Care Home: Arlington House

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What the care home does well We visited each service user still in residence and spoke to staff and management. Residents we saw were comfortable, with clean clothes and bedding. Some of the staff had done their best to work with Torbay Care Trust and put into practice the training that had been provided. The home owner showed us a care plan which she had written, showing good details, including a personal profile and social assessment. This service user had just moved out of Arlington House.A second medicine trolley was delivered, to enable staff to administer medication in a timely way to people living on the second floor. The home owner showed us recent receipts, showing that fresh meat, fruit and vegetables continued to be delivered by local suppliers. New leads had been fitted to the call bells in residents` rooms. We met a newly appointed care worker, which shows that the home owners were continuing their efforts to recruit staff, to maintain the service. We did not examine recruitment documents. When an incident of potential abuse was reported to the home owners, they took prompt action to suspend the staff member, in accordance with their Safeguarding policy. What the care home could do better: Medication must be administered with care and accuracy. We looked at the Medication Administration records of the four residents in the home on 15th March. We found that there were gaps with no reason given for why painkillers had not been administered. One resident had been given a PRN medication (as required) who would not have been able to ask for it. There was no indication of who had made the decision to give it, or why. Care plans and risk assessments must be up-dated and written with more specific details for individuals, to ensure that staff know the best way to provide care. We looked at the care plans for these four residents. One had a care routine dated 09/02/2008, with no recorded reviews. There was a generalised risk assessment for the risks associated with hot water and the use of bed rails, but not with advice for staff specific to this service user. We saw this person sitting calmly in their room, looking at a newspaper, with a glass of juice beside them. Their call bell was neatly coiled on the wall out of reach. There was no mention in the care plan of any risk assessment with regard to this person`s use of the bell, or any plan to assure regular and sufficient attention to this first floor room. Where food and fluid intake and output need to be monitored for health care reasons, they must be accurate to be useful. A food and fluid intake chart was in place, which was inconsistent as it had seven entries on 12th March, 14 on the 13th, but only one on Sunday 14th, of porridge, but no record that the resident was unwell. We looked in care plans and night care records and did not see that professional advice had been obtained with respect to residents` continence needs, and there were not specific plans for these needs to be met for individuals by night and day. However, this was still within the timescale given at our inspection on 25th February 2010. We did not inspect the home`s performance with respect to tissue viability and skin care, because TCT nursing staff were actively involved with this aspect of residents` care. We did not see sufficient moving and handling in practice to come to a judgment as to whether the requirement made on 25th February had been met. Residents were sitting in their rooms or in wheelchairs preparatory to moving. The incident previously mentioned involved an alleged failure to adhere to moving and handling guidance.The requirement to provide training in relation to good care of people with dementia, including communication skills, plus person centred care planning and effective risk assessment had not been met, but was still within the time scale given. We found that there still breaches of regulations warranting action to be taken by the provider in order to comply with the requirements made on 25th February and ensure good care of residents. However, it was acknowledged that there would be no service users at the home from 16th March 2010. Random inspection report Care homes for older people Name: Address: Arlington House Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN two star good service 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: Stella Lindsay Date: 1 5 0 3 2 0 1 0 Information about the care home Name of care home: Address: Arlington House Arlington House Kents Road Wellswood Torquay Devon TQ1 2NN 01803294477 01803212255 manncmann61@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Edward Brian Mann,Mrs Caroline Susan Mann Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 30 30 dementia old age, not falling within any other category Conditions of registration: 30 0 This care home service can provide care for thirty elderly people over the age of 65 who may also have dementia and/or a physical disability. Date of last inspection Brief description of the care home The last key inspection was carried out on 24th June 2008, when the home was found to be providing a good service. Care Homes for Older People Page 2 of 11 2 5 0 2 2 0 1 0 Brief description of the care home Arlington House is registered to provide accommodation with personal care to 30 older people (65 ), older people with physical disability and older people with dementia. The building itself is a large detached property located in the Wellswood area of Torquay. It is close to local shops and amenities and a short bus ride from the town centre. Accommodation is over 3 levels with the home having a passenger lift and a stair lift as well as a range of other aids and adaptations to support those with mobility problems. With regard to residents bedrooms, the home has 20 single bedrooms, (11 of which have en suite facilities) and 5 double bedrooms (all of which have en suite facilities). A few of the bedrooms require the resident to be mobile as access necessitates using stairs. Arlington House has one large lounge, a second lounge area and a dining room as well as a small library area. Care Homes for Older People Page 3 of 11 What we found: We visited Arlington House from 7.30pm - 9pm on Thursday 11th March, 10;30am - 3pm on Friday 12th March, and 10.30am - 5pm on Monday 15th March 2010. The focus of this inspection was to monitor safety of service users, in particular to see whether staff were in place to provide their care. The registered providers had agreed with the Torbay Care Trusts plan to provide staff support and training, but on 2nd March had informed the Care Trust that they were not finding the TCT staff presence supportive. When we arrived, a Senior Practitioner and Assistant Director of Operations for Torbay Care Trust were in the home. They had been in attendance as residents had been moving to alternative care providers. People were moving because a multi-agency and multidisciplinary team (including CQC) and working according to the local multi-agency Safeguarding Adults policy, had come to the conclusion that they could not be confident that vulnerable people would be safe at Arlington House if TCT supporting staff were not there. The Registered Providers were not in agreement with this action. There were eight service users still living at the home. We met the Manager, who told us that the Arlington House night care staff had agreed to work with support from the TCT staff, and that she had introduced the TCT staff to them. There were four TCT staff in the home when we arrived, and two Arlington House staff came on duty for the night shift while we were there. During our visit the following day, four residents moved out, with additional assistance from their families. Arlington House staff were on duty at all times, and Torbay Care Trust were still providing staff for every shift, which was to continue over the weekend. We met with four Arlington House staff, who told us they were upset to see the residents leaving. On the Monday, we met the Manager, who had two Arlington House staff on duty with her. Of the four service users still living in the home, two needed two carers for personal care and this was being provided by the home. We also met two TCT staff in the morning and saw that two others arrived at 2pm. Families and support workers were in the home to help two people move out. Of the two people remaining in the home at the end of this visit, one had arranged for their own move the following day, and one had an assessment for an alternative care home arranged by their family. Arlington House is now a dormant service. The home owners gave a verbal agreement not to admit service users. What the care home does well: We visited each service user still in residence and spoke to staff and management. Residents we saw were comfortable, with clean clothes and bedding. Some of the staff had done their best to work with Torbay Care Trust and put into practice the training that had been provided. The home owner showed us a care plan which she had written, showing good details, including a personal profile and social assessment. This service user had just moved out of Arlington House. Care Homes for Older People Page 4 of 11 A second medicine trolley was delivered, to enable staff to administer medication in a timely way to people living on the second floor. The home owner showed us recent receipts, showing that fresh meat, fruit and vegetables continued to be delivered by local suppliers. New leads had been fitted to the call bells in residents rooms. We met a newly appointed care worker, which shows that the home owners were continuing their efforts to recruit staff, to maintain the service. We did not examine recruitment documents. When an incident of potential abuse was reported to the home owners, they took prompt action to suspend the staff member, in accordance with their Safeguarding policy. What they could do better: Medication must be administered with care and accuracy. We looked at the Medication Administration records of the four residents in the home on 15th March. We found that there were gaps with no reason given for why painkillers had not been administered. One resident had been given a PRN medication (as required) who would not have been able to ask for it. There was no indication of who had made the decision to give it, or why. Care plans and risk assessments must be up-dated and written with more specific details for individuals, to ensure that staff know the best way to provide care. We looked at the care plans for these four residents. One had a care routine dated 09/02/2008, with no recorded reviews. There was a generalised risk assessment for the risks associated with hot water and the use of bed rails, but not with advice for staff specific to this service user. We saw this person sitting calmly in their room, looking at a newspaper, with a glass of juice beside them. Their call bell was neatly coiled on the wall out of reach. There was no mention in the care plan of any risk assessment with regard to this persons use of the bell, or any plan to assure regular and sufficient attention to this first floor room. Where food and fluid intake and output need to be monitored for health care reasons, they must be accurate to be useful. A food and fluid intake chart was in place, which was inconsistent as it had seven entries on 12th March, 14 on the 13th, but only one on Sunday 14th, of porridge, but no record that the resident was unwell. We looked in care plans and night care records and did not see that professional advice had been obtained with respect to residents continence needs, and there were not specific plans for these needs to be met for individuals by night and day. However, this was still within the timescale given at our inspection on 25th February 2010. We did not inspect the homes performance with respect to tissue viability and skin care, because TCT nursing staff were actively involved with this aspect of residents care. We did not see sufficient moving and handling in practice to come to a judgment as to whether the requirement made on 25th February had been met. Residents were sitting in their rooms or in wheelchairs preparatory to moving. The incident previously mentioned involved an alleged failure to adhere to moving and handling guidance. Care Homes for Older People Page 5 of 11 The requirement to provide training in relation to good care of people with dementia, including communication skills, plus person centred care planning and effective risk assessment had not been met, but was still within the time scale given. We found that there still breaches of regulations warranting action to be taken by the provider in order to comply with the requirements made on 25th February and ensure good care of residents. However, it was acknowledged that there would be no service users at the home from 16th March 2010. 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 6 of 11 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 8 13 Professional advice must be obtained in respect to residents continence needs, and care plans agreed for their care by night and day to enable staff to provide good individual care. 02/04/2010 2 8 18 Management must ensure 15/03/2010 that staff follow professional guidance with respect to tissue viability and skin care, according to individual care plans and risk assessments. There must be enough staff to carry this out in a timely way. Management must monitor the quality of the care provided. This is so that residents are cared for in a safe and satisfactory way. 3 8 18 Management must ensure 15/03/2010 that staff follow professional guidance with respect to the intake and recording of food and fluid intake, according to individual care plans and risk assessments. There must be enough staff to carry this out in a timely way. Management must monitor the quality of the care provided. Page 7 of 11 Care Homes for Older People 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 This is so that residents are cared for in a safe and satisfactory way. 4 8 18 Management must ensure 15/03/2010 that staff follow professional guidance with respect to moving and handling residents, according to individual care plans and risk assessments. There must be enough staff to carry this out in a timely way. Management must monitor the quality of the care provided. This is so that care is provided to residents in a safe way. 5 22 12 Call bells must be placed within reach of each service user, unless they are not able to use it, in which case an alternative method of assuring their ability to get attention when they need it is agreed and recorded. This is to make sure people can get help when they need it. 6 25 13(4)(c) The manager must ensure 23/07/2008 that a system for checking the water regular for the hot water for full emersion baths is provided close to 43 C Training must be provided in 18/06/2010 relation to good care of people with dementia, Page 8 of 11 15/03/2010 7 30 18 Care Homes for Older People 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 including communication skills, plus person centred care planning and effective risk assessment. This is in order to provide care in a safe and suitable way for people who have dementia. Care Homes for Older People Page 9 of 11 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 9 13 The registered person shall 24/09/2010 make suitable arrangements for the safe administration and recording of medicines received into the care home. This is to ensure service users are given the correct medication to promote their good health and welfare. 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 Care Homes for Older People Page 10 of 11 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. 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