Inspection on 27/08/08 for Agincourt

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Agincourt 05/08/09

Agincourt 16/08/07

Agincourt 14/02/07

Agincourt 17/07/06

Agincourt 03/01/06

Agincourt 23/06/05

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 19/03/2009.

CARE HOMES FOR OLDER PEOPLE Agincourt 116 Dorchester Road Weymouth Dorset DT4 7LG Lead Inspector Ms Sue Hale Unannounced Inspection 27th August 2008 09:20a 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.V367665.R02.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.V367665.R02.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 office@agincourt.plus.com 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.V367665.R02.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 18th August 2008 Brief Description of the Service: Agincourt care home is registered to provide residential care for a maximum of 31 people, this includes 26 residents’ over the age of sixty five with a Mental Disorder or dementia and five people in the category of old age and not falling within any other category. The home is situated on one of the main roads into Weymouth, approximately one mile from the town centre and half a mile from the sea front. It is close to a range of amenities including a post office, shops, pubs and churches. A ‘bus stop’ is on the road outside the home, for buses to and from Weymouth. Agincourt has been owned and managed by the current registered providers, Mr Luckhurst and Mrs Hodder, for approximately 16 years. Mrs Ros 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 most of the service users currently accommodated experience dementia or a related mental disorder. Residents’ bedrooms are 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 is a communal lounge on each of the two floors 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 most rooms; some first floor bedrooms are separated from the lift by steps. At the rear of the premises is an attractive garden pond with a water feature and flower borders, lawns and garden furniture and gazebo. The garden is fenced and secured and is used by the current residents’ in the warmer weather. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 5 Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. The weekly fees at the home at the time of inspection range between £481.27 and £550 per week, extra amounts are charged for chiropody services, hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspection was to inspect relevant key standards under the Commission for Social Care Inspections ‘Inspecting for Better Lives 2 framework’. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good, adequate and poor. The judgment descriptor in the seven sections is given in the individual outcome groups. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home, inspection activity, notifications made by the home to the Commission, information gathered from other agencies, the general public and a number of resident and if staff files. The inspection was undertaken by one Inspector and a volunteer ‘expert by experience’ spent part of the day at the home and compiled a report of the findings which has been incorporated into this report. The registered manager, Mrs Ros Camp, supplied us (the Commission for Social Care Inspection) with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgments about the service, and has been included in this report. Surveys were distributed by Mrs Camp to medical/health and social care professionals, relatives of residents and staff. We received four surveys from medical/healthcare professionals, seven from relatives and two from staff. No surveys were completed by residents primarily due to their inability to do so but no effort appeared to have been made to ask relatives or representatives to assist residents with this to try and find out their views of the home. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: People do not move into the home until their needs have been assessed and the home is confident that they can be met. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 7 An improved care planning system that is more detailed and personalised is being introduced. Residents are offered personal care from a member of staff of the same gender whenever possible. One professional said that the care staff knew residents well and could meet their needs. Another commented that most of the staff had ‘a caring and positive attitude’. Several relatives who completed our survey commented on the support they had received from the care of staff team. Staff spoken to on the day the inspection and those who completed surveys were very positive about their work at the home and all enjoyed working at Agincourt. People have good access to local General Practitioners and specialist healthcare when required. An ongoing programme of maintenance is in place and some furniture and carpeting has been replaced since the last inspection. Carpets are regularly cleaned to reduce the risk of unpleasant odours. Visitors are made welcome and people are encouraged to maintain contact with family and friends. Recruitment procedures protect residents from the possible risk of abuse. Staff now complete a five day induction period when they start working at the home. Relevant polices and procedures are in place, including those that make sure residents are kept safe are currently being reviewed and updated. Health and safety is taken seriously to make sure that people who live and work at the home are safe. What has improved since the last inspection? All assessments are being reviewed and updated as the new care plans are being introduced. The home has appointed an activity coordinator. Nutritional screening is now in place for all residents. Some furniture and carpeting has been replaced. One of the bathrooms has been redecorated. Improvements have been made to the kitchen. A recent quality assurance survey has been undertaken and the results will be collated and used to inform the homes practice. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 8 What they could do better: All assessment and care planning records should be dated and signed at the time of completion. Residents as far as practicable, and their relatives and representatives must be consulted and included in care planning and review to make sure their views are sought and taken into account. Residents’ toiletries should be kept in their private rooms and not left in communal toilets and or bathrooms to reduce the risk of cross infection. Good practice advice should be sought on the storage of dental tablets and toiletries in residents’ private rooms due to the needs of people who live at the home. All creams and ointments should have an opening and expiry date clearly written on and existing creams and ointments should be audited to make sure they are still fit to use. Prescribed creams and ointments should not be left in communal bathrooms or toilets to make sure they are not used for people they are not prescribed for. Serious consideration should be given to increasing the hours of the activities organiser and provide a range of stimulating activities suitable for the needs of all people living at the home including those who are less able to join in. A professional surveyed said that they felt the home could improve by continued development of more activities and another commented that the home needed to provide stimulating activities. Significant improvements need to be made to ensure that all areas of the home smell fresh and clean to make sure the home provides a pleasant environment for people who live there. All bins in communal bathrooms, toilets and the sluice should be foot operated to reduce the risk of cross infection. Improvement should be made in infection control practice to reduce the risk of cross infection to residents and staff. Consideration should be given to employing more housekeeping staff to relieve carers of responsibility for laundry tasks to allow them to spend more quality time with residents. A considerable amount of the homes linen including towels, flannels sheets and pillows are worn and need replacing to make sure they are of a reasonable standard. All residents should be offered the range of furniture recommended in the standards or if this is not possible the reason for this recorded on their individual plan. A programme of refurbishment and replacement of the fixtures and fittings should be in place to make sure that the home is a pleasant place to live for residents. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 9 Consideration should be given to the Mental Capacity Act and people’s ability to make decisions when offering placements in shared rooms. Current residents in shared rooms should be given the opportunity to move to a single room when this opportunity becomes available. The registered manager should obtain up-to-date information about good practice in dementia care and particularly in dementia care environments to make sure that the home can meet individuals needs. All complaints should be logged and records kept of the investigation and outcome. The steep gradient of the wheelchair access at the front of the house needs to be reviewed so that the risk of injury to residents and staff using it is reduced. Staff induction should be based on the Skills for Care common induction standards and be covered in the same depth. Staffing levels must be reviewed to make sure that there is enough staff to provide a good standard of care and an appropriately stimulating environment. Serious consideration should be given to employing laundry staff to allow carers to spend more quality time with residents so that tasks are less rushed. All information should be kept in a way that meets the requirements of the Data Protection Act and maintain residents right to information about them being kept confidentially. The fire risk assessment must be updated to reflect current fire regulations. 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. The summary of this inspection report can be made available in other formats on request. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 10 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.V367665.R02.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to this service Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not move into the home until their needs have been assessed and the home confirmed that they can be met. EVIDENCE: Mrs Camp told us that the terms and conditions of residency was currently being updated to make sure it meets the national minimum standards and these would be reissued to all residents once this was completed. The AQAA told us that the home is continuing to try and improve the quality of information available about the home so that prospective residents and their relatives can make an informed decision about residency. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 12 Included in the care plans we looked at were two of residents who had recently moved into the home. A robust pre admission assessment takes place before people move in to make sure that the home are able to meet their needs; they are then informed by letter that they are able to move into the home. Health and social care professionals are also involved in the assessment. All the relatives surveyed said that they had been given information that they needed about the care home. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care planning systems have improved and is now more personalised to residents individual needs. Checks need to be made to ensure that residents are receiving personal care. Personal care appears to be task based not person centred. The principles of respect, dignity and privacy are put into practice. Medication practices are safe and make sure that people have their medication as prescribed. EVIDENCE: We looked at four selected care plans. A new care planning system that is more detailed and personalised is being introduced and is a positive change. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 14 Care plans identified residents’ health, care and social needs and gave clear constructions to staff on how they should be met. They included important information such as people’s life history, who was important to them and their preferences while living in the home such as preferring a carer of the same gender and what time they wanted to go to bed and get up. Risk assessments were in place for moving and handling, pressure sores, nutrition and environmental hazards. There were good records detailing the pressure relief equipment that had been provided. However, on one file a risk had been identified such as an allergy to a particular medication. This had not been followed through on the medication care plan. Not all records in the care files had been dated and signed. Care plans showed evidence of review by staff and they had been changed and updated when individual needs now had changed. However, there was no evidence on the majority of plans that residents or relatives were involved in drawing up or reviewing care plans. The standard review form does not include a space to record if anyone attended the review. Not all residents had a toothbrush or toothpaste available and some toothbrushes were in poor condition and needed to be replaced. The majority of sinks were dry when we arrived at 10am so it was unclear if all residents had been assisted to have a wash. Mrs Camp told us that bowls are used to assist residents to wash. The majority of rooms did not have a clean towel or flannel available through the day. Mrs Camp told us that flannels and towels were removed from residents’ rooms after they had been assisted with personal care and replaced by clean ones Two members of staff who completed our survey said that they were always given enough information about the people they looked after. Four relatives surveyed said that the home always met their relatives’ needs and three said that the home usually did. We observed dental tablets in residents’ private rooms and toiletries including aerosol sprays in residents’ private rooms and communal toilets and bathrooms. There was some evidence of risk assessments in relation to their use and storage to reduce the risk of ingestion but having these freely available in a home providing care for people with dementia is not good practice. The medication policy was written in 2004 and needs to be updated to reflect current regulations and good practice advice. In the room where medication was stored there was hand wash and paper towels available for staff. The refrigerator solely for medication was available. A sample list of signatures was available and photographs of all residents were kept with the medication administration records (MAR). Mrs Camp told us that she is currently auditing Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 15 all the residents’ medication and patient information leaflets will be in place with the MAR sheets for each resident. Medication is administered by Mrs Camp and senior members of staff all of whom have undertaken appropriate training. Controlled drugs register is kept and amounts checked were found to be correct. The drugs trolley was stored securely. A professional commented that they felt that on occasions staff had considered the use of medication as ‘first option rather than looking at management of individual behaviours’. Throughout the home in residents private rooms there were prescribed creams and ointments that had expired and that it would not be appropriate to use Staff observed generally had good relationships with the people living at the home and were patient and encouraging. Staff respected people’s privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. However, some staff did not appear to know how to relate to people with dementia who were unable to appreciate why they needed to have personal care or eat lunch. Two professionals said that the home always respected residents’ privacy and dignity and two said that the home usually did. Discussion with the manager, staff, and observation of care plans and daily records tell us that people living in the home have access to health professionals such as GP, dietician, dentist, specialist consultants and chiropodist. Four medical/healthcare professionals responded to our survey. Four said that individuals health care needs were usually met by the service. Two said that the home always sought and acted upon advice to manage residents’ health-care needs with two saying that the home usually did. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to have flexible routines that take into account peoples individual preferences but these are limited by the staffing levels. There are very limited opportunities for residents to participate in activities and insufficient time allocated to this. All food is home cooked but improvements are needed in the way food is presented, the choices available and how residents are assisted to eat within a timely manner. Visitors to the home are made welcome. EVIDENCE: The majority of residents are unable to communicate what time they wished to get up or go to bed. We were told by staff that most residents are ‘got up ‘by night staff so are up by 8 o clock. Mrs Camp told us that staff are familiar with Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 17 individual residents’ wishes and try to respect these in relation to their daily routine. An activities record was in place, this showed that the activity most undertaken by residents was watching TV. An activities organiser is now in post but only for nine hours a week. There was no evidence that any stimulation or activities were tailored to the needs of people who were poorly or bedfast. We observed that there was little opportunity for staff to keep residents active and involved due to the pressure of work on their time and many residents were sat in the lounges sleeping or staring into space. Two residents spoken to said they would like ‘more things to do’. One visitor to the home commented that ‘staff had enough to do’, without providing activities. On the day of the inspection two residents were supported by staff to attend a summer fete which they told us when they returned that they had enjoyed. One professional said that they thought the home always supported residents to live the life they chose and three said that the home usually did. The majority of residents appeared well dressed and clean and tidy when we arrived at the home. However, after lunch we observed that many people’s clothes were covered in food and drink spills and a change of clothes was not offered although this would have maintained residents’ dignity. A relative spoken to confirmed that this was usually the case whenever they visited. A relative surveyed said that they always felt welcomed into the home. Two relatives surveyed said that the home always helped residents keep in touch and three said that the home usually did. Five relatives said that they were always kept up-to-date by the home and one said that they usually were. Four relatives said that the home always supported residents in line with their expectations; two said that the home usually did, and one said that the home sometimes did. The main meal of the day was roast chicken; we did not observe any residents being offered the choice of an alternative, although the cook told us that some people were. All residents’ meat and vegetables were given to them shredded or minced. One resident did not like this and was given chicken that hadn’t been minced that they managed very well without assistance. Plate guards were not offered to residents and food was served in bowls not on plates. Help was offered intermittently by staff to those residents who could not manage to eat by themselves. However, staff were very busy and were not able to stay with individuals and offer consistent assistance until they had eaten their meal. One person did not eat the main meal and was not offered an alternative, that person ate all their pudding but was not offered a second helping in case they were still hungry. All food is home cooked and residents appeared to enjoy their lunch on the day of the inspection. The cook was familiar with residents’ likes and dislikes. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 18 Specialist diets were catered for. A buffet tea and cake is made to celebrate each resident’s birthday. Although the cook had not undertaken training in the nutritional needs of older people with dementia they were aware of the need to use whole milk, whole milk yoghurts and cream to provide extra calories to maintain residents’ weight. Some residents needed a soft/purée diet this was all puréed together which is not in line with good practice for adults. At teatime we saw that a member of staff had dropped an item of food on the floor and then picked it up and put in onto a residents plate to serve it until they realised we had seen this and the item was removed . Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints policy and procedure is in place but complaints are not always fully recorded. Polices and procedures are in place to keep people safe from the risk of abuse. EVIDENCE: The home has a complaints policy that includes timescales and makes clear that people have the right to raise concerns or make a complaint. It does not make clear that complainants are able to contact the Commission at any stage for complaint and does not include the current contact details. The AQAA details that six complaints have been received since the last inspection but these were not all recorded in the complaints log. The complaints log contained a response to one complaint but no record of what the complaint was. Both members of staff who completed our surveys said that they knew what to do about any concerns. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 20 All the relatives surveyed knew how to make a complaint if they needed to. Four people said the home always responded to concerns they had raised and two people said that the home usually had. One professional said that the home always responded appropriately if any concerns had been raised and three said that the home usually did. The home has policies and procedures on safeguarding vulnerable adults and a copy of No Secrets. We spoke to two members of staff both of whom had undertaken training on adult protection and both were clear about any issues of concern that would need to be reported. The home has a policy on violence towards staff that was drawn up in 2006. It does not make clear to staff that some agitation or violence may be due to illness or dementia and be involuntary. It would benefit from more information for staff on how to defuse such incidents. The home has a policy on gifts and wills that makes clear that staff should not accept gifts from residents should not assist with or benefit from residents wills. The home has a whistle blowing policy but this does not include the commissions current contact details or the contact details of Public Concern at Work. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some rooms are shared without any choice of single rooms being offered, even when a vacancy arises. The home has a programme to improve the decoration, fixtures and fittings but this needs to be pursued more proactively. Infection control practice needs to improve to reduce the risk of cross infection. EVIDENCE: Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 22 The home was generally clean and tidy on the day the inspection. Mrs Camp told us that some new furniture and carpeting has been provided since the last inspection. However, several areas of the home including some residents’ private rooms smelt unpleasant which comprises the dignity of people who live there. Mrs Camp told us that more new carpeting was due to be fitted within a few days and that alternative flooring was being considered for one room to resolve this issue. Mrs Camp also told us that a regular programme of carpet shampooing was in place. One corridor on the ground floor was quite dark and could possibly present problems to residents with poor eyesight. Some areas of the home appeared to be ‘shabby’. A professional surveyed said that they thought parts of the home were drab and dark, and raised concerns about the safety of residents who wander about on the first floor for the building because of the risk of falling down stairs. Some of the pipework particularly in bathrooms and en suite facilities is not guarded and could be a scald risk to residents. Not all the communal bathrooms or toilets had a waste bin available. Bins that were available were not foot operated to reduce the risk of cross infection. The AQAA told us that one of the bathrooms upstairs had been redecorated since the last inspection. The toilet seats in some residents’ ensuite facilities were loose and in poor condition, some cistern lids were badly fitted and one toilet was very badly stained and needed replacement. Some metal frame commodes were rusty and could present a hazard to residents when using them. Several of the carpets in the home are stained, worn and frayed through wear and tear and some in residents rooms are ruched and could be a possible trip hazard for residents. Although the AQAA told us that fifteen new chairs had been provided since the last inspection we observed that several chair arms were worn, stained and dirty. At the last inspection it was noted that the home should improve access in and out of the home for people who use wheelchairs. Mrs Camp told us that although this had not yet been addressed it was planned to be sorted out in the near future. Many of the residents’ rooms are personalised according to their individual taste and choice. However, some but not all residents had a bedside lamp and table. Some private rooms are arranged in a way that means that people are not able to access the call bell from their bed. (Although it is acknowledged that some people would not be able to use the call system to summon assistance). Mrs Camp told us that risk assessments were in place for those resident who were unable to use the call system and these were seen on some files looked at. Duvets were used on beds but many of these did not have a cover on but had a sheet on underneath. A significant amount of the homes Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 23 linen including sheets, flannels, towels and pillows were of poor quality due to wear and tear and needed replacement. Some residents in the home are in shared private rooms, it was unclear if they have the capacity to make this decision or that their opinion had been sought. We looked in the laundry where appropriate equipment is provided but saw that there was dirty washing on the floor and some clean clothes were resting on the sink. Protective aprons and gloves are provided for staff and hand washing facilities for staff are provided. Care staff were responsible for doing the laundry and we saw that residents were left alone in the lounge downstairs while staff did this. Some relatives surveyed by the home were not satisfied with the laundry service; Mrs Camp told us that the home is working hard to improve this. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels do not appear to be sufficient to carry out the person centred care that the AQAA says the home provides. The majority of staff are qualified to NVQ level 2 or above. A training programme is in place. Recruitment practice is robust and protects people living in the home. EVIDENCE: A staff rota that included the hours worked by Mrs Camp was seen. It did not make clear who was in charge of each shift or who the qualified first aider was on each shift. The rota showed that there were six carers on duty in the mornings until 12 o clock and then four carers on duty in the afternoon. The home employs catering and housekeeping staff. Three staff are on duty at night. Mrs Camp told us that there had been no increase in the numbers of the staff team since the last inspection. We observed that staff were very busy throughout the day and had very little time to just talk to residents unless they Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 25 were undertaking personal care. We observed one resident asking staff if they could be taken to the toilet, as one member of staff was engaged with another resident, the resident had to wait some time before there were two members of staff available to assist her, increasing the risk of continence ‘accidents’. We looked at the recruitment files of two members of staff. Robust recruitment procedures had been followed and the files contained all the relevant documentation. Some relatives surveyed raised concerns about the staffing levels at the home. Comments made included unfortunately staffing levels are such that Mum is often left just sitting staring into space, staff do their best but there are not enough of them and one person said that when they visited staff showed signs of stress and looked like they could do with another pair of hands to help with the smooth running of the home. Relatives surveyed acknowledged the difficult job done by care staff and were generally very positive about the standard of care given at the home. Both members of staff who completed a survey said that the home usually had enough staff to meet people’s needs. The AQAA told us that 68 of staff are qualified to NVQ level 2 or above and that the home has a training programme in place. A training matrix was requested on the day of the inspection but had not been received at the time of writing this report so this could not be verified. New staff completes a three day induction at Agincare and a two day induction within the home. There was no evidence that this covers the same depth of knowledge as the Skills for Care common induction standard. Comments made by relatives were generally positive and included that staff were very caring and helpful, and always willing to listen to suggestions and act on them when appropriate. One person commented that they were made to feel as if they were a ‘partner with staff in providing care’ for their relative. Two relatives commented that they felt that some staff needed to show more patience and understanding. One relative commented that there were sometimes language barriers with staff from overseas that could make their relative cross and anxious. One professional surveyed said that the staff always had the right skills and experience and three said that staff usually did. Three relatives surveyed said that the staff always had the skills and experience needed and for said the staff usually did. We spoke to two members of staff who confirmed that they are supported to undertake appropriate and relevant training. Both members of staff who completed surveys said that they felt the induction had covered all necessary areas of the job and both said they received relevant and up-to-date training. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. Resident finances are safeguarded by the policies, procedures and practice of the home. Health and safety is taken seriously to make sure that residents and staff are safe. Policies and procedures are in place and being reviewed and updated to make sure they are relevant and meet the standard required. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager, Mrs Camp, is experienced in caring for older people and is suitably qualified. She has achieved the Registered Managers Award, Level 2 BTEC in Caring for the Older Person with Mental Health Problems and an NVQ level 2 in Customer Care. Members of staff spoken to on the day of the inspection were very positive about working there and about the support they received from the registered manager. A professional surveyed said that the manager was experienced and often to hand’. Both members of staff who completed our survey said that they felt that communication in the home worked well. The home had sent out surveys to relatives in July 2008 to find out what they thought about the services provided by the home. 28 people had replied and the responses and comments about the home showed a high level of satisfaction with the service. The home supports residents to manage their personal finances. All monies are kept separate, receipts are kept and records well maintained. Some records showed that the home had to subsidise some residents while they waited for families to bring in the residents personal allowance. Mrs Camp explained that residents would not be denied the opportunity to visit the hairdresser if they did not have sufficient funds. Mrs Camp told us that all staff had undertaken training in fire safety awareness and fire equipment had been regularly serviced and tested. The homes fire risk assessment was dated 2004 and did not include an evacuation policy or procedure as required in current fire regulations. Information provided by the home in the AQAA started that all equipment and services in the home were regularly serviced and well maintained. Kitchen records were well kept and regularly completed. Records were kept of accidents and these were crossed checked with residents’ daily records and found to be correct. Mrs Camp audits the accidents monthly and residents are referred to the falls adviser if they have three falls to look at any physical health reasons as to why they may be occurring. The manager told us that they planned to undertake a more detailed analysis of where and when falls occurred in order to try and reduce their number. Mrs Camp told us that the homes policies and procedures were currently being reviewed and updated.Mrs Camp also told us that regular meetings were held with the registered person when other managers within the group also Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 28 attended. Minutes of staff meetings were requested on the day of the inspection but had not been received at the time of writing this report. A training matrix was also requested but had not been received at the time of this report so we could not check if all staff had completed mandatory training. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 29 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 X 3 X 2 X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 30 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 15 Requirement The registered person must ensure that service users and their relatives involved in care planning and review. The registered person must ensure that the practice of keeping dental tablets and toiletries kept in individual residents’ rooms is reviewed and regularly risk assessed on an individual basis. Timescale for action 30/11/08 2 OP8 13 (4) 30/11/08 3 OP12 16(2)(n) The registered person must 31/12/08 consult residents about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of residents, activities in relation to recreation, fitness and training. Previous timescale of 23/11/07 not fully met. 4 OP16 22(3)(4) The registered person must ensure that all complaints are recorded and fully investigated DS0000026757.V367665.R02.S.doc 30/11/08 Agincourt Version 5.2 Page 31 with records kept of the outcome. 5 OP21 23 (2) (b) (c) The registered person must ensure that all toilet seats are fit for purpose and safely secured. Toilets and baths that become discoloured and uncleanable must be replaced. The registered person must ensure that all linen and bedding provided is of good quality. 30/11/08 6 OP24 16(2)( c ) 31/12/08 7 OP26 16(2)(k) The registered person must 30/11/08 ensure that all areas of the home are free from unpleasant odours. The registered person must ensure that all waste bins including clinical waste are foot operated to reduce the risk of cross infection. Hand wash must be provided for staff in the sluice room and bar soap must not be used. Dirty washing must not be kept on the floor of the laundry to reduce the risk of cross infection. 31/12/08 8 OP26 13(3) 9 OP27 18(1)(a) The registered person must ensure that at all time suitably competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (This must include sufficient staffing hours for activities with residents). Previous timescale of 23/11/07 not fully met. 31/12/08 10 Agincourt OP38 23(4) (c) The registered person must DS0000026757.V367665.R02.S.doc 30/11/08 Version 5.2 Page 32 (e) ensure the fire risk assessment that meets the current fire safety regulations is developed. 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 OP9 Good Practice Recommendations All creams and ointments should have an opening and expiry date clearly written on. The medication policy should be reviewed and updated to reflect current regulations and good practice advice. 2 OP12 Serious consideration should be given to increasing the hours worked by the activities organiser. Serious consideration should be given to how the home will provide a stimulating environment for all people living in the home. 3 OP15 The different ingredients of a soft/ purée meal should be served separately in line with good practice unless this is the residents’ choice and this is recorded on their personal file. The complaints policy should make clear that complainants are able to contact the commission at any stage for complaint. The policy should also include the current contact details of CSCI. The whistle blowing policy should include the current contact details of CSCI and the contact details of Public Concern at Work. Badly stained furniture should be replaced. An assessment should be undertaken of all the carpeting throughout the home to check its safety and whether it needs to be replaced due to wear and tear. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 33 4 OP16 5 OP18 6 OP19 7 OP19 The home should ensure that there is easy access in and out of the home for those people using wheelchairs. This was identified at the last inspection. 8 OP21 The registered person should make sure that all commodes’ are for purpose and do not present a hazard to residents. Residents should only share rooms if they have made a positive choice to do so. When a shared space becomes vacant residents should be offered the opportunity to choose not to share. Serious consideration should be given to replacing poor quality bedding, towels, flannels and pillows as soon as possible. All residents should be offered a bedside table and bedside lamp unless a risk assessment is in place to suggest otherwise. 9 OP23 10 OP24 11 12 13 OP27 OP30 OP37 The staff rota should make clear who is in charge of each shift and who the qualified first aider is on each shift. Staff should undertake the Skills for Care common induction standard or training of an equivalent value. All information and records should be dated and signed. Information should be kept in a way that meets the requirements of the Data Protection Act. Personal information about residents should be kept on their individual file. Agincourt DS0000026757.V367665.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000026757.V367665.R02.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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