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Inspection on 17/07/06 for Agincourt

Also see our care home review for Agincourt for more information

This inspection was carried out on 17th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager ensures that residents and their representatives receive information about the home and residents are supplied with residency agreements. The manager undertakes a pre-admission assessment for each person and draws up an initial care plan before residents are admitted into the home: aletter confirming that the home can meet the prospective resident`s needs is sent prior to accommodation. Care plans and care related risk-assessments are reviewed each month and in place for each resident. There is a medicines policy and medicines are stored in a lockable cupboard and trolley. The home is comfortably furnished and decorated to a high standard: central heating radiators are attractively protected and ensure that vulnerable residents are safe from accidental harm. It was evident that the manager promotes staff training and the ratio of NVQ level trained staff exceeds the recommendation of 50%.

What has improved since the last inspection?

There were two recommendations set out in the last inspection report and both have been implemented. A programme of fitting approved door locks to bedroom doors has commenced and each time a room becomes vacant a new lock is being fitted. The manager is developing a quality assurance programme. The home`s back garden has been improved the large trees have been replaced by secure fencing and rockery borders have been established. Garden furniture and a pond feature make the garden an attractive places to sit and relax.

What the care home could do better:

The previous inspection report had one requirement, which has yet to be met: the registered persons were asked to consult with the local planning department about the alteration concerning the ramp to the front door. The requirement is therefore repeated in this report. The manager is reorganising residents care records and it is recommended that each relevant information form devised for use with care planning be routinely completed, as noted details of social activities and interests and visitors. Risk assessments would benefit from being more individual as they are inclined to be generic with similar statements made about each resident, eg the use of hot water and the risks vary from person to person and in some cases need more urgent remedial action than others. Residents` personal information must be recorded into their care record and not collectively into the day/night logbook: this practice contravenes the Data Protection Act. During the pharmacist`s first visit three immediate requirements were issued to ensure that residents` medicines are administered safely.Following the midnight inspection a letter of concern with relevant requirements was sent to the registered persons regarding the use of reset locking arrangements fitted on the first floor lounge doors, the reporting of an incident through the `No Secrets` process and the need to ensure that the home is well ventilated and kept at a comfortable temperature throughout the day and night during the heat wave. On 17th July the inspectors could not understand why reset switch locks need to be used on the first floor lounge doors and it appeared that the residents in bedrooms beyond the lounge in rooms 18-27 were essentially locked in that area. This practice is considered to be a form of restraint and it was evident from discussion with staff that this is common practice each night. Staff preparing medicines in advance for other staff to administer is poor practice and puts residents at risk. An immediate requirement was made to cease this practice, to record the known allergies of residents and the administration of residents` medicines accurately. Audit trails and monitoring of medication received into and leaving the home, also need improving. The social care provision in the home should be developed to provide individual stimulation and recreation for residents. The registered persons must ensure that all incidents and accidents are properly recorded and reported to the appropriate authorities: an auditing system concerning the accidents and incidents affecting residents. All untoward occurrences must be reported to the Commission as required by Regulation 37 and referred through the `No Secrets` local procedures as necessary. Staff should be supplied with refresher training regarding the reporting of complaints and concerns raised by relatives or representatives to ensure that the manager is fully informed. While viewing the accommodation it was felt that the home was not well ventilated or being kept cool. Although there are large freestanding fans in use during the day in both lounges: the average temperature measured 27 degrees. Staff said they found the temperature most uncomfortable to work in. It was noted that all residents` bedroom and other fire doors are shut at night the air in the home was stifling. A heat wave plan (information is available o the Department of Health website) must be drawn up with strategies implemented to ensure the home is kept at a comfortably cool temperature. The plan must include details of any special needs for each resident, eg how are the bedrooms with patio doors and no windows kept cool at night. The sluice room on the first floor needs to be thoroughly cleaned and reorganised for health & safety reasons.Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 8The hot water supply to washbasins in the home is not governed and may put vulnerable residents at risk. The staffing arrangements must be reviewed, particularly night staffing given the amended Working Times Regulations 2003: consideration should also be given to provide a dedicated social care organiser and a laundry assistant so that care staff time is completely delegated to residents and any training or supervision that the manager may wish to provide. The home should be able to demonstrate that each member of staff has up to date mandatory training and individual supervision sessions should be recommenced. The manager should be supplied with regular supervision to support and promote her continuing development and commitment to the home.

CARE HOMES FOR OLDER PEOPLE Agincourt 116 Dorchester Road Weymouth Dorset DT4 7LG Lead Inspector Rosie Brown Key Unannounced Inspection 12:00a 17th & 26th July 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agincourt Address 116 Dorchester Road Weymouth Dorset DT4 7LG 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) 01305 777999 01305 777999 Mr Derek Edwin Luckhurst Mrs Meryl Susan Hodder Mrs Roslynn Ann Camp Care Home 31 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (26), Old age, not falling within any other category (5) Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only room 7 to be used as a double. Date of last inspection 3rd January 2006 Brief Description of the Service: Agincourt care home is registered to provide residential care for a maximum of 31 people, this includes 26 service users over the age of sixty five with a Mental Disorder or dementia and five service users in the category of old age and not falling within any other category. The home is established in a large regency-style residence situated off the main road into Weymouth, approximately one mile from the town centre and half a mile from the sea front. It is quite close to a range of amenities such as a post office, shops, pubs and churches. Agincourt has been owned and managed by the current registered providers, Mr Luckhurst and Mrs Hodder, for approximately 16 years. Mrs R Camp became the registered manager in April 2003 and is responsible for the day-today running of the home with the assistance of a deputy manager. The home specialises in the care of elderly people who are mentally frail and the majority of the service users now accommodated experience dementia or a related mental disorder. Service users bedrooms are available on the ground and first floor of the home: many of the ground floor rooms have patio doors providing direct access into the back garden. There are two communal lounges; one on each floor and a separate dining room on the ground floor. Assisted bathrooms are available on the ground and first floors of the home and many rooms have en-suite WC’s. A passenger lift links the ground and first floor. There is level access to all rooms in the home except for two single bedrooms on the first floor, which are accessed by a single step. The back garden has recently been improved; there is an established pond with water feature and rockery borders, lawns and garden furniture and gazebo. It is fenced and secured and is well used by the current service users in the warmer weather. The entrance to the home also looks most welcoming with potted plants and mature shrubs enclosing the private car park that is available for visitors’ use. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Lead inspector, Rosie Brown, pharmacy inspector Christine Main and Regulation Manager Tracey Cockburn undertook this unannounced key inspection. The inspection was brought forward due to concerns raised in June 2006 about residents’ personal care; allegations included unsafe medication practice, shortages in staffing, particularly at night and poor management practice. These concerns are part of a current Adult Protection investigation being undertaken by Weymouth Adult Services (also known as Social Services) using the ‘No Secrets’ process. This key inspection included a two-hour unannounced visit, by Rosie Brown and Tracey Cockburn: this began at midnight and took place on 17th July 2006. Following this visit the inspectors contacted the manager and agreed to complete the inspection on the 26th July commencing at 11:00am. Christine Main reviewed the home’s medication storage and administration arrangements during the afternoon of 14th July and made a follow up visit to provide additional guidance on 21st July. The inspectors assessed 31 of the National Minimum Standards and the requirements and recommendations set out in the report of the previous inspection. The communal areas and a selection of bedrooms were viewed: residents’ care and medication records, staff records and certain policies and procedures were examined. The inspectors used observation skills to assess the interactions between staff and residents, spoke with the manager Ros Camp, staff that were on duty during each visit and three residents. Comment cards supplied by the Commission prior to this inspection were received, this included 16 cards from relatives, 18 ‘have your say’ leaflets completed by relatives for residents and one from a GP practice; the views expressed within them have also been used to inform this inspection report. What the service does well: The manager ensures that residents and their representatives receive information about the home and residents are supplied with residency agreements. The manager undertakes a pre-admission assessment for each person and draws up an initial care plan before residents are admitted into the home: a Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 6 letter confirming that the home can meet the prospective resident’s needs is sent prior to accommodation. Care plans and care related risk-assessments are reviewed each month and in place for each resident. There is a medicines policy and medicines are stored in a lockable cupboard and trolley. The home is comfortably furnished and decorated to a high standard: central heating radiators are attractively protected and ensure that vulnerable residents are safe from accidental harm. It was evident that the manager promotes staff training and the ratio of NVQ level trained staff exceeds the recommendation of 50 . What has improved since the last inspection? What they could do better: The previous inspection report had one requirement, which has yet to be met: the registered persons were asked to consult with the local planning department about the alteration concerning the ramp to the front door. The requirement is therefore repeated in this report. The manager is reorganising residents care records and it is recommended that each relevant information form devised for use with care planning be routinely completed, as noted details of social activities and interests and visitors. Risk assessments would benefit from being more individual as they are inclined to be generic with similar statements made about each resident, eg the use of hot water and the risks vary from person to person and in some cases need more urgent remedial action than others. Residents’ personal information must be recorded into their care record and not collectively into the day/night logbook: this practice contravenes the Data Protection Act. During the pharmacist’s first visit three immediate requirements were issued to ensure that residents’ medicines are administered safely. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 7 Following the midnight inspection a letter of concern with relevant requirements was sent to the registered persons regarding the use of reset locking arrangements fitted on the first floor lounge doors, the reporting of an incident through the ‘No Secrets’ process and the need to ensure that the home is well ventilated and kept at a comfortable temperature throughout the day and night during the heat wave. On 17th July the inspectors could not understand why reset switch locks need to be used on the first floor lounge doors and it appeared that the residents in bedrooms beyond the lounge in rooms 18-27 were essentially locked in that area. This practice is considered to be a form of restraint and it was evident from discussion with staff that this is common practice each night. Staff preparing medicines in advance for other staff to administer is poor practice and puts residents at risk. An immediate requirement was made to cease this practice, to record the known allergies of residents and the administration of residents’ medicines accurately. Audit trails and monitoring of medication received into and leaving the home, also need improving. The social care provision in the home should be developed to provide individual stimulation and recreation for residents. The registered persons must ensure that all incidents and accidents are properly recorded and reported to the appropriate authorities: an auditing system concerning the accidents and incidents affecting residents. All untoward occurrences must be reported to the Commission as required by Regulation 37 and referred through the ‘No Secrets’ local procedures as necessary. Staff should be supplied with refresher training regarding the reporting of complaints and concerns raised by relatives or representatives to ensure that the manager is fully informed. While viewing the accommodation it was felt that the home was not well ventilated or being kept cool. Although there are large freestanding fans in use during the day in both lounges: the average temperature measured 27 degrees. Staff said they found the temperature most uncomfortable to work in. It was noted that all residents’ bedroom and other fire doors are shut at night the air in the home was stifling. A heat wave plan (information is available o the Department of Health website) must be drawn up with strategies implemented to ensure the home is kept at a comfortably cool temperature. The plan must include details of any special needs for each resident, eg how are the bedrooms with patio doors and no windows kept cool at night. The sluice room on the first floor needs to be thoroughly cleaned and reorganised for health & safety reasons. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 8 The hot water supply to washbasins in the home is not governed and may put vulnerable residents at risk. The staffing arrangements must be reviewed, particularly night staffing given the amended Working Times Regulations 2003: consideration should also be given to provide a dedicated social care organiser and a laundry assistant so that care staff time is completely delegated to residents and any training or supervision that the manager may wish to provide. The home should be able to demonstrate that each member of staff has up to date mandatory training and individual supervision sessions should be recommenced. The manager should be supplied with regular supervision to support and promote her continuing development and commitment to the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 9 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 Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 does not apply as the home does not provide intermediate care). Quality in the outcome area is good; this judgement has been made using available evidence including a visit to this service. The manager gains pre-admission assessment information concerning each resident before they are admitted into the home. EVIDENCE: The pre-admission information for two residents was examined: these demonstrated that the manager had completed a pre admission assessment form for each person prior to offering them a place in the home. The information was gathered before admission and included, personal details, personal care needs, mental health needs and Community Psychiatric Nurse’s (CPN) assessment, a mental health diagnosis and a care plan provided by the placing care manager for Adult Services. Other information concerned an Occupational Health assessment to determine if the resident could safety use the stairs. Due to the mental frailty of most prospective residents placements are mainly decided by the professionals or relatives involved. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 11 The assessments were signed by relatives to demonstrate their involvement. A copy of the home’s terms and conditions agreement was not available for one resident and the manager explained that this had yet to be returned by the relative and Adult Services. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. Each resident has a care plan in place to provide staff guidance and meet resident’s identified needs. Care records demonstrated that care professionals are contacted for advice in connection with resident’s health care needs but the home’s systems for handling, administering and recording resident’s medication need improving to safeguard their well being. Comment cards from relatives confirmed that residents are treated with respect and that their privacy is respected. EVIDENCE: The care plans and records for two residents were reviewed: care plans and associated risk-assessments are reviewed each month but did not demonstrate they are updated following a fall or an accident or admission into hospital. Some file sheets were incomplete, for example an activities action plan and a falls risk-assessment: risk-assessments tend to be repetitive and generic and Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 13 need to be more individual. Generally the care plans contained a lot of information and provided a clear picture of each resident’s care needs. It was not clear from the records how the problem of a ‘prolapse’ is being managed for one resident although the manager said that the Community nurse is consulted for guidance. The manager said that she is in the process of improving the content of residents’ care files and showed the inspector a recently improved file. Daily care records are sparse and this is because most information concerning residents’ care appears to be documented into a day/night logbook by staff: information is not being routinely written into care records. For example, accidents are not always documented into the accident book and incidents are not recorded into individual records. The manager said that she has developed an incident record sheet for recording purposes: see standard 18 for information relating to the reporting and recording of incidents. Part of the recent allegation was concerned with shortages of general supplies like wipes, tissues and incontinence products. During both visits there were plentiful supplies of protective aprons and gloves, wipes and incontinence pads. The home has a medicines policy but sometimes staff do not follow procedures in it and there was no evidence of regular “in house” monitoring to check on medication handling, administration and recording. One resident was self-medicating one medicine. There was a risk assessment for some aspects of this but it needed reviewing. Medicines were stored securely but one liquid medicine clearly labelled stored at 2-8°C was not stored in the fridge. This was corrected at the time. Four residents’ medicines were checked with the records. Details of medicine allergies were not on one resident’s MAR chart and incorrect on another. There were no copies of prescriptions available to confirm the medication prescribed for individual residents. Receipt and administration of medicines were recorded on the Medication Administration Record (MAR) charts. Staff had not noticed that the pharmacy had incorrectly printed MAR charts for the period 29th May to 25th June, rather than 26th June to 23rd July so at 3pm on 14th July medicines were signed as given up to 6pm on 16th July. Contrary to good practice guidance from the Royal Pharmaceutical Society and CSCI liquid medicines and tablets were dispensed into open pots with loose Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 14 labels, and signed as given, at least 3 hours in advance of the evening round by a carer who had finished work for the day. This meant that staff administering these medicines could not easily confirm that what they were giving was in accordance with the doctor’s directions on the medicine label. A change to one resident’s medication was not recorded on the MAR chart and staff had not informed the pharmacy when the monthly order was sent. The dose of another medicine was incorrectly recorded and handwritten additions to the MAR chart were not countersigned to show that another member of staff, authorised to give medication, had checked them as correct. There were 10 tablets of one medicine unaccounted for. For two other medicines there was one tablet less than expected from the records. A dose of one medicine signed as given was still in the blister pack. For one medicine with a choice of dose staff had not recorded the dose given each time and there were 6 gaps in the records of administration. There was a discrepancy of about 200ml in the current balance of one medicine, due to incorrect balance transfer in March, which staff had not noticed. Staff did not record the date of opening eye drops so that they could be discarded after the recommended 4 weeks use to prevent infection, or of other new packs of medicines to provide an audit trail. There was no evidence of any self-monitoring in the home to ensure that medicines are given as prescribed and correctly recorded. A senior carer told me that some staff, that give medicines, have done a medication course and others are doing one next week. The equipment used did to check blood sugar levels, did not comply with the medical devices alert issued in 2004 and needs replacing urgently. On July 17th the inspectors noted that medication MAR charts were signed by staff to demonstrate if prescribed creams and lotions were applied. On the 26th July the manager said she will be setting up a separate recording system in residents’ rooms for staff to sign to note when creams etc are applied. A discussion took place concerning the small cupboard where the homes keys are kept including duplicate medication keys. As only a small number of staff are designated and trained to give medicines it is strongly recommended that these spare keys be kept elsewhere or another system established. Comment cards received from relatives generally noted that they were satisfied with the care provided for their relatives. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. Care staff organise group activities for residents in the afternoons and the manager is aware that social care provision and general stimulation should be developed. Relatives comment cards confirmed that the home encourages service users to have regular contact with their relatives and friends. Residents’ ability to exercise choice is generally limited by their mental incapacity. The home supplies residents with good home baked meals and alternatives to the menu are provided. EVIDENCE: The home keeps a visitors book in the hallway of the home and this notes when some visitors call into the home as does a day/night logbook: sometimes this information is transferred into residents care records but this is not always the case; for example one resident’s daily notes did not have an entry since February 2006. The use of a collective book contravenes the Data Protection Act and information concerning each resident must be recorded separately and directly into individual care files. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 16 Comment cards received from relatives confirmed that they always feel welcomed by staff when they call into the home. The home does not employ an activities organiser but the manager explained that staff are providing afternoon activities. The manager supplied a weekly activities programme and activities included; nail care, reminiscence, memory box, floor games, colouring, sing-a-longs, quizzes, board games and visits from ‘Pat a dog’. Inspectors noted that some residents were taken into the garden to sit and relax following lunch. The manager said she is considering the employment of an activities coordinator as a future development for the home and it is recommended that social care provision in the home be developed. Residents should be given regular opportunities for stimulation through recreational and leisure activities, which suit their individual needs: particularly people with dementia and other cognitive impairments. Residents’ mental frailty tends to mean that the majority are not able to make informed choices, therefore relatives and friends are involved and consulted about the daily lives and needs of residents. The inspectors noted that residents’ rooms vary in terms of personalisation but most have personal possessions and photographs and ornaments and in some cases items of furniture (eg a favourite armchair, wheelchair or walking aid) from their former homes: an inventory clothes and other personal items is kept. It was evident while talking with the home’s cook that she is familiar with residents’ likes and dislikes regarding the meals supplied. Residents although not always able to recall what they enjoy, are helped by staff to make their preferences clear. The record of food supplied is kept in the home’s kitchen and showed that a good variety of seasonal foods are supplied. The minority of residents are supplied with special diets, for example, sugar free puddings or pureed food, while other less able residents are fed by staff. One comment card from a relative stated they were concerned about their relative forgetting to eat and the manager said they are aware of this problem. The manager arranges nutritional assessments for anyone where a concern about eating is identified. The manager said that during the hot weather extra drinks have been made available to residents. Care staff that prepare or serve food and work in the kitchen when the cook is off duty have appropriate food hygiene training. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in the outcome area is poor; this judgement has been made using available evidence including a visit to this service. The home has a complaints policy and procedure and information is supplied to residents’ representatives in the home’s statement of purpose. The home has guidance available on the proper response to be made following any suspicion or allegation of abuse to ensure residents are protected from harm. However, one recent allegation from two members of staff about verbal abuse by another staff member has been substantiated by an Adult Protection investigation. While another allegation about other members of staff and poor care practice is being investigated by the local Adult Services under the ‘No Secrets’ process. EVIDENCE: The home has a complaints procedure and policy and a complaints record book is kept. A copy of the information is contained within the home’s statement of purpose /guide and this is supplied to residents and their relatives when they are initially accommodated by the home. Several comment cards noted that they knew how to make a complaint if necessary and two noted that complaints were made to staff: one situation related to missing glasses and false teeth and the other concerned a perceived staff shortage. When the home’s complaints book was examined it was evident that neither complaint had been recorded. The manager should ensure that all staff realise they must bring all complaints and/or grumbles raised to the attention of the manager and in her absence another delegated member of staff. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 18 Two complaints have been logged into the complaints record book since the previous inspection by the manager and both referred to recent adult protection investigations undertaken by the local Adult Services: one complaint that had been raised by staff and concerned with verbal abuse to residents was completely substantiated. The other concerned the inappropriate touching of one resident to another and this is currently being investigated by Adult Services. In June the Commission received an anonymous allegation about the home concerning inadequate night staffing, poor care practices, poor medication practice and poor management practice. The allegations were forwarded to the local Adult Services for investigation: this investigation included the CSCI pharmacy inspector, a key inspection of the home by CSCI, an unannounced investigation by Adult Services and the participation of a representative for the home. The outcome has yet to be determined. When the inspectors were in the home on Monday 17th July the night/day logbook was seen to note an incident between two residents, which left one of them bitten and scratched. The inspectors contacted the manager and asked for this to be referred through the ‘No Secrets’ process for investigation and guidance from Adult Services: one resident has since moved into another home. During the second day of the inspection the day/night logbook was again examined. On this occasion an unexplained injury had resulted in a resident being taken to hospital: the inspectors have asked that this matter also be referred through the ‘No Secrets’ process for investigation by Adult Services. Neither of these two untoward incidents had been reported to the Commission when they occurred as required by Regulation 37. While it is acknowledged that the manager has recently drawn up an incident report sheet for staff use a monthly audit system of all accidents and incidents must be set up and maintained. The manager will then become fully aware of all adverse occurrences and able to determine any patterns, eg time, place and persons involved. The most important issue being to prevent recurrence. The home has policies and procedures related to the protection of vulnerable adults and the identification of abuse: staff training in this subject is provided. There is also a Whistle Blowing procedure for staff protection and a copy of the local ‘No Secrets’ guidance is kept for reference purposes. The home has a policy concerning vulnerable adults and the manager is in the process of updating this to make reference to ‘No Secrets’ and ‘POVA’ guidance. Training records evidenced that staff are supplied with Protection of vulnerable adults training and a module of the NVQ 2 training in care course is concerned with the recognition and prevention of abuse. It is however, required that the manager and deputy attend the Adult Services two-day Adult Protection Awareness training course to ensure they become familiar with local processes. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25 and 26 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The home is generally well maintained and has recently undergone major refurbishment: improvements were made to décor, furnishings and carpeting. Health and safety issues concerning the temperature of the home in the hot weather and lack of ventilation in some bedrooms, the use of locking reset switches fitted to the first floor lounge doors and unprotected radiators may put vulnerable residents at risk. The home was generally clean but one bedroom had an unpleasant odour during the inspection. EVIDENCE: A tour of the home was undertaken on the 17th July at midnight and this revealed concerns about residents care at night. It was a hot summer night and the temperature in the home averaged 27 degrees, particularly on the first Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 20 floor. Additionally residents bedroom doors were closed, although some windows were open there was no through draft created and the home felt uncomfortably hot. The majority of doors throughout the home were shut but staff had a large cooling fan switched on in the ground floor lounge where the temperature measured 24 degrees. Staff explained that bedroom and other doors were closed because they are fire doors and these need to be closed at night. However, if the doors were fitted with automatic closures that stay safely in the open position and were integral to the fire safety system they could be left open. The inspectors noted that the doors to both ends of the first floor lounge were shut and are fitted with reset buttons that need to be pressed to reopen the doors: restricting access by a resident should they wish to sit in the lounge during the night. Also, it appeared that the residents in bedrooms beyond the lounge in rooms 18-27 were effectively locked in that area. The inspectors considered this to be a form of restraint and it was evident from discussion with staff that this is common practice each night. It was noted that the communal bathroom/toilet in the area near to room 18 was locked and staff said that most residents use the commode in their room at night or have incontinence pads but if they wanted to use a toilet this would not be possible: inspectors were informed that residents are checked every two hours throughout the night. This situation puts vulnerable confused residents at risk and is wholly unacceptable. These matters were discussed by telephone call with the manager the following day and a letter of concern was sent requiring that a heat wave plan be drawn up and implemented and for the practice of using the reset buttons on the lounge doors to be ceased. Other matters requiring attention identified during the visit included an exit fire door that did not close properly without being locked and the double-glazing seal to a lounge window was hanging loose and needed repairing. On the second day of the inspection the manager provided a heat wave plan but this is very basic and needs to include more specific information about the home. For example there are a number of ground floor bedrooms with patio doors that allow access to the garden but these rooms do not have windows fitted so at night it is difficult to safely ventilate these rooms. Consultation should take place with a fire safety officer to determine the type of closure that could be fitted to bedroom and other doors so they can be safely left in the open position to ventilate the home in the warmer weather. The temperature of the home should be regularly monitored (daily during a heat wave) to ensure it is comfortable for residents and staff. When freestanding cooling fans are used a health & safety risk-assessment should be drawn up for each resident. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 21 The temperature of various rooms in the home was taken and was as follows: in the first floor lounge it was 28 degrees, in the ground floor lounge it was 27 degrees, in rooms 5, 6, 18 and 23 it was 27 degrees and in the home’s kitchen with a cooling system operating it was 32 degrees. The Department of Health Heat wave Plan was published in May 2006 and exists to identify the risks and inform public and health and social care professionals and encourages them to plan ahead for care and sets our practical action in the event of a heat wave. The information advises care home managers that the air should be kept below 25 degrees. The home has two lounges, one on each floor and both are comfortably furnished and pleasantly decorated. There are assisted bathrooms on each floor of the home but again it was noted that the door to the bathroom near to room 18 was locked and therefore not available for resident’s use on the first floor. The temperature of the hot water supply to washbasins throughout the home have yet to be fitted with fail safe valves to ensure that hot water is supplied at the safe temperature of 43 degrees. Residents’ rooms were comfortably furnished, and the manager said that a programme of fitting approved door locks has been implemented. Central heating radiators throughout the home have now been covered for safety reasons. The Fire Safety Officer visited the home in February 2006 and at that time the fire safety precautions were satisfactory. The home’s laundry is situated on the ground floor; it is equipped with a commercial washing machine, which meets disinfections standards and a commercial tumble dryer. Staff told the inspectors they undertake laundry tasks in addition to their care duties: the home does not employ a laundry assistant. One comment card noted that at times items of clothing go missing and the laundry process is slow. The home appeared to have plenty of bed linen and towels available: one bed did not have a cover on the duvet and staff said that this was because the resident concerned would spend all day in it, if the bed was made. The home was generally clean throughout but one room had an unpleasant odour and the manager said that they are aware of this problem. The home has sluice facilities on both floors but the sluice room on the first floor was poorly organised, needed cleaning and redecorating and posed a risk to health & safety. The home has a very attractive and recently improved back garden, which is well used by residents and staff: the garden has rockery borders and a pond with lawns and garden furniture. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in the outcome area is poor; this judgement has been made using available evidence including a visit to this service. The home employs care and domestic staff but because there is no activities organiser or laundry assistant this means care staff have additional duties: night staffing arrangements need to be reviewed to ensure residents’ are properly supervised and their care needs routinely met. Proper recruitment procedures are not routinely followed when employing new staff so residents’ safety is not promoted. The target of 50 care staff with NVQ level 2 qualifications is exceeded and the home has an induction and staff-training programme so that residents’ needs are met. EVIDENCE: On the 17th July at midnight there were three night staff on duty, this included a senior member of staff who was in charge of the shift, a higher care assistant and a new member of staff. The staff rota demonstrates that there are three staff on duty each night from 8pm –8am but the home does not have a senior member of day employed to work one night each week. The manager explained she has recently upgraded an experienced member of night staff to the position of higher care assistant and this person will cover the senior vacancy until someone has been successfully appointed. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 23 When the inspectors arrived at the home on July 26th the manager explained that she was on duty with six care staff including three senior carers, the cook, a kitchen assistant and two cleaners (one designated to work on each floor). The home also employs a maintenance worker, who is currently shared by another home owned by the providers, a gardener and a recently employed office based personal assistant. As noted earlier in addition to care duties care assistants undertake some domestic duties including laundry tasks, the serving of residents’ meals and the preparation of drinks and snacks. It is a requirement that the registered persons review the homes staffing arrangements and implement improvements particularly at night. A discussion took place concerning the need to reconsider the numbers of staff on duty at night. The residents’ accommodation is arranged over two floors and given the layout of the home, the number of residents (a maximum of 31) cared for and their collective needs: to comply with The Working Time Regulations 1998 (amended in 2003) during a 12hr working shift, staff are entitled a 20 minute break after six hours, this means at that point only two staff are working. The amended Regulations also provide staff with rights for 11 consecutive hours’ rest in any 24-hour period and a limit on the normal workers hours of night workers to an average of 8 hours in any 24-hour period but this can be averaged out over a reference period. The home’s day/night logbook and other care records regularly refer to situations where residents are awake in the night and require staff attention. The recruitment and employment records for six members of staff including one foreign care worker were examined. These demonstrated that application forms had been completed and interviews held with written records kept, two references were requested: one being from the person’s former employer. POVA first checks and CRB disclosures are undertaken. However, there were at least two staff that have commenced working in the home without their CRB/POVA First check undertaken before they commenced employment. A recent Adult protection investigation concerning one former member of staff revealed they had a criminal record and the manager has since referred this person for consideration onto the POVA register. The home must be able to demonstrate that recruitment and employment of staff is robust and protects residents from potential harm. Staff training records evidenced that induction training is provided and this meets Skills for Care specification. Staff files contained copies of employment agreements and one contained an agreement to work a maximum of 51hrs each week as recommended by the Working Time Regulations 1998. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 24 It was evident that the manager promotes staff training and 14 members of staff are trained to NVQ level and two of these have achieved NVQ3 qualifications in care. Training records evidenced that staff are supplied with training in dementia care, POVA, fire safety, managing diabetes, sensory loss, safe handling and understanding incontinence. But records did not demonstrate that all staff have up to date training in health & safety topics. Comment cards noted that staff are usually helpful, caring and polite. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The manager is qualified and experienced in management and residential care. The manager is developing the home’s quality assurance programme. Resident’s financial interests are safeguarded. The home generally follows practices that promote and safeguard the health, safety and welfare of residents and staff but until health & safety issues are resolved in relation to the environment, vulnerable residents may be at risk. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager has recently completed a NVQ level 4 managementtraining course and has started an NVQ in Customer Services. The RI, Mr Luckhurst is in regular contact with the home but has delegated the responsibly for Regulation 26 visits concerning the conduct of the home to the manager of another home which forms part of his business but there was no evidence to support that these visits are taking place. The manager said she is pleased with the appointment of the personal administrator and is also pleased to have appointed a deputy manager. The manager has the use of computer in her office but only has Internet access at her home. A discussion took place concerning the loss of the former deputy manager who has now become the manager of another home and how this has affected the general management of such a large home. It is recommended that the registered manager be provided with supervision to ensure support is routinely provided and personal development is promoted. The manager has introduced a quality assurance system into the home and is currently developing this feature of the home: an annual development plan for the home has been drawn up. The manager is currently reviewing and updating residents’ care plans and records and the home’s policies and procedures with the administrator who works 16hrs each week. The home keeps residents’ allowances in a safe. There is an individual card for each person and when financial transactions take place the record is signed by the responsible member of staff (the manager has limited the number of staff involved). It was noted that a large amount of money was being held for one resident and it is recommended that a smaller amount be kept as ready cash in future. There was evidence to show that staff are supplied with mandatory training in the five health & safety subjects but the records did not clearly demonstrate that this training is up to date for all staff. The manager was providing individual staff supervision sessions until the deputy position became vacant and is aware these sessions have lapsed. Staff must be supplied with supervision at least six times a year with written and agreed records kept. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 27 The maintenance worker keeps a record book, which identifies problems concerning the environment, and these matters are reviewed with the manager each month. The passenger lift and hoisting equipment and facilities are regularly serviced: it was noted that one hoist in the ground floor bathroom is out of order and waiting for repair. The home was awarded a Gold food certificate by the Environmental Health Officer following his last inspection to the home on 8/2/06. The home’s fire records demonstrated that regular in-house tests and checks are being undertaken: a qualified electrician undertakes the annual testing of the fire safety system. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Requirement Timescale for action 30/09/06 2. OP8 3. OP8 3. OP9 Residents’ personal information 15 must be recorded into their care record. The home must be able to demonstrate that all medical 13(4) conditions are appropriately managed: as identified in the main body of the report. The registered persons must ensure that all incidents and accidents are properly recorded 13(4)(c) & and reported to the appropriate 37 authorities: an auditing system concerning the accidents and incidents affecting residents The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) The system for administering medicines must be reviewed 13 (2) so that medicines are administered from the labelled pack they were supplied in. They should not be re-dispensed for another carer to give, as they will not have access to the doctor’s directions on the label. DS0000026757.V307353.R01.S.doc 30/09/06 30/09/06 14/08/06 Agincourt Version 5.2 Page 30 4. OP9 13 (2) 5. OP9 13 (2) 6. OP10 15 b) Recording the administration of medicines, or reason for non-administration accurately on the MAR charts at the time medicines are given. c) Recording medicine allergies accurately the MAR chart. This requirement was issued for immediate action because residents’ health & safety may be at risk. If staff check blood sugar levels equipment used must be replaced urgently to comply with the Medical Devices Alert issued in 2004 to protect staff. This requirement was issued for immediate action because residents’ health & safety may be at risk. The audit trail for medicines must provide robust evidence that medicines are given as prescribed and recorded. Regular management checks to monitor this & any follow up action taken must be recorded including: a) The risk assessment for selfmedication must be reviewed and include an assessment of the safety of storage for other residents. b) There must be a system for checking that information on new MAR charts is up to date and accurate, including the start & finish dates, individual medicines & dose directions. This requirement was issued for immediate action because residents’ health & safety may be at risk. Residents’ personal information must be recorded into their care record and not collectively into the day/night logbook: this practice contravenes the Data Protection Act. DS0000026757.V307353.R01.S.doc 21/07/06 31/08/06 30/09/06 Agincourt Version 5.2 Page 31 7. OP18 8. OP19 9. OP19 10. OP22 11. OP22 The registered persons must ensure that all incidents and accidents are properly recorded and reported to the appropriate authorities: an auditing system concerning the accidents and 13 (4) incidents affecting residents. All untoward occurrences must be reported to the Commission as required by Regulation 37 and referred through the ‘No Secrets’ local procedures as necessary. The seal to the double glazed window in the first floor lounge 23 must be repaired & the fire exit door must be in working order. A heat wave plan (information is available o the Department of Health website) must be drawn up with strategies implemented to ensure the home is kept at a comfortably cool temperature. The plan shown to inspectors on 26th July must be expanded and 13(4)(c) & include details of any special 23(2)(p) needs for each resident, eg how are the bedrooms with patio doors and no windows kept cool at night: should their doors be left open at night? This requirement was issued as a serious concern and dated for attention on 18/07/06. The registered provider must consult with the local Planning Department regarding alteration of the ramp to the front door, as recommended by an 13(4)(c) occupational therapy assessment of the home, and provide written evidence to CSCI of this consultation and the outcome. Previous requirement timescale of 28/2/06 not met The registered persons must 12(1)(a) ensure that the home promotes & 13(7) the safety, health & welfare of DS0000026757.V307353.R01.S.doc 30/09/06 30/09/06 31/08/06 30/09/06 30/09/06 Agincourt Version 5.2 Page 32 12. OP25 13. OP26 14. OP27 15. OP29 16. OP38 residents in a manner that respects their dignity. No resident should be subject to restraint unless there are exceptional circumstances and in such instances a record with factual explanation of why restraint was necessary must be kept for each person concerned. This requirement was issued as a serious concern & dated for attention on 18/07/06. The registered persons must ensure that the hot water supply 13 (4) is governed and supplied close to 43 degrees to prevent scalding. The sluice room on the first floor must be thoroughly cleaned and 13 (4) reorganised for health & safety reasons. The night staffing arrangements for the home must be reviewed 18 (1) to ensure that sufficient staff are on duty to meet the residents collective needs. The registered persons must ensure that recruitment and employment of staff is robust to Amended protect residents’ from potential Regs 18 & harm. All new staff employed at 19 the home must have a CRB/POVA First check before commencing work in the home. The registered individual must ensure that monthly visits to the Amended home are undertaken as per the Reg 26 regulation with a written record kept. 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 33 No. 1. 2. 3. Refer to Standard OP4 OP24 OP7 OP9 Good Practice Recommendations The programme of implementing approved locks for bedroom doors has commenced and should be completed to demonstrate that residents’ privacy is promoted. Information form devised for use with care planning should be routinely completed, and risk assessments should contain more individual detail. Staff should routinely record when prescribed creams or lotions are applied to residents. The home should follow guidance from the Royal Pharmaceutical Society including: a) When medicines are handwritten on the MAR chart a second competent person should check the details are accurate and countersign. b) Recording the date of opening eye drops so that they can be discarded after 4 weeks to prevent infection. There should be a copy of written confirmation of each resident’s medication & of any subsequent changes. The social care provision in the home should be developed to provide individual stimulation and recreation for residents, as planned by the manager. Staff should be supplied with refresher training regarding the reporting of complaints and concerns from relatives or representatives to ensure that the manager is fully informed. Each resident’s bedroom should be well ventilated and kept at a comfortable temperature particularly during hot summer nights. All rooms in the home should be kept odour free. The manager should implement the quality assurance questionnaire, which is based on seeking the views of residents and/or their supporters as planned. The manager should ensure that staff are supplied with regular individual supervision. The home should be able to demonstrate that all staff have up to date training in the five mandatory subjects concerning Health & Safety. The manager should be supplied with regular supervision to support and promote her continuing development and commitment to the home. 4. OP9 3. OP12 4. OP16 5. 6. 7. 8. 9. 10. OP19 OP26 OP33 OP36 OP38 OP38 Agincourt DS0000026757.V307353.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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