Care Home: Arranmore Park Rest Home

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What the care home does well Most people wishing to move in to Arranmore Park were given enough information about the home to enable them to make a decision about if it was where they wanted to live. A variety of external professionals had been involved in the care of people living at Arranmore Park to ensure that their health care needs were being appropriately met. The management of medications was good so that people living at the home were protected from possible medication errors and drug misuse. The routines of the home were flexible and activities were arranged for those who wished to participate. People living at the home were treated with respect and dignity, their privacy being respected at all times. People living at the home were treated equally so that everyone was given the same opportunities despite their disabilities. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Personal allowances were managed well to ensure that people`s finances were safeguarded. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was sufficient and those requiring support with eating their meals were assisted in a gentle manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the Service Users` Guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was decorated and furnished to a very good standard and the premises, both internally and externally were well maintained providing those living at Arranmore Park with a safe and homely environment in which to live. Effective infection control measures were in place to ensure that the health and safety of people was well protected. Staff were trained to provide the care and support which people needed and over 50% of care staff had achieved a recognised qualification in care, which was pleasing to note. The health, safety and welfare of residents was protected by the robust recruitment practices and the policies and procedures of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated.The home was well managed and people living there looked happy and were evidently comfortable interacting with the staff. When asked what the service does well comments from those living at the home included, `it does everything well` and `there are no faults` and a relative told us, `Arranmore Park is a nice, clean environment. The food is delicious and the staff genuinely care about the residents` welfare`. When asked if there was anything else they would like to tell us, those living at the home responded by writing on the comment cards, `I can`t find any fault at all` and `I am quite happy where I am, but if I wasn`t sure about something I would go to the people in charge`. When asked the same question a member of staff wrote on the comment card, `Arranmore Park meets the needs of the residents and provides the highest standard of care, creating a home from home atmosphere`. What has improved since the last inspection? There were no requirements issued at the time of our last inspection and the recommendations made were mainly around staff training, which had been addressed since our last visit to this service. It was pleasing to see that four of the en-suite bathrooms had been converted to wet rooms so that more accessible bathing facilities were provided for the people living in these bedrooms. The AQAA shows that the home is continuously striving to improve the service for the people living at Arranmore Park and it was evident that people liked living there. What the care home could do better: More detailed information could have been gathered about people`s needs before they moved into the home so that the staff team could be confident that the care and support required could be delivered. The care planning process could have been more person centered showing clearly how the needs of people living at the home were to be met and what strategies were in place to minimise any potential risks. People living at the home or their relatives could have been given the opportunity to be involved in the planning of their own care so that they could decide how they would like to be supported. The provision of activities could have been more structured and in accordance with people`s interests, which could have been recorded in the plans of care so that those living at the home could plan their days and decide which activities were more suited to them. Although training had been provided for staff since our last visit to this service, in accordance with the recommendations made by the Care Quality Commission, it was established that some mandatory training courses were overdue and staff needed to be able to keep abreast of current legislation and new ways of working. The staffing levels could have been calculated in accordance with the assessed needsof people living at the home with recorded evidence of how this was achieved so that enough staff are always provided to meet the needs of everyone residing at Arranmore Park. The quality of service provided could have been more thoroughly monitored by extending the range of audit trails to encompass every aspect of life at Arranmore Park. The provider could have also compiled regulation 26 reports following monthly inspections of the service so that any issues highlighted could be recorded showing how they were to be addressed. When asked what the service could do better comments from those living at the home included, `nothing really` and `I sometimes feel a bit insecure. Staff try to help but I would like more attention`. When asked the same question one member of staff wrote on the comment card, `it could improve staffing levels and provide more in house training`. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arranmore Park Rest Home 100 Square Lane Lathom Burscough Lancashire L40 7RQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Arranmore Park Rest Home 100 Square Lane Lathom Burscough Lancashire L40 7RQ 01704895887 01704895965 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Arranmore Park Limited care home 35 Number of places (if applicable): Under 65 Over 65 35 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following categories of service only: Care home only - Code PC To people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is 35. Date of last inspection Brief description of the care home Arranmore Park provides 24 hour personal care for up to 35 older people. The home is a detached property, situated close to the village of Burscough in West Lancashire. Both single and shared accommodation is available, many of which have en-suite facilities on the ground, first and second floors. The home has a passenger lift for easy access to the upper floors. A variety of dining facilities and lounge areas are located throughout the home giving people a good choice of where they wish to spend their time. The home also has an enclosed patio area to the rear of the building and a pleasant conservatory is available. Care Homes for Older People Page 4 of 33 Brief description of the care home The fees at the time of our visit ranged from £424.00 to £488.00 per week. Additional charges were being incurred for hairdressing, private chiropody and cigarettes. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 19th July 2007. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. The site visit to Arranmore Park formed part of the inspection process and was conducted over one day in July 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private Care Homes for Older People Page 6 of 33 accommodation and all communal areas were seen. Comment cards were received from eight people who were living at the home and eight staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of this information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Arranmore Park. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Care Quality Commission had not received any complaints about this service since the last inspection. What the care home does well: Most people wishing to move in to Arranmore Park were given enough information about the home to enable them to make a decision about if it was where they wanted to live. A variety of external professionals had been involved in the care of people living at Arranmore Park to ensure that their health care needs were being appropriately met. The management of medications was good so that people living at the home were protected from possible medication errors and drug misuse. The routines of the home were flexible and activities were arranged for those who wished to participate. People living at the home were treated with respect and dignity, their privacy being respected at all times. People living at the home were treated equally so that everyone was given the same opportunities despite their disabilities. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Personal allowances were managed well to ensure that peoples finances were safeguarded. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was sufficient and those requiring support with eating their meals were assisted in a gentle manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the Service Users Guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was decorated and furnished to a very good standard and the premises, both internally and externally were well maintained providing those living at Arranmore Park with a safe and homely environment in which to live. Effective infection control measures were in place to ensure that the health and safety of people was well protected. Staff were trained to provide the care and support which people needed and over 50 of care staff had achieved a recognised qualification in care, which was pleasing to note. The health, safety and welfare of residents was protected by the robust recruitment practices and the policies and procedures of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. Care Homes for Older People Page 8 of 33 The home was well managed and people living there looked happy and were evidently comfortable interacting with the staff. When asked what the service does well comments from those living at the home included, it does everything well and there are no faults and a relative told us, Arranmore Park is a nice, clean environment. The food is delicious and the staff genuinely care about the residents welfare. When asked if there was anything else they would like to tell us, those living at the home responded by writing on the comment cards, I cant find any fault at all and I am quite happy where I am, but if I wasnt sure about something I would go to the people in charge. When asked the same question a member of staff wrote on the comment card, Arranmore Park meets the needs of the residents and provides the highest standard of care, creating a home from home atmosphere. What has improved since the last inspection? What they could do better: More detailed information could have been gathered about peoples needs before they moved into the home so that the staff team could be confident that the care and support required could be delivered. The care planning process could have been more person centered showing clearly how the needs of people living at the home were to be met and what strategies were in place to minimise any potential risks. People living at the home or their relatives could have been given the opportunity to be involved in the planning of their own care so that they could decide how they would like to be supported. The provision of activities could have been more structured and in accordance with peoples interests, which could have been recorded in the plans of care so that those living at the home could plan their days and decide which activities were more suited to them. Although training had been provided for staff since our last visit to this service, in accordance with the recommendations made by the Care Quality Commission, it was established that some mandatory training courses were overdue and staff needed to be able to keep abreast of current legislation and new ways of working. The staffing levels could have been calculated in accordance with the assessed needs Care Homes for Older People Page 9 of 33 of people living at the home with recorded evidence of how this was achieved so that enough staff are always provided to meet the needs of everyone residing at Arranmore Park. The quality of service provided could have been more thoroughly monitored by extending the range of audit trails to encompass every aspect of life at Arranmore Park. The provider could have also compiled regulation 26 reports following monthly inspections of the service so that any issues highlighted could be recorded showing how they were to be addressed. When asked what the service could do better comments from those living at the home included, nothing really and I sometimes feel a bit insecure. Staff try to help but I would like more attention. When asked the same question one member of staff wrote on the comment card, it could improve staffing levels and provide more in house training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move into the home, but information gathered is not detailed enough to ensure that the staff team are confident that they can fully provide the care and support required by each individual. Evidence: The care of three people living at the home was tracked during the course of our inspection. Care records showed that an assessment of peoples needs had been conducted before they were admitted to the home, so that the staff team were confident that they could provide the care and support needed by each individual. However, the needs assessments could have been more detailed and some information had not been completed on the assessment forms. Therefore, a full picture of peoples Care Homes for Older People Page 12 of 33 Evidence: needs was not always evident. The needs assessments had not been signed or dated to show who had conducted them and when they had taken place. In general, the information recorded on the pre-admission needs assessments had been accurately transferred onto the plans of care, but for one person some conflicting information had been recorded in relation to their level of mobility. Comment cards were received from eight people living at the home. Six of these people indicated that they received enough information about the home before they moved in to allow them to decide if it was the right place for them, but two said that they didnt receive sufficient information. Seven of these people said that they had been given written information about the homes terms and conditions of residency. When asked what the service does well the proprietor wrote on the homes selfassessment, We ensure enough information is available for prospective residents and their families to make an informed choice about Arranmore Park. Pre-admission needs assessments are conducted before residents are admitted. Management staff visit the prospective resident and their family. At the same time the prospective resident and family are invited to look around Arranmore Park and meet the staff. Eight staff members sent us comment cards and when asked if they were given up to date information about the needs of people they support, all said that, in general they were. One of these people wrote, information about the needs of residents is passed on at the beginning of each shift and another told us, when a new resident arrives the manager discusses their needs and care package with us. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people living at the home are appropriately met and their privacy and dignity is consistently maintained. Evidence: Care plans seen had been generated from the information obtained before people moved into the home. The plans of care varied in quality. One plan of care was well written and had been reviewed every month, with changes in care needs reflected well. However, it had not been developed with the involvement of the resident or their representative, so that they had the opportunity to say how they would like the care and support they needed to be delivered. The plan of care for another person could have been more detailed to show how this persons needs were to be met. There was evidence of input from a wide range of external professionals to ensure health care needs were being met. A variety of risk assessments had been conducted for this individual, although some had not been identified within the plan of care showing what strategies had been implemented in Care Homes for Older People Page 14 of 33 Evidence: order to minimize the risk factor. The care plan for a third person in relation to their medical needs was insufficient as it simply listed their medical condiions and did not identify what strategies were in place to support this individual to manage their medical care. This plan of care could have been more person centered in relation to risk of falling and the provision of personal hygiene. Medications were, in general, managed well. However, hand written entries on the medication administration records had not always been signed, witnessed and countersigned in order to avoid any transcription errors. People living at Arranmore Park looked happy and staff were seen interacting with them well and talking to them in a respectful manner. One person said, the staff are all very nice. We saw that peoples dignity was respected and that those living at the home were appropriately dressed and looked cared for. The importance of maintaining peoples privacy and dignity was covered during the induction period for new staff and it was included in the service users guide. We saw some minutes of a staff meeting which showed that staff were reminded about treating those living at the home with respect and dignity. The eight people who live at the home and who sent us comment cards said that, in general they received the care and support needed, including medical attention. When asked what improvements had been made recently the proprietor told us, questionnaires have been issued and returned from residents, families, visitors and staff. Lancashire County Council has provided the home with a computer for training purposes. He also told us about the plans for improvement in the next twelve months. One staff member wrote on the comment card, the home managers and ourselves try very hard to meet the needs of service users and another told us, the home strives to deliver the highest standard of care to all service users. It provides support based on the needs of the individual, irrespective of race, gender or disability. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home are flexible and people are encouraged to maintain their leisure interests and activities whilst living there. The management of meals is good and visitors are made welcome to the home. Evidence: An activities co-ordinator was employed at the home, who was responsible for the organisation and provision of activities. However, there was no structured programme in place so that those living at the home could plan their days and decide in advance what activities best suited them. We were told that activities were arranged on an adhoc basis. It was pamper day at the time of our visit, which was being enjoyed, particularly by the ladies. One person told us, I go to play bingo, but I dont like dominoes so I dont join in. This statement showed us that people were able to choose what they preferred to do in their daily life. Other comments received included, I love living here and I join in whatever is going on, I dont do anything and I just sleep. A record was kept of activities people participated in so that any isolation could be easily identified, which showed that individual preferences were considered, such as Care Homes for Older People Page 16 of 33 Evidence: flower arranging. Trips out were organised so that people could keep in touch with community life and external entertainers visited the home, which people told us they enjoyed. We discussed activities with the manager of the home who felt that people living at Arranmore Park did get enough stimulation through the range of activities provided. Talking books were available for those with poor vision and one person told us that staff sit and talk to her and read the newspapers for her, showing that equal opportunities were provided for the people living at the home. One person living at the home told us that a mature motivator visits the home regularly to provide gentle exercise classes for those wishing to join in. She said, it keeps us going. The plans of care seen did not make much reference to peoples social activities and how they were to be supported to maintain their leisure interests whilst living at the home. Locks were fitted to bedroom doors and people were able to keep their own keys if they wanted to do so in order to promote privacy and independence. Freedom of movement within the home was evident and people were able to spend their time in areas of their choice. Those spoken with told us that life at Arranmore Park was flexible in that they were able to do what they wished and we saw staff offering them choices throughout the day. Visitors spoken with said that they were made to feel very welcome to the home and that they felt comfortable visiting their relative or friend. One relative said, this is a very friendly home and staff include families in every aspect of the home. People were made aware of visiting arrangements through information provided before admission to the home. Visitors told us that they were able to see their friend or relative in private areas of the home or in the communal rooms if they preferred. Information leaflets about the use of advocacy services were readily available for people to take, so that they could access an independent person to act on their behalf, if they wished to do so. We were told that people would be supported to access this service if needed. A variety of well presented dining areas were available throughout the home and it was nice to see a married couple dining together in a bay window recess. The dining tables were pleasantly laid with condiments and tea pots, which promoted peoples independence and choice. However, we saw that people had the choice of dining in the Care Homes for Older People Page 17 of 33 Evidence: privacy of their own bedrooms if they preferred to do so. The menu provided a choice of wholesome meals and it was pleasing to see that the menu of the day coincided with the meal being served at the time of our visit to the home. The lunch time menu was sampled, which was found to be very tasty and nutritious. All those spoken with told us that they thoroughly enjoyed their meals and that the choice of menu was good. A staff member was seen assisting one person with their lunch in a caring and unrushed manner, whilst encouragement was provided when needed. However, it would have been nice to see this member of staff sitting with the individual whilst assissting them with their meal, rather than standing next to them, in order to promote a more relaxed activity. The people who live at the Arranmore Park and who sent us comment cards said that, in general, staff listened to them and acted on what they said. They also told us that there were activities arranged that they could take part in and that they enjoyed the meals at the home. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are managed well and people living at Arranmore Park are appropriately safeguarded by the robust policies and procedures adopted by the home. Evidence: A complaints procedure was in place, which was clearly displayed in the home and was included in the Service Users Guide, so that people were aware of how to make a complaint, should they need to do so. A system was in place for recording any complaints received by the home. However, this information was not completely secure and therefore advice was given about confidentiality of information. No complaints had been received by the home or by the Care Quality Commission since the last key inspection. Those spoken with and those who sent us comment cards all said that they would know how to make a complaint if they needed to do so. Policies and procedures were in place in relation to safeguarding vulnerable adults and staff spoken with and those who sent us comment cards all told us that they would know what to do if they had any concerns about the welfare of people living at the home. Records showed that staff had last received training in the Protection of Vulnerable Adults at the end of 2007. It is recommended that this training is provided annually, so that staff are kept up to date with current guidance and legislation. Care Homes for Older People Page 19 of 33 Evidence: When asked what the service does well the proprietor wrote on the homes selfassessment, we have a clear and concise complaints procedure, which explains how to make a complaint, no matter how trivial it may seem, if someone is not happy with the service being provided. Arranmore Park is committed to providing an excellent service and therefore, the management team need to know of any problems, in order that they may be rectified as soon as possible. Our complaints procedure is placed in every Service User Guide, in the Statement of Purpose and on the wall in the main hall, where it can be seen by everyone. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for people living at Arranmore Park. Evidence: We toured the premises, when a random selection of bedrooms and all communal areas were seen. The environment was decorated and furnished throughout to a very high standard, providing exceptionally pleasant surroundings for people to live in, which was commendable. It was nice to see a variety of communal areas throughout the home so that people could decide where to spend their time and where to eat their meals. The home was very well maintained and four en-suite facilities had been replaced with wet rooms since the last key inspection, providing more accessible washing facilities for the people living in these rooms. The laundry department was well organised and fit for purpose. Infection control policies and procedures were in place and clinical waste was being disposed of correctly to minimise the risk of cross infection. Records showed that staff had received training in relation to infection control, but not for some time. It is recommended that training in this area be planned into the annual mandatory training Care Homes for Older People Page 21 of 33 Evidence: programme so that staff are kept up to date with current legislation and new ways of working. Those who live at Arranmore Park and who sent us comment cards told us that, in general the home was always fresh and clean. The proprietor told us of some plans for improvement over the next twelve months, which included, to complete refurbishment of our ground floor en-suites. To repoint and clean patio areas. To obtain a quotation with a view to extending the sun lounge and to make internal alterations in order to improve facilities for residents and staff. To progress the redecorating programme. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number and skill mix of staff on duty meet peoples needs and the recruitment practices protect those living at Arranmore Park. Evidence: At the time of our visit to the service there were 30 people living at the home. We examined the staffing rota, which showed staff that were on duty at any time of day or night so that the skill mix of the staff team could be easily identified. We found that peoples needs were being met and we were told that staffing levels would be increased in accordance with the needs of people living in the home. However, there was no system in place to show how staffing levels were calculated in accordance with the assessed needs of people living at the home to ensure that the numbers of staff on duty were appropriate for the dependency levels of those living at Arranmore Park. When staff were asked on the comment cards if there were enough staff to meet the individual needs of all the people who use the service their responses varied. One said that there were always enough staff, five said there usually were and two responded by saying there were sometimes enough staff on duty to meet the needs of people living at Arranmore Park. We established that there were 20 care staff employed at the home, ten of who had Care Homes for Older People Page 23 of 33 Evidence: achieved a recognised qualification in care to ensure that appropriate care and support was being delivered. Training certificates were retained on staff files and although people working at the home had received relevant training some courses needed to be updated, such as Protection of Vulnerable Adults, infection control and fire safety. All eight staff members also told us that they were being given training which was relevant to their role, which helped them understand and meet the individual needs of people living at the home and which keeps them up to date with new ways of working. Comments written by staff included, training is ongoing with regards to the needs of people we support, National Vocational Qualifications (NVQ) play an important part to enable us to give the highest standard of care and people in my place of work are very understanding and help me with information that is relevant to my study. Detailed induction records were present on staff files. Although staff told us that they had received a thorough induction period information had not always been signed off as completed on some individual records. All eight members of staff who sent us comment cards said that their induction covered everything they needed to do the job very well before they started working at the home. One of these people wrote, my induction was conducted over a three month period. We examined the records of three staff members in order to see if thorough recruitment practices were adopted by the home. In general, all appropriate checks had been conducted before people started to work at the home. However, two references for one person had not been dated and therefore it was not possible to check if they had been received by the home before employment commenced. All eight staff members who sent us comment cards said that their employer carried out relevant checks, such as Criminal Record Bureau disclosures and references before they started work at the home. When asked if staff were available when they were needed, the responses from those who sent in comment cards varied. Six people said staff were always available, one person said that they usually were and another responded by saying they sometimes were. The proprietor told us, staff turnover has been minimal over the last year and it has only been necessary to employ the services of agency staff occasionally. Our training standard has improved slightly over the last year to 89 percent. We have sent our Activities Coordinator on an Activities Management course. The home has also held in house fire awareness and dementia awareness courses. Care Homes for Older People Page 24 of 33 Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well so that the health, welfare and safety of the people living and working there is, in general protected. Evidence: The current manager of Arranmore Park has been registered with the Care Quality Commission and has achieved relevant qualifications as expected of a registered care home manager. Records showed that she had completed all mandatory training courses and that she attended training in order to keep up to date with new ways of working and current legislation. Staff spoken with and those who sent us comment cards told us that, in general they felt well supported by the management of the home and that they were able to seek advice and assistance as was needed. The home had sent questionnaires out to a variety of people so that the quality of service provided could be monitored. The results of surveys returned by the people living at the home had been correlated and published in the Service Users Guide so Care Homes for Older People Page 26 of 33 Evidence: that anyone thinking about moving into the home could see what life was like at Arranmore Park. The last Environmental Health Officers and Fire Officers reports highlighted some areas that needed attention and we were told that these items had been addressed. A programme of routine maintenance was in place to ensure that the environment was kept to a high standard for the people living there. Audits of the environment were being conducted annually, which were very detailed showing that work was scheduled and carried out when issues were highlighted. We were told that new boilers had been installed in May 2008 due to necessary work being identified. However, more audits could be introduced, for example, care planning, medications, activities, meals and recruitment. We were told that the provider attends the home three times a week and conducts regular discussions with people living at the home, which was good practice. However, the provider needs to complete the regulation 26 notice every month to show that a full inspection of the home has taken place and these reports need to be kept on site for inspection by the Care Quality Commission. Training in relation to Health and Safety was provided for staff and no Health and Safety issues were identified on this occasion. Accident records were completed. However they were not retained in line with data protection guidelines to ensure that personal details of those living at the home were confidentially retained. The personal allowances for people living at the home were managed well so that their finances were consistently protected. A range of mandatory training was provided for staff. However, the training programme needed to be more structured so that those working at the home received annual updates in order to keep them abreast of current legislation and new ways of working. The homes self assessment showed that systems and equipment was serviced appropriately to ensure that it was safe for use and this was confirmed by checking a random selection of service certificates. When asked what the home could do better the proprietor told us, To ensure optimum outcomes are achieved for our residents, staff and the Home, we need to make further progress in order to complete our self-assessment programme. This will enable us to take corrective action, with regard to any deficiencies in the system. Care Homes for Older People Page 27 of 33 Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The plans of care must detail 03/09/2009 how the needs of people are to be met. This is so that staff deliver the appropriate care to those living at the home. 2 7 15 People living at the home or 30/09/2009 their representative must be given the opportunity to be involved in the care planning process. This is so that people can have some input about how they would like their care to be delivered. 3 33 26 A company representative must prepare a written report following their monthly unannounced inspection to the service, which must be kept on site for inspection by the Care Quality Commission as required. 30/09/2009 Care Homes for Older People Page 30 of 33 This is so that a record can be retained of any concerns identified and how they have been addressed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The information gathered before people move into the home should be more detailed, so that the staff team are confident that they can fully meet all the assessed needs of each individual. Care records should not contain conflicting information so that a consistent approach to care is maintained. The assessments conducted before people move into the home should be signed and dated so that it is evident who carried out the assessment and when it took place. 2 7 Any potential risks should be recorded within the plans of care showing any strategies in place to minimizing the risk factor. It is recommended that a structured activity programme be developed in accordance with peoples leisure interests, which should be recorded in the plans of care, so that those living at the home are supported to maintain these interests and are able to plan how to spend their time whilst living at the home. It is recommended that when staff are assisting people with their meals they sit with them in order to provide a more conducive setting. It is recommended that information in relation to complaints be kept more securely in order to promote confidentiality within the home. It is recommended that staff are provided with annual training in relation to the Protection of Vulnerable Adults, so that they are kept up to date with current guidance and legislation. It is recommended that training in relation to infection control be provided annually so that staff are kept upto date with current legislation and new ways of working. Page 31 of 33 3 12 4 15 5 16 6 18 7 26 Care Homes for Older People 8 9 33 38 Further audits should be introduced so that all aspect of the service provided can be more closely monitored. Accident records should be retained in line with data protection guidelines so that personal details of people living in the home are consistently protected. The training programme needed to be more structured so that annual updates were given in relation to some mandatory Health and Safety courses, such as infection control, fire safety, first aid and Health and Safety. 10 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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