Inspection on 15/05/06 for Anchor Lodge

This inspection was carried out on 15th May 2006.

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

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

Other inspections for this house

Anchor Lodge 02/01/08

Anchor Lodge 31/01/07

Anchor Lodge 06/03/06

Anchor Lodge 31/10/05

Anchor Lodge 02/03/05

Anchor Lodge 28/09/04

Anchor Lodge 28/04/04

Anchor Lodge 12/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Anchor Lodge Cliff Parade Walton-on-Naze Essex CO14 8HB Lead Inspector Sara Naylor-Wild Key Unannounced Inspection 15th May 2006 10:30 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 Anchor Lodge DS0000036541.V294937.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. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Anchor Lodge Address Cliff Parade Walton-on-Naze Essex CO14 8HB 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) 01255 850710 01255 850710 www.anchor-lodge.co.uk Mr Farooq Mohammed Mrs Uzaira Farooq Care Home 14 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (2), Old age, not falling within any other of places category (14) Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 14 persons) Two persons, aged 65 years and over, who require care by reason of dementia, whose names were provided to the Commission in April 2005 One person, under the age of 65 years, who requires care by reason of Korsakoff Syndrome (dementia) whose name was provided to the Commission in March 2004 6th March 2006 Date of last inspection Brief Description of the Service: Anchor Lodge is an established care home situated in a residential area of Walton on Naze. Local shops, post office, library, churches and leisure facilities are all found in the town. The detached property overlooks the seafront with views of the beach and the sea from the home. There is a front garden in which service users can sit. There is off road parking to the rear and side of the home. Accommodation is in twelve single rooms and one double room, over three floors. Access is via a staircase or passenger lift. In recent years alterations and additions have been made to the bedroom accommodation, all now having en suite facilities of wash hand basin and toilet. Communal areas are a ground floor main lounge and a small sun lounge. Thee is also a small first floor lounge with sea views. The range of fees charged by the service are between £354 and £650 per week. There are not any additional charges. This information was provided to the Commission by the provider in June 2006. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was looked at when compiling this report. A preinspection questionnaire was not returned in the period prior to the inspection therefore information was primarily gathered at the site visit. This included some documentary evidence such as menus, staff rotas and care plans. Visits to the home took place on 11th and 26th May 2006; Jenny Elliott, Regulation Inspector, also attended the second visit. Both visits included a tour of the premises, discussions with the person in charge of each shift, conversations with service users and members of staff. Subsequent to the visits surveys have been sent to relatives and health professionals, and the outcomes of these will be included in this and subsequent reports. The date of the second site visit was announced to the proprietor to enable opportunity for inspectors to assess the compliance of documentation held on staff files. However, the proprietor was unavailable on this date due to annual leave commitments and the person in charge at that time did not have access to these files. What the service does well: Discussions with staff indicated they had formed a close team, and were passionate about their commitment to service users and the service. This is a strong contributing factor to the service users experience of the service delivery. Evidence of staff providing support in terms of their own time and resources was seen throughout the inspection visit. Service users and their families strongly support the service and the work carried out by care staff and spoke highly of both. The meals provided are tailored to meet the service users’ preferences, and alternatives are readily available. The cook enjoys developing the menu and providing service users with new food experiences, which are incorporated into the menu if successful. The service users’ rooms are bright and clean. The service encourages new service users to bring personal items with them and the rooms are homely, personal and comfortable. New decorating and furnishings planned for service users’ rooms and communal areas will enhance their experience. Service users and their relatives were reported to have chosen colours and items such as beds. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The overall management of the service towards compliance with national minimum standards and regulation, requires a greater sustained effort through the daily leadership of the home, as many of the outstanding requirements have been repeated since 2002. The culture and attitude of staff towards the regulatory process does not support an understanding of good practice and regulatory requirements. Staff’s knowledge of the regulation and standards should be developed; this will enhance the quality of care provided by the home and achieve a greater level of compliance with National Minimum Standards. The service must consider how it will support the provision of meaningful activities that meet the assessed needs and expectations of service users. Specifically there needs to be review of the staffing numbers and arrangements to support the all the needs of service users. The service must develop care planning to more accurately reflect the service users’ needs and the staff’s delivery of care. This includes a greater input by staff in the updating of care planning documents and the close monitoring of health needs. The service must provide equipment required by service users as part of their assessed needs, in particular the moving and handling equipment such as hoists. Staff training requires ongoing development and an annual programme linked to service users’ needs should be developed. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 7 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. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 8 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 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some service users’ assessments provided a sufficient level of information to inform the individual’s care plan. The service does not provide intermediate care. EVIDENCE: The inspectors considered samples of four service users’ files. These contained assessments of need. The format of these documents encourages the assessor to gather a variety of information in respect of the service user’s preferences, strengths and needs, that when completed would provide sufficient detail to inform the decision to admit the service user and to develop care plans. The actual level of information completed in these documents varied, and this would impact on how successfully a person centred care plan could be developed to deliver the quality of care to meet the individual’s abilities and preferences. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 10 There is no evidence to suggest the home operates an intermediate care service. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not adequately reflect the changing needs of service users. The health care needs of service users are recorded, but not always followed up in practice. Medication was not fully administered according to The Royal Pharmaceutical Society Guidance and relevant legislation. Service users’ expressions of interest in activities are not supported by the service. EVIDENCE: The care-planning tool introduced just prior to the last inspection in March 2006 was looked at again at these site visits to understand how they informed and influenced the staff’s care practices in the home. From discussions with staff and the person in charge at each visit it was clear that staff do not Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 12 understand the link between their daily recording and the overall care plan for the individual service user. Staff reported that care plans were the responsibility of the Proprietor and Deputy Manager alone, and that they considered there to be an over emphasis on the documentation, which detracted from the time they could spend with service users, and was not useful in meeting their needs. The care plans themselves are based on the Alzheimer’s Society strengths based care-planning documents. The Society promotes a person centred approach to care planning, where individuals independence is maximised by identifying how to support their strengths in all aspects of their care. This is the service’s first attempt at completion of such documents and as such is an improvement in gaining a greater individual understanding of service users and how the staff can best support them. The detail of instruction in areas of abilities was on the whole good, with steps broken down to assist staff to provide support in the way the service user preferred or responded best to. However the content needs some further development. In particular it was not clear that all areas identified in the plans were based in assessments and how these had been tested out. For example some plans stated that “(the service user) does not express a need by being restless”. There is not any reference in the individual’s assessment of how this conclusion was arrived at or what this information indicates, and therefore it is not clear how this information would assist staff in meeting the individual’s needs. In another case the care plan of an individual who had experienced significant changes to their health care needs had not been reviewed and those changes included within the care planning section. Although it was contained in other documents such as risk assessments and health care records. Staff wishing to understand how this would impact on the care they should provide to the individual would need to search this out in those records. Further records in another service user file indicated that the nurse had visited to take blood samples to monitor for sugar levels in respect diagnosing diabetes. The results had not been entered some 20 days later, although the record indicated that these would be available in three working days. Although the visit had been initially requested by the service there had not been any follow up to ascertain the outcomes and how this may impact on the care they provide to the individual. Moving and handling instructions in care plans were not arrived at from a full assessment of the individual’s mobility and the risks entailed. Furthermore the action described in these documents did not reflect the information given by care staff in discussing how they assisted service users to move. Overall the presence of the document does not enhance service users’ care and how staff deliver this. Whilst staff can demonstrate that they have the intuitive knowledge of service users, gained through their daily interactions, the assessment and care planning documents do not provide evidence that their Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 13 approach recognises the diversity of the service user group. This affects the overall quality of the service provision and does not uphold the ethos of person centred care. Medication records and administration were considered at both visits. On the first visit the inspector established that the records were all completed and included receipt and disposal of medications to the pharmacist. During this assessment of the processes undertaken to dispense medication in the home, two compliance devices, (small unlabelled medication trays), labelled with service user names in each compartment were located on the shelf with other items used for dispensing such as medicines pots. When asked about these devices the person in charge indicated that staff secondary dispensed into these in order to dispense night medication to service users in their rooms, as the medication trolley was chained to the wall. This is contrary to the Care Standards Act 2000, The Medicines Act 1968, the Royal Pharmaceutical Society Guidance “The administration and control of medicines in care homes and children’s services”, and the home’s medication policy. The person in charge was advised of this serious non-compliance at the time of the inspection and these items were immediately removed. At the second site visit the person in charge advised that the practice had ceased. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The services users’ experience of the service varies depending on the manner in which it is delivered. Family and friends of service users are welcome in the home. Service users’ choices are not fully supported by care planning and staff actions. Meals are provided to a planned menu based on service user preferences. EVIDENCE: Within the service user’s file were documents evidencing that their personal preferences and interests in relation to activities had been sought. The care plan documents also contained reference to these and how staff should include this in their daily care routines. From discussions with staff and service users and observations on the two visits to the home, there was no evidence that the activities listed were actively carried out. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 15 There was evidence that staff provided stimulation in the form of watching videos, listening to music and reminiscing in group chats, all of which were mainly group activities and not specific to the individual’s plan. Some other activities such as going for walks or to the shops were supported by staff in their own time and there was considerable evidence of staff seeking to provide support in this way. Staff commented that this was mainly due to the lack of time and staff availability within the rota week. Whilst staff’s commitment to the service users is to be congratulated the provider must ensure that the holistic needs of service users can be met by the staffing arrangements within the home. Two CSCI relatives survey returns praised the staff’s attitude and approach to service users. Comments included “nothing is too much trouble for staff”, ”Care is of an exceptionally high standard” and “this appears to be an excellent home.” Service users spoken to during the inspection visits indicated that the experience of the service was varied and was dependent on the members of staff delivering their care. This was supported during observations of staff interaction with service users during the inspection visits. In one visit a staff member was assisting service users to make choices during a meal time, with good humour and encouragement to the individuals, and service users commented on how much they liked her happy and genuine approach to them. During the same meal another staff member entered the room and approached a service user experiencing difficulty in eating their meal, and without speaking scooped food into the middle of the plate then walked away again. This indicates a lack of understanding in a person centred approach and negatively impacts on the home’s stated ethos and Statement of Purpose in providing quality care provision to meet individuals’ abilities. Service users also gave different views in respect of how they were given choices. The décor of a room was said by the person in charge to have been chosen by a service user, however the individual service user was not aware that they had made such choices. Another service user was proud and pleased to show how their room had been filled with their personal items. Meals were offered from a planned menu. Although service users spoken with before the meal were not aware of the choices for the day. Staff made enquiries with each service user at the mealtime as to their preferences. Service users spoken with during mealtime said the meal was enjoyable, and the service routinely carries out a quality check following meals to ascertain if service users had enjoyed the meal. The food stocks were reasonable and the cook indicated that the quality of purchases from exclusive and basic ranges is purchased appropriate as required. Fruit and vegetables are freshly delivered. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints policy is appropriate. The abuse policy is appropriate. EVIDENCE: The policies for complaints and protection were unchanged from previous inspections and met the standard expectations. Staff and service users were able to confirm they understood the procedures for these, although no reports of complaints or abuse had been made. Staff were undertaking training in Protection of Vulnerable Adults. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises are generally bright, well maintained and clean in appearance. Communal facilities were not fully operational at the time of the inspection. The dining room does not provide accommodation for all the service users. Only one bathroom is suitable to meet the assessed needs of the current service user group. There is insufficient equipment to meet the service users’ assessed needs. Bedrooms are bright, spacious and contain individual’s personal possessions. The refurbishment of the premises is not carried out in the shortest period possible, so as to reduce the impact on service users’ access to these rooms. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 18 EVIDENCE: A tour of the premises identified that the majority of the home was well maintained and bright. Rooms were clean and there was no evidence of unpleasant odours in the home. The communal lounge was out of order at both visits, due to decorating works being carried out, that when completed will greatly enhance the space. The progress in completion of this work between the two inspectors visits had been slow, and staff reported that there was not an end date given, and that the workmen only attended once a week when the proprietor brought them. Whilst this work has been carried out the service users’ communal lounge has been temporarily accommodated on the first floor in a spare twin bedroom, this arrangement has an impact on their daily lives and the proprietor should seek to reduce this as far as practicable by ensuring a timely resolution to the works. The size of the dining room was discussed with the person in charge on the second visit. Although not all the current service users come into the dining room for their meals, this room does not appear to be sufficiently spacious to accommodate all the service users should they all wish to attend for meal times. In particular this would present difficulties in safely accommodating more that one person who had limited mobility and the associated mobility aids such as frames and wheelchairs. This has been raised with the proprietor at previous inspections, and is a repeated requirement. The person in charge on the second visit indicated that alternative furnishings were being considered as a possible solution. Discussions with the person in charge indicated that only one bathroom is equipped to meet the needs of the existing service users. There are two bathrooms and two shower rooms in the building. However the ground floor shower room has not been updated and is not appropriate to meet the physical needs of service users and the recently fitted first floor shower room is not in use by service users. Of the two bathrooms only the ground floor has hoisting facilities. The staff member reported that the proprietors were considering alternative fittings to the second floor bathroom as an alternative provision. During the first visit to the home on 15th May 2006 discussions with staff indicated that some service users were unable to weight bear when assisted to stand and therefore required moving and handling equipment in order to safely transfer from, for example their bed to their wheelchair. This information was not reflected in the care plans of the individual service users, and the full assessment of moving and handling risks was not documented. At that time staff reported that the only hoist was out of order, and awaiting repair. Staff were therefore carrying out illegal lifts when attending to service users who Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 19 could not weight bear. Staff had become aware of the issue following their moving and handling training. The proprietor was advised that this was an immediate requirement for attention and that the inspector was requesting independent assessment of moving and handling needs by the PCT Specialist Nurse for Residential Care. At the second visit the inspector was pleased to be shown a new hoist on hire to the home, whilst their own awaited repair. However staff advised that this was not operational as it did not fit into the home’s lift and could not therefore be used in service users’ rooms. The person in charge at that time did not know when the appropriate equipment was being delivered. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing arrangements do not support the identified care planning. Staff training had been updated. Some staff practice and understanding does not evidence a competent staff team. The staff files were unavailable for the inspection. EVIDENCE: The provider has previously stated the numbers and skill mix of staff support the service users’ assessed needs, particularly as the numbers of service users accommodated at the home has decreased in the last 12 months. However the observations of staff working practices and discussions with them and service users in the course of inspections do not support the view that all service users’ needs can be accommodated in the existing arrangements. This is further evidenced by care planning arrangements in areas such as social needs, where in order to meet those aspects of the plan a staff member would need to be absent from the home leaving only two staff, one of whom is in charge to meet the needs of other service users. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 21 The proprietor had advised the inspector in March 2006, that the training required for all staff was being updated in May/June 2006. At the visit on 30th May 2006, although training records were not available, staff on duty confirmed that they had undertaken this training. Although the planned programme had been intensive they stated they found the pace and delivery of the training good and it had stimulated their understanding of health and safety issues. An example of this was provided in the subsequent discussions in respect of moving and handling techniques. However, whilst staff identified that the manoeuvres they were carrying out were inappropriate they had not altered their practice or pushed for the correct equipment to support them. The first inspection visit for 2006/2007 took place on 15th May 2006, and was unannounced. However in the absence of the proprietor it was not possible to examine evidence contained in staff files in respect of recruitment, induction, training and supervision. In order to provide opportunity for the full assessment of this outcome group the inspector advised the proprietor of an additional planned visit on 30th May 2006. Although the proprietor advised she was unavailable due to leave on that date, the inspector outlined the reasons for the additional date and the records that they would require to access. However, the person in charge did not have access to these records. In the absence of such records it is not possible to update the assessment of compliance with the Care Homes Regulations 2001 and NMS. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 22 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, 32, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager. The culture and attitude within the service to the requirements of the National Minimum Standards do not support an understanding of good practice. There is no system in operation to improve quality of the service provision. Service users’ finances are appropriately managed. The records required to evidence best practice and to meet the Care Homes Regulations 2001 were not evident. Health and safety was not complied with. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 23 EVIDENCE: The service has been without a registered manager since 2003. Although the proprietors have repeatedly advertised for a replacement there have not been any applicants suitable for registration. In the interim the service has been managed by the proprietor visiting once or twice weekly, supported by the Deputy Manager. During this period the service has operated with a large number of repeated requirements and the vacancy in the registered manager’s position has been acknowledged by the proprietor as a contributing factor being able to work on the ongoing non-compliance levels. At the inspection in March 2006, the proprietor indicated that they were considering how else they may be able to appoint a suitable candidate to this position. During previous inspections the inspector has spent some time explaining how the service needs to comply with the Care Homes Regulations 2001 and NMS including why evidence presented does not always support the proprietor’s assertions of compliance. At various times they have indicated that the evidential records required such as care plans, staff recruitment records and induction records were only paperwork and that there is a disproportionate value placed on these in comparison to experience of care delivery. At the first inspection on 15th May 2006 the inspector encountered similar responses from senior staff in charge of the home, when discussions in respect of care planning within the home took place with the staff on duty. This lack of understanding and respect for the Regulations and Standards is the cause of some concern for the Commission. There was no indication that the quality assurance system had been further developed since the previous inspection visit. The service users’ finances were unavailable for inspection, however previous inspections indicated a full compliance with this standard, and there was no indication from the information available to inspectors that there had been any change in these circumstances. As detailed in other sections of this report the records required by Care Homes Regulations 2001, 17, Schedule 4 were not fully present or accessible. This included assessments of need, care planning, moving and handling risk assessments, and staff records. The failure to provide suitable equipment to support staff in meeting the moving and handling needs of service users demonstrates a failure to protect both parties from serious injury. Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 24 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 1 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 2 1 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 25 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 OP2 Regulation 17(1)(a) Schedule 3 Requirement The registered person must ensure that each service user has a written contract/terms and conditions with the home. This regulation was not assessed at this inspection and therefore is carried over to the next visit. 2. OP4 14 The registered person must ensure that the home meets the assessed needs (including specialist needs) of individuals admitted to the home. This regulation was not assessed at this inspection and therefore is carried over to the next visit. 3. OP7 12 (4)(a), 13 (5), 15 The registered person must develop and review the service users’ plans of care, as detailed in National Minimum Standards for Care Homes for Older People This is a repeat requirement. 31/07/06 31/07/06 Timescale for action 31/07/06 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 26 4. OP8 12,13(a), 15 The registered person must develop and review the service users’ plans of care, to ensure that the individuals health needs are appropriately responded to and action required to maintain their wellbeing is taken. This is a repeat requirement. 31/07/06 5. OP9 12,13,18 The registered person must ensure that the practice for dispensing medication adheres at all times to legislative requirements and good practice guidance. The registered person must ensure that service users’ rights to be treated with dignity and respect are upheld. Specifically this relates how staff support service users and the provision of equipment for moving and handling. The registered person must ensure that service users’ expectations and preferences in respect of activities, that are noted in care planning are supported by the daily routine of the home. This is a repeat requirement. 14/07/06 6. OP10 15 14/07/06 7. OP12 16(n) 31/07/06 8. OP14 12 The registered person must ensure that the home is conducted so as to maximise service users’ capacity to exercise autonomy and choice. Specifically this relates to adherence to care plans and provision of activities. This is a repeat requirement. 31/07/06 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 27 9. OP22 OP38 13(5),23 The registered person must ensure that facilities are suitable to meet the assessed needs of all service users, specifically equipment for moving and handling, communication and signage, which assists service users with dementia. This is a repeat requirement. 31/07/06 10. OP25 13(4)(c), 23 The registered person must ensure that pipework and radiators are guarded or have guaranteed low temperature surfaces. The registered person must ensure that the number and skill mix of staff meets service users’ needs. This is a repeat requirement. 31/08/06 11. OP27 18 31/07/06 12. OP30 18,19 The registered person must ensure that there is a staff training and development programme, which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims and objectives of the home and meet the changing needs of service users, with particular regard to meeting the needs of service users with dementia. This is a repeat requirement. 31/07/06 13. OP31 8,9,38 The registered person must ensure that the home has a registered manager who is qualified, competent and experienced to run a home. This is a repeat requirement. 31/08/06 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 28 14. OP32 18 (4) The registered person must ensure that the persons working in the care home adhere to the General Social Care Council Code of Conduct Section 6.7 in “recognising and respecting the roles and expertise of workers from other agencies and working in partnership with them.” Specifically that they respond to inspectors in a professional manner. 31/07/06 15. OP33 24 The registered person must 31/07/06 consider the introduction of quality assurance and monitoring systems to ensure the home is running in the best interests of the service users. This is a repeat requirement. 16. OP34 25 The registered person must provide a business and financial plan for the establishment, open to inspection and reviewed annually. This is a repeat requirement. 31/07/06 17. OP36 18 The registered person must ensure staff receive appropriate induction, supervision and training. This is a repeat requirement. 14/07/06 18. OP37 17 The registered person must ensure records as detailed in Care Homes Regulations, Regulation 17 and Schedule 4 are available for inspection. This is a repeat requirement. 14/07/06 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 29 19. OP38 12,13 The registered person must ensure so far as is reasonably practicable the health, safety and welfare of service users and staff. Specifically the provision of suitable equipment to meet moving and handling safe practice. This is a repeat requirement 14/07/06 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 OP3 Good Practice Recommendations The registered person should ensure that the assessments of service users are sufficiently complete , including reassessment at review. The registered person should maintain a record of service users’ choices to exercise their right to participate in the civic process and how this is supported. This standard was not assessed at this inspection and therefore is carried over to the next visit. 3. OP19 The registered person should ensure that maintainance carried out in the home with the minimum of impact to service users’ daily lives. Specifically that timescales are given for contractors to complete the work. The registered person should consider whether the dining room facilities are suitable for the purpose of achieving the aims and objectives set out in the Statement of Purpose and the needs of service users. The registered person should ensure that impact of the reduced access to communal facilities due to refurbishment of those rooms is kept to a minimum, and that the works are carried out in a timely manner. DS0000036541.V294937.R01.S.doc Version 5.1 Page 30 2. OP17 4. OP20 5. OP20 Anchor Lodge Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Anchor Lodge DS0000036541.V294937.R01.S.doc Version 5.1 Page 31 - 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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