Inspection on 06/12/06 for Ancona

This inspection was carried out on 6th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ancona 11/09/07

Ancona 24/01/06

Ancona 04/08/05

Ancona 28/10/04

Ancona 14/04/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Ancona The Square Freshwater Bay Isle Of Wight PO40 9QG Lead Inspector Mark Sims Unannounced Inspection 6th December 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.V316293.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. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 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.V316293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 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. The fee’s charged for accommodation at Ancona range from £365 to £480 per week, according to the statement of purpose. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for Ancona Residential Home, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the home, was conducted over one day, where in addition to any paperwork that required reviewing the inspector met with service users, relatives and staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involved far more pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service, comment cards completed by both relatives and service users and linking with previous inspectors who have visited the home. What the service does well: What has improved since the last inspection? What they could do better: The following is an indication of the areas where the service could perform better: • • • • • Promotion of Independence Recruitment & Selection Care Planning Health & Safety Medications Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 6 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. Ancona DS0000034735.V316293.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 Ancona DS0000034735.V316293.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 3: All service users are assessed prior to admission and provided with information relating to the service they can expect to receive whilst resident at Ancona. Standard 6: This standard is not applicable, as the home does not provide an intermediate care facility. EVIDENCE: Assessments: The evidence indicates that assessments are undertaken/obtained prior to admission, with files containing either assessments completed by the manager or her deputy (proprietor) or professional assessments. Information gathered during the inspection process, which substantiates these judgements and findings includes: Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 9 • Pre-admission assessments: A number of completed pre-admission assessments were seen during the case-tracking process (a review methodology used by the Commission’s inspectors during visits), when three care plans were scrutinised. The care plans of two of the three service users found to contain a completed in house assessment, which appeared to address the principle’s set out in Standard 3 of the National Minimum Standards for Older People. All three care plans also contained professional assessment documentation, the placement summaries provided by the local authority care managers and describing the persons needs and reasons for admission. • In conversation with service users it was established that people’s recall, of having been visited prior to admission was limited, however, two service users did discuss how their families had supported them in finding the home and had ensured it would meet their needs before they moved in. The dataset also confirms that the home has a policy on the specific area of ‘Emergency Admission’, although no indication of when this was last updated was available. In discussion with the proprietor(s), it was established that following last years inspection, when a requirement was made under standard 3, for the admission procedure to be formalised, the management team have worked hard to ensure appropriate pre-admission information is gathered. • • Ancona DS0000034735.V316293.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standard 7: The home’s care planning process provides inadequate guidance to staff around the service users’ care needs and how these are to be met. Standard 8: The health and social care support needs of the clients are well managed internally and are clearly meeting people’s needs. Standard 9: The home’s medication system is not being appropriately managed. Standard 10: The rights of the service users to be treated with respect and dignity are not being appropriately promoted by the practices of the home. EVIDENCE: Care Plans: The evidence indicates that the home’s care planning process is not being used appropriately and does not reflected adequately the needs and aspirations of service users. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 11 • Running records, used by the staff to evidence the care and service provided to the residents, document that five service users are repeatedly the first people up each morning at the home. In discussion with staff it was established that the majority of these individuals exhibit short-term memory problems and/or confusion and are often the people deemed to be awake first each day. However, the staff also discussed the management’s expectation that five people had to be up each morning before the day staff arrived for work. On challenging the proprietor’s it was established that their view is the same as the staff, that these people are awake, often in need of personal care and therefore should be attended to. However, the care plans for these people show no signs of their rising requirements or morning routines having been taken into consideration, the records also make no reference to any of these residents having ever been allowed to remain in bed if asleep, etc, despite the proprietors stating that this occurs from time-to-time. It is important that a care plan does what it states, creates a plan of care for the people residing at the home, taking into consideration their needs, wishes and aspirations. The care plans should also take into account people’s rights to selfdetermination and choice, the care plans for clients with dementia or confusional states, making allowances for their lack of capacity i.e. enabling a resident, who is not awake to lie in, as this could be sign that they are unready to wake. • Three care planning packages were reviewed, as part of the Commissions case tracking agenda and found to include or incorporate: 1. 2. 3. 4. 5. 6. 7. A resident’s profile & admission information Moving & Handling Assessment A Communications Report Professional Involvement/Medical Visits Record Care Plans Risk Assessments Accident Records Of the files reviewed none, had been properly reviewed or updated, including both care plans and risk assessment documentation, one clients file noted to have last been reviewed on the 01st August 2005, whilst another clients moving and handling needs had clear altered, her records Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 12 indicating she could still mobilise, whilst observations and staff comments established that the individual was reliant on staff for her mobility needs. • The service also remains at a crossroads, with the last inspector documenting that the implementation of a new computerised care planning system was imminent, however, since that inspection (24th January 2006) little appears to have altered, with the system in place, staff awaiting training and the care plan documentation currently paper based. In discussions the service users praised the staff for the care delivered, although seemed to know little about the care plans maintained on their behalf or to be interested in the content of their care plan when asked. Five comment cards, returned by local general practitioners, indicate that they find the home’s care planning process to be adequate and believe that ‘special advice is incorporated into the service users plan’. Two general practitioners also added separate remarks: ‘excellent care in a homely environment’ and ‘good care’. Health Care Supported: The evidence indicates that clients health care needs are well managed at Ancona. • • • The care plans, as listed above, document the visits of all health, social care and medical professionals. The care planning files including evidence of the treatment plans followed re-referrals or follow up appointments. The health and social care professionals comment cards returned indicating that people are generally happy with the service provided to service users. The general practitioners’ and health care professionals’ comment cards, as reported above, also indicating that care plans are amended to include their treatment plans or specialist advice. • Direct feedback from service users and relatives suggests that people feel the standards of care to be high and confirmed that access to medical attention / general practitioners’, etc, is appropriate. • • Medication: The evidence indicates that the home have made improvements to the way service users are supported with their medicines, however, some issues were noted to require further attention. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 13 • During the fieldwork visit the inspector scrutinised the homes’ medication system and whilst most elements of its management were found to be appropriate: o o o o o Storage Records Correct disposal Individually held and/or stored medications Availability of medication policies and guidance However, some elements were found to require attention, the medications had not been properly received into the home when the medication administration records were reviewed. The medication fridge thermometer was found not to be working accurately, although a replacement was available and quickly installed, however, the fridge temperatures were not being documented and the thermometer in use does not indicate the maximum and minimum daily temperatures reached. • The five professional comment cards returned by the general practitioners indicate that people receive their medication appropriately all five ticked ‘yes’, in response to the question ‘are service users medications appropriately managed’. Observations from the fieldwork visit day also suggest that service users receive their medications appropriately and that people are given time and support when taking their medicines. The dataset also establishes that the home has a medication policy/procedure available and that staff are receiving access to medication updates. • • Dignity and respect: The evidence indicates that the home is failing to give proper consideration to the service users rights. • It is discussed above how some of the service users rights to choice and self-determination is being neglected, the issue regarding rising and retiring times the perceived expectation that the night staff will assist five clients up each morning. The service users guide, however, (included with the dataset information), establishes for prospective service users that the home aims to: ‘preserve dignity – we respect those who support themselves and acknowledge that they are all entitled to a life of self-determination and individuality’. • Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 14 • It must be acknowledged that whilst the above situation is unfortunate and requires addressing, the staff and management also demonstrated some good practice, with one service user discussing trips out into the community and socialising with friends at local hostelries, etc. The comment cards of the general practitioners and seven relatives all indicated that they were enabled to visit their next of kin/patients in private and the eight service user comment cards all confirmed that ‘staff listen and act on what is said to them’. • Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 12: The service users enjoy a varied, if somewhat limited social activities programme, which appears to meet their needs and preferences. Standard 13: The visiting arrangements at the home meet the needs of both the residents and their relatives and good community links are maintained. Standard 14: The service users are helped to exercise choice and control over their lives. Standard 15: The meals are nutritionally well balanced and appetising. The menu’s varied and appealing. EVIDENCE: Entertainment and Leisure: The evidence indicates that all service users are afforded the opportunity to participate within activities and entertainments, although it is felt these are a little limited at times: Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 16 • The statement of purpose, provided as part of the dataset, establishes that: ‘During the summer months there is a list on the notice board in the hall of various places of interest that residents can be taken to in the home’s people carrier. If residents do not wish to go to particular venues then drives round the local area are arranged. We have programmes of activities to cater for most needs, which help to keep mind and body active. Trips with staff members to the local memorial hall are also arranged residents can go to see concerts and plays, etc. Twice yearly we hold a residents and their relatives party usually at Christmas and during the summer. • The dataset also, includes details of the activities available generally to the clients’ including: o o o o o o o o o o o Sponsored activities Independent Arts Cloth shows Parties Family History Albums Hairdressing Shopping trips Wheelchair & walking outings Pantomime shows Car rides Chiropody • None of the comment cards returned by relatives made any remarks about the activities provided within the home, however, several service user comment cards including a few completed by relatives incoropated statements such as: ‘The only activities available is a church service once or twice a month’. ‘Dad doesn’t always choose to participate but he is always included/invited’. ‘Mother being blind is not able to join in as much’. Sometime I believe activities are arranged but unfortunately my mother is no longer able to take part’. The above comments suggesting that entertainments are not arranged to meet the varying needs of the clients. • The above concerns, however, were not a surprise to the management, as they had undertaken their own quality audit recently, targeting DS0000034735.V316293.R01.S.doc Version 5.2 Page 17 Ancona entertainments and are now considering or reviewing the activities made available to service users. In conversation with the proprietor it was stated that with Christmas coming the following additional entertainments were being arranged: o Carol Service o Christmas Party. Visiting: The evidence indicates that the visiting arrangements at the home met both the service users and/or their relatives/visitors needs: • The previous inspector recorded within his report that ‘Residents are welcome to have visitors at any reasonable time’. This comment was supported by the visiting inspectors observations, with family members and friends observed arriving at and leaving on occasions throughout the day. • Comments made via the relatives comment cards indicate that people generally find visiting arrangements satisfactory, all seven comment cards ticked ‘yes’ in response to the question ‘do staff welcome you in the home at any time’. The service users also acknowledged the flexibility of the visiting arrangements and stated that they could entertain their families/friends in a variety of locations, lounge/diner, lounge or their bedrooms. On arrival and departure from the home visitors are expected to sign the visitors book, this providing a degree of security and keeping track of the people in the home in the event of fire, etc. However, the log also provides evidence of the visitors to the home and the type of people undertaking the visits, relatives, friends or professionals. Examination of the home’s log demonstrated that not all visitors sign in, although where people had the picture created was of a mixed social and professional visitor group, improved use of the log would of course provide a far better view of the people visiting the home. Self-determination & Choice: The evidence indicates that the homes’ approach to supporting people exercise their rights to choice and selfdetermination are not good, as demonstrated through this report: • • Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 18 • The information reported in regards to peoples’ rising and retiring arrangements and the expectation that night staff will help five people up each morning before day staff arrive at work. However, there is also evidence of good practice reported throughout the report: 1. Comments from service users 2. Participation in and choice of activities/community contacts, highlighted above 3. Choice of where to entertain visitors, also mentioned above 4. Previous inspection report comments/observations. • In addition to the information already contained within the report the inspector also found that: • Service users receive a varied menu, which affords people choice and selection, a copy of the home’s menu provided along with other information included within the dataset. In discussion with people using both this and the main lounge it was determined that people feel generally free and able to do what they please and find none of the home’s routines restrictive or limiting (mealtime, tea rounds, etc, etc). Comment cards from service users and their relatives indicate that people feel they are afforded choice, the service users remarking on being ‘listen to and their requests addressed’, whilst the relatives added comments like: ‘my farther is given exceptional care, he is treated as an individual with all his needs met’. • • Meals & Menus: The evidence indicates that service users are receiving a well-balanced and varied diet that is meeting their needs: • Sample menus provided to the Commission prior to the fieldwork visits and information taken from the previous inspection reports indicate that menus are ‘varied and balanced’. Observations of the meals provided to the service users indicate that teas are plated up according to the person’s known preference and appetite and conversations with staff evidenced that they understand the particular eating habits of their clients. Records checked during the visit indicate that information about the meals chosen and consumed by the clients are available and that fridges/freezers and meals are monitored to ensure food is stored and served at the correct temperature. DS0000034735.V316293.R01.S.doc Version 5.2 Page 19 • • Ancona 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standard 16: Relatives and visitors are confident that complaints or concerns brought to the attention of the management are appropriately addressed. Standard 17: Efforts to protect service users from abuse/harm could be improved. EVIDENCE: Complaints & Concerns: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and confident that the issues will be appropriately handled and addressed. • Five service user comment cards returned confirmed/ticked ‘always’ in response to the question ‘do you know how to make a complaint’. One person indicated ‘usually’ in response to the same question, one indicating ‘sometimes’, whilst the last comment card was completed: ‘due to the nature of dad’s disease, he would not comprehend how to make a complaint. However, I am certain they always have dad’s concerns in hand for any worries he may have’. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 20 • All seven of the of the relative comment cards indicating that people know how to make a complaint, all seven also confirming they have never needed to use the process. All five professional comment cards also indicated that they have never received a complaint about the home, several remarking on the quality of the care provided at the home. The statement of purpose, supplied as part of the dataset, establishes for residents and their relatives the home’s complaints process, should they require to use it, although further evidence gleaned from the dataset indicates that the home have received no complaints in the last twelve months. The dataset, also indicates that the management have a complaints procedure, which staff are able to access in house should they require, four staff questionnaires, returned in the build up to the fieldwork visit, suggest staff have a good working knowledge of the complaints process, all four staff indicating that they would keep records of the complaint and pass the information on the their manager, one person adding that they would ensure the client was satisfied with the outcome and another mentioning adherence to the home’s policy. • • • Protection: The evidence indicates that the service users welfare is being considered, however, the management are failing to completely ensure people are protect people from abuse and/or harm by their practices. • The dataset contains a statement from the manager, which establishes that adult protection training has both been provided to staff within the preceding twelve months and is planned for staff development, later in the New Year. All new employees are required to complete a full and detailed induction programme, which addresses all of the units defined by ‘Skills for Care’ under the new ‘Common Induction Standards’, as evidenced by the management during the fieldwork visit, and confirmed by a relatively new member of staff and the questionnaires returned by staff, all four questionnaires ticked ‘yes’ in response to the question ‘when you began work for this home did you receive induction training (to help you understand the way the home works and how to work safely and respectfully with service users). In discussion with staff, whilst none specifically mentioned the abuse training, it was established that the manager provides access to numerous skills development courses, a sentiment reflected within the questionnaires returned by staff, all four questionnaires ticked ‘yes’ in • • Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 21 response to the question ‘does the home provide funding and time for you to receive relevant training’. • As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing was identified. Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. The dataset also provides a clear statement of the fact that the staff are provided with access to an adult protection policy and procedure and that within the last twelve months no adult protection incidents have been referred to social service or the Commission. However, despite the good practice reflected above the inspector feels it is important to mention within this section of the report the managements failure to take up appropriate checks on new staff, an issue which is addressed in more detail within the staffing section of this report. The purpose, however, of making reference to this issue within the complaints & protection section of the report is to emphasis for the management that the purpose of taking up checks, references, Criminal Record Bureau (CRB) and Protection Of Vulnerable Adults (POVA), is to safeguard the service users and ensure that their wellbeing is promoted at all times. • • • Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 19 & 26: The premises’ is generally well maintained, clean & tidy and a reasonably pleasant environment for the service users. EVIDENCE: Environment: Work on the refurbishment and redecoration of the premises continues, although where work has been completed this is to a good standard. • A tour of the premises evidenced that the home is clean, tidy and generally well maintained throughout. The tour was undertaken with the management, when in addition to following up on issues outstanding from the last inspection the inspector also checked the premises for continued compliance with the standards. Issues identified during the last inspection included: Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 23 1. ‘Bedrooms are not provided with appropriate privacy locking arrangements for potential residents needs and wishes, in line with the standards’. This issue has now been addressed and bedrooms fitted with appropriate locking devises. • The actual tour of the premises was useful to the inspector, who had not visited the home for sometime, and was able to re-orientate himself to the environment and its layout. Much work has been undertaken since the proprietors purchased the home in 2003, with one half of the home completely redecorated, alterations to office accommodation and the creation of utility space with the kitchen. During the fieldwork visit the proprietors discussed the forthcoming refitting of the kitchen and the plan completion of redecoration of those parts of the home used by the service users. Work has also been completed on making the gardens more accessible to less mobile clients and this should pay dividends for people during the warm months of the year. • Information gleaned from the previous inspection report indicates that the last inspector found: ‘the home is well presented and maintained and there was clear evidence of the ongoing investment into the physical environment of the home’, as similar picture was noted at this visit. Information gathered from the service users during the visit indicated that they felt the environment at Ancona meet their needs and feeling/sentiment reflected within comment cards of both relatives and professional visitors: ‘excellent care within a homely environment’. • Cleanliness: The evidence again indicates that the home is clean and tidy throughout. • Seven of the eight service user comment cards indicate that people find the home to be clean and well maintained, all seven ticking ‘always’ in response to the question ‘is the home fresh and clean’, the remaining resident responding ‘usually’, to the same question. The tour of the premise raised no issues with regards to cleanliness, although chemicals used to clean the home should be stored more securely, this issue will be addressed within the management section of the report. DS0000034735.V316293.R01.S.doc Version 5.2 Page 24 • Ancona • • The previous inspector reflected through his report that: the home was cleaned to a good standard throughout at the time of the visit’. The dataset also indicates that polices and procedures are available around infection control and the Control Of Substances Hazardous to Health (COSHH). Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standard 27: Staffing levels are sufficient to meet the needs of the service users. Standard 28: The management team have achieved the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. Standard 29: The recruitment and selection practices of the home are not sufficiently robust to ensure service users’ wellbeing and safety are promoted. Standard 30: In-house training and development opportunities for staff are good. EVIDENCE: Staffing: The evidence indicates that the home employs staff in sufficient numbers to meet the needs of service users. • Copies of the staffing rosters, supplied prior to the fieldwork visits, indicate that the home is well staffed and that sufficient care staff are available, across the twenty-four hour period, to meet the needs of the service users. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 26 • Observations further evidence the fact that adequate staff are available to meet people’s health and social care needs, the staff on duty comprising: 1. The deputy manager (proprietor) 2. Proprietors 3. Three care staff • The seven relatives comment cards returned in the build-up to the fieldwork visit indicate that sufficient staff are available, all seven ticked ‘yes’ in response to the question ‘in your opinion are there always sufficient numbers of staff on duty’. The professional comments also appear to support the fact that sufficient and appropriate staffing levels are maintained, people’s testimonies indicating that: ‘there is always a senior member of staff to confer with’ and that people are ‘satisfied with the overall care provided to the service users’. The previous inspector also found the staffing arrangement of the home to be adequate, reporting: ‘staffing levels were maintained to a good standard’. The majority of the service users who responded via the comment cards also indicated that they found the home’s staffing arrangements to be satisfactory, five ticking ‘always’, two indicating ‘usually’ and one person ticking ‘sometimes’ in response to the question ‘ are staff available when you need them’. • • • Training & Development: Training & Development: The evidence indicates that the training opportunities for the staff are good, although the records maintained in respect of the courses completed require attention. • The four staff surveys returned to the commission, prior to the fieldwork visit, all establish that the staff believe they have access to sufficient training events. All four questionnaires ticked ‘yes’ in response to the question ‘does the home provide funding and time for you to receive relevant training’. • The dataset provides details of both the training completed by staff over the last twelve months and courses planned for the New Year: 1. Completed:Manual Handling Catheter Care Stoma Care Fire safety DS0000034735.V316293.R01.S.doc Version 5.2 Page 27 Ancona Adult Protection Aggressive behaviour Staff supervision Alzheimer’s & dementia Awareness Risk Assessment. 2. Scheduled training:Abuse/Adult Protection First Aid at Work Medication Administration & Record Keeping Depression Awareness Learning about strokes Introduction to Mental Health • It was also clear, given the information gleaned from the manager and feedback from the staff, that they are also being well supported when accessing National Vocational Qualifications (NVQ), staff discussing accessing both level 2 and level 3 qualifications. The evidence within the dataset, establishing that the home has met and surpassed the 50 ratio recommended within the National Minimum Standards, the percentage rate reportedly 90 , although the inspectors math differs, making the percentage 71 , based on the information supplied. Recruitment & Selection: The evidence indicates that the home’s recruitment and selection process is not being appropriately managed. • At the last inspection it was reported that: ‘staff recruitment, selection, supervision and retention met the standards’. However, at this visit significant short fallings were found in the home’s recruitment process, with five newly recruit staff discovered to have incomplete employment files. Missing or erroneous items from the files of these staff included: 1. 2. 3. 4. 5. 6. 7. Photographic identification Documents establishing identification Full employment histories Reference from last employers Criminal Record Bureau and Protection of Vulnerable Adults Checks Work permit/visa information No records at all. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 28 • Some records were available on the file, which suggests that appropriate recruitment tools are available to the management, they were just not being appropriately used during this visit: 1. 2. 3. 4. 5. Application forms Health check forms Declaration of Criminal Background (DCB) Induction outcome Interview Records. • Information from the four staff questionnaires also indicates that a more robust recruitment process/tool is available to the management, all four people indicating that on applying to the home for employment they submitted to: 1. 2. 3. 4. 5. 6. Interview CRB & POVA checks Provided photographic Identification Completed and Application Completed and Induction Were provided with a Job Description and Contract. • The latter findings suggesting that clerical and or managerial errors are responsible for the shortfall discovered at this visit. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standard 31: The manager may be of good character but her part-time position within the home is not enabling her to run the home effectively or efficiently. Standard 33: The home is run in the best interests of the service users. Standard 35: The financial interests of the service users are properly managed. Standard 38: Some work is required to ensure the safety and wellbeing of the service users is always maintained. EVIDENCE: Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 30 Management: The evidence is confusing, as the home is generally meeting the needs of the service users and providing a satisfactory level of care, however, the muddled and disorderly employment files and hiccups with medication receipting, etc give cause for concern, especially as the manager is no longer solely working at the home. • The evidence from previous inspection visits have established that the manager is appropriately qualified for the role and has experience of working throughout the social care sector. However, in discussion with the deputy manager/proprietor, it was established that the manager has reduced her hours and now works part-time at the home and locally at the health clinic. Given the debacle with the staffing records and some other records seen during the visit, as reported, the inspector is concerned that the management arrangements are currently unsuitable for the home and should be reviewed, a matter discussed with the proprietor. • Other information gathered during the visit and in the build up to the visit indicates that the home is running in the best interests of the clients: The general practitioners indicating that they believe the management ‘take appropriate decisions when they can no longer manage the care needs of the service users’. Relatives making comments such as, ‘I am more than satisfied with the staff, the home and the treatment of my mother’, a statement supported by all six other relative and the five professionals, who unanimously ticked ‘yes’ when asked ‘are you satisfied with the overall care provided’. Quality Assurance: The evidence indicates that both formal and informal quality auditing are used at Ancona. • During the fieldwork visit the inspector took the opportunity to read through the comment book made available to service users and visitors within the main entrance hall. This journal allowing visitors and relatives, especially, to make or pass comment on the service provided to their friends and/or next of kin, recent entries including: ‘E never tired of saying how much help, care and kindness you gave her, she loved to know about your children and families’. ‘I’m so glad they had the downstairs bedroom, some sunshine, space outside, my mother felt very looked after and loved the garden’. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 31 • In addition to this informal opportunity for people to provide feedback on the service provided that management also conduct quality surveys, the deputy manager (proprietor) showing the inspector the outcomes of a survey into people preferences for entertainment. In discussion with the deputy manager (proprietor) the benefits of smaller targeted quality auditing activities were considered, the deputy manager of the opinion that this process enabled a far better tailored response to issues and feedback. • The poor recruitment files and the failure to update or record that care plans had been reviewed and updated, along with the failure to properly receipt/account for medications, tend to indicate that people are forgetting to audit their own practice and this should be tightened up on, although generally efforts to audit the service provided at Ancona are progressing. Service users Monies: The evidence indicates that service users are appropriately supported when managing/accessing finances. • The last inspector reported that: ‘residents spoken to confirmed that they could have access to monies if they needed it, the home providing this service and billing retrospectively’, the statement of purpose also makes reference to this service. Neither during conversation with service users nor through the comment cards, did any individual raise a concerns or issue with the way their finances are managed in house, again people generally relaying how satisfied they are with the service provided. • Health & Safety: The evidence indicates that the health and safety of the service users and staff is generally being well managed. • No immediate health and safety concerns were identified with regards to the fabric of the premises during the tour of the property. However, a number of chemicals, which should be stored in accordance with COSHH regulations, were noted left around the home and therefore accessible to residents, etc. It is important that all substances controlled under these regulation be properly stored at all times and that staff using these chemical, etc have access to data sheets, which describe how to use, store and clean up the applicable product. • The dataset establishes that full health and safety policies/guidance documents are made available to the staff. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 32 • Health and safety training is clearly made available to staff, with the dataset evidencing that staff complete first aid, fire safety, moving and handling, infection control and food hygiene. Access to paper towels and liquid soaps within bathrooms & toilets are indicators of attention to infection control, as is the availability of a specific infection control policy, as listed within the dataset and the training opportunities, as planned for later in the year. At the last inspection the home was required to increase the number of staff possessing a first aid qualification: Through this inspection it has been established that five staff currently hold the required qualification, with a further two staff completing their first aid course, this information was taken from the dataset. • • Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation Requirement Timescale for action 01/02/07 2 OP9 Regulation The care plans of the service 15 users should reflect their personal choices and wishes and should be regularly updated and reviewed. Regulation Medication must be properly 13 receipted/accounted for on entry to the home. Medications stored in a fridge must be maintained at the correct temperature and records of the temperatures made each day. Regulation How service users rights to self15 determination and choice over rising and retiring times, etc, must be clearly evidenced. Regulation The management must ensure a 19 through and robust recruitment and selection process is established and maintained at Ancona. Regulation All chemicals must be stored in 13 accordance with the appropriate COSHH guidance and their individual data sheets. 01/02/07 3 OP10 OP14 01/02/07 4 OP18 OP29 01/02/07 5 OP38 01/02/07 Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 35 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 OP31 Good Practice Recommendations The current management arrangements should be reviewed to ensure they are best meeting the needs of the service users and the home at large. Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Ancona DS0000034735.V316293.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!