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Inspection on 26/04/05 for The Arches Residential Care Home

Also see our care home review for The Arches Residential Care Home for more information

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is decorated and furnished to a high standard. The living room, dining room and conservatory areas are very spacious and the overall impression is homely, comfortable, clean, bright and airy. The systems for medication administration are good with clear arrangements in place to ensure Service users` medication needs are met.

What has improved since the last inspection?

Dining seating is now provided on two floors instead of one and this has greatly improved the available space for service users at mealtimes and has resulted in a more pleasant and calm atmosphere overall for eating in. The daily records have improved since the previous inspection providing more detailed information than previously about how service users were and how they had spent their day.

What the care home could do better:

Each service users care plans should be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet all aspects of their health and welfare needs. Appropriate activities should be provided on a daily basis. If these are to be provided by staff then they should have appropriate training. Service users with dementia should be encouraged and enabled to choose their meals.

CARE HOMES FOR OLDER PEOPLE The Arches Residential Home Mounts Road Greenhithe Kent DA9 9ND Lead Inspector Fiona Holdaway Unannounced 26 April 2005 08:00 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 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 H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Arches Residential Home Address Mounts Road Greenhithe Kent DA9 9ND 01322 370163 01322 381642 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Arches Care Home Ltd Mrs Joy Chapman Care Home 21 Category(ies) of Dementia - over 65 (8) registration, with number Mental Disorder - over 65 (1) of places Old age (12) The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care for one older person with mental health difficulties is restricted to one person whose date of birth is 13 May 1929 Date of last inspection 14 January 2005 Brief Description of the Service: The Arches is registered to accommodate 21 older persons, up to eight of these may 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 accessible to service users. 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. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Inspection was carried out by Regulation Inspectors Fiona Holdaway and Ruth Burnham, between 8.00am and 1.30pm. The Manager of the home was present throughout the Inspection and the Inspectors also met with the owner / provider of the home. What the service does well: What has improved since the last inspection? What they could do better: 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 H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 7 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 standard(s) 2,3,4, standard 6 does not apply. Prospective service users and their relatives have the information they need to make a choice about the home. Service users and their relatives are encouraged to visit the home before the person moves in. The needs of service users are assessed prior to admission to ensure that the home can meet their needs. However, there are more service users paying a dementia care rate than the home is registered for which is a potential risk to service users. EVIDENCE: Pre-admission assessments were seen for all of the present service users and these provided sufficient details of the service users care needs. However the home is registered for 8 service users with a diagnosis of dementia and it was found that 10 service users fees were being paid at dementia care rates of which 2 had no formal diagnosis of dementia recorded. There is, therefore a breach of the conditions of registration by the provider and manager. This was identified at the last inspection and is being addressed by an application for a variation to the numbers for dementia care. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 8 Each service user has a contract with the home stating the terms and conditions of their residency. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9,10 Staff do not have a detailed plan of care to follow that clearly tells them how to help and care for each individual service user. Service users are protected by the homes medication policies, procedures and good practice. Service users healthcare needs are met but the privacy and dignity of service users is not always upheld. EVIDENCE: Care plans were examined for 3 service users in detail. The manager was aware that these were still in need of updating following the previous inspection on 24.11.04 and discussion took place in relation to the need for the care plans to include clear, detailed guidance to staff on how to meet the individual care needs of the service user. The daily records had improved since the previous inspection and provided information about how service users were and how they had spent their day. Care records also included assessments for risk of pressure sores and healthcare appointments and the outcomes. General guidance for staff on managing behaviour of service users with dementia was present on files but there was not any guidance specific to the individual, that tells staff how to respond to the person, what the best approach is for them and why. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 10 There was no guidance or training for staff for caring for those service users with epilepsy and diabetes. Some general information is recorded on the initial assessments but the care plans do not give guidance to staff on service users personal preferences and how to support each person with washing, dressing, social activities, meals etc or how to support those service users with a diagnosis of dementia who may be confused and upset or even become aggressive. The GP for all the service users is the registered provider Dr Desai. It is the opinion of the Inspectors that this presents a conflict of interest and the service users should be given the opportunity to change their GP to another practice. This statement is not intended in any way to suggest that they are not receiving a satisfactory service from Dr Desai as a GP or as the registered provider of the home. However, Ethical Guidance from The General Medical Care Council states: “Treating patients in an institution in which you or members of your immediate family have a financial interest may lead to serious conflicts of interest…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.” Privacy and dignity remain compromised as personal care records continue to be kept in the main lounge in a cabinet that is not locked. The manager stated that a lockable cabinet was on order. Also a notice on the wall stated “ All residents must be toileted before and after lunch” – there were no individual continence plans in place. Service users right to privacy is compromised by insufficient screening in one bedroom and personal information on display on the window in the lounge and in the communication book (rather than on each individuals records). The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 14,15 Service users social and recreational needs are not met by the home. Service users are offered a balanced diet although the opportunity to choose meals may be limited for service users with dementia. EVIDENCE: The home does not employ an activities person. Activities for service users are limited to those offered by staff as and when there is sufficient time to provide them. The manager stated that there are no planned activities and activities such as card games, bingo or reminiscence groups may be provided by staff if there are enough staff on duty. There are library books, videos, playing cards, puzzles and board games available in the home for service users though many service users would be reliant on staff to instigate these activities. Staff have not received any training in providing appropriate activities for the elderly, particularly those suffering with dementia. The daily records indicated that activities were infrequent. Visiting entertainers are arranged approximately 3 or 4 times a year. There are 6 service users in shared rooms that were not able to make a positive choice to share as they have a diagnosis of dementia. Menu records were seen and these showed that a balanced and varied diet is offered. Service users are asked to make a choice from 2 main meals on offer, one day in advance. However this does not allow for those service users with The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 12 dementia that may find it difficult to make a choice, or to remember it. It is recommended that either pictures of meals or actual meals plated up ready are offered to service users to make a choice from. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24 and 26 Service users live in a clean, homely, comfortable, safe and well-maintained home. Service users have sufficient bathroom facilities. EVIDENCE: The Inspectors did a tour of the building and found a high standard of cleanliness throughout. 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 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. A significant improvement, from the last inspection, in the use of the dining room and lounge areas was seen and service users were clearly benefiting from the increase in space. Service users have access throughout the home including the garden patio and decking area. A gate is needed to separate the lower garden as this may be unsafe if service users wander down the uneven path (there is no handrail and the garden slopes steeply). The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 15 Service users had brought in their own pictures and ornaments and small items of furniture to their rooms. Some beds had a loose plastic covering on mattresses and duvets which may pose a risk of pressure sores to service users, they are also hot and noisy. None of the bedrooms have en-suite facilities. Service users privacy is ensured in double rooms by use of screens, in one bedroom the curtain needed to be bigger to maintain privacy. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36 and 37 The manager is approachable and is available in the home on a daily basis to service users, relatives and staff. However, service users’ rights and best interests are not safeguarded as records are not kept securely. EVIDENCE: The manager provided guidance to staff and worked hands on with service users. The manager was open about the changes needed to care plans and care records, had been seeking appropriate advice to improve on the systems in place and were beginning to implement changes. The Manager is aware that the person in charge of the home on a day-to-day basis is required to hold a qualification that equates to NVQ 4 in care, but she stated that she did not intend to do the course as she was planning to retire in the near future. Evidence was seen that staff receive appropriate formal supervision for their work. Care records are kept in an un-lockable cupboard in the dining / lounge area. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 3 2 3 3 2 3 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 3 x x 3 2 x The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 19 yes 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 C 14 Section 24. Care Standards Act 2000 Regulation OP4 Requirement The home must abide by its conditions of registration in that no more than 8 persons shall be accommodated with dementia. The provider must confirm the identities for 2 service users that are to be added as a condition to the registration. Service users plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Service User plans must be kept under review. The manager must make sure that the care home is conducted in a manner which respects the privacy and dignity of service users; personal information must not be on display in communal areas, adaquate screening to ensure privacy must be provided in all double rooms (1 room was identified as needing this). Appropriate and meaningful activities must be provided for service users. The garden area must be made safe for service users. Timescale for action 31st May 2005 2. 15 OP7 31st July 2005 3. 16 OP10 30th September 2005 4. 5. 16.2 (n) 23. 2 (o) OP 12 OP20 30th June 2005 Action Plan The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 20 6. 7. 16.2 c 17.1 OP23 OP37 Furnishings and bedding suitable to the needs of service users must be provided. service users records must be kept securely. 31st July 20005 Action Plan RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 14 14 8.10 Good Practice Recommendations Service users that are unable to make a positive choice to share a room are accomodated in single rooms and consent from relatives to share is not accepted. It is recommended that choice is promoted at mealtimes for those service users with dementia by using methods (such as pictures) that will aid memory and recognition. The service users GP should not be the Registered Provider. The Arches Residential Home H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent 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 H56-H06 S24030 The Arches V223557 260405 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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