Care Home: Arrigadeen Nursing Home

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What the care home does well Residents health care needs are well met by a motivated staff team. Staff treat residents with dignity and respect. The managers have put systems in place to ensure that staff are trained in their roles and know what is expected of them. All residents and their relatives spoken with expressed their appreciation of the care provided. One person reported, the manager is really good another relative reported that, the staff a re very kind and helpful, I am very happy here. Several people reported, the cook is really good. What has improved since the last inspection? Care documentation contains information about residents social and recreational activities. The environment was in good decorative order and well carpeted and furnished. What the care home could do better: The registered Manager should ensure that end of life planning and personcenteredness is further developed. The matron and senior staff should have training in The Gold Standard, Mental Capacity and Deprivation of liberty and it implications for residents and care planning. The registered provider should ensure that staff interview notes be more comprehensive and include standard questioning for which responses could be recorded and scored and compared with other candidates. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arrigadeen Nursing Home 20 Cambridge Road Clevedon North Somerset BS21 7HX     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: Andrew Pollard     Date: 0 2 0 6 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 26 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 26 Information about the care home Name of care home: Address: Arrigadeen Nursing Home 20 Cambridge Road Clevedon North Somerset BS21 7HX 01275879405 NONE 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) : Arrigadeen Nursing Home Ltd care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 29. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Arrigadeen is registered for 29 older people requiring nursing care. Arrigadeen Nursing Home Ltd owns the service. Mrs Roberts is the responsible individual for the company. Arrigadeen is a large house situated on a hill in Clevedon and has been adapted to meet the needs of the residents. The area around the home is pleasant and level and mainly comprises of private houses. Transport would be required to access the facilities of the town. The accommodation of the home is provided on three floors, with split landings each served by a passenger lift. It is comfortably furnished and has the appropriate handrails and grab rails to assist independence. The home has twenty bedrooms (fifteen single, and five double), five of which have en suite facilities. The Care Homes for Older People Page 4 of 26 Brief description of the care home communal areas on the ground floor consist of one large lounge/dining room, one smaller lounge and a conservatory. The current fees range from #523.57 to #550.00 Care Homes for Older People Page 5 of 26 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: This unannounced inspection was carried out over a day. Before the site visit, all information CQC has received about Arrigadeen since the last inspection was reviewed. Ms Morey the registered manager and Ms Chandy the matron of Arrigadeen were available throughout the inspection; Mrs Roberts, the responsible individual was present for part of the visit. All areas of the home were inspected. A number of surveys were returned from residents and staff. During the inspection, there were people visiting residents. Visitors were approached for their views of Arrigadeen. There were 26 people resident in Arrigadeen. A number of residents were consulted Care Homes for Older People Page 6 of 26 individually and people were observed in the communal areas of the home. Not all people were able to comment on the care they received but those who could and relatives spoken with were positive about the care received. Observations of interactions between staff and residents were were seen to be friendly and supportive. Individual discussions took place with members of staff. Other staff were observed as they went about their work. What the care home does well: What has improved since the last inspection? 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 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 8 of 26 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 9 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective clients and their families are given relevant information and terms and conditions in written or verbal form about the home to assist them in deciding if the home is suitable for their purpose. As a result of effective assessment of needs prospective residents can be confident that these will be met in a manner to suit the individual. Evidence: Arrigadeen has a statement of purpose and a residents guide to inform people of services offered. Visits by prospective residents to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. The home has an admission procedure and pre admission assessments including activities of daily living, health needs and brief personal history. All residents have pressure area, handling, nutritional, falls and continence assessments. The Care Homes for Older People Page 10 of 26 Evidence: assessments were fully completed and gave useful information to staff. This information was supplemented by the social services assessment and care plan. More detailed assessments of a persons needs are drawn up promptly after admission and a full care plan completed by the fourth week and repeated at intervals thereafter. The surveys returned stated that people had received good information to help them decide if Arrigadeen was somewhere they would like to live. They also confirmed that they had received terms and conditions and a contract on admission to the home. All of the residents are older people and are of white UK ethnic origin. The AQAA does not indicate any residents with particular needs related to sexuality. Individual assessments ensure that any specific needs i.e. spiritual and cultural are identified and included in the care support plans if need be. The Current Terms and conditions include a breakdown of fees, and how the nursing care element of these is calculated. Care Homes for Older People Page 11 of 26 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. Care plans detail residents care needs they are clearly written and give directions to staff. End of life planning and a person centeredness approach needs further development to enhance quality of care for residents . Appropriate personal and nursing care is offered to residents to maintain residents health, well being and dignity and residents are treated with respect and given choice in how needs are met. Proper arrangements are in place for residents to access healthcare services and for the administration of their medication to maintain or improve their quality of life. Evidence: Several residents files were looked at, including assessments, care plans personal history profiles and risk assessments. The records showed consistency and were detailed and up to date. Where possible residents and or relatives are requested sign care plans and consents. Risk assessments were in place with information to ensure safe procedures including, manual handling, and the correct use of bed rails and how to reduce the risk of falls. Care Homes for Older People Page 12 of 26 Evidence: Nutritional assessments are completed for those at risk and weights recorded monthly. Information about people who are having difficulty in eating or who will need a special diet is in their care plan. The intention is to develop care plans in a more person centred way and to involve the resident and family more comprehensively in the care planning process. It was suggested that each resident has a brief biography written and a person centred assessment of their wishes, likes and dislikes which will be at the centre of the service offered to provided more focus on the holistic and social model of care. This information will supports peoples health and social needs including, psychological, emotional, and cultural needs and can demonstrate that the home puts residents wishes first. Wound care plans require enhancement to be accompanied by wound classification assessment forms and detail of the size and condition of the wound. The records produced will detail any improvement or deterioration in the wound. Regular evaluations of residents care plans were taking place although this seems to be a generalised statement about all care plan elements. The intention is that named nurses will conduct an annual reassessment and care plan rewrite, which could be linked to Social services, review and involve residents, and relatives. In support of this approach the senior staff will need training in the application of person centeredness and the Mental Capacity and the Deprivation of Liberty Acts as a number of residents have advancing levels of dementia. A record of resident wishes in the event of death is made and it is intended to expand this. Formal end of life Care Plans are to be established in the home whereby residents and relatives are encouraged to think ahead about the care they would like to receive if their health deteriorates. Documents relating to advanced directions will require a mental capacity assessment to be carried out which support the direction. The manager is making enquiries about accessing training in this field and the Gold standard training and documentation, which will further enhance end of life care. Where the home cares for very frail people who are not able to look after themselves, there was evidence that the needs of such people were met, with full documentation relating to changes of position, drinks and meals offered. A full range of equipment to prevent pressure damage was provided and correctly used. Staff showed a positive attitude to their roles and responsibilities ensuring they provide quality of care to the residents. Residents were appropriately dressed and in Care Homes for Older People Page 13 of 26 Evidence: their own clothes and well groomed. Staff were observed to ensure that residents rights to privacy were upheld. Residents and relatives spoken with supported this view. There was a warm cheerful atmosphere in the home. The staff, resident interactions were respectful and caring. Where a resident showed distress, staff quickly observed this and the person supported. Policies and arrangements are in place for the storage administration, disposal and recording of drugs. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were up to date and in order. The storage and recording of controlled drugs was in order. None of the residents is self medicating at the present time. Care Homes for Older People Page 14 of 26 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. There is some provision of meaningful recreation for residents but they would benefit from a more structured approach to enhanced individuals quality of life.Residents are supported in exercising choice in their daily lives and social activities.Mealtimes offer choice of food that residents enjoy and they are supported to eat their food if need be. Evidence: A volunteer visits two mornings a week and a carer is employed two afternoons a week to provide activities for the residents. As well as the activities coordinator, staff regarded meeting residents social care needs as part of their role. The home offers a programme of low key activities, such as quizzes, bingo and memory games. The manager is considering arranging meetings between the two staff to plan and coordinate their programme. It was suggested that a programme of activities is put on display on display. The co-ordinators maintain a simple resident profile and social care assessment and records of activities they have been involved in. It was suggested that the staff try to write more detailed resident biographies with the help of family and friends. Only one regular entertainer visits the home. In the past trips were arranged but at present the dependency levels of the residents are such that it is not viable. Care Homes for Older People Page 15 of 26 Evidence: The managers regards maintaining contacts with peoples families a key area of care provision. The visitors book showed that a range of people visited the home and several different visitors were seen and spoken to throughout the inspection. Relatives with said they were kept up to date with issues relating to their relative and all felt the standard of care was high and praised the managers and staff. Visitors said that they were always made welcome. A resident and relative forum is to be set up, as there may be a limited number of residents who can fully participate. The majority of surveys and all those spoken with said that meals at Arrigadeen are very good. The Cook regularly talks to residents, and knows about individual needs and preferences. Staff gave appropriate assistance to residents who were unable to eat independently. Currently there are no residents with specific cultural or religious needs other than those of a Christian background. At present services of Holy Communion are taking place on an individual basis. Care Homes for Older People Page 16 of 26 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. There are policies in place to protect residents, investigate complaints or manage allegations of abuse. Arrangements are in place for staff training in these matters so residents can feel safe and have their concerns dealt with. Evidence: A copy of the complaints procedure is on display in the main foyer and is part of the information provided to people on admission. The complaints policy and procedure is detailed and contains all the required information. Relative surveys indicated people knew how to complain. Staff surveys indicate they understand the complaint and adult protection procedures. There have been no complaints in the last year. The home has written procedures for adult protection, whistle blowing and management of money and valuables. The home manages small amounts of money for residents, where requested. Records of all transactions are kept and were up to date and in order The Local Authority No Secrets document was available. All staff are instructed in adult protection and prevention of abuse as part of their induction. Staff attend update training in dealing with vulnerable adults and the manager has booked update sessions to be run in the near future. Care Homes for Older People Page 17 of 26 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. Residents benefit from a safe and well maintained clean environment with good furnishing and decor, their needs are met by having bedrooms and communal rooms and facilities, which are suitable for their purpose. Evidence: The home was found to be clean, warm, and free from offensive odour and suitable for its stated purpose. The home is well decorated and maintained to ensure that all areas are homely. Residents are supported to personalise their bedrooms with pictures and ornaments and are able to bring items of furniture should they wish. There is one lounge/dining room one quiet lounge and a conservatory. Residents surveys confirmed that the home is and clean and one resident stated, That the cleaning is good and the decoration is nice. All of the bathrooms and toilets were in good order, clean and fresh. Baths have thermostatic mixer valves and the monitoring hot water temperatures take place. Mobile and fixed hoists, adjustable beds, pressure relieving equipment and specialist Care Homes for Older People Page 18 of 26 Evidence: baths are provided to meet residents needs. The suction apparatus requires a ridged catheter to be fitted for ease of use. The kitchen was in good order and has recently been awarded 5 stars by the EHO. The home has a washer disinfector and infection control policies are in place. Principles of good hygiene is well maintained at the home and all staff are appropriately trained. The laundry facilities are suitable for the purpose. Care Homes for Older People Page 19 of 26 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. Recruitment procedures, NMC and Criminal Records Bureau disclosures are in place to make ensure suitable staff are recruited to care for residents. There are sufficient numbers of staff to meet residents needs. Evidence: A robust recruitment policy and procedure is in place. Files for three staff appointed since the last inspection were reviewed. The employment records and checks were in good order. After completion of induction staff enrol on the National Vocational Qualification (NVQ) programme level 2. The Majority of staff have attained level 2 or 3 or have a nurse qualification in their country of origin. Mandatory training including fire safety, food hygiene, first aid, load handling and adult protection was undertaken and course dates had been organised for staff. The manager has developed a matrix to track learning and ensure updates are arranged on time. Staff surveys said that the induction and training was relevant to the work undertaken. Staffing levels meet the needs of the current residents although there were two surveys questioning the staff numbers. Residents spoken with stated that staff are kind, attended them when they rang the bell and treated them with respect. Residents surveys agreed that staff were always or usually available when they needed them and always listened and acted upon what the Care Homes for Older People Page 20 of 26 Evidence: residents had to say. The home operates a key working system to enhance the resident and staff relationships. Residents surveys stated that, the staff work hard to make everyone happy. Visitors comments included, The nurses have a caring nature and Staff are friendly and respectful. There are adequate staff levels for cleaning catering and laundry. Care Homes for Older People Page 21 of 26 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. Residents and staff benefit from an effective management team who endeavour to promote an open and inclusive style of management. There are good arrangements in place to maintain and service the equipment and facilities in the home. The Home protects the health and safety of residents and staff. The staff supervision and appraisal arrangements are good. Evidence: Denise Morey is the registered manager at Arrigadeen. She oversees the day to day management of the service, whilst Ms Chandy, who is a Registered Nurse, leads on clinical issues. Mrs Roberts, the Managing Director of Arrigadeen Nursing Home Ltd is actively involved in the service. Mrs Morey and Ms Chandy have job descriptions to Care Homes for Older People Page 22 of 26 Evidence: ensure that there is no confusion about roles and responsibilities. According to staff and residents this arrangement works well. The atmosphere in the home was positive and calm. Staff were noted interacting with residents in a caring and friendly manner. A quality assurance system has been introduced. The outcomes from a recently completed survey were generally positive and the management team has addressed issues raised. A new resident and relative forum is being put in place to aid good communications and improve the quality of life for residents. There was a high degree of satisfaction expressed by all of the residents and relatives spoken with. Based on the surveys, comments made and through the inspectors observation it is evident that the home seeks to operate with the best interests of the residents in mind and ensure their needs are being met. Staff receive regular supervision and appraisals by cascade, a new supervision format is in place, which is comprehensively structured. Health and Safety records showed that the home had undertaken appropriate risk assessments throughout the home. Records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, gas and electrical services, hoists and lift. The fire logbook was up to date and in order. Staff fire safety drills and training are taking place at the required intervals. Care Homes for Older People Page 23 of 26 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 24 of 26 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 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 7 Review the care plans to ensure they are holistic and person centred and evidence the involvement of the resident and relative in their development. Wound care plans require enhancement to be accompanied by wound classification assessment forms and detail of the size and condition of the wound. 2 8 Care Homes for Older People Page 25 of 26 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). 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