Care Home: Arthur`s Court

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What the care home does well We observed that care staff are generally cheerful and kind to people. We observed some interactions where carers considered peoples` independence and dignity. The environment continues to be pleasant and clean.We saw lunch being served that appeared appetising and wholesome however we are concerned that people who have pureed diet are not offered a choice of meal. What the care home could do better: The management and staffing of the home continue to cause concern. The manager is not able to work full time and yet there appears to be little additional structured support for the home. The shortage of trained nurses may not only compromise care of people in the home but also means routine staff appraisals and supervision are not occurring. There is a need to co-ordinate events in the home and to make arrangements for meetings in advance. An immediate requirement was issued with respect to the management of fluids and monitoring. Some charts were completed but there was a great deal of variation from day to day. There was no sense of management of the records. A safeguarding alert had been raised regarding the care of one person`s wound. This is currently being reviewed and investigated. We were concerned about the continued absence of of fire training in the home and made an immediate requirement for the organisation of training and rapid implementation. There were several events during this random inspection that indicated the systems of staff management in the home are lax. It is an essential part of health and safety management and important for safeguarding people that all staff and visitors sign in and out of the home. Random inspection report Care homes for older people Name: Address: Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG one star adequate service 29/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Shelagh Laver Date: 1 1 0 3 2 0 1 0 Information about the care home Name of care home: Address: Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG 01458442319 01458447254 AC1Europeancare@aol.com www.europeancare.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Pauline Purnell Type of registration: Number of places registered: Conditions of registration: Category(ies) : European Care (UK) Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 0 old age, not falling within any other category physical disability Conditions of registration: 0 40 Persons of either sex, not less than 60 years, who require general nursing care Places for up to 30 clients for nursing care Places for up to ten clients for personal care Registered for a total of 40 places in categories OP and PD Up to four persons in the age range 18-59 years who require general nursing care Date of last inspection 2 9 1 2 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Arthurs Court is an established care home providing nursing and personal care for up to 40 service users. The care home can be found near to the centre of Street and within walking distance of the shops. The care home is in an area surrounded by domestic housing. There is limited parking on the home premises. The care home can provide accommodation in single and shared rooms over two floors. The bedrooms and communal rooms can be reached by stairs from the reception area or by passenger lift from the reception area.There are adequate well equipped bathrooms and toilet facilities around the home. There is a choice of communal areas including a large lounge / dining area on the ground floor and a smaller lounge/diner on the upper floor. There is also a conservatory to the rear of the home. The main lounge on the ground floor can accommodate residents who wish to watch television. The care home provides twenty four hour nursing and personal care services to older persons and can offer general nursing services for up to four persons between the ages of eighteen and fifty nine years. The care home aims to provide nutritious meals to suit peoples wishes. The current fees charged are 487 - 640 pounds for nursing care and 361 - 530 pounds for personal care Pauline Purnell is the registered manager. Care Homes for Older People Page 3 of 11 What we found: A requirement was made at the last two key inspections that the system of care plans must clear and comprehensive. At this visit there are still two systems in place. Staff said that the paperwork was confusing and they did not know where to start. The manager told us that there were plans to introduce a new system of paperwork by July. A requirement made at the key inspection of 29/12/09 that the home must ensure that when the need for monitoring fluids was identified this is carried out with care and is supervised by trained nurses did not appear to have been actioned. In one room we saw one person who appeared light in weight and reviewed the food and fluid charts. The chart for 11/03/10 stated that at 08:30 100 mls of tea and a bowl of porridge had been taken. At 13:00 the person was saying I am hungry I want mine now. In the room were unopened Forticreme pots. Records for 10/03/10 were more complete but again there were no records of supplements being taken. In the nurses treatment room we asked to see the persons weight record. There were weight records from 13/07/09. Between August 2009 and October 2009 the person had lost 6.1kgs. Subsequent months the records statedunable to weigh. The last record was 28/02/10 which again said unable to weigh. Generally we could see that care staff were offering fluids and food. We spoke to one relative who came in daily. There were no concerns about the general care in the home although some niggles of forgetfulness like putting in teeth. A safeguarding alert had been raised regarding the care of one persons wound. This is currently being reviewed and investigated. We recommend a review of oral care in the home. We spoke to one person who had a very dirty tongue and another who said she had had a sore mouth for some time. Another person told us she needed new teeth. At the key inspection there were concerns about the level of vacancies for trained nurses particularly as the registered manager was ill at the time. We looked at the rota for week commencing 01/03/10 and 08/03/10. Currently there is one full-time nurse (who usually works nights) two part-time nurses and three bank nurses. Agency nurses are covering other shifts. Nurses work a majority of long days 8-8 shifts. The manager told us that there are hopes that bank and part-time nurses may become permanent staff and there are advertisements in place. The carers off-duty does not specify who are the senior carers so it was difficult for us to gain a clear view of the staff skill mix. Staff are working a variety of contracted hours from 15 to 54. Some staff are working additional hours resulting in 56 hours. Care Homes for Older People Page 4 of 11 The home is now registered for up to 40 people with nursing needs. The current availability of trained nurses is not sufficient to meet the needs of the home. We request that the home does not admit any more people with nursing needs until there are sufficient permanent qualified nurses available in the home. The manager continues to work phased hours as part of a planned return to full time employment after a period of illness. The manager informed us that she was supported by a full-time administrator who undertook the completion of management reports such as the managers report, accidents, the use of agency staff and the vacancy reports. We had hoped to meet with the administrator but this was not possible. We were told that although she had not signed out of the home she was not available for the rest of the day. It is important that staff in the home know when key personnel on on duty and can be accessed for information and support. During the visit to the home health and professional staff began to arrive for a planned review for a person who lived in the home. The room usually used for the review had been booked for training and as people arrived for the meeting the maintenance man tried to find a suitable room. Visitors to the home expressed the view that the meeting had been booked for months and yet no arrangements had been made. When we needed to find the agency nurse in the home who attended the review she could only be contacted by going to the review room. Staff did not know where she was. There are monthly visits to the home by the regional manager. The organisation should consider whether in the current situation this is sufficient support for this home. At the key inspection we spoke to staff who were unsure when they last had fire training. We were told that there were plans to deliver this in-house . However at this inspection no training had been delivered and there were no plans for training known by the maintenance man who was expecting to do the training. The home must ensure that on every shift there is someone who is competent to take appropriate action in the event of a fire. This is particularly important when agency staff are in charge of the home and at night. We made an immediate requirement regarding fire training in the home. We were told that there had been a fire evacuation practise on 02/03/2010 and that this had been efficient and effective. All staff on duty had participated and the event had been completed in good time. What the care home does well: We observed that care staff are generally cheerful and kind to people. We observed some interactions where carers considered peoples independence and dignity. The environment continues to be pleasant and clean. Care Homes for Older People Page 5 of 11 We saw lunch being served that appeared appetising and wholesome however we are concerned that people who have pureed diet are not offered a choice of meal. 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 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be a clear and comprehensive care plan for each person. The care plan is the basis on which care staff provide care in the home. It must give clear instructions to them that can be easily accessed and understood. 01/08/2009 2 8 12 The home must ensure that when the need for monitoring of fluids is identified this is carried out with care and is supervised by trained nurses. mono It is important that efforts are made to ensure that people receive a required amount of fluid for their needs. Nurses must be able to review the intake and output of people when this is a specified health need. 14/01/2010 3 18 13 All staff must receive training 07/04/2010 in the recognition and prevention of abuse. All staff must be aware of different types of abuse and must be able to take appropriate action to prevent and report it. Care Homes for Older People Page 7 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 38 13 The manager must ensure that the work to the new sluices is completed and includes functioning bedpan cleaning equipment. Current arrangements do not facilitate best practise in infection control. 30/05/2009 Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 8 12 There must be a system in place that ensures that all people in the home receive sufficient fluids and food. When a need is identified to record fluids this must be monitored by the nurses in the home to ensure appropriate action is taken by the care staff to meet peoples needs. 18/03/2010 2 30 23 All staff must receive fire 18/03/2010 training. Plans must be put in place immediately to ensure that staff would be able to take appropriate action in a fire. There must be a competent person on duty at all times who could take appropriate action in the event of a fire. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 There must be sufficient trained nurses on duty to ensure both continuity of clinical care and appropriate support for staff. In a nursing home trained nurses are responsible for 16/04/2010 Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action planning and implementing care and supervising staff. 2 32 10 The management arrangements in the home must be reviewed to ensure there is sufficient management support and direction available at all times. Management arrangements must be sufficiently robust to ensure both peoples care and the management of staff are fulfilled competently. 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 16/04/2010 1 8 There should be a review of peoples oral care to determine that needs are being met in a planned and appropriate manner. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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