CARE HOMES FOR OLDER PEOPLE
Ancona The Square Freshwater Bay Isle Of Wight PO40 9QG Lead Inspector
Richard Slimm Unannounced Inspection 24th January 2006 10:00 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 Ancona DS0000034735.V260051.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. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ancona Address The Square Freshwater Bay Isle Of Wight PO40 9QG 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) 01983 753284 01983 753284 Mrs Carole Mary Brooke Mrs Patricia Susan Ann White Care Home 18 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (18), of places Physical disability over 65 years of age (6) Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: Ancona is a registered care home, which provides care/support and accommodation for people who may have dementia over the age of sixty-five years. Six residents may be accommodated by reason of age related physical disability over 65 years. The home is situated in a quiet residential area of Freshwater close to the centre of the village. The home has benefited from significant building works, upkeep and maintenance programs including the development of improved access to the extensive rear gardens, and an ongoing refurbishment plan is in place to continue the improvement of the physical environment. Accommodation is organised over 2 floors across 2 houses that are linked on the ground floor, with access to all floors via the two shaft lifts. There are large gardens to the rear of the home, which are enclosed and fully accessible to residents. The ground floor has some bedrooms, but also provides communal space, including a large lounge split into two areas, a dining area, communal bath/toilet facilities, the kitchen, a utility room and staff WC. All bedrooms are single and 13 have been provided with en suite facilities. Each floor has access to communal bathing/shower and WC facilities. The home also has staff accommodation in the attic area. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between the hours of 10 am and 4 pm on the 23/1/06. The day was spent visiting service users in their own rooms, and communal areas of the home and interviewing them in order to establish their views of the quality of service provided by the home. The inspector followed up progress with recommendations made in the last inspection report. There had been one new admission since that time. A privacy door lock had not been provided due to the special needs of the resident concerned. The owner will be seeking dispensation from providing this standard from the CSCI. However, longer term the owner plans to invest significantly in the development of the physical environment of the home, and is fully aware that registration for such a development will require the provision of privacy locks to bedroom doors. Action had been taken to produce individualised daily care records. Staff members are now careful to ensure that where medications change, the prescribing medical professional signs the relevant records. Residents had been provided with increased opportunities to journey out from the home. No action had been taken to obtain a copy of the department of health guidance for adult protection, “No Secrets”. Records of staff fire training and drills had improved, and action had been taken to defrost the freezers. The inspector checked records and other relevant documentation, interviewing care, management staff/owners. Both residents, staff and visitors spoken to, made positive comments about the home. The inspector spoke to a local GP visiting at the time of the visit that confirmed the home was meeting the needs of those patients she was visiting. This report will make 3 requirements and 2 recommendations. What the service does well: What has improved since the last inspection?
Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 6 Action had been taken to implement four of the six recommendations made in the last inspection report. Ongoing improvements to the environment were noted, and the home was well presented and clean, providing a valuing environment to residents. A number of bedrooms had been totally refurbished including the provision of new carpets and furnishings. The old outhouse had been demolished, as it was unsafe. Handrails had been provided to the slopped area of the garden to promote greater independence of residents’. A new workstation has been developed for the staff, and an improved secure medication area developed. A new computer system has been purchased with a care related software package to promote more efficient systems of assessment, care planning and recording, as well as a human resources package. 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. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents have their needs assessed prior to admission. Residents’ are assured that their needs will be met at the home. EVIDENCE: The home does not provide intermediate care services. Consequently standard 6 was not assessed. A sample of care assessments, planning and review systems were inspected, via a case tracking process. Care assessments continue to develop, and appeared to provide the information needed to develop clear plans of care. Where necessary the home will seek additional input from residents’ advocates/relatives, wherever possible with the consent of the resident. Residents were found to be contented, more able residents spoke very highly of the quality of the service they received at the home. However, given the degree of confusion of some residents they were not all fully aware of care records held about them. Staff members were able to demonstrate an awareness of residents’ needs and the importance of care planning systems in regard to promoting consistency and accountability. Staff will need some training input in the ongoing implementation of the new computerised system at the home.
Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 Residents had individual plans of care. Care plan records were specific. Daily monitoring care records are kept appropriately. Care plans, and management systems, did ensure residents health care needs were identified and met. Arrangements for the administration of medications were found to be appropriate to the needs of the residents who needed support. Changes to medication dosages where signed by the external professional making these changes. EVIDENCE: Each Resident has a plan of care. Monitoring notes of care plans were being maintained on an individual basis, and providing a clear chronology of the care provided or issues arising. Care plans appeared to have developed to provide increased insight into the mental health/psychological needs of residents. More confused and frail residents have fluid/food intake records. Staff members training needs were identified in the area of implantation of the new computerised system, and the owners were aware of this need. Residents were able to confirm that they had access to community health care support as required, and confirmed that they could see their GP in private on request; this was also confirmed by a visiting GP. Some residents were under specialist health services, including consultants and community psychiatric nurses. The
Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 10 inspector spoke to visitors who confirmed that they visited the home on a regular basis and always found the home to be welcoming, clean, and with a staff group who were interested in the residents, and responsive to their needs. Residents spoken to confirmed that the staff members treat them with dignity and respect, and this was also observed throughout the visit. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The home provides opportunities for residents to have outings from the home. Residents experience a lifestyle of their choosing. EVIDENCE: Residents are support and enabled to take outings from the home with staff support where needed. More able residents journey out independently or with the support of friends/relatives. Residents confirmed that they felt part of the local community, and were happy with the amount of activities provided. The home plans to improve the choice of activity available, and residents will need to be consulted about these issues. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 12 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): 18 Systems are in place to ensure the protection of vulnerable residents from potential abuse. EVIDENCE: There is an adult protection policy and procedure in place and this is available to staff members. Staff training in adult protection is provided in-house, with plans to access external courses. A number of staff members have received adult protection training via their NVQ courses. The home reports all incidents affecting the wellbeing of residents to the CSCI as required. Residents confirmed that they felt safe living at Ancona. The home would benefit from accessing a copy of the department of health adult protection document “NO Secrets”. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 13 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): 19-24-30 The home was clean and well maintained, providing a valuing environment to residents. Bedrooms are not provided with appropriate privacy locking arrangements for potential residents needs and wishes, in line with the standards. There is a clear commitment and written plans for the ongoing improvement and development of the home’s environment. EVIDENCE: The home is well presented and maintained, and there was clear evidence of the ongoing investment into the physical environment of the home. The home was cleaned to a good standard throughout at the time of the visit. Residents stated that they were happy living at the home, and confirmed their home was always kept clean and decoration is ongoing, and that they were involved in deciding colour schemes including carpets. Residents also confirmed that they accessed the garden frequently in warmer months. There are plans to invest in the enlargement of the home. A workstation for staff had been developed since the last inspection and an improved storage area for drugs and medications. Several rooms had benefited form refurbishment and new carpets. No bedrooms have appropriate privacy locking arrangements that meet the
Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 14 standards, however, existing residents were not concerned with this matter. The owners have once more agreed that they will consult with all residents about the provision of door locks to individual bedroom doors, and where necessary provide appropriate locks. It was agreed that existing residents who choose not to have locks will have their wishes respected, however, as residents move on rooms will be provided with locks before new residents are admitted to the home in the future. The owner will be seeking dispensation from this standard for one resident for whom door locks have been assessed as being potentially detrimental to the promotion of independence. The owner is fully aware that any future development of the home will be subject to the provision of suitable doors locks prior to registration being granted. The manager/owner have agreed to monitor this issue in consultation with the resident group. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-29-30 Staffing levels were maintained to a good standard. Staff recruitment, selection, supervision and retention met the standards. Staff members may benefit from training in the new computerised care record system. There is an ongoing commitment to the training and development of staff in NVQ. Insufficient staff members are trained in first aid. EVIDENCE: The home has clear staff rosters. Staffing levels were maintained to a good standard. The home has taken on additional senior staff in order to free up the owners to provide other service developments, in such areas as resident outings. The current manager will be standing down from this role, and a new applicant for manager will be contacting the CSCI in due course. Residents spoke highly of the staff team, and confirmed that they are always treated with dignity and respect. Staff members were observed interacting well with residents, and providing sensitive, discreet support. Staff may benefit from increased training in the implementation of the homes’ new computerised care record system. There is one waking and one sleep in staff member at night. In addition to care staff the home employs ancillary staff including a cook and domestic. The home uses a recruitment and selection system that meets the legal requirements and provides safeguards for residents, by ensuring staff receive appropriate checks. There is a clear commitment to the ongoing training and development of the staff team to NVQ levels 2 and 3. There are a number of highly dependent residents, however, staffing levels were of a level that ensure their care needs did not detract staff time from other residents accommodated. The manager is qualified to NVQ 4 and is currently doing the
Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 16 registered managers’ award. The inspector met and interviewed 5 care staff. Two staff on duty had NVQ 3 and one was currently doing NVQ 2. Staff had also been provided with other specialist training relevant to the care needs of the resident group, and there was a session on manual handling and moving being provided at the time of the inspection. Staff members confirmed there are regular staff meetings, and formal staff supervision is being provided. Staff spoken to confirmed that they were happy working at the home. There were insufficient staff members trained in first aid to provide 24 hour cover at the home. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 17 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): 33-35-38 The home is run in the best interests of residents. The home has no input into the residents’ financial interests or affairs. The induction for new staff, in the area of fire protection failed to promote best practice. Insufficient staff members are trained in first aid. EVIDENCE: Systems of quality assurance continue to develop at the home. The homes’ owners’ are a husband and wife team who employ a manager, and are keen to work with the CSCI in the ongoing development of the service. Residents’ spoken to confirmed that they could have access to money if they needed it, the home providing this service and billing retrospectively, thus avoiding the need to handle any personal allowances. Staff members had received training in core training topics, including manual handling, fire safety, and food-hygiene and infection control, however, there were insufficient staff trained in first aid. The manager and one of the owners make arrangements for the maintenance of health and safety at the home. As identified above the current manager will
Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 18 be standing down in due course, once the replacement manager has been registered. At the time of the visit induction of at least one new staff member had not focused adequately on fire training and other fire related issues contrary to best practice, the standards and the recommendations of the chief fire officer. The owner/manager agreed that this omission would be rectified. Residents confirmed that the fire alarm system is tested regularly and that they felt safe living at the home. Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 19 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X 1 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 1 Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 OP24 Regulation 23 Requirement Privacy door locks must be provided to bedroom doors prior to any new resident being admitted to the home. Existing residents must be consulted regularly about having a choice of privacy locks fitted to their individual bedroom doors. The registered persons must ensure that all new staff members receive full and adequate induction, including clear induction into fire precautions and emergency routines at the home. Full records must be maintained. The registered persons must ensure that sufficient staff members are trained in first aid, in order to provide cover over any 24 hour period. Timescale for action 05/04/06 2 OP38 12/13/23 05/04/06 3 OP38OP30 13 05/05/06 Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 21 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 OP33OP12 Good Practice Recommendations The registered persons should consult residents carefully about the plans to review activities provided at the home. Residents will also need to be consulted about plans to develop and extend the services provided at their home. The registered persons should obtain a copy of the government guidance on adult protection No Secrets from department of health. This recommendation is repeated. 2. OP18 Ancona DS0000034735.V260051.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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