Care Home: The Arches Residential Care Home

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What the care home does well People who live in the home benefit from the pleasant and homely environment where visitors are always welcome. Staff are caring and committed and there is a strong management team. People who live in the home are protected through safe systems of medication storage and administration in compliance with recognised guidelines. The routines of daily living and activities, is enhanced by the work undertaken by the activities co-ordinator. Choice and opportunity to have involvement with decision-making processes is offered in a way that residents can comprehend. Food is offered and prepared in a way, which takes account of the nutritional needs of older people with dementia. Good recruitment procedures and effective supervision of staff are in place to protect residents from harm. What has improved since the last inspection? Since the last inspection the homes manager has been registered with the commission. A system is now in place to review care plans and risk assessments and update them to give clear and current guidance to staff on how to meet the needs of individuals. People living in the home are benefiting from the significant investment in time and resources to the training of staff. Through the commitment and dedication of the management and staff teams we are of the opinion that the service continues to improve the quality outcomes for people living in the home. What the care home could do better: Medication records should record the actions taken in the event of a refusal to take prescribed medication for the wellbeing of individuals. Waste material awaiting collection should be kept in secure containers in the interests of hygiene and public health. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Arches Residential Care Home Mounts Road Greenhithe Kent DA9 9ND     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Stibbons     Date: 3 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Arches Residential Care Home Mounts Road Greenhithe Kent DA9 9ND 01322370163 01322381642 archescarehome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Arches Care Home Ltd care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Additional conditions: 21 0 The maximum number of service users to be accommodated is 21. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Arches is registered to accommodate 21 older persons who have been diagnosed with dementia. There is a large lounge/dining room on the first floor and smaller lounge diner on the lower ground floor, the home also benefits from a large conservatory with extensive views over the valley. There is a small garden to the rear. The home is on 3 floors; there is a 5-person lift to all floors. The owner employs a manager who leads a team of carers including 2 carers who work at night on waking duty, together with one carer sleeping in. A cook, an activities coordinator and a cleaner are also employed. Care Homes for Older People Page 4 of 27 Brief description of the care home The home is situated in a quiet residential area of Greenhithe with local shops and post office close by. Bluewater shopping complex is approximately 2 miles away. The Manager stated that currently fees range from 410 to 430 pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on the 4th July 2007. This unannounced inspection was conducted over a period of 4 hours from 12:00 until 16:00 hours. The home returned a completed AQAA (Annual Quality Assurance Assessment) when we requested it and it included excellent evidence to support compliance with the required standards. The registered provider was present during the inspection as the registered manager was off sick. Discussions were held with the provider, senior carer, 4 members of staff and 2 service users. Care Homes for Older People Page 6 of 27 A variety of documents and records were examined that included care plans, risk assessments, recruitment and training records, staffing rosters, medication records and health and safety records. Observations were made of interactions between management, staff and service users. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have sufficient information on which to make an informed decision as to whether the home can meet their needs. A trial period and full assessment of needs is conducted before a permanent placement and written contract of terms and conditions is offered to prospective residents. Evidence: We wanted to look at the information provided to people prior to moving into the home to see whether it was sufficient enough on which to make an informed decision. The home provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service and is supported by a service users guide. The documents are also explained to individuals, so they fully understand the information. Care Homes for Older People Page 11 of 27 Evidence: The AQAA states that it is the homes intention to create a website for information about the home. The pre-admission assessments of one recently admitted service user were examined and these demonstrated that significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. The AQAA states that a 4 week trial period is offered to ensure the placement is suitable. Intermediate care is not offered by the service. All residents receive a contract to which they have agreed and it gives clear information about fees and extra charges which are reviewed and kept up to date. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have an individual plan of care that sets out how their health, personal and social care needs will be fully met. People living in the home are protected by the homes policies and procedures for dealing with medication. People living in the home are treated with respect and their right to privacy is upheld. Evidence: We wanted to look at whether peoples health care needs were being met and whether the care was being provided in a manner acceptable to the individual. We looked at 3 care plans and these indicated that personal support is responsive to the varied and individual needs and preferences. Particular attention was paid to the care plan of a service user who had been admitted within the last 3 months. Personal preferences were clearly documented that included, Care Homes for Older People Page 13 of 27 Evidence: how they wished to be addressed, choice of carer gender for personal care, choosing own clothes, sleeping routines, food likes and dislikes and guidelines for staff in promoting independence with dignity and respect. Risk assessments are included in care plans that cover mobility, mental capacity assessment, malnutrition screening and medical information. Charts and records were viewed that monitored medication administered, weight, eating and drinking, elimination and other health care appointments with the optician, dentist and chiropodist. There is evidence of the care plan and risk assessments having been recently reviewed to ensure that the requirements of service users is current. The health care needs of service users unable to leave the home are managed by visits from local health care services. Service users have the aids and equipment they need and these are well maintained to support them and staff in daily living. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. The home respects and understands the rights of service users in the area of health care and medication. They work with individuals regarding any refusal to take medication, it is recommended however that staff record the actions taken following the refusal of medication. We observed the interaction between staff and service users and there was mutual respect with staff members responding in a manner and at a pace appropriate for the service user. We observed that service users were appropriately dressed, clean, relaxed and generally appeared cheerful. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have the opportunity to participate in a range of activities that meet their social, spiritual and recreational interests and needs. People living in the home enjoy a healthy and varied diet that is of their choosing. Evidence: We wanted to know whether the lifestyle experienced by people living in the home provided variety and stimulation as wanted by the individual. The home employs an activities coordinator who with input from service users, relatives, staff and a dementia consultant, has developed individual life biographies that enables the promotion of activities of interest in a person centred manner. The service actively encourages and provides imaginative and varied opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. Examples were seen of arts and crafts made by people living in the home and the Care Homes for Older People Page 15 of 27 Evidence: continuation of hobbies such as reading, painting and spectator sports are encouraged. There is sufficient communal space within the home for quiet relaxation away from television and radio should that be the persons choice. The AQAA states that special events such as birthdays, anniversaries and religious festivals are celebrated. There are some opportunities for trips out into the community and relatives are involved and encouraged to facilitate outside activities. Visitors are made welcome at any reasonable time and encouraged to maintain contact with their relative. The AQAA states that a church service is held monthly in the home and a Catholic priest attends 3 monthly to provide spiritual support. The home employs a qualified cook who is knowledgeable about the specialist nutritional needs of the elderly and specifically those suffering from dementia. Menus viewed indicated a wholesome and balanced diet and the provider states that the cook consults with service users daily about their choice of meals. Two service users spoken with confirmed the food at the home was to their liking. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home, or their representative, can be confident that their views will be listened to, taken seriously and acted upon. People living in the home are protected from abuse. Evidence: We wanted to know whether people living in the home are protected from abuse and that procedures are in place to address any complaints they may have. There is a copy of the complaints procedure displayed in the entrance hall on the notice board. The provider states that a copy is provided to all service users/representatives and explained to them. The provider also states that there has only been 1 verbal complaint raised in the last 12 months but any formal complaint would be acknowledged in writing within 7 days and investigated. The home has a monthly service user meeting which facilitates a forum to raise concerns with help from their individual key worker. The home has good recruitment practices to ensure that only suitable people are employed for the safety of people living in the home. Care Homes for Older People Page 17 of 27 Evidence: Training records viewed indicated that all staff have received training in safeguarding vulnerable adults and discussions with 3 members of staff demonstrated that they had a good understanding of recognising abusive practices and the reporting procedures. The AQAA states that the home has experienced difficulties in accessing advocates for service users but will persevere for the benefit of people without relatives to speak for them. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained environment with ample personal and communal space to meet their needs. People living in the home have the specialist equipment they require to maximise their independence. Evidence: The services mission is to provide a safe and comfortable home for people suffering from dementia. We wanted to see if the home and facilities catered specifically for people with dementia. The AQAA states that the home has been looked at by a dementia consultant and appropriate changes have been made following the advice given. Floors, doors and corridors are colour coded and each bedroom has a picture of the individuals choice and their name on the door. Three bedrooms were viewed and each had items of personal interest on display and the provider states that the decoration is of the individuals or their representatives choice. Care Homes for Older People Page 19 of 27 Evidence: Some of the bedrooms have en-suite facilities and others just a handbasin, there are however sufficient baths, shower room and toilets to meet the needs of people living in the home. There is a variety of equipment to maximise service users independence, for example, ramps, handrails and hoists and the provider confirms that all equipment is regularly serviced and a certificate obtained. For the safety of people living in the home there are security key pads installed on doorsteps, an emergency call system throughout the home and door closures linked to fire alarms. There are regular environment checks that include hot water temperatures, heating and ventilation and radiators are covered to protect people living in the home from harm. The home is well maintained with ample communal space for people to move around in although on the day of this visit the weather was extremely hot and people were inclined to stay put in the lounge. It was noted that staff ensured service users had cold drinks. There is a large conservatory with access to the garden although the conservatory was too hot for comfort due to the hot weather and not being used by service users. It was noted that some bagged waste was not in secure containers outside the building and it is recommended that this be addressed in the interests of hygiene. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are in safe hands at all times supported by a trained staff team who have the knowledge and skills to meet their needs. People living in the home are protected by robust recruitment policies and procedures. Evidence: We wanted to look at whether people living in the home were in safe hands at all times with sufficient knowledge and skills available to meet the specific needs of service users. We looked at the recruitment procedures and practices to ensure only suitable persons were employed for the safety of people living in the home. Three personnel files were examined that confirmed appropriate checks such as Criminal Record and POVA list, references, identity and interviews were carried out. Two Training records were examined that showed new employees had undergone induction that met with Skills for Care standards. Other training undergone included dementia, food hygiene, manual handling, infection control and first aid. The AQAA states that the vast majority of carers have achieved the NVQ level 2 in care Care Homes for Older People Page 21 of 27 Evidence: and this was confirmed by the senior carer. Staff rosters viewed indicated that the registered manager works full time and in addition to carers there is a cook, domestic person, laundry person and a part time activities coordinator. The provider states that they have daily input into the service. Observations of carers during the visit demonstrated an enthusiastic and dedicated care team. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home that is run by a competent manager and the ethos, leadership and management approach of the home. The home is run in the best interests of the residents and their health, safety and welfare is promoted and protected. Evidence: The registration certificate is displayed in the entrance to the home and correctly states the category of people living in the home. The homes manager is registered with the commission and is qualified to NVQ level 4 in management and care. The home manager is supported by the registered provider who has daily input into the running of the home. The registered manager has a clear understanding of the key principles and focus of Care Homes for Older People Page 23 of 27 Evidence: the service, based on organisational values and priorities. They work with the registered provider to continuously improve services. They provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking, with residents shaping service delivery. There is a strong ethos of being open and transparent in all areas of running of the home. The manager leads and supports a strong staff team who have been recruited and trained to a high standard. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The home works to a clear health and safety policy and all staff are fully aware of the policy and are trained to put theory into practice. The registered provider has the skills and ability to deliver good business planning, and effective financial controls, they provide a quality assurance and monitoring process to ensure efficient running of the home, which gives value for money and delivers effective outcomes for the people who use the service. The registered provider is planning to achieve The Investor in People award in the next 12 months. Staff meetings and supervision sessions are regular with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 When a service user refuses medication, as well as recording the refusal it is strongly recommended that the action taken as a result is also recorded. Bagged waste awaiting collection should be kept in secure containers in the interests of hygiene. 2 26 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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