Inspection on 23/05/06 for The Arches Residential Care Home

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Arches Residential Care Home 04/07/07

The Arches Residential Care Home 14/02/07

The Arches Residential Care Home 21/09/05

The Arches Residential Care Home 26/04/05

The Arches Residential Care Home 14/01/05

The Arches Residential Care Home 14/07/04

The Arches Residential Care Home 14/01/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Arches Residential Home Mounts Road Greenhithe Kent DA9 9ND Lead Inspector Ruth Burnham Key Unannounced Inspection 23rd May 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Arches Residential Home Address Mounts Road Greenhithe Kent DA9 9ND Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01322 370163 01322 381642 Arches Care Home Limited Mrs Joy Chapman Care Home 21 Category(ies) of Dementia - over 65 years of age (21) registration, with number of places The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only 18 beds can be used as Dementia Care beds until new extension is built and then the number can increase to 21. 21st September 2005 Date of last inspection Brief Description of the Service: The Arches is currently registered to accommodate 18 older persons who have been diagnosed with dementia. There is a large lounge/dining room on the first floor and a smaller lounge diner on the lower ground floor, the home also benefits from a large conservatory with extensive views over the valley. There is a small garden to the rear which is currently inaccessible to service users due to the work in progress to add an extension to the property. The home is on 3 floors; there is a 5-person lift to all floors. The home is situated in a quiet residential area of Greenhithe with local shops and post office close by. Bluewater shopping complex is approximately 2 miles away. Fees charged range from £400 to £420 per week. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the home during which the unannounced site visit took place on 23 May 2006 at 10.15am. It was carried out by 2 inspectors were in the home until 5.15pm. and continued on the 22nd September 2005. Before the visit service users, relatives and health and social care professionals were written to asking them to comment on their experience of the home, at the time of writing this report 9 written responses had been received the majority of which were positive. Two relatives commented, ‘The management and carers are very caring,’ they endeavour to provide a homely friendly atmosphere,’ ‘the food is good.’ ‘When I leave my relative after visiting I have a smile on my face knowing she is in safe hands, and living in a very happy environment.’ None of the correspondents had had to make a complaint however a number of complaints were brought directly to the attention of the lead inspector in the 4 weeks leading up to the visit which were referred to the local Social Services Department for investigation under their Adult Protection procedures. During the visit a number of documents and records were examined, discussion took place with the owner and the manager, some staff and service users were spoken to however, given that all the people who live in the home have dementia, a large proportion of the visit was spent directly observing the care and interaction between staff and residents and case tracking through care plans and other records. A tour of the premises was also carried out. What the service does well: What has improved since the last inspection? The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 6 What they could do better: An accurate statement of purpose and service user guide must be provided to the Commission and be made available to service users, prospective service users and their representatives. Statements of terms and conditions must include the room number and level of fees and, where a local authority has made arrangements for the provision of accommodation, nursing or personal care to the service user at the care home, the registered person shall supply to the service user a copy of the agreement specifying the arrangements made. The assessment of the service users’ needs must be kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances and the premises, staffing, activities and other services provided by the home must be suitable to met the needs of people with dementia. Care plans must be drawn up in line with the assessment to include risk assessments with particular attention to the prevention of falls. The conflict of interest where the owner and GP are the same person must be resolved. People who live in the home must be protected through safe systems of medication storage and administration in compliance with recognised guidelines. The routines of daily living and activities made available must be flexible and varied to suit service users’ expectations, preferences and capacities with activities and service users’ stimulation being facilitated as programmed. The home needs to ensure Service users are able to develop and maintain links with the local community in accordance with service users’ preferences enabling service users to access safely the community with regular outings. Choice and opportunity to have involvement with decision-making processes must be offered in a way that service users can comprehend. Food must be offered and prepared in a way, which takes account of the nutritional needs of older people with dementia. The registered person shall supply to the Commission at its request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. Staff must not be instructed not to speak to the Commission about any concerns they may have. Whilst building work is in progress effective risk management process must be in place to protect service users from harm and must be managed in a way which minimises the negative impact on service users, access to fresh air and daylight must not be blocked in residents’ bedrooms. The garden must be made safe and accessible for service users once building work is completed. Advice should be sought from appropriate professionals who specialise in elderly and dementia care in order for adaptations to be made in line with the home’s stated aims and objectives. Suitable arrangements for maintaining satisfactory standards of hygiene in the care home must be made in that the kitchen and food storage and handling must comply with the requirements of the Food Safety Act and care practice must minimise the risk of cross infection. There must be sufficient, suitably qualified and competent staff on duty at all The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 7 times to meet the needs of the residents and recruitment procedures and effective supervision of staff must protect them from harm. The manager and the owner must work together to ensure that the home is run in the best interests of the people who live there and has effective quality assurance system to ensure that improvements are carried out. Service users must be protected through safe working practices carried out by suitably trained staff. Compliance with a number of requirements following the inspection in September 2005 has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with these and the additional requirements has been requested. . Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. People who are considering moving to the home are still not provided with accurate information upon which to base a judgment and they will be disadvantaged by the a lack of understanding of their particular needs. EVIDENCE: The Statement of Purpose and Service Users Guide still do not accurately reflect the changes to the home’s registration which occurred last year. Information contained in these documents was found to be out of date or in some cases misleading in that it is stated that all bedrooms are single when there is still a shared room in the home, statements about the qualifications of staff were also misleading. The statement of terms and conditions for service users who are publicly funded still does not contain information about fees and by whom they are payable or the number of the room occupied. The manager said that the service user guide and statement of purpose were available in the home in a folder but copies were not being provided to people who live in the home or their representatives neither were copies provided to people who are The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 10 considering moving into the home to assist them to make a judgement about whether their needs can be met. People who are considering moving into the home are assessed by the manager who uses a pre assessment form that she completes when visiting prospective service users in their own home or hospital. Samples of these were seen and the manager had made detailed notes. The Manager explained that this information was then used to determine if the home could meet the service user’s needs. The home now only admits service users who suffer from dementia, the last inspection report in September 2005 stated that it is paramount that staff are all trained in the care of people with dementia and that they would also benefit from accessing some training in the management and handling of challenging behaviour. The manager explained at that time that all staff have undertaken a dementia course and gradually staff are being put forward for other associated courses, it was disappointing to find that the additional training has still not been undertaken by all staff therefore people who live in the home are being disadvantaged by the a lack of understanding of their particular needs. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Inadequate care planning, risk management, staff training and medication management systems are placing people who live in the home at risk of harm. The EVIDENCE: A number of care plans were sampled which showed good initial assessment of the residents’ care needs. A place is provided on this care plan for staff to date and sign to indicate when reviews have taken place however; this does not allow space for the outcome of the review to be recorded. This was discussed with the manager at the previous inspection, the plans were now being reviewed monthly however these reviews rarely result in alterations to the care plan, this was of particular concern where significant weight losses were being recorded. The manager was also reminded at the last inspection that a reassessment of needs and a full care plan review for each service user was due every 6 months and that these should involve the family and care manager if possible. Whilst it is recognised that service users have dementia and this does make it difficult for them to be part of the care plan process, their key workers should be able to make a valuable contribution on their behalf. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 12 The daily notes seen still varied in quality and content, with some staff demonstrating a better understanding of what needs to be recorded. Failure to ensure that daily records cross reference with the plans of care, may mean that the identified care needs of people who live in the home are not being met. The entries were dated but they did not always record the timing of events or the care interventions; this was discussed with the manager at the previous inspection. The majority of people who live in the home still have the same GP, Dr Desai, who is also the owner of the home. It has been pointed out at a number of previous inspections that this situation should be urgently reviewed. It is the view of the Commission that, the carrying out this duel role as the service users’ Doctor and owner of the home could lead to a possible conflict of interest. To show openness and transparency the home must show that any medical advice or treatment received by service users is wholly independent of it and its owner, service users should be given the choice of retaining their existing G.P. when moving into the home and not be persuaded to change practices. Dr Desai stated to the inspectors that he had sought advice from his professional body who had told his that there was no problem with the dual role however this is clearly not in the best interests of the people who live in the home and conflicts with section 58 of the good medical practice guidance produced by the General medical Council which states: Treating patients in an institution in which you or members of your immediate family have a financial or commercial interest may lead to serious conflicts of interest. If you do so, your patients and anyone funding their treatment must be made aware of the financial interest. In addition, if you offer specialist services, you must not accept patients unless they have been referred by another doctor who will have overall responsibility for managing the patients care. If you are a general practitioner with a financial interest in a residential or nursing home, it is inadvisable to provide primary care services for patients in that home, unless the patient asks you to do so or there are no alternatives. If you do this, you must be prepared to justify your decision. In the files sampled there was examples seen of health care needs of people who live in the home being identified and followed up by staff. The plans of care include details of the general dietary needs of the service users however it was of concern that there was an apparent lack of understanding of the increased nutritional needs of people with dementia who are often very active and have difficulty in maintaining an optimum weight, evidence seen of significant weight loss was discussed with the manager, it was found that the cook has not had training in the specific nutritional needs of the elderly and reduced fat foods such as milk and margarine were found in the kitchen despite the fact that there did not appear to be anyone in the home who was overweight. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 13 People who live in the home are provided with access to a chiropodist, dentist and optician when required. The home encourages the family to go to hospital appointments with their relative. An escort from the home can be arranged for a fee. The manager explained that they do try to offer a home for life but they are not a nursing home so if the service users develop an ongoing nursing need then an alternative home would have to be found. Medication is mainly stored in a small drug trolley which holds the monitored dosage system packs, creams, additional medication and records. The trolley is secured to the wall in a sectioned off area adjacent to residents rooms. The medication administration records now include the amount of medication received and that carried over. There were some omissions without explanation in the record. The limited storage led to current and stock of the same medication being stored together. In two cases, this has led to two of the same item in current use for the same resident. Dates of opening were not routinely recorded. Out of date cream was found without being named to an individual. Staff said that only trained staff would administer medication. Records of staff administering controlled medication did not tally with those having received training. Controlled medication was properly signed for and stored safely. An inhalant mask was incorrectly stored and required thorough cleaning to reduce the risk of cross infection. There is a list of staff signatures with their initials. The member of staff on duty had not recorded his initials although had been giving out medication for some time. These shortfalls are placing people who live in the home at risk of harm. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The quality of life of people who live in the home is adversely affected by the lack of understanding of their condition as it affects their ability to make choices and exercise control over their own lives. They may be at risk where there is a lack of understanding of their nutritional needs and inadequate staff training. They benefit from the welcome afforded to visitors. EVIDENCE: The quality of life for people who live in the home is reduced by the inadequate provision of recreational activities, the home still does not have an activities co-ordinator and hard pressed care staff are still responsible for the organisation and provision of activities. Staff spoken said that they do their best to provide all service users with some sort of stimulation through the week but that activities have to be fitted in with the other tasks, i.e. laundry, personal care and supervision of people who live in the home. A notice was seen on the wall of the lounge which described activities for that morning neither of which were actually available. Staff have not received any training in the provision of suitable activities for people with dementia and those spoken to had little understanding of how to offer choice to people with dementia in a way which could be understood by them. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 15 People who live in the home have limited opportunity for trips out into the community, inadequate staffing levels make this difficult and the home has no suitable transport. The home does have church services that are held monthly. The staff said that visitors are made to feel welcome and can visit at anytime. Visitors who were spoken to confirmed this. The dining rooms are pleasant and have been made to look homely. The cook is qualified but has had no training in the specialist nutritional needs of the elderly and specifically those suffering from dementia. The meal served at lunchtime on the day of inspection was served in a way which failed to present choice to people who live in the home in a way they would be able to understand, they were unable to see what was on the trolley before it was plated up and placed in front of them and the trolley, which was brought up from the ground floor and was not heated, was taken away before any opportunity was given for seconds. The only food offered between meals was a biscuit with morning or afternoon tea. It was disappointing to see the poor practice at morning tea. A box of broken biscuits were taken around, with a member of staff handing a biscuit from the box to each resident, usually without the recipient having any opportunity to choose or even see the selection available. There was a clear risk to the health of residents where the member of staff, who was not wearing gloves, was picking over the biscuits in the box to find unbroken ones, she had not received any basic food hygiene training. Tea and coffee was offered, both of which were served from teapots, there was a mismatch of mugs and cups and saucers. Milk and sugar was added without reference to the residents, when asked about this the staff member said she already knew what each resident wanted although there was no written list of likes and dislikes for reference and no allowance made for any change of mind. There is limited provision for staff to offer service users snacks. A reference was made to a service user having a cup of tea when she was restless at night. There was no fresh fruit; the manager said she hadn’t been able to go shopping that day. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. People who live in the home are disadvantaged by the inadequate system for managing complaints. No judgement has been made about the protection of people who live in the home from abuse. EVIDENCE: It is difficult to see how people who live in the home can feel confident that they will be listened to given the lack of adequate training for staff in dementia, there was no record available of any complaints in spite of the fact that serious complaints have been received in the last few weeks by the Commission. The manager said that she did not keep a record of complaints as required by the regulations. No comment is being made in this report about the protection of people who live in the home from abuse as there is currently an Adult Protection investigation in progress and it would be inappropriate to comment on this until the outcome of that investigation is known. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 – 22 & 25 - 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from the high standard of cleanliness and homeliness of the environment however there is serious risk of harm and negative impact on the quality of life for service users due to the poor management of building work on the new extension. Privacy, dignity and choice are compromised for occupants of the shared room and poor practice is placing residents at risk of infection. EVIDENCE: People who live in the home are benefiting from improvements which have been made in the environment, there is now a better use of space and residents can move around more easily in the communal areas. Rooms are generally pleasant and homely with a high standard of cleanliness throughout. Most of the home was light and airy with domestic lighting. A passenger lift enables Service Users to access lounges situated on two floors. There are ramps and handrails situated around the home. There is an emergency call The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 18 system throughout the home. There are 2 baths with hoists, a shower room which is suitable for people with reduced mobility and there are 5 WC`S. People may be at some risk of infection where sponges and bars of soap were being left in bathrooms and there are inadequate facilities for waste disposal. The management of building work to provide an extension to the existing property is poor and is placing residents at serious risk in that access to outside space has not been restricted. The door between the conservatory and the outside of the building, where builders are working on scaffolding and debris is lying around, was seen propped open with a brick during the inspection, even at times when residents on the ground floor were unsupervised. Residents cannot access the garden safely and there have been no plans made to manage the building in a way which reduces the negative impact or minimises the risk or injury to service users during the building work. The quality of life for 3 people who live in the home has been severely affected by the erection of the extension in that the windows to their bedrooms have been built over leaving them without access to fresh air or adequate daylight, the manager said that she had pointed this out to the provider but that the care managers of the affected residents had neither been consulted or informed. This was discussed with the provider who agreed that this had been poorly managed and that new windows should have been created in these rooms before the existing ones were blocked. He agreed to provide an action plan of how he intends to rectify the situation and ensure that plans are drawn up with risk assessments to ensure that further harm is not caused as the new build progresses. The placing authorities responsible for the residents affected were informed of the situation following the inspection by the inspector. Further discussion took place with the owner and the manager about the need for an assessment of the existing premises and the new extension by a suitable professional with a relevant specialism in the provision of residential care for the category of residents accommodated in the home. There are currently no adaptations which would help people with dementia to find their way around the home or locate their own bedrooms. Service users have brought in their own pictures and ornaments and small items of furniture to their rooms. None of the bedrooms have en-suite facilities. It was encouraging to see that there is now only one shared room in the home, this is not fit for purpose in that there is insufficient space to provide the occupants with adequate privacy or preserve their dignity. The inspectors remain concerned that people with dementia accommodated in the double room have not been able to make a positive choice to share. The manager confirmed that all bedrooms will be single once the new extension is completed. Poor practice around food storage is placing people who live in the home at risk of infection, dry goods are stored in outside sheds and some foods such as cold meats, custard etc were seen in the fridge without labelling to note when they had been placed there. The Environmental Health Officer was contacted by the inspector following the visit and asked to liaise with the home to improve standards, particularly as a new kitchen is being built in the extension. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Inadequate staffing levels and training, poor recruitment practice, lack of supervision are placing people who live in the home at risk. EVIDENCE: The home’s accommodation is located over three floors with most service users being on two floors during the daytime hours. The home employs 3 care staff on the morning and afternoon shifts. The home has only one cleaner working six days a week. This means that the care staff are also responsible for bed making, laundry, preparing snacks and the meal at tea time, activities etc in addition to providing personal care and supervision of people who live in the home. The staff forum for staffing hours indicates that the number of hours being employed is about right for the size of home. However, these are caring hours, they also do not take into account that the home is split on two levels during the day, there were times during the inspection that residents on the ground floor were unsupervised. Staff said they relied on managers to oversee the ground floor when service users needed two people to assist with baths as they couldn’t leave the first floor unsupervised. Staff are also helping with other duties such as cleaning during the evening. These issues were raised at the previous inspection when it is recommended that the staffing levels be reviewed. With consideration being given to the employment of a second cleaner and laundry personnel for example, particularly now many of the service users are incontinent, no action has been taken. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 20 A number of staff have left in the last year and new staff have been employed. Five staff files were sampled three of which were found to contain an appropriate application form, interview notes, proof of a satisfactory CRB, references and employment contract. The files still did not contain all of the required ID or photos although the manager was shown at the previous inspection where to find the list of what is required. The best interests of people who live in the home are clearly not being served where a member of staff has been re-employed even though documentation evidences their unsuitability, The manager explained that this person had been re-employed in her absence having previously left employment in the home and taken up employment elsewhere, there was no evidence that new references had been taken up or a new application submitted or of any interview having taken place. It was of further concern that a person from overseas was working in the home without adequate checks having been carried out and without a valid work permit. The owner said that she was being allowed to work in the home as a favour to a friend and suggested that he wasn’t paying her. Another staff file contained file notes recorded by the manager about the unsatisfactory and negligent conduct of a member of staff, no disciplinary action had been taken and the file notes stated that the owner had overridden the recommendations of the manager in respect of the conduct of this member of staff. The staff training records show that many staff have been included on some of the required courses, but that refresher courses are still needed by some staff, as many are out of date. People who live in the home are being placed at risk where a number of staff have received no training in basic food hygiene, adult protection or infection control in spite of being a requirement from the last inspection. None of the staff are suitably trained or qualified to care for people with dementia although the manager is sourcing suitable training for the future. All staff have undertaken fire training and courses are held six monthly, one was in progress on the afternoon of the inspection. It was encouraging to hear that staff are now being paid a minimum of three training days per year. Some staff are undertaking NVQ training, one commented that she would love to do it but numbers were limited. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36 & 38 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The welfare of people who live in the home is compromised by the lack of effective quality assurance and risk management systems and the continued failure to meet requirements made at previous inspections. Residents are being adversely affected by the ineffective working relationship between the owner and manager. EVIDENCE: The registered manager at the home has many years working in the caring industry, starting off in nursing and then becoming a social worker, having gained a social work qualification. The manager also has completed a diploma in management. As the manager is nearing retirement she has now chosen not to undertake the required Registered Manager’s Award. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 22 It was noted at the previous inspection that staff morale is low generally in the home. Most then said that they were well supported by the manager and her deputy, but did not feel the same way about the home’s owner. The staff felt that the other jobs they have to do such as all the laundry, elements of cleaning and cooking, take them away from the care of the service users. The manager said that the home has staff meetings about once every three months, it was very disturbing to note that the minutes of the last meeting recorded an instruction from the owner that staff must not contact the Commission. There is still no effective quality assurance system in the home and the failure to meet requirements from the last and previous inspections indicates the general poor management of the home. The manager says that she has tried to take the appropriate action but is constantly overruled by the owner. The staff at the home are still not receiving the required formal supervision six times a year. There was evidence on the file that staff are having regular appraisals and the manager said that the practice of formal supervision has started but has still not been completed for each member of staff. As detailed in earlier standards, people who live in the home are being put at risk through inadequate staff training, training requirements are still not up to date and staff still do not have the required knowledge and skills to meet the service users’ needs and comply with health and safety regulations. The manager still needs to complete a building risk assessment with the owner, prioritising any identified risks and giving time scales for action, this was noted in previous reports and has become even more urgent with the building work and additional subsequent risks. The provider has informed the Commission that he is intending to register a new manager as the current manager is seeking retirement. The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 2 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 x 1 2 3 1 x x 1 1 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 1 1 x x 1 x 1 The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4,5, schedule 1 Requirement The registered person produces and makes available to service users, an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users’ guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the home’s service user’s guide. The timescale for compliance with this requirement following the inspection in September 2005 was 30/11/05. This has not been achieved. An accurate statement of purpose and service user guide must be provided to the Commission and be made available to service users, The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 25 Timescale for action 30/06/06 prospective service users and their representatives. 2 OP2 5 the terms and conditions in respect of accommodation to be provided for service users shall include the amount and method of payment of fees; Where a local authority has made arrangements for the provision of accommodation, nursing or personal care to the service user at the care home, the registered person shall supply to the service user a copy of the agreement specifying the arrangements made. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 3 OP3 14 The registered person shall ensure that the assessment of the service users needs is kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 4 OP4 14 The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so needs of the service user have been assessed by a suitably qualified or suitably trained person; the registered person has obtained a DS0000024030.V295458.R01.S.doc 30/06/06 30/06/06 30/06/06 The Arches Residential Home Version 5.2 Page 26 copy of the assessment; there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. Specifically the premises, staffing, activities and other services provided by the home must be suitable to meet the needs of people with dementia. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 5. OP7 15,13 A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. It is reviewed monthly by staff, with out comes recorded and a new assessment and review is held with family/care manager six monthly. All entries in the daily log have the time recorded of the care provision or event. The timescale for compliance with this requirement following the inspection in September 2005 was 30/11/05. This has not been achieved. 30/06/06 The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 27 Risk assessments must be drawn up as part of the care plan with particular attention to the prevention of falls. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 6. OP8 12,13 The registered person promotes 30/06/06 and maintains service users’ health and ensures access to health care services to meet assessed needs which are open and transparent. Specifically the conflict of interest where the owner and GP are the same person must be resolved The timescale for compliance with this requirement following the inspection in September 2005 was 30/11/05. This has not been achieved. The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, following The Royal Pharmaceutical Society Medication guide lines for care homes The timescale for compliance with this requirement following the inspection in September 2005 was 30/10/05. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 30/06/06 7 OP9 13(2) The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 28 8 OP12 16.2 (m)(n The routines of daily living and 30/06/06 activities made available must be flexible and varied to suit service users’ expectations, preferences and capacities. With activities and service users stimulation being facilitated as programmed The timescale for compliance with this requirement following the inspection in September 2005 was 30/11/05. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 9. OP13 12(4)(a) 16.2 30/06/06 The home needs to ensure Service users are able to develop and maintain links with the local community in accordance with service users’ preferences. Enabling service users to access safely the community with regular outings The timescale for compliance with this requirement following the inspection in September 2005 was 31/01/06. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 10 OP14 12 The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. DS0000024030.V295458.R01.S.doc 30/06/06 The Arches Residential Home Version 5.2 Page 29 The registered person shall make suitable arrangements to ensure that the care home is conducted with due regard to any disability of service users. Specifically choice and opportunity to have involvement with decision-making processes must be offered in a way that service users can comprehend. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 11 OP15 16(2)(i) The registered person shall having regard to the size of the care home and the number and needs of service users provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users; An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 12 OP16 22(5) The registered person shall supply to the Commission at its request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. Staff must not be instructed not to speak to the Commission about any concerns they may have. An improvement plan specifying how the registered person The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 30 30/06/06 30/06/06 intends to achieve compliance with this requirement has been requested. 13 OP19 13(4)(a) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated; specifically whilst building work is in progress effective risk management process must be in place to protect service users from harm. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 14 OP20 23(o) The registered person shall 30/06/06 having regard to the number and needs of the service users ensure that external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained; Specifically the garden shall be made safe and accessible for service users once building work is completed. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 15 OP22 23(2)(a) The registered person shall 30/06/06 having regard to the number and needs of the service users ensure that the physical design DS0000024030.V295458.R01.S.doc Version 5.2 Page 31 30/06/06 The Arches Residential Home and layout of the premises to be used as the care home meet the needs of the service users; specifically advice should be sought from appropriate professionals who specialise in elderly and dementia care in order for adaptations to be made in line with the home’s stated aims and objectives. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 16 OP25 12 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users; specifically the building work must be managed in a way which minimises the negative impact on service users, access to fresh air and daylight must not be blocked in residents’ bedrooms. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 17 OP26 13(4) 16(2)(j) 23(5) The registered person shall undertake appropriate consultation with the authority responsible for environmental health for the area in which the care home is situated. after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care DS0000024030.V295458.R01.S.doc 30/06/06 30/06/06 The Arches Residential Home Version 5.2 Page 32 home; in that the kitchen and food storage and handling shall comply with the requirements of the food Safety Act and care practice shall minimise the risk of cross infection. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 18 OP27 18 Staffing numbers and skill mix of qualified/unqualified staff must be appropriate to the assessed needs of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. The timescale for compliance with this requirement following the inspection in September 2005 was 30/10/05. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 19 OP29 19 The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home and he has obtained in respect of that person the information and documents specified in Schedule 2 An improvement plan specifying how the registered person intends to achieve compliance The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 33 30/06/06 30/06/06 with this requirement has been requested. 20 OP30 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. He shall ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform; specifically in the specialist needs of the client group. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 21 OP32 10,12 The registered manager/owner ensures that the management approach of the home creates an open, positive and inclusive atmosphere. The timescale for compliance with this requirement following the inspection in September 2005 was 30/10/05. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 30/06/06 30/06/06 The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 34 22 OP33 24 Effective quality assurance and quality monitoring systems, based on seeking the views of service users, family and health professionals are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. The timescale for compliance with this requirement following the inspection in September 2005 was 30/11/05. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 30/06/06 23. OP36 12,13,17, 23,25 The registered person ensures that the supervision arrangements are put into practice, and formal supervision takes place at a minimum of six times a year. The timescale for compliance with this requirement following the inspection in September 2005 was 30/10/05. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. 30/06/06 24. OP38 25,41,sch edule 4.3 The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and DS0000024030.V295458.R01.S.doc 30/06/06 The Arches Residential Home Version 5.2 Page 35 staff. Required training to be facilitated by the registered person. The timescale for compliance with this requirement following the inspection in September 2005 was 28/02/06. This has not been achieved. An improvement plan specifying how the registered person intends to achieve compliance with this requirement has been requested. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Arches Residential Home DS0000024030.V295458.R01.S.doc Version 5.2 Page 37 - 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!