Care Home: Arrowsmith Lodge Rest Home

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CARE HOMES FOR OLDER PEOPLE Arrowsmith Lodge Rest Home Arrowsmith Lodge Bournes Row Hoghton Lancashire PR5 0DR Lead Inspector Mr Kevan Royston Unannounced Inspection 11th March 2009 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arrowsmith Lodge Rest Home Address Arrowsmith Lodge Bournes Row Hoghton Lancashire PR5 0DR 01254 854311 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Kesavamalar Rajaratnam Manager post vacant Care Home 22 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (22) of places Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 22) Dementia - Code DE (maximum number of places: 16) The maximum number of people who can be accommodated is: 22 Date of last inspection Brief Description of the Service: Arrowsmith Lodge is a purpose built home, of two floors, set in a quiet residential area of Hoghton. The home provides services for up to 16 older people, it does not provide nursing care, but provides social and personal care in a small, homely environment. At the time of this site visit a two storey extension was almost completed which comprised of 5 new en suite bedrooms, a lounge/dining area and a new conservatory. In addition there was the existing lounge and conservatory and bedrooms. The two floors were linked by a passenger lift. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide is issued to all residents and their relatives/representatives on admission. The fees at the home range from £386.50 to £435.00 per week. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit was part of the key inspection process and took place on the 11th March 2009 and lasted approximately 6.0 hours. We spoke to residents on their own, staff, the owner, and a group of resident’s in the lounge area. Maintenance and financial records were looked at during the site visit and we had a walk around the building and outside areas. As part of the inspection process we talked to people using the service and asked staff about those peoples needs. We also looked at their rooms, care plans, records and daily notes this is called case tracking. Other residents are invited to pass their opinions to us if they wish. We had responses from surveys/questionnaires sent to residents and staff for their views on how the home is run. There was little response however comments we did receive were good and some are included in this report. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of their service. This document is called ‘Annual Quality Assurance Assessment’ (AQAA). We use this information, in part, to focus our inspection activity. What the service does well: Routines in the home looked relaxed with people being allowed to all parts of the premises. We saw residents sat talking together and enjoying each other’s company. From observations made and from talking to residents and staff, it appeared that the privacy and dignity of residents was protected and that residents were able to have choice in their daily routines. One resident spoken to said, “I please myself what to do the staff appreciate that” We looked at training records and spoke to staff and residents, we found staff have good access to training in particular dementia courses so they are competent to do their jobs ensuring people at the home receive the right care and support from a well trained staff team, One resident spoken to said, “They know what they are doing”. One member of staff wrote in a survey about training, “Thorough training available”. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 6 Visiting arrangements are informal and family/friends are welcome at any time of the day or night and are encouraged to maintain contact with residents. One resident spoken to said, “My family visit at any time”. We sat in the lounge for a while and watched staff talking to and supporting residents throughout the day and observations and comments from people show that residents are treated with respect and dignity. One staff member spoken to said, “Equality and respect is what is important here”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. There is admission and assessment procedures in place to ensure the care needs of people are met. EVIDENCE: We looked at assessment information of two people admitted to the home; all had full assessment information including personal information, health needs and relationship details. The assessment had identified the nutritional needs of the people and risk assessment information advising staff members of the action to be taken to minimize identified risks and hazards. The process has been improved since the last inspection ensuring the home can meet the needs of people who plan to live at Arrowsmith Lodge. The owner tells us in the AQAA they complete a care plan based on this assessment to ensure all needs can be met. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 9 We spoke to a member of staff about the assessment process and found they know the importance of getting to know people before they move in so that they are aware of the needs and wishes of the person entering the home. One staff member wrote, “All information is given in the care plan of residents”. Standard 6 was not assessed, as the home does not provide intermediate care. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously, people’s welfare is monitored and health needs are met. EVIDENCE: We looked at individual records for resident’s, each had a plan of care setting out the action that is needed to be taken by care staff to ensure all aspects of health, personal and social care needs of people living at the home were met. Staff spoken to are aware of residents needs one spoken to said, “Care plans are easy to follow”. On file mental health assessments had been completed. Significant events had been recorded and daily entries made setting out the care given. Care plan information has improved since the last inspection they were well structured ensuring all information is contained and any health needs can be monitored and support given. Records show risk assessments have been completed and are updated when necessary reflecting any changes that may have occurred individually and in the environment ensuring the resident’s safety and protection is a priority. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 11 We went through the medication procedures at lunchtime with the manager of the people case tracked, they were found to be safe and practices have improved, staff administering medicines have received training, also medicines are checked when they enter the home and stored appropriately to ensure residents are protected. A staff member spoken to said, “Only trained staff administer medicines”. Residents spoken to said how the staff are respectful and treat them with dignity, comments included, “Very happy here the girls care”, Also, Respectful staff and they know what I need to be comfortable”. We sat in the lounge area for a while and watched staff knocking on doors before entering rooms, helping people individually, supporting with meals sensitively and talking to residents despite some difficulties in communication. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: People spoken to confirmed they enjoyed the quality and variation of food provided. We had a look around the kitchen and found the cook using fresh fruit and vegetables and making home produced meals to ensure people receive good wholesome well-prepared meals. Appropriate records were kept of storage and cooking of food. One resident spoken to said, “The food is good”. One staff member spoken to said, “Always good home cooking”. We talked to residents individually and in a group during the visit and confirmed social activities are centred on each individual’s needs and choices to ensure residents are able to follow there chosen interests as much as possible. One staff member said, “Certain residents enjoy the memory games in the afternoons”. A resident spoken to said, “I enjoy little walks out when the weather is good the staff do help me if I want to go out”. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 13 We were invited to look in some of the residents rooms and found personal belongings are allowed into the home to provide a homely atmosphere for each individual. Residents and staff spoken to confirmed visitors are allowed at any time of the day or night. One resident said, “My family visit at any time”. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. EVIDENCE: There is a complaints procedure, which is made available to all residents on admission and written in the Statement of Purpose and Service User Guide to ensure they feel protected. Staff and residents spoken to are aware of how to make a complaint and who to speak to if they have any problems. One resident spoken to said, “Yes I know how to complain”. An open approach to encourage comments through resident and staff discussions goes some way in ensuring that concerns are looked at prior to them becoming formal complaints. There have been no complaints since the last inspection in November 2008. We looked at records and found there is a procedure and policy for dealing with allegations of abuse and safeguarding adults to protect people living at the home. Records confirmed training was in place for staff to attend safeguarding adult’s courses and we spoke to staff about safeguarding training, comments included, “Yes I have done abuse training” Also, “The owner has provided safeguarding adults training”. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: We walked around the building and found the home to be clean and tidy so residents live in comfortable clean premises. Positive comments about the cleanliness and maintenance of the home included, “Always kept clean”. Parts of the building are new and rooms have been added to the existing building, they are tastefully decorated with aids and equipment available to support the residents. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 16 Hot water temperatures throughout the building and in resident’s rooms were checked and found to deliver water at a safe temperature in line with health and safety guidelines. There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff have improved but still need to be more thorough to ensure suitable people are employed. Training for staff is accessible and supported by the owner and enables staff to have the skills and competencies for their roles. EVIDENCE: We looked at staff duty rotas for the home and spoke to staff and the manager about staffing levels. There were sufficient numbers of personnel on duty to ensure the resident’s needs are met. One staff member wrote in a survey, “We always have enough staff on”. One Staff file examined confirms recruitment procedures have improved with all checks for employment in place before people start to work at Arrowsmith Lodge. However the application form for employment should be amended to request people applying for a job to provide a full employment history with any gaps explained. Staff receive induction training and regular updates. Records looked at confirm training is ongoing for personnel to attend mandatory courses such as fire safety, moving and handling and first aid through their development programme to ensure they have the competencies to care and support people Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 18 living at the home. Staff have attended dementia training and speaking to staff confirmed this. Records show over 50 of care staff has completed NVQ (National Vocational Qualification) level 2 in care. Staff spoken to said, “Good first induction training”. And, “Yes I have completed dementia training”. Staff spoken to said they were clear about their role and work well as a team to ensure the individual and collective needs of residents are met. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and has policies and procedures in place to ensure the health and safety of staff and people living there are promoted and protected. EVIDENCE: The owner has completed the recognised qualifications to run a care home and has overall responsibility for the management and operation of the home. She has an understanding of the need to keep developing the care service in the best interests of the residents with staff support. Comments from staff and people who live at Arrowsmith Lodge were very positive in their responses about how the home is managed and the way the Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 20 service is being provided, One staff member said in a survey, “Its run so that residents get the best care”. We looked at records of residents and found they are comprehensive, well written and up to date ensuring the correct information is available and health; social and welfare needs are continuously monitored. We looked at random residents finamcial records and found good systems in place for residents to control there own money where possible and ensure safeguards are in place for there protection. Examination of records confirmed regular tests to emergency lighting, fire procedures and electrical equipment had been carried out ensuring the safety of residents and staff is maintained. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP29 Good Practice Recommendations The application form for employment should request a full employment history with any gaps explained. Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Arrowsmith Lodge Rest Home DS0000061375.V374730.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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