Inspection on 31/05/07 for Anchorage Nursing Home

This inspection was carried out on 31st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Anchorage Nursing Home 14/05/09

Anchorage Nursing Home 22/05/08

Anchorage Nursing Home 26/09/06

Anchorage Nursing Home 18/03/06

Anchorage Nursing Home 29/11/04

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

CARE HOMES FOR OLDER PEOPLE Anchorage Nursing Home 17 Queens Road Hoylake Wirral CH47 2AQ Lead Inspector Julie King Unannounced Inspection 31st May 2007 10:50 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 Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Anchorage Nursing Home Address 17 Queens Road Hoylake Wirral CH47 2AQ 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) 0151 638 4391 0151 632 0367 rolfields@btconnect.com Rolfields Limited Helen Devaney Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Anchorage Nursing Home is a three storey building situated in Hoylake. The home is registered to provide nursing care for up to thirty-five service users over the age of 65 years of age. There are bedrooms on all three floors of the home. There are two dining rooms, lounge and conservatory situated on the ground floor, as is the kitchen and laundry room. There is a passenger lift to all floors and a stair/chair lift from ground to first floor. There are two care parks, providing ample space for visitors. Rolfields Ltd owns the home and the registered manager is Helen Devaney. The home have a sister home located in the local area. It costs £480.00 per week to live at the home Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was completed in one day as part of The Anchorage’s key inspection. During the visit some members of staff, residents, management and multidisciplinary healthcare team (MDT) members were spoken to. Most areas of the internal environment were also inspected. Documentation, especially staff files, resident’s care files and medication administration records were examined. What the service does well: What has improved since the last inspection? Since the previous unannounced site visit there have been improvements in the standard of record keeping, staff training and personnel files and the overall teamwork of the home. The biggest improvement has been in the environment, with many areas being recently decorated and refurbished. Some areas of staff records have also improved, but ongoing improvement is required to fully meet all necessary standards. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs appear to be met, and the home is now able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: A random selection of resident’s care files were examined as part of the casetracking process during the site visit. All residents files seen evidenced a pre admission nursing assessment before they were admitted to the home; the manager, or one of the nurses in the home undertakes the assessment. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 9 Residents, family and other health care professionals known to the resident contribute to the assessment. Pre admission assessments provide an assessment of actual and potential needs of each prospective resident; thus allowing a care plan to be developed. It was recommended that the pre admission assessment tool be utilised in more detail to ensure that all prospective resident’s needs are fully identified, therefore providing adequate information upon which to formulate a more detailed care plan. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS outpatient’s appointments, opticians, dentistry, and tissue viability nurse specialist (TVNS) input at the home when needed. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s individual health, personal and social care needs are recorded, providing staff with most of the information they need to meet each resident’s care needs. Medication management is inadequate, potentially placing residents at risk. EVIDENCE: A random selection of residents care files was examined, including newly admitted residents and any resident with a wound. All care files seen were in process of being updated to reflect the expectations of the national minimum standards, and some seen evidenced an improvement since the previous site visit. Risk assessments have been expanded and are now more detailed Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 11 regarding resident’s care needs related environmental risks such as those associated with the use of bed rails, immersion bathing, etc. Medications were not fully compliant with regulations. This is the second concurrent time this has happened. The findings of concern were gaps in the medication administration records (MARs), especially for ‘as needed’ medications; and the medication fridge and room temperatures were outside of the required ranges. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in, such as outings, bingo and manicure therapy. Since the previous inspection a designated activities co-ordinator has been recruited for 24 hours per week- a welcome addition to the staff team according to residents and relatives spoken to during the site visit. Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors in the communal lounges, or in their own bedroom. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 13 The gardens are accessible and tidy, and are an ideal setting for residents to sit with their relatives, especially in the summer months. The residents informed the inspector that they enjoyed the variety of food in the home. Comments such as “if I don’t like what’s on the menu I can choose from a selection”, and “the food is good” were received from residents. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: The Anchorage has a complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that service users, relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’ (reporting concerns regarding poor practice), in accordance with the Department of Health ‘No Secrets’ guidelines. The CSCI has not received any complaints about this service since the previous inspection and site visit. Some of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the future. However all staff do receive basic training in the protection of vulnerable adults during induction, but it is required that all staff, including housekeeping staff complete adult protection training as soon as possible. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most resident’s rooms are personalized, providing the residents with a homely, comfortable place to live. EVIDENCE: The Anchorage has pleasant gardens to the side and rear of the property that are accessible to residents. A patio area with seating is also provided. The home benefits from a conservatory and an additional quiet lounge for relatives and families to use as they wish. Most communal areas and bedrooms were examined, and some evidenced ongoing decoration and / or refurbishment, albeit to varying degrees. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 16 Bedrooms were personalised, with many residents bringing in their own furniture, etc. There were a couple of rooms that had a malodour, and the inspector was informed that consideration is being given regarding management of this problem which will be resolved as soon as possible. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a consistency within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: A selection of staff personnel files were examined as part of the case-tracking process. Some files contained the required documents and records, but most are still in process of completion. CRB and POVA evidence was available, as were references, some training information, NVQ training, proof of identification and basic inductions. Records of staff training lack sufficient detail and do not evidence the competence of staff to do their jobs. The specialist care training needs of staff must be reviewed to ensure the health, safety and well being of all residents. Staff stated, “I feel supported”, and “I am told about peoples care and what they need”. Staff supervision records were not assessed on this occasion. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. There is adequate leadership to staff from the home’s management which helps provide stability for residents. EVIDENCE: The manager is a first level registered nurse with many years experience of working with frail elderly people in a care home setting, and is registered with the CSCI. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 19 Some quality assurance (QA) is available, and the home achieved a nationally recognised award in this area last year. It is recommended that additional QA that reflects the changes in legislation is implemented, and should include accident, falls, medications and staff training information. A small amount or residents money was being processed via the company’s own bank account, which is a breach of regulation, despite accurate record keeping by the home’s administrator. This was discussed with the administrator and registered manager who assured the inspector that separate accounting facilities will be established as a priority. Examination of the fire log book evidenced that staff do receive training, but it is strongly recommended that staff are told to sign the log sheet to prove that they have attended their training, rather than ‘all staff on duty attended’ is recorded. It is also strongly recommended that at least one designated member of staff completes recognised training in the safe fitting and assessing of bed rails. Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 21 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 OP30 Regulation 18 Requirement All staff must have undertaken the mandatory training programmes. Remains outstanding from previous inspection report. The registered person must ensure all care plans are detailed and provide the basis of which care can be given. Remains outstanding from previous inspection report. The registered person must ensure that all handwritten medications are double signed. Remains outstanding from previous inspection report. The registered person must produce a maintenance and decoration plan, to include provision for replacement of the carpets identified in the report The registered person must ensure that all staff employed receive suitable and sufficient training in the protection of DS0000065659.V332647.R01.S.doc Timescale for action 01/09/07 2. OP7 15(1) 01/09/07 3. OP9 13(2) 01/07/07 4. OP19 23(1)(2) 01/08/07 5. OP18 13(6) 01/09/07 Anchorage Nursing Home Version 5.2 Page 22 6. OP19 23(2) 7. OP26 16(2) 8. OP28 18 9. OP29 19 vulnerable adults, including the prevention of abuse. The registered person must ensure that the care home is kept well furnished and well maintained at all times. The registered person must ensure that the care home is kept clean and odour free at all times. The registered person must ensure that all staff receives training appropriate to the work they perform, and this training is clearly recorded. The registered person is required to ensure that all documents and records as specified in Schedule 2 of the Care Homes Regulations 2001(amended 2006) are obtained for all persons employed. 01/10/07 01/08/07 01/10/07 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 1. OP9 2. OP33 3. OP35 4. OP38 5. OP38 Good Practice Recommendations It is recommended that the manager audits medication charts on a monthly basis. It is recommended that quality assurance systems are developed in conjunction with the relevant national minimum standards. It is strongly recommended that the current practice of transferring resident’s personal allowances ceases and separate accounts are obtained. It is recommended that all staff how receive training, including fire training, sign to evidence that they have attended. It is strongly recommended that a designated member of staff completes suitable and sufficient training in the fitting and monitoring of bed rails. DS0000065659.V332647.R01.S.doc Version 5.2 Page 23 Anchorage Nursing Home Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Anchorage Nursing Home DS0000065659.V332647.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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