Care Home: Arle House

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What the care home does well The home has an admission process in place for new people and this includes an assessment of their needs and where able a visit prior to moving in. A requirement issued at the last inspection for the home to provide all people who use the service with a Service Users Guide has been addressed. The home has a system in place for the management of controlled medication. People have care plans in place for all assessed needs. We found that from examining the two new staff recruitment files that these members of staff did not start working at the home until a full CRB had been received, which is good practice. The home has met some requirements issued at the last key inspection in relation to care plans, medication, recruitment and that the manager has applied to us to be considered for registration. What the care home could do better: The staff need to continue to transfer peoples` care records onto the new format and work at making them more person centered and that the writing is legible. The home needs to make sure that the medication cupboard that stores controlled medication is changed to meet current legislation and the manager said this will be done as soon as possible. We made some recommendations in relation to medication to help improve the system the home has in place for managing peoples` medication. The home needs to review how they transport food around the home and make sure food is covered when not in use. This will help to prevent cross infection. The home needs to make sure that all the required pre employment checks take place prior to new staff starting at the home and this includes a full employment history with any gaps explored and written reasons as to why this happened. Random inspection report Care homes for older people Name: Address: Arle House Village Road Arle Cheltenham Glos GL51 0BG one star adequate service 25/08/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sharon Hayward-Wright Date: 0 1 0 6 2 0 1 0 Information about the care home Name of care home: Address: Arle House Village Road Arle Cheltenham Glos GL51 0BG 01242514586 01242224259 manager.arle@osjctglos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Joseph Caine Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Orders of St John Care Trust care home 50 Number of places (if applicable): Under 65 Over 65 50 old age, not falling within any other category Conditions of registration: 0 To accommodate two (2) named Service Users under the age of 65 years. The home will revert to the original service user category when these service users reach the age of 65 or no longer reside at the home. Date of last inspection Brief description of the care home Arle House is a purpose built care home providing personal and nursing care. It is situated in a large housing estate close to local shops and other amenities. The Orders of St. John Care Trust is responsible for the management of the Home. The accommodation, consisting of forty-eight single rooms and one double room, is arranged on two floors and has been equipped with a shaft lift to access the first floor. Care Homes for Older People Page 2 of 12 2 5 0 8 2 0 0 9 Brief description of the care home Although none of the rooms have en suite facilities, there are several assisted bathrooms and separate toilet facilities throughout the home. Some of the bedrooms at the front of the property have the benefit of a small balcony. There are three lounges within the home plus a large dining room and a number of smaller sitting areas where residents and their visitors may meet. The enclosed rear gardens are easily accessible and have attractive shaded areas where residents are able to sit when the weather permits. The provider supplies information about the home, including the most recent inspection report, in a file at the entrance of Arle House. Current fees range from 395 pounds basic local authority rate, to 830 pounds private nursing rate per week. Hairdressing, chiropody, optical services and any personal items are charged extra. Prices are available on request. Care Homes for Older People Page 3 of 12 What we found: This unannounced inspection took place on one day in June 2010. Prior to the visit to the home we sent them an Annual Quality Assurance Assessment (AQAA). This was returned to us on time and contained information about what the service feels they do well and any areas they are looking to improve on. The AQAA also contained numerical data called Dataset. We also sent to the service some questionnaires for people who use the service and staff. We received 9 from people who use the service and 4 from staff. Some of the results from these have been used in this report. At this inspection we focused on pre admission assessments of people recently admitted to the home, some peoples care plans, arrangements in place for the management of controlled medication, a tour of some of the environment and recruitment records of recently appointed staff. We also followed up on some of the requirements issued at the last key inspection which took place in August 2009. We examined the pre admission assessments of two people who have recently moved into the home. Both people were transferred from a local hospital and they had been assessed by the manager prior to moving into the home. Both people had detailed pre admission assessments that listed their needs. One assessment had not been dated when it was undertaken, however we could see from the information obtained that this person had been assessed prior to moving into the home. Both people had discharge information from the hospital. Risk assessments for falls, moving and handling and pressure area care had also been completed. We examined the care plans of the two people who were recently admitted to the home and another persons who had been at the home for a period of time. The homes AQAA states All residents have a person centred plan tailored to their individual care needs, choices and preferences are drawn up and if possible are signed by the resident or due to limitations their relative and then reviewed monthly. We found that the two people recently admitted to the home had care plans for all assessed needs and the staff are working towards making them more person centered. For the person who has been at the home for a period of time they are yet to have their care plans transferred onto the new format and the majority of their care plans were core plans. Core care plans are a printed format where all the directions for staff to follow are dictated and not based on the individual persons needs. We did see that one persons relative had signed their care plans. We did find that we were unable to read some peoples care plans as the writing was not legible. All qualified nurses need to be reminded of the Nursing and Midwifery Councils (NMC) guidance about record keeping. We found that not all of the two new peoples care plans had been updated with their latest care needs, however one qualified nurse told us they are behind with this due to changes within the staff team. From speaking to one of the qualified nurses they demonstrated good knowledge of both new peoples care needs. We discussed with the manager ways on how the care plans we examined could be improved. We found that risk assessments for falls, pressure area care, nutrition and moving and handling were in place. For people who have bed rails a consent form and risk assessment was also in place. We saw in peoples care plans ongoing progress reports. We looked at the system the home has in place for management of controlled Care Homes for Older People Page 4 of 12 medication. The manager informed us that they are in the process of changing the cupboard as it does not meet current legislation. We checked the medication against the records with the manager and all was correct. We did find that one medication was at the 90 days shelf life and would need to be changed and disposed of as per their guidance. We saw that these medications are checked at each shift change over and records are maintained of this. We randomly selected some peoples Medication Administration Records (MAR) to follow up a requirement issued at the last key inspection. This related to clear instruction for the use of all medications. We found that for some people where it had been written as directed there was not always a care plan in place for its use. For example, one person is a diabetic and they are written up for a medication in case they have a hypoglycaemic attack (very low blood sugar) but no directions for when this medication needs to be used was in their care plans. We did find there were no gaps in administration records for these people which is good. However we would recommend the following; all handwritten entires need to be countersigned by a second member of staff and for people who are prescribed prn or as required pain relief the actual time and dose is recorded on the MAR. This is to make sure that the required time span in between doses is met. We did see that one person had been given two doses of pain relief in one day but the times were not recorded therefore the home is unable to demonstrate the required time span between doses took place. We would also recommend that care plans are in place for all medications prescribed as prn or as required to make sure staff all follow the same guidance for its use. We asked people in the questionnaires we sent them, Do you receive the care and support you need?, 3 people said always, 5 people said usually and 1 person said sometimes. We also asked, Are the staff available when you need them?, 3 people said always, 5 said usually and 1 person did not answer the question. We asked staff in the questionnaires we sent them, Are you given up to date information about the needs of people you support or care for (for example, in the care plan)? 2 staff said always and 2 staff said usually. We walked around parts of the environment and viewed several peoples rooms. We saw that people had their personal belongings on display. The cleanliness of the home was good and saw the domestics were still cleaning in a number of areas. We did find that an air freshener spray and black bin liners were left unattended in the upstairs corridor and best practice would be that these are stored in secure place for the safety of people who use the service and visitors. We did observe that the breakfast items were left uncovered at 10.40am in the dining room to include fruit and cereals. At lunchtime the puddings were taken round the home on a tray uncovered and the member of care staff was going in and out of peoples rooms. This is not good infection control as it places people at risk of cross infection and must be reviewed. The manager was informed of this. On the tour of the home we did notice that prescribed food supplements were stored in the downstairs linen cupboard and door was unlocked. All prescribed medication needs to be stored securely and in the appropriate place. We asked people in the questionnaires we sent them, Is the home clean and fresh? 6 people said always and 3 people said usually. We reviewed the staff recruitment records of the last two members of staff who have Care Homes for Older People Page 5 of 12 started working at the home. The AQAA states, Robust recruitment policy and procedure to ensure protection of our residents. All staff have their own personnel file where the regulatory recruitment documents are held including POVA and CRB. We found that not all the required pre employment checks were in place as they had not explored the employment history of both members of staff and we found gaps in the history that were present. We did find that both members of staff did not start working at the home until a full Criminal Records Bureau Disclosure (CRB) had been obtained which is good practice. We did not examine the actual CRB as these are stored at the local head office of the Registered Provider and not at the home. We did see a letter from this office stating that both CRBs were clear and the new staff could start working at the home. We asked staff in the questionnaires we sent them, did your employer carry out checks, such as your CRB and references before you started work? all 4 staff members said yes. We asked people in the questionnaires we sent them, What does the home do well? and we received the following comments; the home is visually very clean and the meals are nice, good food and activities, I consider the home does most things well, staff and nurses are friendly and cleaning staff do well. A number of people said the food was good. We also asked What could the home do better? and we received the following comments; more variety of choice with food and the cooking could be better and make sure my false teeth are in daily as they are left out sometimes. Several people answered they didnt know what could make the home better. We asked the staff What does the home do well? and we received the following comments; provides the residents with all the care they could wish for, great training available within the home and the home is very friendly and the staff look after the residents well and seem to treat them in a caring way We also asked What could the home do better, staff said the following, more staff please, support needs to be encouraged so that the rapor between nursing and care staff work better as a team and the home needs stability that it hasnt had for several years and hopefully it is now in a more stable position and able to improve. What the care home does well: The home has an admission process in place for new people and this includes an assessment of their needs and where able a visit prior to moving in. A requirement issued at the last inspection for the home to provide all people who use the service with a Service Users Guide has been addressed. The home has a system in place for the management of controlled medication. People have care plans in place for all assessed needs. We found that from examining the two new staff recruitment files that these members of staff did not start working at the home until a full CRB had been received, which is good practice. The home has met some requirements issued at the last key inspection in relation to care plans, medication, recruitment and that the manager has applied to us to be considered for registration. Care Homes for Older People Page 6 of 12 What they could do better: 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 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must ensure that written confirmation is provided to prospective residents following an assessment of their needs. This is so that the person can be assured that the home will be able to meet their needs in respect of their health and welfare. This requirement was not followed up at this random inspection. 31/10/2009 2 8 12 The registered person must ensure that staff review pressure area risk assessments fully and appropriately. This requirement was not followed up at this random inspection. This is so that the correct risk factor can be identified and the most suitable care provided. 31/10/2009 3 9 13 The registered person must ensure that medication charts contain clearly recorded instructions for the 31/10/2009 Care Homes for Older People Page 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action use of all medications, including for external preparations. This requirment remains outstanding at this inspection. This is so that residents can receive their prescribed medications in accordance with prescribed instructions to meet their health needs. Care Homes for Older People Page 9 of 12 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, 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 29 19 The Registered Person must 09/07/2010 make sure that all the required pre employment checks take place prior to a new member of staff starting work at the home. This includes a full employment history with any gaps explored and written verification for the reasons for this. This will help to make sure people who use the service are safeguarded from any possible risks. 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 9 The actual time of administration and the dose of any prn pain relief should be recorded to make sure the required time span takes place between each dose. The home needs to review the storage arrangements for prescribed food supplements as the linen cupboard is not the best place. Page 10 of 12 2 9 Care Homes for Older People 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 3 4 9 9 Handwritten entries on MAR need to be countersigned by another member of staff for safety. Care plans need to be in place for all medication that is prescribed as prn or as required to make sure staff are following the same clear instructions. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - 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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