Inspection on 23/06/05 for Agincourt

This inspection was carried out on 23rd June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Agincourt 05/08/09

Agincourt 27/08/08

Agincourt 16/08/07

Agincourt 14/02/07

Agincourt 17/07/06

Agincourt 03/01/06

Agincourt 10/03/05

Agincourt 05/08/04

Agincourt 18/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Agincourt 116 Dorchester Road Weymouth Dorset DT4 7LG Lead Inspector Pat Downes Unannounced 23 June 2005 10:00 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 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 D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Agincourt Address 116 Dorchester Road, Weymouth, Dorset, DT4 7LG Telephone number Fax number Email 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 CRH 31 Category(ies) of OP - 5 registration, with number DE(E) - 26 of places MD(E) - 26 Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Only room 7 to be used as a double. Date of last inspection 10 March 2005 Brief Description of the Service: Agincourt care home is registered to provide residential care for a maximum of 31 people; 26 service users over the age of sixty five with a Mental Disorder or dementia and five service users falling within the category of old age, not falling within any other category. The home is established in a large regencystyle 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 15 years. Mrs R Camp became the registered manager in April 2003 and is responsible for the day-today running of the establishment with the assistance of a Deputy Manager. Two years ago the home began to specialise 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. The intention is to develop this more specialist service in the years ahead. Service users accommodation is available on the ground and first floor of the home. There are two communal lounges; one on each floor and a separate dining room on the ground floor. 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. There is a large car park at the front of the house. The garden is well used by the current service users in the warmer weather. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place without prior notice during the morning and afternoon of 23rd June 2005. The home manager Ros Camp was on duty throughout the visit, the purpose of which was to spend time talking with residents and visitors, review the progress made in meeting requirements from the previous inspection, and to take a general look at the day-to-day running of the home. The home was accommodating 31 residents, 26 of whom had mental health needs associated with dementia; during the visit, around 15 residents and 4 visitors were spoken with, as well as all staff who were on duty during the day. Time was also spent examining records and discussing these with the manager; a tour of the premises, including the garden, was also made. What the service does well: Residents, their relatives and friends feel that the home meets their needs very well: “X is safe and well looked after here and staff know her very well. She doesn’t like change and staff do their best to keep everything steady for her.”; “I visit every day and can say that they look after my wife beautifully and the staff are very kind to both of us.”, “It is very good here, the staff are lovely, couldn’t be better.” The home offers a specialist service to older people who have dementia; the manager and staff have a good understanding of this specialist area and works in partnership with other professionals and services to ensure that needs are met. Health care professionals confirmed that the home properly identifies the health needs of residents and makes sure these are met appropriately; “Staff are knowledgeable about each resident and make sure that they identify and promptly report any changes in health; I can be certain that the staff will correctly follow any care instructions that I leave.” (District Nurse) The manager and staff treat residents with respect and actively promote their dignity; the staff also take a lot of care to understand how having dementia effects each individual resident, including any specific behaviour that may arise. Staff feel that they have good access to training and support which helps them to respond to the needs of residents more effectively. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed as no new residents had been admitted to the home since December 2004. EVIDENCE: Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 9 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 standard(s) 8 & 10 The home ensures that health care needs are met by seeking appropriate professional assessment, documenting identified needs into care plans and risk assessments, and by ensuring that health care services are readily available to residents. Staff had comprehensive information to assist them in meeting resident’s needs consistently, although it is important to ensure that the knowledge held by staff about service user’s behavioural and communication needs is fully documented. The majority of residents who live at Agincourt have dementia which affects their ability to comment on the quality of care they receive at the home; however, observation of the interactions between staff and residents and the views of visitors confirmed that staff were very respectful of privacy and take care to ensure that dignity was promoted. EVIDENCE: A random sample of 5 personal health care records for residents were looked at; each provided full and detailed information about the person’s health care needs, supported by professional assessments and advice from GP’s and community nursing staff. There was evidence that residents were registered Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 10 with health care services, and records demonstrated that routine and ‘as needed’ appointments were taking place. During the inspection the views of a visiting community nurse were sought; the nurse confirmed that health care needs were being properly identified and referred, and that staff at the home were clearly following any treatment instructions where it was appropriate for them to carry these out. The manager and staff demonstrated a high degree of sensitivity to the privacy and dignity of service users, and practice seen during the visit indicated that privacy and dignity were being respected. Staff were seen to take extreme care to protect the dignity of service users who were being helped to move using hoists and other equipment. Visitors stated that staff made sure that they and their relatives had time and space during visits, and also confirmed that personal mail is handed to the resident. One visitor commented that they would like to spend time with their spouse in the privacy of their room, the manager immediately agreed to make arrangements for this. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 11 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 standard(s) 12 & 14 The home seeks to ensure that each resident’s lifestyle preferences are known and documented, so that staff have good information when supporting residents in their daily lives. Leisure and social needs are met by providing a programme of activities and opportunities, which broadly meet with each person’s expectations. Residents are supported and encouraged to make choices in their daily lives and are not prevented from determining their own lifestyles, within the limits of their health and mental capacity. EVIDENCE: A documented preferred daily routine and choice of interests and activities was in place for each resident, and staff spoken with were well aware of the detail in these. A random sample of daily care records showed that the identified preferences were being offered, and also confirmed that contact with relatives, friends and the local community was being actively promoted. The home provides a programme of activities, which include organised exercise, a range of games designed to promote mental stimulation, aromatherapy and various musical entertainments. Some staff have undertaken specialist training in the provision of appropriate activities for older people and an additional member of staff works between 3-5 pm each day with Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 12 responsibility for organising activities. Staff are positively encouraged to spend time talking and interacting with residents, and this was evident during the inspection. The degree of dementia suffered by residents of Agincourt potentially limits the opportunities they have for making choices and maintaining control over their daily lives and affairs; the manager and staff were clearly aware of this potential, and the assessments and plans of care seen during the inspection included action to promote and maintain choice and self-determination for each person. During the visit, the manager discussed whether family members have the right to make decisions on behalf of their relatives; she was advised that this was only the case where the relative(s) had been officially appointed in this capacity by their relative or the Court of Protection. A requirement for all bedrooms to be fitted with appropriate locks had not been met; this was discussed at some length and the manager advised that she would be introducing a programme of replacing locks as rooms became vacant. It was acknowledged that some service users would not be able to manage a key and as a result, may not be able to get into their room without assistance; this demonstrates the need for individualised risk assessments to be used for each person. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 13 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 standard(s) The manager and staff actively encourage comment and take action to address any matters raised; clear information on how to raise concerns is provided to residents and their representatives. This ensures that both parties feel confident that their concerns will be listened and responded to. Procedures for responding to suspicions of abuse are in place and written in line with Department of Health guidance; these have been made known to all staff through training and supervision, thereby ensuring that any allegations of abuse are responded to and investigated appropriately. A detailed and robust programme of staff training contributes to the protection of residents from abuse. EVIDENCE: The written policy and procedures for the protection of vulnerable adults (POVA) were examined and found to need very minor adjustment, which was completed during the inspection. In the last 12 months, there has been one adult protection investigation at the home, into concerns reported by the manager; recommendations made as result of the investigation had been implemented without delay. There was evidence that all staff had been provided with a personal copy of the home’s POVA procedures and the Dorset multi-agency guidelines ‘No Secrets’ during their induction and worked through a training programme developed by Action on Elder Abuse, which the manager and one of the senior staff are accredited trainers for. Refresher training is provided for all staff through formal supervision. All staff spoken with demonstrated a high degree of awareness about abuse and were clear on what action they would take to report suspicions and concerns. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 14 Most residents rely on their relatives and friends to raise concerns on their behalf; visitors spoken with during the visit said that, whilst they had not cause to complain, they found the manager and staff were keen to hear their views and made themselves available. The manager is to implement a system for recording complaints, which complies with recent amendments to the Data Protection Act. No formal complaints had been recorded, but their was evidence in the daily records of residents of minor concerns – such as lost property or a meal not meeting with expectations, being recorded and dealt with. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 15 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 standard(s) 19,22,24, 25 & 26 one requirement from the previous inspection was not met, the requirement has been adjusted and repeated Overall, Agincourt provides a safe and well-maintained environment and offers comfort for residents in both their private rooms and communal areas. A small number of matters need attention to ensure the ongoing safety and well-being of residents . Requirements relating to the provision of specialist equipment had been met, with the exception of one in respect of the ramp at the front of the home. Well organised cleaning, maintenance and decoration schedules ensure that the home remains hygienic and attractive for residents. EVIDENCE: Agincourt is an attractive home throughout and residents have been helped to personalise their bedrooms to a high degree. New chairs for the ground floor were due for delivery the day after the inspection, and were on order for the 1st floor. Five requirements in respect of the physical environment at Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 16 Agincourt were made as a result of the last inspection and all had been addressed, with work either in progress or completed. The manager was asked to confirm to CSCI in writing when completion of the required works has been achieved. One matter remains outstanding, which concerns the recommendation contained in an assessment of the property by an occupational therapist for the angle of the access ramp to the front door to be adjusted. The registered provider states that such adjustment is not possible, due to the conditions of the original planning permission for the home; a further requirement is made in this report for the provider to consult with the local Planning Department on this matter and provide written evidence on the outcome to CSCI. A small number of requirements are made in this report, which the manager indicated would be dealt with without delay. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 & 30 The numbers of staff on duty for each shift and their respective skills and roles is appropriate to the level of need of residents in the home, ensuring that individual and collective needs can be met appropriately at all times. The procedures used by the home to recruit staff provide adequate protection for service users. EVIDENCE: The staff rota provides for 6 care staff to be on duty between 8:00 am and 8:pm, which includes 2 senior staff supervising care on each floor. An additional member of staff is on duty each day between 3 & 7 pm. With responsibility for activities until 5:00 and then additional support until 7:00 pm. Night staff comprises 3 awake care staff and a senior member of staff on call. Discussion with staff confirmed that these staffing levels were almost always maintained; the manager advised that the home was running 60 hours per week short of care staff hours, due to vacancies, but that these hours were being covered by the existing staff team. In addition to care staff, there are 2 cleaners, a kitchen assistant and cook on duty each day and a maintenance person during weekdays. Records of staff recruited since the last inspection were examined; these demonstrated that proper procedures for ensuring that staff were fit to work with vulnerable adults were in place; one member of staff had been recruited through an overseas recruitment agency and whilst two references had been obtained for the person, neither was from their most recent employer; the Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 18 manager agreed to address this with the agency. The home has a robust and effective induction programme and staff do not commence shifts until they have satisfactorily completed this and worked a number of ‘shadow’ shifts alongside experienced staff. The home has an organised programme of staff training, which includes statutory health and safety subjects, together with specialist areas relating to the needs of the resident group. A total of 10 staff hold NVQ awards at levels 2 & 3, with further staff working towards awards. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 There are well organised procedures and practices in place in the home to ensure that the health and safety of residents and staff is promoted and protected. EVIDENCE: All records of safety checks, servicing and maintenance of equipment were examined and found to be up to date. All staff had undertaken fire safety training at the required intervals, and fire drills had included various scenarios and use of night-time drills. Staff had undertaken appropriate health and safety training and the manual handling procedures seen in use during the visit demonstrated that this training had been effective. Inspection of the premises demonstrated that routine maintenance and refurbishment work was being implemented. A free-standing electric heater was in use in one resident’s bedroom, the manager agreed to undertake a risk assessment and implement any necessary precautions without delay. Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 x COMPLAINTS AND PROTECTION 2 2 x x x 2 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 21 no Are there any outstanding requirements from the last inspection? 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 8 Regulation 13(1)(b) Timescale for action Where risk assessment is used in 31/08/05 respect of health needs, the manager must ensure that specialist advice is sought and included – for example, dietary and nutritional needs. A risk assessment relating to 31/08/05 the safe use of the free-standing heater must be undertaken and any action implemented without delay The commode in room 27 and 31/09/05 the seat of the Oxford Mermaid bath hoist must be replaced. The registered provider must 31/09/05 consult with the local Planning Department regarding allteration of the ramp to the front door, as recommended by an occupational therapy assessment of the home, and provide written evidence to CSCI of this consulation and the outcome.13(4)(c) Requirement 2. 22 13(4)(c) 3. 4. 24 22 13(4)(c) 13(4)(c) Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 8 Good Practice Recommendations Care plans could include more specific information about behavioural and communication needs, to ensure that such information is available to all staff and not lost when staff members leave the team. The manager should review risk assessments for residents where freedom of choice and/or liberty is potentially restricted – such as controlling medication, having a key to a bedroom door, to ensure that the assessments include the views of all people who have an interest in the resident’s care and clearly demonstrate the reasoning behind decisions made on behalf of residents. The introduction of suitable locks for bedroom doors as rooms become vacant should be implemented Systems for quality assurance which are based on seeking the views of residents and/or their supporters should be introduced without delay. The manager should also consider introducing a method of checking equipment in service user’s rooms and communal areas of the home, to ensure that matters needing attention are identified at an early stage. 2. 12(2&3) 3. 4. 4(a) 33 Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Agincourt D55 S26757 Agincourt V220790 230605 Stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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