Care Home: Seven Arches

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What the care home does well People have an assessment of their needs before admission and are told by the manager if they can be me at Seven Arches. Individual care needs were identified in care plans that included clear guidelines for staff to follow. Comments from residents and relatives indicate that they are satisfied with the care and support provided at the home. One person commented "keep everybody clean and well fed". People using the service told us they were generally satisfied with the food and the choices available. The environment at Seven Arches is clean and very well maintained, making it a pleasant place for people to live. Everybody has their own bedroom giving Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 them some privacy. Residents told us they were satisfied with their own rooms and all comments received said that the home is kept clean and fresh. People living at the home and their relatives are given opportunities to comment on the service so that improvements can be made. The registered provider`s representative also undertakes detailed monthly visits to the home to ensure that things are running properly. Residents and relatives spoken with said there are some good staff working at Seven Arches and that they are very friendly. A comment from a survey we received said "There is a sense of friendliness and relaxed atmosphere among staff and patients". What has improved since the last inspection? The manager and provider responded positively to the requirements made at the last inspection and have taken action to improve a number of areas. Care plans were better organised, clearer and more detailed, providing staff with good information on how to meet people`s individual needs. Medication records and storage had improved. Medications sampled tallied with the records indicating that people receive their prescribed medications when they should. Systems were in place to ensure that medication was stored at appropriate temperatures to ensure it retained its effectiveness. Photographs of residents were held with care plans and medication records to support accurate identification. Information on the outcomes of part of the quality assurance surveys was readily available in the home although final report and action plan have yet to be completed. Additional staff hours have been allocated to supporting residents with activities and stimulation. Activity support staff and senior staff attended training to help them assess and support activities for people living with dementia. Staff training has also been provided for example on safeguarding, fire awareness and moving and handling, increasing staff knowledge and promoting the well being and safety of residents and staff. The premises has had new carpets and been decorated throughout and additional furniture provided in the garden so it can be used by more people. What the care home could do better: Seven ArchesDS0000015560.V376679.R01.S.doc Version 5.2 While improvements are noted to many aspects of the service, these need to be maintained and additional actions taken to further develop the service provided. In a survey received one person stated that what the home could do better would be "to have more entertainments for residents after lunch and also day outings to the sea or somewhere could be arranged.. to give them a break away from home". Another person said on what the home could do better "There should always be at least one person on duty in the lounge at all times". The manager should provide better information to people in formats that are easy for them to read and understand including a complaints procedure and the service user guide. The manager should ensure that recommendations in this report are actioned such as obtaining current information on safeguarding vulnerable people and undertaking risk timely risk assessments to promote the health and safety of people at Seven Arches. Key inspection report CARE HOMES FOR OLDER PEOPLE Seven Arches Lea Rigg Cornsland Brentwood Essex CM14 4JN Lead Inspector Bernadette Little Key Unannounced Inspection 15th July 2009 09:30 DS0000015560.V376679.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seven Arches Address Lea Rigg Cornsland Brentwood Essex CM14 4JN 01277 263076 01277 216692 sevenarches@brookvalehealthcare.co.uk 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) Brentwood Homes Limited Mr Lochan Kunkun Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care Home with Nursing - Code N to service users of the following gender: Either, whose primary care needs on admission to the home are within the following catergories: `Old age, not falling within any other category - Code OP` The maximum number of service users who can be accommodated is: 30 24th July 2008 2. Date of last inspection Brief Description of the Service: Seven Arches is a large purpose built two-storey property situated in a quiet residential area close to Brentwood town centre and within approximately one mile from Brentwood rail station. The home provides single bedroom accommodation for up to a maximum of thirty older people. Communal areas and service facilities i.e. laundry and kitchen, are on the ground floor. Residents have access to extensive well maintained external grounds and the home is decorated and maintained to a reasonable standard. The manager said that the current scale of charges at the home ranges between £561.00 - £665.00 per week. The actual fee depends on the source of funding, assessed nursing needs and /or type of accommodation available i.e. with or without an ensuite. The home’s current Statement of Purpose and Service User’s Guide are available upon request. Seven Arches DS0000015560.V376679.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 that people who use this service experience good quality outcomes. The site visit was undertaken over a nine hour period as part of the routine key inspection of Seven Arches Nursing Home. Time was spent with residents, visitors and staff and information gathered from these conversations, as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has improved and what could be done better. This information was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, staff, care managers and healthcare professionals. Completed surveys were received from eight residents some of whom were supported by relatives and from two staff. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back in detail and discussed with the manager and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection is appreciated. What the service does well: People have an assessment of their needs before admission and are told by the manager if they can be me at Seven Arches. Individual care needs were identified in care plans that included clear guidelines for staff to follow. Comments from residents and relatives indicate that they are satisfied with the care and support provided at the home. One person commented keep everybody clean and well fed. People using the service told us they were generally satisfied with the food and the choices available. The environment at Seven Arches is clean and very well maintained, making it a pleasant place for people to live. Everybody has their own bedroom giving Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 6 them some privacy. Residents told us they were satisfied with their own rooms and all comments received said that the home is kept clean and fresh. People living at the home and their relatives are given opportunities to comment on the service so that improvements can be made. The registered providers representative also undertakes detailed monthly visits to the home to ensure that things are running properly. Residents and relatives spoken with said there are some good staff working at Seven Arches and that they are very friendly. A comment from a survey we received said There is a sense of friendliness and relaxed atmosphere among staff and patients. What has improved since the last inspection? What they could do better: Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 7 While improvements are noted to many aspects of the service, these need to be maintained and additional actions taken to further develop the service provided. In a survey received one person stated that what the home could do better would be to have more entertainments for residents after lunch and also day outings to the sea or somewhere could be arranged.. to give them a break away from home. Another person said on what the home could do better There should always be at least one person on duty in the lounge at all times. The manager should provide better information to people in formats that are easy for them to read and understand including a complaints procedure and the service user guide. The manager should ensure that recommendations in this report are actioned such as obtaining current information on safeguarding vulnerable people and undertaking risk timely risk assessments to promote the health and safety of people at Seven Arches. 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 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. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 8 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 Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Standard 6 does not apply to this service. People using the 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 residents will have their needs assessed and be informed that these can be met by Seven Arches, and will have enough information about the home on which to base a decision to live there. EVIDENCE: Seven Arches provide a statement of purpose and service user guide as required by regulation so that people thinking of living there have information about the services and facilities they can expect. The statement of purpose had been recently reviewed and advised people how to access a copy of the Commissions most recent inspection report about the home. The service user guide should be dated and the size of the print could be bigger to make it easier for people to read. Parts of the service user guide were available in each residents bedroom. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 10 The managers AQAA advises that people thinking of moving into Seven Arches can have one weeks respite care as a trial and that people are encouraged to visit the home or ring with questions as many times as they wish. It also states that all service users receive a contract clearly setting out the terms and conditions of their residency. Information from all service user surveys confirmed that people felt they had received enough information to help them to decide if this home was the right place for them before they moved in and that they had been given a written contract. People spoken with at the site visit confirmed that they had visited prior to admission and were given information about the service and have received a copy of their contract. Files for two people admitted to the home since the last inspection were reviewed. Thorough pre-admission assessment would ensure that the home had obtained all the information necessary so they could be sure they would be able to meet the persons individual needs. Both files sampled showed good detail in the pre-admission assessment, only one of which was dated. Additional information was available from either the funding authority and/or the family and this confirmed that a brochure had been provided and that the family had visited. Copies of the contracts were also available. While the manager had not referred to it in their AQAA, there was a letter on each file confirming to the person that, based on the homes assessment of the persons needs, Seven Arches could meet these. This was a requirement from the last inspection and is a noted improvement. Seven Arches does not provide intermediate care. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the 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 can expect their care and health needs to be met and their privacy and dignity to be respected. EVIDENCE: Surveys received from residents of Seven Arches indicated that they generally felt they received the care and support they needed and that staff listened and acted on what they said. Comments included very caring and give attention to all and kind caring TLC. However one person said they would like to staff to be just a little more careful when washing and dressing a resident. Discussions with residents at the site visit indicated that they were satisfied with the care received, that staff did listen to them and respect their privacy and dignity. Visitors spoken with also stated satisfaction with the care provided at Seven Arches and comments included we are quite satisfied and the care Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 12 is good. Visitors also told us that staff respect residents privacy and dignity and speak to people with respect. The manager has a care planning system in place that has been audited by the organisations Senior Nursing Officer. Care plans reviewed at this site visit showed that residents’ needs had been identified well and that detailed information was in place to guide staff as to what support was needed. They were signed by the persons relative to confirm their inclusion and had information on final wishes relating to end of life care. While a care plan was written on admission, in one case some baseline risk assessments were not completed for several days although the pre-admission assessment clearly indicated these as needs. This does not support best care outcomes for residents from admission. Daily care notes were detailed and reflected the plan of care. This helps to monitor if the care plan is effective or if it needs to be changed. Detailed care plans were available relating to specific health care needs such as diabetes. Nutritional screening was undertaken and where this raised concerns people were weighed regularly, specific food monitoring was undertaken and referral made to the dietician. Care plans such as continence needs clearly guide staff on respecting the persons privacy and dignity. The information received in resident surveys as well as in records viewed and discussions with residents and relatives indicated that residents health care needs were monitored and met. Records showed that residents have access to health professionals including GP, chiropodist, optician and dietician. The results of the quality assurance survey of health professionals indicated positive views of the service provided. It was noted positively that a photograph of the resident was held with their care plan and medication records to enable correct identification to ensure they receive the appropriate individual and medication. This is a noted improvement from the last inspection. Medication records sampled were found to be in good order. Medicines received were recorded and remaining medications tallied with the Medication Administration Record charts. This is an improvement from the last inspection. Records of receipt and administration of controlled drugs were also satisfactory. Since the last inspection, the home has changed their supplier and now use a monitored dosage blister system. All medication is now stored in the secure medication room. The medication storage room temperatures are well controlled and monitored regularly to ensure the quality of medicines in use. This is a noted improvement from the last inspection. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the 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 can expect to have their social care needs met, their choices respected and to receive a satisfactory diet according to their individual needs. EVIDENCE: Surveys received from residents varied in their view as to whether the home arranges activities that they can take part in if they want to. Three people felt they always did, three people felt they usually did and one person said they sometimes did. Two surveys suggested that residents could be possibly taken into the garden more often to sit in the fresh air although a relative spoken with said that this did happen. A resident spoken with advised that they are able to keep themselves busy with puzzles and by reading. The managers AQAA states that as a result of listening to verbal feedback from residents and family they have largely extended their activities programme and equipment, recently employing a new activity coordinator for nine hours per week. One of the qualified nurses also provides five hours activity support each week to residents although this has reduced since the appointment of the activities coordinator. The activities coordinator and senior Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 14 staff have very recently attended training relating to activities for people living with dementia and the activity coordinator undertakes an assessment of preferences and social care needs with each person soon after admission. Care files sampled contained a life map and had a social care plan in place identifying the persons likes and preferences. Records of activities were recorded for each person, however many of these referred only to visits from relatives. There were occasional group and individual activities such as bingo or sitting with a resident in their room and singing along to their gospel music with them. There was also evidence of people going out for lunch, attending the on-site hairdresser and participating in the pat-a-dog scheme. These actions are noted positively as improvements from the last inspection and are expected to continue to expand particularly as the manager advised there are plans to increase the activity coordinators hours.Visitors spoken with at the time of the site visit clearly felt welcome at Seven Arches and some people said they come every day. Residents spoken with also felt that their visitors were welcomed. One survey said of Seven Arches it treats residents as individuals. There was better evidence at this inspection of people being given the opportunity to exercise choice including through the care plans, for example indicating that people would make their own choice of what to wear each day. Staff spoken with said they were aware that they do advocate choices for some residents who are unable to express these, for example food and stated that they base this on the information provided by the persons relatives or by judging their response is to the meal. Residents were heard to be offered choices. Another staff member confirmed that residents are offered a choice of tea, coffee and cold drinks and asked why would they not be, as not everybody likes tea. The manager advised of plans to introduce photographs of food to help people make choices more easily. Peoples differences were respected such as relating to cultural and religious dietary needs and supporting visits from a priest where requested. A four weekly menu was operating that offered a choice of main meals. A few residents ate in the dining room, some ate in their bed/room and many residents ate in the lounge. It was not possible at this site visit to ascertain if this was always through active choice and the manager is recommended to review whether some residents might benefit from a change of scenery if they ate in the dining room. The record of food served to residents was improved from the last inspection. It indicates the three main meals that people eat each day. The manager was recommended to include other snacks and drinks provided to residents, particularly supper, to demonstrate that residents do not fast from tea-time at approximately 5pm to breakfast at approximately 8am, some fifteen hours. Surveys from residents showed that people generally liked the meals at Seven Arches. Residents spoken with where satisfied with the meals and one person said the meals are not so bad at all. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 can be expect to be listened to and to be safeguarded by staff knowledge and competence. EVIDENCE: Of the seven surveys received from residents/relatives all but one person said there is someone they could speak to informally if they were not happy and five of seven said they knew how to make a formal complaint. The service user guide made reference to the complaints procedure and gave the registered providers contact details but gave people little information on how to make a complaint and what to expect when they did. The complaints procedure was displayed in the main entrance hall next to the visitors signing in book. It had been updated to reflect the change to the Commissions title and should also include information that people may take their complaints to their funding authority. A laminated copy of the complaints procedure was seen to be available in all resident bedrooms viewed. Relatives spoken with confirmed that they would feel able to raise any issues or concerns they had and feel that they would be listened to. The manager stated that three complaints had been made to the home since the last inspection. Records showed these related to a residents clothes being Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 16 on the floor of their wardrobe and an apology was issued. The others were from a resident that the transport booked for a hospital appointment had been late and that a delivery person to the home drove too fast. The Commission received a complaint that a member of staff was not fit to undertake their duties at Seven Arches and this was passed to the registered provider. This complaint was not recorded as it should have been in the homes records. The Commission are aware that it had been investigated by the registered provider and the manager who found no evidence to support it. The manager stated that there had been no safeguarding incidents or referrals since the last inspection. The whistleblowing procedure for staff had been updated since the last inspection as noted in the AQAA and was clear and easy to understand. This should include information on the support available to the whistleblower. The managers AQAA identifies that their policy and procedure for safeguarding adults and prevention of abuse had also been updated as recommended at the last inspection. However this was not available to demonstrate that the manager has clear and up-to-date strategies in place that link effectively with other agencies to safeguard vulnerable people. The manager was also again recommended to request a copy of the current safeguarding protocols and procedures from the local authority so that they have up-to-date information on required good practice. The manager advised that all staff had attended in-house training on safeguarding and that additionally a number of staff had attended recent training from an outside trainer. This was confirmed on the staff training records viewed. Staff spoken with confirmed that they had received training on safeguarding vulnerable people and were aware of appropriate reporting procedures. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Seven Arches provides its residents with a safe, comfortable and pleasant environment that meets their needs. EVIDENCE: Seven Arches provides residents with a large ground floor communal lounge and a separate dining room as well an additional lounge/visitors room. Areas of the home viewed, both communal and residents bedrooms, were clean and there were no odours noted. Many bedrooms presented as personalised and residents spoken with confirmed that they were happy with their own rooms and found them appropriate to their needs. The manager stated that all resident bedrooms now have profiling (adjustable) beds to better support the needs and safety of residents and staff. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 18 The minutes of the recent residents and relatives meeting advise that the entire nursing home has been redecorated and recarpetted and there are new light fittings in the communal areas. This was observed at the time of the site to visit and clearly improved the environment for the people living there. A rolling programme was advised as in operation to maintain the upkeep of the nursing home and evidence of this years programme was available. Seven Arches also has accessible and well maintained gardens. One survey commented that there were a limited number of seats there. The minutes of the recent resident/relatives meeting and the managers AQAA advise that all new garden furniture has very recently been provided. The health and safety concerns identified during the last inspection had been addressed and the front door and laundry doors were closed. Where oxygen was used this was clearly identified on the door and a policy and procedure for safe management was in place. However, the manager was advised to follow the recommendation of the last inspection report and ensure that risk assessments were readily available and that it was included in the fire risk assessment and fire plan. All surveys received confirmed that the home is always fresh and clean and this was observed at the time of the site visit. Comments from surveys included very clean or keep the rooms very nice. As part of quality assurance, audits of the premises are undertaken monthly, recorded and passed to the relevant maintenance person for action. Residents bedrooms also displayed a weekly room cleaning schedule. The laundry and kitchen were noted to be clean and tidy. The laundry has been upgraded with new equipment since the last inspection. In their AQAA, the manager told us that they had installed air fresheners and antibacterial hand wash systems around the home to minimise the spread of infection, as well is in the kitchen to minimise cross infection, and these were seen to be in place. The provider and manager have clearly made many improvements to the premises since the last inspection to benefit the people living there. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the 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 can expect to be cared for by adequate numbers of competent and safely recruited staff. EVIDENCE: There were twenty nine residents living and Seven Arches at the time of this inspection. The manager advised that the current staffing ratio was one qualified staff and five carers and that this was adequate to meet the needs of the current resident group. Each staff is allocated a group of up to six residents to support each shift and staff work together where a resident requires the support of two staff. Staff spoken with and information received from surveys indicated that there are enough staff to meet the needs of the people using the service. Resident surveys and residents spoken with also indicate that staff are generally available when needed, confirming that staff respond promptly to the call bells. The manager advised there are twenty-eight care staff currently, both full and part time, sixteen of whom have completed training to NVQ2 and three who have completed NVQ3. Additionally the manager stated that two staff are currently working towards NVQ2 and one person working towards NVQ3, with Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 20 five further staff recently enrolled to undertake NVQ2. This indicates that the home have met the national minimum standard of 50 of care staff in achieving at least NVQ level 2 and demonstrates a positive approach to training and development by both the provider and the staff. Files were reviewed for two staff recently recruited to assess if appropriate references and checks had been undertaken to ensure that prospective staff are suitable people to care for the residents at Seven Arches. Both contained evidence of required information, checks and identity to evidence robust recruitment procedures. Initial records of induction were available for both staff along with evidence of ongoing induction training to Skills for Care standards. Records for a longer serving member of staff demonstrated that they had completed induction to Skills for Care standards. The manager agreed that it would be more appropriate for them, rather than an administrator to sign the certificate of completion of the induction to confirm the persons competence. Current certificates were seen for two of the qualified staff enabling them to train other staff on moving and handling. The managers policy is for all staff to attend moving and handling training annually including a practical equipment and risk assessment session. Copies were available of each staff members training profile. Those sampled confirmed the managers information of training since the last inspection relating to fire awareness, safeguarding, moving and handling, dementia activities assessment and in-house training sessions relating to infection-control. Some staff are also recorded as attending training on medication, first aid and nutrition and well-being. Staff spoken with and information from staff surveys confirmed that they are provided with appropriate induction, training and information on service users that is relevant to their role and helps them to understand and meet the individuals needs. One person said Seven Arches make sure that staff are updated with all the important things that has something to do with the service user and ensures safety of both the staff and client and another person said there is a good, caring environment… most of the staff appear happy working at Seven Arches and we have got good working relationships. Minutes of staff meetings were available and these demonstrated that appropriate information and topics are discussed with the staff team. Residents and relatives spoke positively about the staff with comments such as staff are friendly, always welcoming and good relationships with staff. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a safe, well-managed home that is run in their best interests. EVIDENCE: The manager is a registered nurse who has also achieved NVQ 4 Registered Managers Award and has some 20 years experience managing care homes for the elderly. They were able to evidence recent training in infection control, health and safety, dementia awareness, fire and Deprivation of Liberty Safeguards, ensuring they keep their practice up to date. The manager is now working in partnership with Essex County Council arranging training for staff. Residents, visitors and staff spoken with said the manager was approachable. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 22 In discussion, the manager confirmed that they could have completed the AQAA more effectively rather than adding or changing a very limited number of sentences from the AQAA of the previous year and now realise its importance. It is noted positively that many of the requirements and issues highlighted in the last report have been addressed and this is reflected in the homes new quality rating. There has been a recent meeting for residents and residents. The home is currently collating surveys from residents and relatives. This means that residents and their families have the opportunity to be open about their views of the home and help shape and influence future changes and developments. The findings of surveys of completed to date, including staff and professionals who visit the home, were available and displayed in the foyer. A Quality Assurance report will be ready by the end of the year to demonstrate the actions taken and planned in response to the information received in the surveys. Reports were available that demonstrate that the owners representative visits monthly as required to ensure that the home is operating properly. The manager confirmed that no money is looked after for residents. Relatives are routinely invoiced for charges such as hairdressing and chiropody. Accidents records were appropriately recorded although disappointingly there was no evidence of audits to note any potential trends. Comments on other records reviewed are noted throughout this report and include noted improvements in relation to care management documentation. Aspects of health and safety management were reviewed. A random selection of service and maintenance records were sampled and assessed to be in good order. Records were available to demonstrate that fire drills are undertaken. Records to demonstrate that the fire fighting equipment, emergency lighting and fire alarms are checked to ensure they are in good working order were available but not always regularly completed and this needs to be monitored. No health and safety concerns were noted during the inspection. The manager was again unable to demonstrate that current environmental and safe working practice risks assessments were in place and this is an area for development. Risk assessments and datasheets were available relating to hazardous products. Current safety inspection certificates were available for the gas, portable appliances, electrical fixed wiring, lift, hoist, call bell system, emergency lighting and the fire alarm. Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 23 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 3 3 3 X 3 n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X n/a X 3 2 Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 24 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 OP8 Good Practice Recommendations Risk assessments should be completed prior to and on admission to ensure the safety and well being of residents at all times. To safeguard residents the managers/organisations’ procedure on management of abuse should be available in the home and provide links to the current local safeguarding protocols and procedures. The manager should obtain a copy of these and keep them in an accessible place. To safeguard the health and welfare of people at Seven Arches current environmental, individual and safe working practice risks assessments should be in place, including in relation to the use and storage of oxygen. 2. OP18 3. OP38 Seven Arches DS0000015560.V376679.R01.S.doc Version 5.2 Page 25 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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