have identified could be better. Page 36 of 38 6 15 8 29 9 30 10 33 Care Homes for Older People 11 38 The advice of the fire officer should be considered. Automatic closers should be provided for those bedroom fire doors which people choose to have open during the day. This is a safer way to meet their wishes, because the closers would allow the door to shut automatically in the event of a fire. Risk assessments for those people occupying rooms with unrestricted windows which open wide should be kept under review. They should also be completed for future occupants who use the rooms to check that they too are safe. Enquiries should be made with the Environmental Health Officer to see whether it is necessary to obtain and keep a record of the temperature of chilled meats when they are delivered to the home. This check would provide reassurance that it has been maintained at the right temperature before being accepted by the home. Care Homes for Older People Page 37 of 38 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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. 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