CARE HOMES FOR OLDER PEOPLE
Anglebury Court 21 Bonnets Lane Wareham Dorset BH20 4HB Lead Inspector
Trevor Julian Unannounced 09 June 2005 11:30 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 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. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Anglebury Court Address 21 Bonnets Lane, Wareham, Dorset, BH20 4HB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01929 552585 01929 551984 s.evans@dorsetcc.gov.uk Dorset County Council Mrs Susan Elizabeth Evans CRH PC - Care Home Only 36 Category(ies) of DE(E) Dementia - over 65 (15) registration, with number OP Old age (21) of places Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. Date of last inspection 10th January 2005 Brief Description of the Service: Anglebury Court is a purpose built facility situated within level walking distance of Wareham providing a range of local amenities including shops, cinema, library, churches etc. It was built by and has been run by the local authority, Dorset County Council since January 1989. The service is registered with the Commission for Social Care Inspection. The registered manager is Sue Evans. The home is sited adjacent to the local Social Services Offices and a day centre. The home benefits from some of the day centre facilities, particularly transport for social outings. The home is designed to accommodate a total of 36 older persons including 15 specialist dementia places, 31 in permanent beds and 5 short term care places. All accommodation is provided on ground floor level in 28 single rooms and 4 double rooms. All rooms are supplied with ensuite shower rooms with toilet and washbasin. Although in one premises, the home is arranged on a unit style basis incorporating 4 ‘bungalows’, a central service corridor known as ‘The Street’ links each bungalow. Each bungalow comprises of 7 single and one double bedroom, one bathroom and a lounge/dining room with kitchenette. There are 2 laundry rooms, each shared by 2 bungalows.
Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 9th June 2005 between 11:30 and 17:00. The inspection process including preparation, inspection, travelling time and write up took a total of 16 hours. During the visit information was gathered through discussion with the residents, visitors, manager and staff. Residents were seen individually and in groups. Further information was obtained by inspection of records and policies and a tour of the premises. For the purpose of this report the term resident and service user are interchangeable. What the service does well: What has improved since the last inspection?
Since the last inspection the organisation had carried out one provider visit and produced a report; these visits now need to continue monthly. The medication systems in the home had been updated and on the inspection all the required information and recording was in place. The medication was securely stored.
Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 6 The home had been assessed by an Occupational Therapist there were no recommendations made from the assessment. The home had a contract with agencies supplying temporary staff which confirmed that those staff had the required clearances. 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. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 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 standard(s) 1 & 3. Standard 6 Intermediate care was not offered at Anglebury Court. The home provided prospective residents and their representatives with information about the services available within the home. Placements were only offered once pre-admission assessments had considered the needs of the individual and whether the home was suitably equipped to meet those needs. The assessment and information allow people to make informed choices about the appropriateness of the placement. EVIDENCE: Two residents and their visitors were able to discuss the admission process. Both had been referred through their care manager and confirmed that staff had visited them before admission for assessment of need. The visitors said they had visited the home and had been given suitable information about the services offered at Anglebury Court. The files of three residents were examined, each contained information from the pre-admission process.
Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 & 10 Care plans were in place to inform how identified needs were to be met, however, some information was out of date. Healthcare needs were monitored and met with support provided from the community health teams in order to maintain the wellbeing of the residents. For the protection of residents medication was safely held, distributed and administered. The staff treated the residents with respect and dignity supporting their rights’ as individuals. EVIDENCE: A sample of care plans showed that they were developed from the preadmission assessment. A system was in place to react to unexpected changes in need. The files contained the required information however there was evidence that one working care plan held within a unit contained some historic information which could confuse the care being given. There was evidence of reviews of care plans and involvement of the resident and/or their representatives.
Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 10 Residents confirmed that they had care reviews and they were consulted. Staff said that care needs were discussed at each shift changeover to ensure any changes were passed on. Healthcare needs including nutritional intakes were monitored as needed. The records showed appropriate referral for community healthcare support. Residents confirmed that the staff arranged for GP visits on request. Medication was securely held. The records were up to date. Staff managing medication had received training. Several residents said the medication system was good and that they were happy for the staff to look after it for them. Residents said that the staff treated them with kindness and respect. This was also observed during the visit. Staff were seen knocking on bedroom doors before entering. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 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 standard(s) 12, 14 and15. Residents at the home are supported to maintain their personal interests and their contacts with their friends, families and the community to enable people to feel valued. In order to maintain good nutritional intake for the residents the home provided a varied and balanced diet in comfortable surroundings. EVIDENCE: Records showed that the social and religious preferences were considered during the admission process, they also recorded the activities that the individuals had participated in. There were many examples on display of arts and craft sessions held in the home. Residents were able to sign up for excursions and several were able to manage the short walk into the town. Some people said they attended local churches either independently or with friends from the church. Residents said they were very satisfied with the activities on offer and also that there was no compulsion to join in. The home celebrated residents’ birthdays and other special events. There were no restrictions on visiting times and visitors confirmed that they could visit at any time and that they were made welcome.
Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 12 The home did not manage the finances for any of the residents although most had a personal allowance held securely in the home. The meals were prepared and cooked in the central kitchen then served in the individual bungalows from heated trolleys. The kitchen also caters for the day centre and meals on wheels service. Some people ate their meals in their own rooms at their own preference. Residents spoken to were full of praise for the variety and quality of the food. One person added that she liked curry and that was also on the menu from time to time. Cooked breakfasts were enjoyed at weekends. The cook said she is given dietary information during the admission process. She has in the past managed a range of special diets including gluten free, diabetic and religious. Specialist support is available within the Council. The cook manages the food budget. Within the home the menus are discussed in resident meetings and suggestions from those meeting are included in future menus. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 13 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 standard(s) Not assessed during this visit. EVIDENCE: Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 and 26. The premises were clean and well maintained in order to provide a safe and hygienic environment. EVIDENCE: During the tour of the premises all areas of the home were well presented, clean with no unpleasant odours. The rooms visited had been personalised by the residents using pictures furniture and other ornaments. Several people including visitors were enjoying the enclosed garden, some were wearing hats and others were using the picnic table umbrella for shade. The home had a call alarm system in all areas of the home. During the visit several residents were seen with pendant type call points allowing them to call for assistance throughout the premises. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 15 The laundry facilities were well away from food storage and preparation areas and were appropriately equipped with attention paid to managing infection control. Staff received training in infection control procedures with policies and procedures also accessible in the home. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30. For the protection of the residents the home was appropriately staffed by people who had completed thorough recruitment and initial training. EVIDENCE: The staffing levels were varied during the day to match the differing demands. The manager monitors the staffing levels and was looking to increase some care hours to meet an increased need. Residents said that the staff remained very busy, emergency calls were answered but at busy times there could be a wait. They also said that the staff were very good and helpful. Staff said that they had access to good standards of training. A core training programme was in place with specialist training needs identified during supervision meetings. A sample of three recruitment records were checked all contained copies of identification documents, two references and evidence of required clearances. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38. The views of the residents were sought in order to ensure that the home was run in their best interest and to their liking. Financial procedures and policies ensure that residents were protected from financial abuse within the home. Residents and staff were protected through compliance with health and safety legislation. EVIDENCE: The home carried out consultation exercises with residents these included regular resident meetings and annual surveys. The results were used to identify areas for improvement. Residents said they felt they could raise issues and concerns within the residents’ meeting.
Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 18 The home did not manage the finances of any resident; those people seen during the visit confirmed this. The home did look after personal allowances for most people; a sample showed the balances matched the transaction records and receipts. Approved contractors checked the fire safety, electrical and gas installations. Internal checks of the fire safety precautions were carried out. The manager monitors accidents and incidents for trend analysis. The accident records were appropriately held in terms of data protection however the completed form were not serialised and could therefore not be fully audited. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x 3 x x 2 Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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. 2. Refer to Standard OP 7 OP38 Good Practice Recommendations Care plans should be reviewed to ensure that the information for the care staff is relevant and up to date. Each accident report should have a unique identifier to allow the system to be auditted. Anglebury Court D55 S31937 Anglebury Court V220811 090605 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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