Inspection on 14/01/08 for Angel Court Residential Home

This inspection was carried out on 14th January 2008.

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

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

Angel Court Residential Home 23/03/09

Angel Court Residential Home 21/02/07

Angel Court Residential Home 02/02/06

Angel Court Residential Home 31/08/05

Angel Court Residential Home 30/09/04

Angel Court Residential Home 12/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Angel Court Residential Home Angel Street Hadleigh Ipswich Suffolk IP7 5HA Lead Inspector Jenny Elliott Unannounced Inspection 14th January 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Angel Court Residential Home DS0000037158.V357826.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. Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Angel Court Residential Home Address Angel Street Hadleigh Ipswich Suffolk IP7 5HA 01473 823147 01473 829157 frances.nunn@socserv.suffolkcc.gov.uk 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) Suffolk County Council Mrs Frances Mary Nunn Care Home 29 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (19) of places Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2007 Brief Description of the Service: Angel Court is a residential home for older people situated in the heart of the market town of Hadleigh, close to local amenities and owned and administrated by Suffolk County Council. The home offers accommodation and care for up to 29 residents. 10 places are allocated for those with special needs (inclusive of one special needs respite bed), the remaining 19 places also includes one respite bed. The home was initially opened in the mid 1960s and extensively refurbished between September 1996 and May 1997. Angel Court also operates a twelve place day centre for older people, having its own access and facilities. At the present time the day service is not subject to registration and inspection. The accommodation, located on two floors, includes a lift, and a staircase, connecting the two floor levels. The home has a garden, which includes patio-seating areas, birdbath and table. There is off road car parking at the front of the home. Current fees for this home range from £500.00 to £691.00 Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report includes information gathered from a visit to the home on 14th January 2008, lasting nearly 7 hours. During this visit time was spent with people who live and work in the home as well as the inspection of records and documents relating to the provision of care. A tour of the home was also undertaken. In addition information received be the Commission for Social Care Inspection (Commission) since the last inspection was taken into account. This includes information contained in the Annual Quality Assurance Assessment, completed by the manager of the home. What the service does well: What has improved since the last inspection? The service has improved the checks it undertakes on new staff. This helps to ensure that people who are recruited are suitable for the work. Angel Court Residential Home DS0000037158.V357826.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. Angel Court Residential Home DS0000037158.V357826.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 Angel Court Residential Home DS0000037158.V357826.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): 2,3 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People moving into the home cannot be confident that their needs will be fully assessed or that the home can meet those needs. EVIDENCE: Records belonging to three people living at the home were reviewed in detail as part of this inspection. Two sets of records included contracts. The contracts would have met the requirements of regulations in place at the time the people moved into the home, but do not satisfy the amended regulations in place at the time of the inspection. The information provided was clear about the services that are covered by fees but do not state how much the fees are. The third set of records, belonging to the person most recently admitted to the home did not include a contract. The home was aware of the need to include fees in contracts. The Annual Quality Assurance Assessment (AQAA) which is a document the home is required to complete under Care Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 9 Homes Regulations 2001, stated, under our plans for improvement over the next 12 months ‘In consultation with the Finance Dept. obtain clear quotes of the cost of the service, (at present this arrives after the admission of the resident).’ This was sent to the Commission on 24th October 2007. Social Services had supplied information to the home about the person who moved in most recently. This included (in a number of places) reference to issues that need to be addressed ‘for the benefit of other residents’. There was no evidence that these issues had been followed up by home prior to the person moving in. The Manager said she had visited the person at their previous accommodation to carry out her own assessment but had not written anything down because she didn’t think she would be accepting them as a resident. The Manager said that the social worker was ‘seeking a place as a safety net’ and that at this point she didn’t feel as she had much choice about taking the person into the home, and accepted that the lack of assessment by the home didn’t help. Shortly after this inspection the Commission was advised that the person had moved to more suitable accommodation. Intermediate care is not provided at Angel Court. Angel Court Residential Home DS0000037158.V357826.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. People who live in the home cannot be confident that plans of care will detail the support they want or that changing needs will be addressed promptly. EVIDENCE: Care plans belonging to three people living at the home were also inspected in detail. The plans were held in ring binders, each ring binder had a contents page with 26 elements. It was not always easy to locate information. Two of the plans included personal histories. These provided good information about important events or people in the life of the person living in the home. One was particularly well presented as it included photographs. This is important because it helps people to maintain their own identity, and for staff to see residents as individual people. Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 11 One section of the care plan was headed ‘Residents Personal Care’. This provided information about the help people needed. Some entries were very general, for example ‘Assistance and guidance required’ or ‘Encourage [name] to maintain levels of independence’. These could apply to anyone living at the home. For one person every area of this part of the care plan had the words ‘needs assistance’. This person had very challenging behaviour at times, and ‘Needs assistance’ does not provide sufficient information to enable staff to ensure that all aspects of the person’s health, personal and social care needs will be met in the way they wish. There was one example of very clear guidance about how to assist one person dressing in the morning. The guidance was practical and specific to the person and would ensure that they were able to maintain their independence in this area. There was evidence in the records belonging to one person that staff had noticed they were eating poorly. It was positive that this had been recorded. It was not until a month later that this person had a new nutritional screening assessment, their weight was monitored more closely and medical advice was sought. The manager was not sure why it had taken so long to bring this to her attention. The daily records for another person were inspected for the two-week period beginning 1st January 2008. During this period there were six separate entries relating to verbal or physical aggression, three entries relating to injuries and a number of entries related to poor diet. The home had contacted the GP who visited twice in this period, but there was no evidence of a full review of care needs, of any specialist support or of any behaviour management strategies to deal with the more challenging behaviour. People living in the home appeared content during the inspection. One person said the day and night staff were ‘good, very attentive and respond quickly to call bells’. Two visitors to the home said they were ‘very happy with home’, and that they were ‘kept informed about everything’. Records relating to the administration of medication were inspected. There were two entries where a line had been put through. These dates and times corresponded with entries in the person’s daily notes when they had been away from the home. The home should use agreed codes so that it is clear whether or not the medication was taken by the person when they were away or whether it was not taken. This is important for the wellbeing of the person as well as to enable stocks of medication to be checked accurately. Angel Court Residential Home DS0000037158.V357826.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 adequate. This judgement has been made using available evidence including a visit to this service. Most of the people who live at the home benefited from good relations with the staff. The home did not provide a range of activities to meet the different needs and interests of people living there. EVIDENCE: There were no organised activities during the day of the inspection. The person responsible for activities had been off for some time. One person was knitting squares in the lounge. They said they liked to watch TV in the morning, and that a relative visited every afternoon. Two other people living at the home were involved in the conversation, they were very positive about the home. One person said it was good because a lot of the people didn’t need too much help. Just before 11am hot drinks were brought round to the lounge on domestic size trolleys, people appeared to enjoy this and there was friendly Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 13 conversation between staff and people living at the home. Staff sought people in different areas of the home to make sure everyone was offered a drink. One person said ‘the place is great, people bring you drinks and there are good people about me’. Another person who had worked outside for most of their life, made use of the garden. The discussion overheard between staff and this person suggested they understood how important it was for them to get out regularly. Following the inspection, the manager advised that ‘Residents were all taken out to a local restaurant for lunch over the Christmas period and parties were held for both Christmas and new year’ and that ‘An entertainer came in over the holiday period’ this would clearly be important for many people living in care homes.’ People were seen finishing their midday meal. The food was well presented and people said they had enjoyed it. Meals are served in small dining rooms that have a homely feel. Angel Court Residential Home DS0000037158.V357826.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 good. This judgement has been made using available evidence including a visit to this service. People who live at the home were confident that any concerns would be dealt with. EVIDENCE: There had been no complaints received by the Commission or the home since the last inspection. One of the people living at the home said they ‘had no concerns at all about anything at home, but that if they did they would be happy raising them and confident that they would get sorted out’. The manager advised that following a letter from the Commission she had made a referral to the local authorities safeguarding unit about the assault of one person living at the home on another. Staff recruitment records provided evidence that checks were carried out on people before they came to work at the home. Angel Court Residential Home DS0000037158.V357826.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 good. This judgement has been made using available evidence including a visit to this service. People who live at the home benefit from the homely environment and range of indoor and outdoor spaces. EVIDENCE: A tour of the premises was undertaken during the inspection. The home was clean throughout and no offensive odours were noted. There were plenty of sinks for staff to wash their hands in addition to anti-bacterial hand gel sited at an entry to the upstairs unit. The home has a range of spaces for people to use, allowing them to spend time out of bedrooms with other people living at the home, with visitors or on their own. The building was light and airy throughout, and furniture and decoration was domestic in style. All of the bedrooms were en-suite. Rooms Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 16 have views to external gardens and courtyards or the road at the front of the building. During a conversation with one person the noise of people walking overhead was very loud, I mentioned this to them and they said ‘it started about 6 weeks ago’ and ‘you want to try sleeping with it’. Another person said they thought ‘the home was good’ and they were ‘comfortable’ living there. The building also has a large conference/meeting room used for reviews and for staff to view training videos. Angel Court Residential Home DS0000037158.V357826.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. People who live at the home cannot be confident that staff will have sufficient knowledge (through training or the provision of information), or be deployed in sufficient numbers to meet all of their social and emotional needs. EVIDENCE: People who live at the home were complimentary about staff. One person felt there were ‘enough staff available because quite a number of people are still able to do things for themselves’. The manager said current occupancy was 28 (out of 29 bedrooms), she said she had deliberately kept one room empty because of the number of people with high needs accommodated and the pressure this put on staff. The manager was also concerned about the amount of time staff had to spend away from the home, accompanying people to hospital, and was seeking a resolution to this. Staff said they did not feel listened to or valued. They said they had regular supervision but in five years had only had one staff meeting. They were unhappy about the admission of one person to the home, they felt this person had mental health needs that could not be accommodated by the home. They were not aware of any agreed approach to deal with this person’s challenging behaviours. The manager confirmed that staff meetings were not Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 18 held on a regular basis, but that supervision was in place. The manager said it had been agreed that they could have a couple of hours extra staffing each day in the evening, but they had not been able to recruit someone for this limited shift. Care staff had also taken on some laundry tasks to enable the person responsible for laundry to carry out cleaning in the communal areas. The manager advised that the training budget had been cut. This is of concern because the home accommodates people with a wide range of needs. The only Dementia training available was through watching ‘Coping with Maggie Caring for Margaret’. The manager advised that this had not been seen for some time by care staff and that she wanted everyone to watch it again. A list from 2007 showed that one person had watched the video since the last inspection (which took place on 3.11.07). Training in fire safety and food hygiene was also covered by watching a video. The manager accepted that staff needed additional training to deal with the high needs and challenging behaviour of people within the home. There was evidence on the two staff files inspected that they had successfully completed the Skills for Care common induction standards. This is positive because it provides an introduction to key issues such as privacy, dignity and protection. The AQAA, completed by the home, states that a high number of staff (19 out of 24) had completed National Vocational Training, Level 2 in Care. This exceeds national minimum standards. The staff files provided evidence that full checks had been carried out on staff before they began working at the home. This is a positive improvement from the situation at the last inspection. Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can be confident about safety practices. EVIDENCE: The manager has many years experience of caring for older people. There were though, some basic, key pieces of work that had not been carried out, specifically an assessment of a new person moving into the home and poor communication between care staff and the management team. Some staff were feeling that their concerns were not listened to. There was some evidence that the manager had taken steps to address some of the issues concerning staff, but it was not clear that staff were aware of this. Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 20 The manager completed the Annual Quality Assurance document providing information about the service, and plans for improvement in a timely manner. This includes the statement that the home seeks to improve by having ‘More resident involvement to discuss improvements in service provision’. This is a very important part of the quality assurance process and it is positive that the service recognises the need to extend this. The Local Authority oversees maintenance and health and safety issues. An inspection of certificates showed that checks and maintenance had been carried out in a timely fashion on equipment and services. There was evidence in the two staff files seen that new staff were regularly supervised during their probationary period at the home. There were no copies of supervision notes on file after they had completed the probation period. Team meetings were not in place. These are important when a group of people need to respond to challenging behaviour in a consistent manner. Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 21 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 2 1 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 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 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 3 Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1) (b) Requirement Timescale for action 31/03/08 2. OP3 14 (1) (a)(2) (a) The responsible person must ensure the fees payable and the method of payment is included in the individual residents contract. This requirement has been carried forward from the last inspection. The responsible person must 28/02/08 demonstrate they have sufficient information to decide whether or not the home can meet the needs of potential residents. The home must ensure that 30/04/08 there is sufficient detail in care plans to enable the health and social needs of residents to be met. The home must ensure that 28/02/08 records relating to the administration of medication accurately reflect where a person has left the home with their medication. The home must ensure that 28/02/08 assaults by one person living at the home on another, are considered under the Protection of Vulnerable Adults policy. DS0000037158.V357826.R01.S.doc Version 5.2 3. OP7 15 4. OP9 13(2) 5. OP18 13(6) Angel Court Residential Home Page 23 6. OP27 OP30 18 The home must ensure that there are sufficient number of staff, with sufficient training and understanding to care for the people living at the home. This refers particularly to the needs of people with dementia and challenging behaviour. 30/04/08 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 Good Practice Recommendations Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Angel Court Residential Home DS0000037158.V357826.R01.S.doc Version 5.2 Page 25 - 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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