Care Home: Arthur Roberts House

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What the care home does well The home encourages people to visit and provides information about the service, as well as ensuring that they can meet people`s care needs before they move in. Care plans continue to improve and include people`s personal histories to make them more individual to each person. There is good contact with social and health care professionals to help ensure people`s physical and mental health needs are met. Medication is generally well managed, and we saw a number of examples of people`s privacy and dignity being respected. The home has shown a commitment to developing the activities offered, and staff are positive about using newly bought activities equipment. Visitors are made to feel welcome and told us that staff were supportive. People living at the home are offered choices and benefit from good quality food chosen to reflect their tastes. People living at the home can feel confident that the home will respond appropriately to complaints and supports people who whistle-blow on poor practice. The building is well maintained with an accessible garden, and investment has been made to improve furnishings and the look of the home. The home is clean and generally odour free. There are appropriate levels of staffing, who have access to training in a supportive environment. People living at the home benefit from a caring and skilled staff team who help create a calm atmosphere. The home is well managed which has resulted in improved communication and teamwork, as well as higher standards. There are various ways in which people visiting and working in the home can influence the way the service is run. The building is maintained to help keep people safe. What has improved since the last inspection? All the previous recommendations have been met. Since the last inspection, new contracts have been sent out to advise people of the home`s terms and conditions. Medication practice is monitored to measure people`s competence. There have been improvements in providing opportunities outside of the home. Communication has improved with relatives and the home is now advertising for permanent staff. Staff training records are now clearer, and easier to audit and staff feel supported in their work through supervision and staff meetings. CARE HOMES FOR OLDER PEOPLE Arthur Roberts House 121 Burnthouse Lane Exeter Devon EX2 6NB Lead Inspector Louise Delacroix Unannounced Inspection 24th July 2008 09:20 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 Arthur Roberts House DS0000039616.V364433.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. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arthur Roberts House Address 121 Burnthouse Lane Exeter Devon EX2 6NB 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) 01392 274388 01392 210251 http/www.devon.gov.uk Devon County Council Mrs Pauline May Lake Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (23) Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Arthur Roberts House provides personal care and accommodation for up to twenty three older people with dementia or mental health related problems. The home does not employ registered nurses. The Home is situated in the Wonford area of Exeter within close walking distance from local shops and on a regularly served bus route into the centre of the city. The building provides level access with a large secure lawned garden. Accommodation is provided on two floors with a shaft lift allowing easy access to both. Bedrooms are all single occupancy and there are four shared living areas, two on each floor. There is a small car parking area. The Home also offers short-term respite care. The Home now has a no smoking policy for all new admissions. Those residents who are smokers are still able to continue to smoke in designated areas. Within the building there is also a day centre for people living in the Exeter area, run by Age Concern. People using this centre use a separate entrance and therefore do not disturb the people living in the home, although, with prior agreement, some people who live in the home may attend the day centre if they wish. Fee levels are assessed according to the financial circumstances of each individual. The maximum cost of care was £570.50 per week at the time of inspection. Additional costs not covered in the fees include some transport, private chiropody, hairdressing and personal items such as toiletries and newspapers. A copy of the most recent inspection report can normally be seen in the entrance hallway, or alternatively the home will provide a copy on request. Arthur Roberts House DS0000039616.V364433.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 star. This means the people using this service experience good quality outcomes. The inspection was unannounced and took place over ten hours and fifteen minutes. There were twenty-two people living at the home and one person in hospital. During the inspection we spent time talking to people living, visiting and working at the home. We looked round the home, including the communal areas and individuals’ rooms. We also looked at records relating to people’s physical and mental health, as well as staff training and recruitment files, and maintenance files. Some people have difficulty expressing themselves verbally so we spent time in the communal areas to observe what life is . like for people living at the home. Before the inspection we sent out an annual quality assurance assessment (AQAA), which the home completed to tell us how they worked and improvements they plan to make. We also sent out surveys to a range of people, including people living at the home and visiting the home. People living at the home were supported to fill in their surveys. We received five surveys from people living at the home, five from relatives and five from health professionals. Their views and comments have been included in the report. What the service does well: The home encourages people to visit and provides information about the service, as well as ensuring that they can meet people’s care needs before they move in. Care plans continue to improve and include people’s personal histories to make them more individual to each person. There is good contact with social and health care professionals to help ensure people’s physical and mental health needs are met. Medication is generally well managed, and we saw a number of examples of people’s privacy and dignity being respected. The home has shown a commitment to developing the activities offered, and staff are positive about using newly bought activities equipment. Visitors are made to feel welcome and told us that staff were supportive. People living at the home are offered choices and benefit from good quality food chosen to reflect their tastes. People living at the home can feel confident that the home will respond appropriately to complaints and supports people who whistle-blow on poor practice. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 6 The building is well maintained with an accessible garden, and investment has been made to improve furnishings and the look of the home. The home is clean and generally odour free. There are appropriate levels of staffing, who have access to training in a supportive environment. People living at the home benefit from a caring and skilled staff team who help create a calm atmosphere. The home is well managed which has resulted in improved communication and teamwork, as well as higher standards. There are various ways in which people visiting and working in the home can influence the way the service is run. The building is maintained to help keep people safe. 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. Arthur Roberts House DS0000039616.V364433.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 Arthur Roberts House DS0000039616.V364433.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): We looked at standards 2,3,5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good exchange of information before people move to the home to help ensure the home can meet their needs. EVIDENCE: On the last inspection we made a recommendation to ensure that people living at the home, or where appropriate their representatives, had been sent details of the home’s terms and conditions, the manager told us that new contracts have been sent out to everyone, which is also stated in the home’s AQAA. We saw that information about people’s care needs is sought by the manager from health and social care professionals before people move to the home, which is good practice. The management team also carries out their own assessment by meeting the person and their representatives, and look at social needs, as well as physical and mental health needs. On the day of the inspection, we saw how the home worked with health and social care Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 9 professionals to ensure that a person who had recently moved to the home had their health needs met and their assessment updated. The manager told us that people are encouraged to visit, and on the day of the inspection a relative was looking at the home on their mother’s behalf. A person currently staying at the home told us they had been unable to visit but that their family had visited on their behalf and made a good choice. The home does not provide intermediate care. Arthur Roberts House DS0000039616.V364433.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): We looked at standards 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. People can be confident that their personal and health care needs will be met by staff who understand how they want to be assisted. Medicines are generally well managed, and people can be confident that their privacy and dignity will be respected. EVIDENCE: Care plans are all kept in one place and staff confirmed that they were accessible. We looked at three plans of care for people, which were generally up to date and appropriately written. There are risk assessments in place, for different areas of care such as moving and handling or how to manage inappropriate behaviour. Monthly reviews take place but do not provide a holistic overview of people’s well-being, and sometimes miss an issue that has occurred during the month or are written in an ambiguous way. For example, in one month problems with equipment and resulting pressure area concerns were identified, the following Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 11 month the reviewer wrote no change, even though the manager confirmed that the problems had been resolved. For another person it was shown that they had a fungal infection on their feet but the progress of treatment was not commented on in monthly reviews. In the AQAA, it states that the home is considering further ways to ensure the care plans highlight how people’s individual needs are met. Work has been completed to record people’s social histories to help staff recognise people as individuals with a past and a wealth of experience. When staff spoke about people living at the home, they demonstrated through their descriptions their recognition of people’s individuality, and we saw from their approach that they understood people’s individual needs. Four people living at the home told us in their surveys that they always received the care and support they needed and one said sometimes. One person commented ‘yes, someone is always there for me’. People that we spoke to were positive about the home and the support they received. The general response from visitors was that the care home meets the needs of their relatives. We received four surveys from GPs who were all positive about the quality of care, including communication, although one person felt that this could depend on which senior/deputy manager was on duty. We saw from daily records and communication books that when health problems are identified, advice is sought from health professionals. People’s well-being is also monitored as part of monthly reviews. For example, one person has been unwell and has been eating and drinking less. We observed how staff encouraged the person to eat and drink by offering choice, providing verbal and physical support, and ensuring that concerns are monitored. We saw from the person’s records how advice has been sought from health professionals and how the home worked with the person’s relative to monitor the person’s well-being. The care plan files provided good evidence of how the home has liaised with health and social care professionals to ensure that people’s health needs are met. Visits and treatment from GP’s and district nurses have been requested when needed. Advice is well documented. Opticians, dentists, and chiropodists provide regular healthcare checks and treatment. Weights are recorded for people living at the home although there are some omissions, which the manager said was due to staff not reporting that the sitting scales were not working. She said this has now been rectified, and that she has stressed the importance of this form of monitoring. We observed how people’s medication is managed. Medical administration record sheets are appropriately completed and are up to date. We saw that there is guidance for staff to promote safe practice. We saw from staff members’ files that people who administer medication have received training and the manager spot checks their competency levels. We discussed with the Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 12 manager how they update their practice, and they told us about a peer support group they attend, we also discussed updating their practice through refresher training. Senior staff give out medication and currently sign when it has been given out rather than when it is taken. We saw that medication is left with people for them to take when they are ready; we heard care staff agreeing to let the senior know when this had happened. However, some people looked bemused by the tablets and therefore did not take the medication straight away. This means that there is the potential for their medication to be left on the table and for another person to take it by mistake. We have discussed the home’s policy procedure for dispensing medication with our pharmacist, who has expressed concern about the risks involved for the home’s client group. We saw that there are cream charts in people’s individual wardrobes but that these are not filled out consistently and therefore it is not clear if people are receiving the care they need. We saw from the minutes of a staff meeting on 9th July 2008 that the manager had already brought this to the staff’s attention, and we heard staff being reminded again during a handover between shifts. We spent time in the communal areas of the home to see how people’s dignity and privacy is respected. Staff spoke to people respectfully, recognising those people who enjoyed a joke and those who communicated on a more formal basis, and changed their approach accordingly. Staff listened to people’s wishes and also spent time explaining about choices. One person took a pride in their room and we saw how staff respected their need to carry out household chores i.e. washing dishes. We saw people being discreetly asked about using the toilet, and prompts being subtly given to help people with their memory difficulties. We saw how people looked relaxed with staff and confident in expressing themselves. We saw from people’s appearance that they looked well cared for, including their nails. One person told us about their love for jewellery and later we saw a staff member complimenting them on a new item of jewellery, while another member of staff recognised the significance of a locket and what it meant to the person. We saw that people’s clothes were well cared for and hung up in their wardrobes. A person showed us their clothes and it was clear that they took pride in their appearance and that the storage of their clothes was important to them. Staff were heard checking that a person’s formal clothes were clean so that they could look smart to attend a funeral. We saw how staff supported friendships amongst people living at the home and encouraged conversation between people, on one occasion moving a menu out the way so people could see each other across the table. They also discreetly intervened when people became irritated with one another to help Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 13 resolve tensions. These staff actions help support people’s sense of identity and feelings of well-being. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 14 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): We looked at standards 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. People who live at this home benefit from staff who appreciate the importance of mental stimulation, and provide a growing range of activities. People visiting the home feel welcomed and supported by staff. There is a strong commitment to providing good quality food that reflects the tastes and needs of people living at the home. EVIDENCE: As part of the inspection, we looked at how people spend their time. We saw how staff supported a small group of people to access the garden before dinner. This enabled people to have some gentle exercise and also triggered conversations about the past and people’s former gardens. The garden has a range of sitting areas and a small circular path. A relative praised the garden in their survey. After dinner, we saw how two staff members gave one to one attention to people sitting in the lounge. One member of staff skilfully used a reminiscence kit with people to instigate discussions around the memories that the scents evoked. The staff member carefully changed their approach to reflect the Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 15 response of each individual and treated each person as an equal. Other staff also became involved but were careful not to overwhelm people with too many questions, and paced their conversations to match the needs of individual people. The home has invested in two interactive model cats, which move and purr. Staff told us how well some people have responded to the physical contact that the cats provide, and one person told us how much they loved the cat, while another joked about it. Staff knew who responded well to the cats and who preferred not to get involved. Staff were positive about the investment in new activities equipment and appeared committed to their use, which was shown in people’s individual activity records. We also saw staff spending time talking with people during everyday tasks, which indicates that they recognise that mental stimulation and involvement is important. People who live at the home and who responded to our survey were generally positive about activities with two saying there were always activities they could take part in, with one person saying usually and two people saying sometimes. Another person told us they liked to walk around the home or read their newspaper, which we saw in their room. They confirmed they liked their own company but also seemed to enjoy conversations with staff as they walked around. However, one person’s care plans states that they benefit from one to one sessions but these have not been recorded as happening on a regular basis and another person’s interests i.e. flower arranging, sewing, listening to music and spending money have been listed but are not reflected in the activities they have taken part in. Both of which would benefit from monitoring. (See standard 7 re: monthly reviews). One visitor felt there should be ‘more activities’ and another felt their relative would benefit from local walks; the home’s AQAA states people are supported on a regular basis to go to local shops. A relative said ‘ the staff seem well aware when residents want to be left to their own devices or can be coaxed to join in with activities’. Another response was ‘the staff do well. But I think with more staff it would be a lot better as they would have more time for each person’. The manager told us they were committed to employing a staff member who will specifically organise activities, and oversee trips, and hopes to recruit for this post. They told us they have also attended training themselves to give them ideas to share with staff. Since the last inspection, one trip has taken place to Exmouth and we saw paperwork confirming that another trip is planned. We were told that plans were being made for outings at Christmas. During our inspection, we looked at how people are supported to keep in contact with people who are important to them. We saw a number of relatives visiting, who appeared relaxed and confident with staff, while staff were welcoming in their approach. During the inspection, a relative confirmed this Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 16 impression. One person said in their survey response that an alternative to the payphone would be good as it was expensive for their relative to use to call them. Another visitor said that their relative ‘does not normally request to make a call, although the help would be there if required’. Another relative appreciated the support that staff gave them when they were upset. Another said ‘the home is a very caring place …and the home keep close in touch with me’. Another relative said they had to ask about the care provided but ‘they give it when I ask. I am happy with the care…’ We saw how people are offered choice, including drinks, and how and where they spent their time. Staff respected people’s choice at mealtimes but also explained why they were encouraging people to eat or drink, which generally people responded well to. People make choices about where they ate their meal, which we observed. People’s preferences for getting up and going to bed are noted, and staff confirmed that there had been improvements in the routine of the home becoming more flexible to suit individual need, and daily notes confirmed this. In the home’s AQAA, the manager told us that plans were being put into place to photograph meals to help people make informed choices about what they would like to eat. We met with staff who work in the kitchen, who showed a strong commitment to good quality food to suit the tastes of the people living at the home. They could give examples of improvements they have made, including daily menus and condiments on the tables. They recognise the difference sizes of meals that individuals like, and we saw people enjoying ‘seconds’. They have undertaken some specialist training for cooking for people with diabetes and have food hygiene certificates but would also like further training specifically for people with dementia. They told us how they monitored the amount of food eaten to see what was popular and gave examples of changes they had made as a result. During a lunchtime meal, we saw that people were relaxed and chatted to one another with staff creating a calm atmosphere by not, speaking at a soft pitch and at an appropriate pace. One person who needed help with their meal had their meal at the same time as others rather than having to wait, which is good practice. Fresh fruit is available and we saw people helping themselves from fruit bowls as well as having fruit in their daily diet. We also saw a range of soft drinks, including cranberry juice, which the staff member recognised as being beneficial for people prone to urine infections. People were heard making favourable comments about the meal as they left the table, and were generally positive in their surveys with one person saying ‘very enjoyable’. Staff told us that some spouses regularly stay for a meal and relatives told us that the food was ‘good’ and ‘very good’. The home’s kitchen has recently been awarded an in-house gold award for their standards. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 17 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): We looked at standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can feel confident that the home has taken appropriate steps to minimise the risk of abuse. EVIDENCE: The home’s AQAA states there have been no complaints since the last key inspection, and CSCI have received no complaints about the home. There has been one safeguarding concern since the last key inspection, which the home responded appropriately to, with the outcome being a training issue for one staff member. Other areas of the concern were looked at as part of a random inspection, which took place in the evening of 2nd January 2008 and were not substantiated with no new requirements or recommendations made. Visitors told us that the home generally responded appropriately if they raised concerns, although some were unclear how to make a complaint. Four out of five people living at the home told us in their surveys that they knew how to make a complaint, and one person said ‘don’t need to as everyone friendly and happy’. The home’s AQAA states that there is a commitment to supporting staff who whistle-blow on poor practice. We spoke to staff about whistle-blowing who confirmed this ethos and told us that the new manager will not tolerate poor practice and has challenged practice that has not benefited people living at the Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 18 home. Staff training records showed that all the staff files that we checked had received training in safeguarding vulnerable adults. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 19 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): We looked at standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in clean and homely surroundings with an accessible garden, which are well maintained. EVIDENCE: During our inspection, we overheard a visitor praising the appearance of the home. We saw that the home was clean and well maintained. We spoke to staff involved in maintaining its appearance. They were clear about their role, took a pride in their work, and were positive about equipment that had been bought for them since the appointment of the new manager that supported them to carry out their job. People living at the home showed us their rooms and stated that they were happy with them. In the home’s AQAA, the manager told us that since the last inspection new soft furnishings, new furniture, new duvets and pillows have been bought with Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 20 extra seating areas around the home. There are photographs of local places of interest or beauty on the walls and furniture is domestic in appearance. The garden is accessible and offers a choice of places to sit, and is well managed. Visitors and people living at the home told us that it was always kept clean, and we this was the case during a tour of the building looking at bathrooms, individual rooms and communal areas. There were no odours, apart from in one bedroom, and the manager was clear about the work that was being done to combat this, including buying specialist cleaning equipment to maintain ongoing intensive cleaning. Staff involved in cleaning the home told us about their training to carry out this role safely, and the steps they take to manage infection control. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 21 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): We looked at standards 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from a skilled and caring staff group, whose training needs are generally met. However, some aspects of the recruitment process has the potential to put people living at the home at risk. EVIDENCE: On the day of the inspection, the manager and two seniors were on duty, which we were told occurs to enable essential paperwork to be completed, plus five care staff in the morning, and four in the afternoon and evening, later changing to two night waking staff and one senior. Kitchen staff and domestic staff support these staff members. Two relatives felt more staff would be beneficial. People living at the home told us that generally staff were there when they needed them and in their surveys people told us that staff were always or usually available. One person said ‘staff are friendly and always there for me’. During the day the pace appeared calm and relaxed, although in the evening staff were more pressured as one person living at the home became very anxious and needed one to one support to reassure them. Staff told us that staffing levels were appropriate. The AQAA states that the home is currently recruiting permanent staff as there is a strong reliance on agency staff. However, we were told that many of the Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 22 agency staff have worked at the home for a number of months and in the case of one person we met, two years. The manager confirmed that agency staff are employed on a block booking basis and this helped with continuity. We saw that agency staff were confident supporting and talking with people living at the home, and that people living at the home seemed relaxed with them, although one person commented generally that ‘there were lots of faces’. According to the home’s AQAA, the home has almost reached the recommended levels of staff with a NVQ 2 in care with other staff currently training for this qualification. We looked at two recruitment files for newly employed members of staff. One file had two references, ID and a police check (CRB) in place before the member of staff started working at the home. We saw that their application form had no employment gaps and that there was an interview assessment form in place. This is good practice. However, on a second file the person had stared working at the home before a POVA First or CRB (these are checks to ensure that staff are suitable to work with vulnerable people) had been received, which is not safe practice, although references were in place and ID. There were also employment gaps on their application form, which the manager said had been discussed but not recorded. A CRB application form has been sent off by the home but has not yet been returned. We observed on the day of the inspection that this person was not allowed to provide personal care to help reduce risks to people living at the home. Since the inspection, we have been sent proof that the person’s POVA First check is clear but this confirmation was not received by the employer until a month after the person had started working at the home. This is not safe practice. As part of our inspection we looked at the skills and training of staff. Visitors told us that ‘the residents and the staff always appear happy and relaxed’ and that ‘staff show a very caring attitude towards clients. Warm and supportive’. The care staff we observed had a skilled approach, reducing tensions between people and changing their approach to suit individuals. We heard staff relating to people’s experiences during a handover session, this was particularly noticeable for people new to the home and experiencing a sense of loss. A visitor told us how supportive staff had been to their relative who has been recently bereaved. The home has now developed a method of recording the training all staff have received in order to provide a clear clearer method of checking those staff who may have missed any essential training topics. The manager has identified nineteen staff members for training in dementia care, which she said was planned. Senior staff have received training in this specialist area of care. We looked at the training records for four people and saw that they all had training in moving and handling, food hygiene and where appropriate medication Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 23 administration. The manager said that two new members of staff needed moving and handling training but that there were currently no in-house training places available. We discussed the home’s current induction process and we advised the manager that this should be in line with the Skills for Care induction standards. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 24 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): We looked at standards 31,32,33,35,36 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 managed with a positive ethos and a safe place to live. EVIDENCE: The home has been without a registered manager since August 2007. However, there is an acting manager in post who told us that they have submitted their application to be registered. People told us about the positive changes that the acting manager has instigated by challenging practice that does not benefit people living at the home and by promoting a better working relationship between all staff members. Staff told us that communication had improved between staff members and a relative told us that there is ‘very good communication Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 25 between staff and clients’. A member of staff told us in writing that the acting manager is ‘highly organised, very conscientious and is well motivated…she has really pulled the staff together’. Other people told us that the acting manager had made a positive impact on the home by raising standards and expectations. Staff told us that they felt the acting manager recognises their potential and has recognised their work and commitment. The manager meets regularly with staff from the local mental health service to promote better communication and understanding of each others roles. We looked at how people can influence the service. Staff are able to do this through staff meetings or individual supervision sessions. There are also manager’s meetings to help provide an overview of the service. The manager carries out spot checks to help measure the quality of care, and the home receives monthly visits from Devon County Council to help monitor the home’s performance. Surveys have been sent to families and visiting professionals to gain feedback about the service. We also saw a compliments file, a GP said that the changes at the home were ‘very positive and noticeable’ and a CPN noted in their survey that there has been an improvement in the last year with respect to the care service respecting individuals’ privacy and dignity. A relative praised the staff for helping them celebrate their wedding anniversary with their spouse who lives at the home. We also spoke with people who are involved in catering who told us how they monitor people’s responses to the food and the changes they make as a result. As part of the inspection we looked at how people are supported with their finances. If people are unable to handle their own finances the home encourages people to arrange help from their families or representatives. The home holds sums of cash for those people who are unable to look after it themselves. The bulk of this money is kept in a bank account that has been specifically opened for people living at the home. Records seen during this inspection showed that interest gathered is regularly shared between the people using this account. The home holds a float so that people can also have daily access to their money. The records are well maintained and regularly checked by a second member of staff. The home’s AQAA states that staff are now regularly supervised, and staff confirmed that they felt supported in their role and are helped to develop their skills. We looked to see how people living at the home are helped to keep safe, and so we visited communal areas and a selection of bedrooms. We saw radiators are covered in the rooms and windows are restricted to help reduce the risks to people living at the home. Call bells are placed in accessible locations. Staff spoke to us about the importance of storing chemicals correctly; including the way they are moved around the home. This safe practice was seen on the day of the inspection. The manager has sent us proof of future infection control training, and staff were able to tell us about infection control measures in the Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 26 home. The home’s AQAA states that all the catering staff have training in safe food handling and that the majority of care staff have also been trained. The home’s AQAA also shows that that the lift, emergency call system and heating system have been recently serviced and that the portable hoists will soon be due for servicing. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 27 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 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 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 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 3 x 3 Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 28 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. 1. Standard OP9 Regulation 13(2) Requirement A risk assessment must be carried out to ensure that current medication practice i.e. leaving medication with each individual for them to take in their own time, does not put people living at the home at risk. Staff must have a full employment history and POVA/CRB checks before working at Arthur Roberts. Timescale for action 01/09/08 2. OP29 19 (1) (a) (b) Schedule 2 01/09/08 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. 2. 3. Refer to Standard OP7 OP29 OP30 Good Practice Recommendations Monthly reviews should be used more effectively to monitor all aspects of a person’s well-being including pressure care, foot care and social needs. The manager should ensure that they are clear what paperwork and Police checks are needed before new staff start working at the home. Devon County Council should provide funding for training DS0000039616.V364433.R01.S.doc Version 5.2 Page 29 Arthur Roberts House 4. OP33 by external trainers if the in-house training department do not have capacity to meet the identified training needs of staff. The home should consider how it captures the views of people living at the home about what works well and what needs to change. Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Arthur Roberts House DS0000039616.V364433.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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