Inspection on 05/08/09 for Agincourt

This inspection was carried out on 5th August 2009.

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

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 27/08/08

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 24/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Agincourt 116 Dorchester Road Weymouth Dorset DT4 7LG Lead Inspector Tracey Cockburn Key Unannounced Inspection 5th August 2009 09:45 DS0000026757.V376901.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agincourt Address 116 Dorchester Road Weymouth Dorset DT4 7LG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01305 777999 01305 777999 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.V376901.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only room 7 to be used as a double. Date of last inspection 27th 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 residents’ in the warmer weather. Agincourt DS0000026757.V376901.R01.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.V376901.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection carried out over one day by two inspectors. Throughout the report the term ‘we’ is used to show that the report is the view of the Care Quality Commission. We sent out survey forms for people to complete and tell us what they think of the service. We received two surveys back from social and health care professionals, eleven surveys back from people who live in the service and six from people who work in the service. Six of the survey forms returned by people who use the service were completed by the same member of staff, who works in the home. The other five survey forms were completed by a relative of the person receiving care. People with dementia and complex needs are not always able to reliably communicate their views and experiences of a service so we developed a formal tool to enable us to observe people and help us understand their life in the home. This tool is called Short Observational Framework for Inspection (SOFI). This involves observing up to five people who live in the home for up to two hours and recording their experiences at regular intervals. This included their state of wellbeing and how they interact with members of staff, other people who use the service and the environment. We observed five people with dementia and communication needs in the ground floor lounge and dining area. The two hour period included lunchtime. During the visit we looked at care records, spoke to people who use the service, reviewed recruitment and training records as well as medication, health and safety audits and quality assurance information. What the service does well: People only move into the home following an assessment of their needs and assurance that the home can meet them. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 7 People are treated with respect and their privacy maintained. People living in the home are supported to maintain contact with people who are important to them. Recruitment practice is consistent which ensures that people are protected. The service has a quality assurance process which uses a variety of methods to find out the views of people using the service as well as other people who visit the service in order to determine if they are meeting people’s needs and the aims and objectives of the home. What has improved since the last inspection? At the end of the inspection in August 2008 there were ten requirements and thirteen recommendations. People who use the service must have a plan of their care which has to demonstrate they or their representative was involved in the process. We found in two of the care plans we looked at that care plans are now signed by a representative of the individual to say they agree with the plan. To ensure people’s health is maintained dental tablets are no longer kept in individual rooms and all toiletries are now risk assessed on an individual basis. Work is continuing on providing activities in which people will be interested. All complaints are recorded, investigated and responded to within agreed timescales so people should be confident their concerns will be listened to and acted upon. We found improvements to the washing and toilet facilities in the home; we also found that poor quality and worn linen has been replaced as well as bedding. There were no unpleasant odours in the home; infection control practice has improved with all waste bins now foot operated. The laundry room has also been improved. The fire risk assessment has been developed to meet current fire safety regulations. The medication policy has been reviewed and updated. The hours of the activity organiser have been increased. People who have a soft diet have their meals presented in an appealing way. The complaint policy includes the contact details of the commission. The whistle blowing policy as been amended to ensure people know who to contact if they are unhappy with the provider. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 8 There is a programme of refurbishment in the home including the replacement of items of furniture. Carpets have been replaced and access to the home has been improved for people who use wheelchairs. All commodes are fit for purpose. Poor quality bedding, towels, flannels and pillows have been replaced. The staff rota makes clear who is in charge of a shift and who working on shift is a qualified first aider. All new staff now complete the skills for care common induction standards. What they could do better: At the end of this inspection we left one immediate requirement and a further four requirements were made as well as five recommendations. It is important that people’s health care needs are met consistently which means that care plans should detail precisely the action which staff need to take to meet an individual’s health care needs. We found that controlled drugs were not being stored and recorded correctly, we asked the registered manager to address this immediately. We received written confirmation from the registered manager that the controlled drugs had been logged correctly before being returned to the pharmacy. This was done within the agreed timescale on the immediate requirement. It is important that if a person is prescribed medication PRN (when needed) that there is a clear plan in place so they are not put at risk of harm. There must be no gaps in the MAR chart, a code should be used in order to ensure that people receive the medication they are prescribed. The home must be staffed to meet the needs of the people living there and ensure they are safe. It is important to consider how people with dementia are supported with activities and stimulation throughout the day not just in the afternoon. People who are cared for in bed should be supported with equipment to stimulate and interest them. The registered manager should consider how pictures can be used to compliment different signs around the home to support people with dementia to move freely around the home. The registered manager should consider how staff can be used more flexibly at peak times of activity in the day. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 9 The registered manager should source training for the activity coordinator in activities for people with dementia. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Agincourt DS0000026757.V376901.R01.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.V376901.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People only move into the home following an assessment of their needs and confirmation that the home can meet their needs. EVIDENCE: We looked at two files both contained pre admission assessments covering the areas we would expect such as personal care, medical history, diet and weight as well as mobility, social interests and mental state. We looked at the care plans and could see that the information in the assessments was used to form the basis of the care plan along with other information gained from nutritional assessments, pressure area assessments and fall risk assessments. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 12 We saw limited information about gender and sexuality and would suggest that the service considers what information it is trying to establish with this question and how it would support someone within an equality and diversity framework. Agincourt DS0000026757.V376901.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to care planning show a more person centred approach to individual needs and wishes. Further work is needed to develop plans which focus on what the individual can do rather than what they can’t do. People’s health care needs can only be fully met when information is clear and precise. Medication practice in the home is not of an acceptable standard to ensure the safety of the people in the service. Staff understand the principles of respect, dignity and privacy. EVIDENCE: We looked at the care plans for three people, each person now has a cover sheet which has a photograph of them and covers: ‘what is important to me’ ‘How best to support me’ ‘what those who know me like and admire about me’ Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 14 The manager has undertaken a course recently in advanced care planning. The annual quality assurance assessment submitted by the home says: “We have made further improvements to the care plans by ensuring photographs are included in all files and introduced more thorough checks on a monthly basis. We have further improved the medication system. We now have two medication trolleys, one for each floor which has greatly improved the effectiveness of administration of medications. Regular audits are carried out. Designated persons are identified in the MARS books to indicate those who have eligibility to perform administration of medications. The Medication Policy has been thoroughly updated.” We looked at the daily records for one person and noted that the following comment “good fluid intake” on 5/08/09 we could not find any evidence of how this opinion could be reached. We did find fluid records were well maintained on one particular day 08/07/09 which was a hot day and the records were in place stating how much each person drank at regularly hourly intervals. We looked at the care plan for one person who is cared for in bed. The care plan states “X need constant mouth care which should be encouraged by staff” It was difficult to evidence how this was being achieved as no record was visible in the person’s room of when staff were completing this task. The care plan did not contain information on how often staff should do this task or what equipment they should use. The nutritional assessment for the same person states “ staff will need to encourage daily intake of fluids” but there is no information on how this will be achieve or what the recommended daily intake is for this person. The individual risk assessment states that “if X is not eating her food staff to monitor” there is no mention of how this should be done or where; we could not see a food or fluid chart for the person. We spoke to staff they were very clear about reporting concerns to their senior who would involve the manager and contact a health care professional for advice and support. A requirement at the last key inspection regarding keeping dental tablet and toiletries in individual rooms has been addressed and risk assessed. We reviewed the homes medication practice and found there were some gaps in Medication Administration Records (MAR) sheets; a few did not have any explanation. One person who has a medication administered weekly did not have it administered in the previous week. There was no explanation recorded. The use of an agreed code alerts other care workers that this person has not taken the medicine for a recorded reason. This information maybe essential when the GP reviews the treatment for this person. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 15 One person has medication which should be taken when required but the MAR sheet states two to be taken at night. We could not find any PRN plans for people. For one person the MAR sheet says the medication is to be taken three times a day but the member of staff told us it was PRN. Another person was prescribed thick and easy but it was not consistently used and we were told it is only given depending on the person’s mood which suggests it is not being used as it should be. We looked in the controlled drugs cabinet and checked the stock for one person we found the stock matched the number recorded in the book. We found another controlled drug stored in the medication cabinet which was not logged in the controlled drug book. The member of staff said that it was prescribed for someone who no longer took it. The records for this prescribed medication were not up to date. We asked the manager to address this which they did within the required forty eight hours. We received confirmation from the manager that the medication had been logged correctly then immediately returned to the pharmacy. We were also concerned because the home completes a monthly audit of medication and this had not been picked up during the last audit which did not have a date on it. The previous medication audit took place on 5/6/09 on the ground floor. Audits are only of value if they are being carried out correctly. A recommendation at the last inspection that all ointments and creams have an opening and expiry date on them has been addressed. During the morning we observed staff supporting people to make choices, one person did not want to have a bath and was asked several times by a member of staff, this was done in a quiet and supportive way, when the person said no for the third time the member of staff asked gently if they would like another member of staff to support them to which they replied ‘yes’ another member of staff was sought. Throughout the day we observed staff encouraging people to eat and drink, when they were carrying out tasks such as supporting someone to the bathroom they chatted to them. Agincourt DS0000026757.V376901.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further development of activities for people with dementia would enhance people’s experience of living in the home. EVIDENCE: The annual quality assurance assessment says the following about activities: “We document on a daily basis all activities undertaken and by whom. The activity co-ordinator regularly audits and reviews her activities. We issue newsletters to family/visitors and make them available throughout the home. Menus are available for residents/visitors to see within the home and menu plans are kept in the kitchen. Dietary requirements are documented and adhered to. Care plans contain all relevant information specific to the individual relating to activities and daily life.” The AQAA also says: Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 17 “We have introduced regular family & resident forums where residents and families incorporate their ideas into daily life at Agincourt. We place posters up and send out flyers and letters to families to notify them of up coming events. We listen to and implement any ideas e.g. garden parties, table top sales, and karaoke sessions. Door plaques have been placed on resident’s rooms with their name and room no.” This is what the home plan to do over the next 12 months: “Continue to try and source outside volunteers to come and visit the home to offer further stimulation. The Activity Co-Coordinator is in the process of auditing and evaluating activities undertaken and appropriate to the individual to ascertain that their stimulation and activities are tailored for.” One person who works in the service wrote in a survey form under the heading ‘what could the home do better?’ “ could do more activities and one to one outings but not enough people to do it often, staff do volunteer and do take clients out” At the last key inspection a requirement regarding consultation with people about activities in the home was made. Work has been done to address this requirement through gathering of information from family and friends of people in the home as well as the work being done by the activity person. A recommendation was made at the last inspection that consideration should be given to increasing the hours of the activity person; we found that their hours have increased from 9 per week to 16 hours per week. The activity person is a member of the National Association for Providers of Activities for older people (NAPA) and we observed her for part of the afternoon encouraging people to participate in a ball game and later on playing a board game with four people. The manager told us that in the afternoons the activity person splits her time between the lounge on the ground floor and the lounge on the first floor. We looked at the range of activities recorded for one person over the course of a week. Activities such as board games, ball games, looking through the papers, bingo and watching TV were recorded. We also noted that personal care activities such as bathing and nail and hair care were recorded. The notice board in the office suggests that memory boxes are used and activities based on reminiscence. In the morning of the site visit, there were no activities available we noted in the first floor lounge that the hairdresser was using one corner and other people were sitting either asleep or not engaged in any activity. The SOFI observation took place in the ground floor lounge and the following was observed: “There were 10 people in the lounge area and for the first hour of the observation there was only 1 member of staff. Other staff were around but Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 18 occupied in providing personal care to people and were not consistently in the lounge area. The people sat in the lounge area were clean and generally well groomed. One person did have a threadbare cardigan on and short jogging trousers. People had nothing to hold or there was not anything around to hold or pick up and do so people could stimulate themselves. There were no ‘poor’ interactions from staff. However, all of the good or neutral interactions related to tasks either drinking, mobilising or lunch. This appeared to be due to staff time rather than any poor practice. We observed genuine warmth from staff towards people. Staff were observed to be relaxed with people. They reassured people by talking quietly, touching and supporting them when they were unsettled. Overall people were in passive state of being. There was a direct link to staff engagement and people being in a positive state of being. This suggests that people’s well being would increase if there were more staff available to engage with people and participate in either social activities or activities of daily living. There were good levels of engagement at lunch and this is to be expected because people are engaged in the task of eating and drinking and there are more staff around. Music was put on that some people actively listened to, tapped their feet etc. People were not given a choice of drinks nor do they tell people what is for lunch. People were not given a verbal or visual choice of food or drink. The domestic was hoovering in the lounge whilst people were eating their lunch in there. Not conducive to a relaxed lunchtime There are not any spare stools or seats for staff to sit and assist people to eat. Staff did not describe to people they were assisting what their food was. Staff were very patient and encouraging with one person who did not want their lunch. They repeatedly placed the lunch in front of them and encouraged them to eat. They offered them a sandwich and ice cream and repeated the same process.” The manager told us there should be spare stools available for staff to sit on while they are supporting people to eat their lunch. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 19 There are several people in the home who are cared for in bed, we noted that in each room there was music on and we looked in one care plan which said that the person liked classical music and this was playing when we visited them. There did not appear to be any other sensory stimulation for people who are on their own in their room. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be confident that their concerns are listened to and acted upon. Staff receive training in safeguarding so they are able to recognise abuse and know what action to take. EVIDENCE: The home has a complaints policy that details the procedure for making a complaint and the timescales in which it will be responded to. We looked at the record of all complaints received; there have been twelve since the last inspection. The complaints policy has the address of the commission on it should the complainant wish to refer to us at any point. The home has the pan Dorset guidance on responding to abuse and all staff have received training in safeguarding. Agincourt DS0000026757.V376901.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the fixtures and fittings in the home have enhanced people’s living environment. Improvements to infection control practice ensure that the home is clean, pleasant and hygienic. EVIDENCE: This is what the AQAA says about the home: “We aim to make the environment as homely and comfortable as possible for the residents and visitors. The resident’s rooms are decorated and furnished Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 22 to a high standard and all accommodation complies with the national minimum standards. The premises are accessible, safe, and secure and all areas well maintained. There is a continual maintenance programme and all maintenance work is logged and future maintenance work is planned. The garden area is well maintained and accessible for all residents who should wish to use it. The home fully complies with the fire service and environmental health department.” The manager told us that they are in the process of sourcing a small table to put in the entrance vestibule of the home, which they will use to put information about the service such as the statement of purpose, service user guide and reports from the commission. This is what the home told us they have done to improve the environment over the last 12 months: “The Laundry Room has been totally refurbished, with two new sluice washing machines and tumble driers. New Laundry trolleys have also been provided to comply with infection control. All rooms which have become available have been totally redecorated. New hand wash facilities and hand towel facilities have been provided in the en-suites. New carpets and furniture has been replaced where necessary. New bedding, bedspreads, curtains and towels have been purchased. An alternative wheelchair access has been built at the rear of the building and landscaping to the garden. All paintwork and fire exit stairs have been repainted at the rear of the building. A downstairs bathroom has been totally redecorated.” The AQAA told us that all staff working in the home have received training in infection control. We looked at the training records and found that all staff were up to date with this training. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A flexible approach to staffing the home to fully meet people’s needs would enhance people’s experience of living in the home. Consistent recruitment practice ensures that people are protected. Improvements to training mean that staff are gaining the skills and knowledge they need to do the job well. EVIDENCE: There are nineteen full time care staff working in the home, one part time member of care staff and nine other staff working in a non direct care capacity. This information was taken from the annual quality assurance assessment. There is fifteen care staff with National Vocational Qualifications at level two or above. This is what the home told us about how they recruit and staff the home: “We have a robust recruitment process in place to ensure we adhere to all relevant regulatory checks. All staff attends a 3 Day Skills for Care Induction Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 24 Course specifically tailored to care homes. New staff also has a staff induction pack and a personal development plan. All staff receives training free of charge. The majority of our staff is qualified to NVQ2 and those who are not at the moment are working towards it. We also have a number of staff training for NVQ3. All care staff are undertaking a VRQ in Dementia Care. Rotas are planned well in advance to ensure appropriate staff levels and senior staff are on duty to maintain the smooth running of the home. There is always a senior member of staff on duty along side management. The Activities Co-Coordinator is on duty Monday to Friday. Domestic staff are on duty every day.” This is what the home told us they have done in the last 12 months: “We now have the Skills for Care Common Induction Standards and all the new staff have a personal induction folder and personal development plan. The majority of care staff have either completed or are completing VRQ in Dementia Care. The recruitment of a new Deputy Manager has been extremely beneficial. The introduction of the Activity Co-Coordinator has been very successful.” This is what they plan to do in the next 12 months: “We have identified the need for further training and updating and have booked an In house POVA Course and shall be booking a DOLS/Mental Capacity Act Course.” A member of staff wrote: “All staff are friendly and caring to the people they care for and work well under sometimes extreme difficulties” They also wrote under ‘what could the home do better?’ “Better staffing” Another person who works in the home wrote: “Where there are a lot of “doubles” (two carers needed) there is not enough one on one time with service users. Problems can be missed or not reacted to straight away as not enough staff” Four out of the six survey forms returned by people who work in the home raised staffing as an issue. There is twenty care staff working in the home. A health care professional wrote under the heading’ what does the service do well?’ “Friendly, cheery informed approach to clients. Senior member of staff usually to hand to discuss patients with. Good communication channels with us. Management plans are acted on. Caring Staff” The staff rota shows us that in the morning there is a total of six care staff working in the home, three staff work on the ground floor and three staff work on the 1st floor. In the afternoon the number of care staff drops to two staff on the first floor and two on the ground floor. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 25 This staffing ratio has not changed since the last inspection. On the day of the inspection we were told there were there were seven people in the home who required two staff to support them with personal care and using a hoist. In the afternoon’s this would mean there could be times when no care staff would be in the communal areas supporting people if two staff were assisting someone either in their own room or in the bathroom. This staffing ratio means that people could be at risk at certain times of the day and means the service continues to be driven by tasks and this will inhibit a person centred approach. We looked at the recruitment files for two people who started work in the home since the last inspection. We found that all the required paperwork was in place, including two written references, proof of identity and criminal records bureau checks. In one application we looked at the dates of previous employment was only in years and it would be good practice to request that they include the month as well. However gaps were explored at the interview. We looked at the training matrix for the staff and could see that mandatory training had been covered and that staff had completed training in Dementia care. The manager explained that they were looking at further courses in ‘end of life care’ and that all staff had enrolled on a distance learning course in Dementia at Weymouth College. Staff have also completed course in Diabetes and care of the dying. Agincourt DS0000026757.V376901.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management work hard to address shortfalls in the service and move forward in a person centred way. The views of others are considered in the development of the service. Management understand the importance of ensuring the health, safety and welfare of people in the service is promoted and protected. EVIDENCE: Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 27 The registered manager has been on Mental Capacity Act Training, she has also attended a training course of person centred planning and is putting this information into practice in the home. The manager told us that they have not made any Deprivation of Liberty referrals. The manager also told us that they are applying to become Dignity Champions. The manager has met nine of the ten requirements made at the last key inspection. The home has a flu pandemic plan based on good practice guidance and a variety of sources including the UK homecare association and department of health. The home has a quality assurance process whereby people’s views are sought and an annual development plan completed. The views of people’s family and friends are sought as well as other interested parties such as health care professionals. The report we looked at is for the period August 2008 to August 2009. The manager told us about the resident’s forum and how people are supported to be part of the group and have their say. We think it is important to seek advice on how to support people with dementia to play a part in this process maybe from an outside advocacy service. They told us how they have improved over the last 12 months: “A far more effective management team who work well together. We have been very proactive with implementing changes and sourcing information.” One person who works in the home wrote: “Management are supportive” they also said “I thoroughly enjoy working at Agincourt” We looked at the fire records and noted that the fire Safety audit had been completed on 5/5/09 by the Dorset Fire & Rescue Service. Four recommendations were made and we could see evidence that one relating to the kitchen smoke and heat detectors had been addressed on the 18th May 2009. The fire risk assessment had been updated to reflect the other changes recommended. All staff have completed mandatory training such as moving and handling, infection control and fire safety. All accidents, injuries and incidents are recorded and reported. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 12 (1) Requirement Timescale for action 30/10/09 2. OP9 13 (2) The registered manager must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. This can be done by ensuring that care plans set out in detail the action which needs to be taken by care staff to ensure all aspects of the health of an individual are met. The monitoring of food and fluid intake must be clear and precise so that care staff know when they should be concerned. Immediate Requirement 07/08/09 The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Controlled Drugs must be recorded in the Controlled Drugs book. If medication is not being used it must be returned to the pharmacy. If someone is no longer taking a prescribed medication their GP DS0000026757.V376901.R01.S.doc Version 5.2 Agincourt Page 30 3. OP9 13 (2) 4. OP9 13(2) 5. OP27 18(1) (a) must be informed and the prescription reviewed. The registered person must 30/09/09 ensure there are plans in place for administering PRN medication otherwise people are at risk of harm. The registered person must 30/09/09 ensure that all medication is signed for correctly on the MAR sheet. The use of an agreed code for any medication not taken is an alert to the person completing the audit of a possible problem. The registered manager must 30/10/09 ensure that at all times there are suitably qualified, competent and experienced persons working in the care home in such numbers as appropriate for the health and welfare of people living in the home. 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 OP12 Good Practice Recommendations The registered manager should give consideration as to how people with dementia are given opportunities for stimulation through leisure and recreational activities throughout the day not just in the afternoon. The registered manager should consider what sensory equipment and activities would suit the needs of people cared for in bed. The registered manager should consider the use of pictoral signs to enable people with dementia to access all parts of the home freely taking into account their sensory limitations. The registered manager should give consideration to the DS0000026757.V376901.R01.S.doc Version 5.2 Page 31 2. 3. OP12 OP19 4. OP27 Agincourt 5. OP30 use of additional staff on duty at peak times of activity during the day. The registered manager should consider what training needs the activity coordinator has in order that they can meet the particular needs of people with dementia. Agincourt DS0000026757.V376901.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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