CARE HOMES FOR OLDER PEOPLE
Agincourt 116 Dorchester Road Weymouth Dorset DT4 7LG Lead Inspector
Sally Wernick Unannounced Inspection 09:00 3 January 2006
rd 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.V275438.R01.S.doc Version 5.1 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.V275438.R01.S.doc Version 5.1 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.V275438.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Only room 7 to be used as a double. Date of last inspection 23rd June 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 DS0000026757.V275438.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 9:00am on Tuesday, 3rd January 2006. It was conducted as part of the normal routine of inspecting twice during a twelve-month period. The Registered manager, staff and residents assisted in the inspection and methodology used included a tour of the premises, review of records and discussions with service users, one visitor and staff. The inspector also reviewed the contact sheet for Agincourt and documentation submitted by the registered manager in response to requirements made at the last inspection. Not all of the minimum standards were assessed on this occasion. Please note where a national minimum standard was not assessed the score is shown as X. What the service does well:
Agincourt provides a service for older people with dementia and long-term mental disorders in a comfortably furnished house. The home has a relaxed atmosphere and residents are at ease. Good care plans are in place for all residents and these are regularly updated to make sure that staff know how to care for the residents living at the home. Daily notes provide evidence to show the way that care is delivered. A range of community health professionals supports the care staff in caring for residents. Staff was observed throughout the inspection to be treating residents with courtesy, kindness and patience. Relatives and friends are encouraged to visit and links with the community through a range of activities are facilitated. Meals are tasty, nutritional and varied and take into account the likes and dislikes of residents. There is a competent, experienced registered manager in place and service users financial interests are safeguarded. A quality assurance system continues to monitor the well being of residents. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed as no new residents had been admitted to the home since December 2004. EVIDENCE: Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9. Agincourt has a detailed care planning system in place, which ensures that staff has sufficient information to meet needs of residents. Good support from community health professionals helps to ensure that the health needs of residents are well met. Medicines are safely stored and carefully administered to residents by staff. EVIDENCE: Three care plans were examined all of which were detailed and clearly set out. Information on all elements of personal and social care was included as was the resident’s social history. There are detailed risk assessments including moving and handling guidance in place and evidence of good links with other community health professionals such as District Nurses and G.P’s. Daily care notes also support and evidence the delivery of care to residents. Records demonstrate that care plans are reviewed monthly and relatives are encouraged to contribute. All information contained in the care plans was relevant and up to date with an emphasis on providing total care to each person. Language used is sensitive and respectful referring to the need to “reassure” or “explain” if residents are uncertain. The appearance and general
Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 10 demeanour of the residents demonstrated that care plans are put into action and people are well cared for. Risk Assessments were well documented in line with a requirement from the previous inspection. There was good evidence of appropriate referrals to a range of community services and where assessments have identified a special need such as managing sensory loss or referral to the falls clinic this was dealt with promptly. Records indicated that medicines are properly stored and correctly administered. Staff has received relevant training and dispensed medication is recorded correctly on MAR charts. Medicines are dated and secured appropriately and the systems in place follow proper guidance and procedures. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 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 the following standard(s): 13,15. Residents are encouraged to maintain contact with family and friends. The meals in the home are good, varied and nutritious. EVIDENCE: During the inspection there were visitors to the home and comment cards received by the commission for social care evidence that they are made welcome and that visiting times are flexible. Visits may be taken in the communal lounges or in resident’s rooms and during the summer months many choose to visit in the attractive garden. If they wish relatives, may stay for lunch and for one large family who visited from Canada over the Christmas period a buffet lunch was provided. There is an open invitation for all to parties held at the home and arrangements can be made for overnight stays. One relative was not aware that he could visit his mother in her room the registered manager has agreed therefore to include that information in the service user guide and to ensure that the new guide is readily available. The range of activities on offer includes a range of individuals from within the local community including “pat a dog” “extend” and the local Scrabble representative. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 12 Menu’s in the home are varied and are based around the known likes and dislikes of residents as well as good nutrition. Special diets can be catered for and although not all residents are able to say what they enjoy they are able to make their preferences clear. A glass of sherry is generally enjoyed before dinner and meals are based around a four-week rota. Individual preferences are catered for by a dedicated cook who has been at Agincourt for 11 years and who knows the residents well. Meals are generally at fixed times and are eaten in the communal dining areas although breakfast is flexible to accommodate the large number of residents who wake at different times. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 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 the following standard(s): Not assessed on this occasion. EVIDENCE: Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 14 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): 22,24. Specialist equipment is provided to maximise service users independence. Service users bedrooms were safe and comfortably furnished. EVIDENCE: These standards were examined in full during the previous inspection and will not be repeated here. Three requirements were previously made two of which have now been met. Equipment in room 27 has been replaced, as has the seat of the Oxford Mermaid bath hoist. A freestanding heater has now been removed. The planning department have been consulted regarding alteration of the ramp at the front door, which was identified by the Occupational Therapist at her assessment as in need of adapting. A decision has not yet been made about this by the registered providers and a written outline of their plans has not been received by the CSCI. This requirement will therefore be repeated. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 15 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): Not assessed on this occasion. EVIDENCE: Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 16 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. The Registered manager is experienced in care and provides clear leadership within the home. The home reviews its performance and seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Resident’s financial interests are safeguarded. EVIDENCE: Mrs Camp became the Registered Manager in April 2004 and is responsible for the day-to-day running of the home. Staff confirm that she provides clear leadership and promotes good practice within a positive atmosphere. Mrs Camp has the Registered Managers award and will very shortly have completed her NVQ level 4 in care. All staff at the home including the Registered Manager accesses a full range of training through a number of
Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 17 different providers. A large proportion of staff is qualified at NVQ level 2 and there are clear lines of accountability within the home. Agincourt is one of a number of homes owned by the Registered providers. As part of their quality assurance system managers from within the cluster make unannounced visits to each home on a monthly basis to check on the standard of care provided. A written report is then prepared and forwarded to the Commission for Social Care. In addition Mrs Camp has devised her own Quality Assurance Questionnaires, which have been sent out to relatives and stakeholders to obtain their views on standards of care within the home. The inspector saw a large proportion of these although the results have not yet been collated. A written response will be incorporated into the Annual Development plan and viewed at the next inspection. Mrs Camp confirmed that, in order to protect residents, it is the policy of the home not to have any involvement in their personal finances. Therefore all residents who are unable or do not wish to handle their own affairs have a relative or other representative to deal with financial matters. This means that where necessary, the home pays for services such as chiropody and hairdressing and a record is maintained. The amount is then invoiced to residents, relatives or representatives for payment at appropriate intervals. Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x X X X 2 X 3 X x STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X x Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement The registered provider must consult with the local Planning Department regarding alteration 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 consultation and the outcome.13(4)(c) Timescale for action 1. OP22 13(4)(c) 28/02/06 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 OP4 Good Practice Recommendations 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 users rooms and communal areas of the home, to ensure that matters needing attention are identified at an early stage. 2 OP33 Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 20 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. Extracts may not be used or reproduced without the express permission of CSCI Agincourt DS0000026757.V275438.R01.S.doc Version 5.1 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
