Inspection on 08/06/09 for Anglesea Heights Nursing Home

This inspection was carried out on 8th June 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Anglesea Heights Nursing Home 03/01/08

Anglesea Heights Nursing Home 20/02/07

Anglesea Heights Nursing Home 13/02/06

Anglesea Heights Nursing Home 24/05/05

Anglesea Heights Nursing Home 08/12/04

Anglesea Heights Nursing Home 14/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Thematic inspection report Care homes for older people Name: Address: Anglesea Heights Nursing Home Anglesea Road Ipswich Suffolk IP1 3NG two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a thematic inspection of this care home. A thematic inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jill Clarke Date: 0 8 0 6 2 0 0 9 Information about the care home Name of care home: Address: Anglesea Heights Nursing Home Anglesea Road Ipswich Suffolk IP1 3NG 01473289810 01473286908 jonesgrd@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Tina Ellen Rose Askew Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFHCare) Ltd care home 120 Number of places (if applicable): Under 65 Over 65 60 0 60 0 dementia learning disability old age, not falling within any other category terminally ill Conditions of registration: 1 1 0 3 1 Persons of either sex, aged 65 years and over, who require nursing by reason of old age (not to exceed 60 persons) accommodated in Alexandra House and Christchurch House. 2 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 60 persons), accommodated in Bourne House and Gippeswyk House. 3 One named person whose name was made known to the Commission for Social Care Inspection in June 2004, aged under 65 years of age, who requires care by reason of Care Homes for Older People Page 2 of 12 dementia, accommodated in Bourne House or Gippeswyk House. 4 The total number of service users accommodated must not exceed 120 persons. 5 Persons of either sex, aged 18 or over, who require care by reason of terminal illness (not to exceed 3 persons) 6. One named person whose name was made known to the Commission for Social Care Inspection in November 2004 who requires care by reason of dementia with a learning disability. Date of last inspection Brief description of the care home Anglesea Heights is owned by BUPA Care Homes and is registered as a care home with nursing, providing care and accommodation to a maximum of 120 service users in the categories of old age and dementia. Situated in a residential area of Ipswich it is close to the town centre. Local shops are within walking distance and the Home is on a local bus route. The building is a local landmark in Ipswich, with the listed Victorian administration block originally forming part of the old Ipswich Hospital. Service user accommodation is, by comparison, modern, purpose built, single story, ground floor accommodation comprising of 4 separate, 30 bedded bungalows, named after parks in the town, Alexander, Bourne, Gippeswyk and Christchurch. All bedrooms are of single occupancy and although not en-suite, each has a wash hand basin, and there are communal toilets, and bathrooms located close by. Each bungalow also has a lounge/dining room and access to the gardens. Care Homes for Older People Page 3 of 12 What we found: We (The Commission) visited Bourne House (part of Anglesea heights), which is 1 of 2 dedicated houses, supporting up to 30 residents, who have a diagnosis of dementia. At the time of the inspection, the home had applied to increase the number of people they can support with dementia, from 60 to 90. The focus of this visit was to assess the experiences of 5 residents, with varying levels of dementia, during a 2-hour period of their day (4 to 6 pm). To do this we used our Short Observational Framework for Inspection (SOFI) tool, which breaks down the 2 hours into 5 minute periods of time, where we look at what is happening to each of the people we are observing, and how it affects their well-being. Undertaking the assessment also helps us assess the way staff engage with the people we are observing, and the culture of care which has developed. Our period of observation identified that staff are working hard to try and meet the needs of people, whos physical and mental health needs varied greatly. Needs ranged from end of life care, to fully mobile residents who are at an earlier stage in their dementia. This resulted in staff meeting the physical needs, but had insufficient time to fully support people with their emotional, social and occupational needs. We saw examples where a resident was causing anxiety to another resident, who was chair bound, by leaning over them, and trying to touch their legs. The vulnerable resident, unable to get away from the situation, was shouting no, no, come on Granddad move on - get somebody else trying to hit the resident to get them to move away, which they did, only to return within a short space of time. Staff were in the area, but were busy assisting residents to the toilet before tea. The layout of the house does not enable quiet areas for staff to support residents with different behaviours. The communal space consists of 1 large lounge/dining room, which staff have divided up into smaller (dining and sitting) areas. Although we were undertaking the survey in a corner of a lounge which had no television or music on, we could clearly hear white cliffs of Dover, from the music system, and also the sound coming from the television on the other side of the room. The sound level went up further when 2 residents started calling out. We asked a resident who had joined us, if it was always that noisy, they replied, looking over at 1 of the residents calling out, they can keep that up all day. We asked if the constant shouting disturbed them, and they replied you get used to it. Rotating tea-time menus, enable residents, in addition to being offered home made soup, and their choice of sandwiches daily, an additional dish of the day, such as Salmon Pasta, Pate on Toast, Mackerel and Prawn salad (which staff said residents love), Mushroom Quiche. On Sundays a buffet tea is laid on. The evening meal on the day we visited was assorted sandwiches, soup, and sausages, gravy and mash potatoes. We watched as 2 residents sitting at a table close to us, as they were given a plate which had sausages, gravy and mash in the middle, with the sandwiches, cut up in quarters, arranged around the outside of the sausages and gravy. Where residents required their hot meal to be served in a bowl, the sandwiches were served on a separate plate at the same time. Soup was also served at the same time in a Care Homes for Older People Page 4 of 12 cup. The meal time routines were more task orientated, rather than being treated as a social occasion. Staff served the residents a table at a time, but did not have time to sit and join the residents to eat. Instead staff who were not assisting residents to eat, or were serving the food, walked around offering assistance if needed. As residents finished their meal, their plate was cleared straightaway, and offered their dessert. Good practice was seen when staff supported a resident up to the table, and introduced them to the other residents. We also heard a member of staff ask if they could take their plate away to wash up. In the area we were observing, we watched a member of staff squeeze themselves between 2 residents specialist armchairs in the lounge, in preparation to give 1 of the residents their meal. But in doing this they turned their back towards the resident who we were observing. We noted that the resident tried to get their attention by pulling at the staffs apron. The resident then kept looking over, watching the other resident have their tea, then sat quietly, staring ahead. The interaction on a 1 to 1 basis, with the resident being assisted to eat was good, with the member of staff giving their full focus to the resident whilst they assisted them. When staff did come over to the resident who had not been given any food or drink, they decided to move their chair away from the other resident, to give more space. This resulted in the resident being opposite the resident who was eating. We noticed the improvement in the residents wellbeing as soon as staff adjusted their chair, to a sitting up position, as they became more alert, taking more of an interest in what was happening around them. The resident was then given a plate of sandwiches on a tray, and did not require any assistance to eat them. Another resident sitting in the same lounge area we were sitting in, was given a plate of sandwiches, but given no further assistance. The resident didnt seem to know what to do with it at first, then put the plate flat up to their face, rotating the plate around, biting on the plastic, until their tongue came across a sandwich, which they then started to eat. After tea, we saw a resident being given a hot drink, whilst they already had a cold drink in the other hand. There were no smalls tables in the area to be able to put their drinks down in the lounge where they were sitting. The engagement between the staff and the 5 residents we were observing was minimal, mostly to undertake a task. The quality of the engagement varied. Where the quality of the interaction was good, we could see the positive outcome to the residents wellbeing. Examples included a carer quickly stepping in, to divert a residents attention away as their relative left, talking to the resident in a warm, friendly manner. When a member of staff helped a resident tidy them self up after they had eaten, the resident responded with a smile, saying you spoil me. Another resident was asked by the member of staff, if they had a nice tea, we saw them smile at the member of staff as they walked away. Other interaction with staff asking residents a question did not have the same positive well-being for the residents involved, due to staff asking the question, but walking away before waiting for an answer. We noted that when staff approached a resident to undertake a task (moving the resident, giving them tea or medication), they focused on that person and interacted well, but did not always acknowledge the other residents Care Homes for Older People Page 5 of 12 sitting in that area. We watched a new resident walk around the tables as others were eating, when they came across some material they could fold, we could see the change in their face from walking around with a passive expression, to smiling as they concentrated on their task. No action was taken by staff to include the resident in assisting them with small domestic tasks. The resident then walked up to us, wondering what they should do. During 2 safeguarding meetings held in November and December 2008, shortfalls were identified in the way staff assist residents with their mobility and during transfers (manual handling), which the home was asked to address through training. During this inspection we observed staff using a hoist safely in the lounge area. However, when 2 staff approached a resident, 1 either side, to help the person to stand up from their armchair, and be supported to walk to the table staff did not use a manual handling belt for this procedure. On the next occasion, 1 of the 2 carers went to put their arm under the residents arm, to lift them, but was quickly corrected by the other member of staff they were working with, as to the correct positioning of their hands. Discussions with staff identified that Bourne House has set staffing levels, made up of 6 staff in the morning, and 5 in the afternoon, which includes 2 nurses, and 1 nurse and 2 carers at night. We asked for a sample of rotas, from the previous 2 months, to see if the staffing levels are being maintained. In the rotas dated April 17 -30th and May 1-14th 2009, we identified that the morning staffing levels had been running 1 short 15 out of the 28 days. We were informed that they do not use agency cover, but try and find someone to cover from the other houses. Staff did say they were not always full, but further discussion identified that the staffing levels were not set on how much help the current residents needed, but on occupancy levels. In addition to the care hours, there is a hostess on most mornings, who serves meals and drinks, enabling staff to concentrate on personal care. Due to concerns raised directly with ourselves, prior to the inspection over the lack of stimulation for residents, we asked if staff had been given any extra care hours to cover the activity organisers vacancy, to their knowledge there had not been. We looked at the activity folder, where staff write down what activities they have been undertaking with residents, and found 1 completed sheet for May (3.30 - 4.30 pm sing a long and listening to music, 10 residents) and 2 for March. When we fed this back to the staff, they said carers had been undertaking sessions such as sing-a-longs and putting on old movies, which they said the residents enjoyed, but it had not been recorded. We were informed that a new Activities Co-coordinator had been taken on, and will be starting on the 19th June. Since the last inspection we were made aware that a relative, due to a toilet being out of action for a long period of time, had ended up purchasing, and fitting the broken part them self. Discussion with staff, and information given in the maintenance book, further evidenced that this had happened. We found 2 of the toilets had out of use signs on them. Staff write-in a maintenance book any shortfalls they come across, and the procedure is for the person responsible for maintaining the home, to write down what action they have Care Homes for Older People Page 6 of 12 taken to address it. The book showed that on the 24 May 2009, staff had written wobbly toilet seat, however there was no information, just a line drawn, to say what action had been taken to fix it. We looked at the toilet which moved side to side, which we felt was unsafe, and asked the Deputy Manager to take action straight away. They did this by putting the toilet out of use, until it could be fixed. In the same toilet we also noticed that the handle to the hot water tap was missing. This had also been reported by staff, who had been asked on the 6 May 2009, to try and find the handle, and another one that was also missing. We also noted that 2 of the toilets, 1 of which included a shower, did not have a lock fitted, on 1 door there was just a hole. Without having working locks on the doors, staff cannot ensure residents privacy and dignity when using these facilities. Although it was a pleasant day when we visited at 2 pm, we noted that residents did not have free access to the garden, as staff needed to unlock it for us. There are 2 gardens leading off either side of the lounge. The first garden we looked at had a raised flower bed, which encourages people to look and touch the flowers, which staff told us they had raised the money for, and planted themselves. On the ground next to the raised bed was a large lump of cement/broken brick, which we pointed out to staff, worried that someone might catch their ankle on it. The second small garden also had a potential trip hazard, due to a large plant pot being placed on the pathway. Whilst looking at the toilets and sluices, we found 2 urinal bottles, which looked like they had dried faeces around the rim, a member of staff agreed that this was what they thought it was. The bottles were in the clean area, ready for a resident to use. When we went to wash our hands, we found the liquid soap dispenser empty, as well as a disposable glove dispenser in the sluice. This was fed back to staff to address, assurances were given that they did have plenty of stock, it was more a problem that someone had forgotten to refill them. In a corridor, there was an unpleasant musty smell, which reflects a relatives comments about their clothes smelling when they left. Staff also confirmed that the unit often smells when they come on duty in the morning, which they put down to the unit not being ventilated at night. What the care home does well: What they could do better: The management should look at their current admission procedures, and management of people with different levels of dementia, to enable staff to meet person centred care. Staffing levels need to be looked at, to ensure that it is flexible to meet different dependency levels, taking into account their social, occupational, emotional and Care Homes for Older People Page 7 of 12 behavioural needs over a 24 hour period. Staff need to look at their meal time routines, to see how they can make it a more positive, social experience for residents. The maintenance and environment of Bourne House (and if applicable reflected across all the houses) needs to be better managed, to ensure it provides an enabling, safe, clean, hygienic, and well maintained environment, to meet residents individual needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 Toilets and bathrooms must 31/07/2009 be fitted with a lock, which can be overridden by staff to gain access in an emergency. To ensure the privacy and dignity of the people using the facilities. 2 19 23 The environment must be kept well maintained, and free from hazards. To ensure the safety of the people living and working at the home. 14/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 4 The home should review their current admission procedures, and allocation of places, so they are confident that they can accommodate the persons occupational, social and emotional, as well as their physical care. needs. Systems should be in place to ensure residents urine bottles are thoroughly cleaned, prior to them being stored Page 10 of 12 2 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations ready for use. The home should also investigate any unpleasant odours, and take action to get rid of them. 3 33 The home should look as part of their quality assurance work, to undertake their own dementia care assessment, using a recognised tool, to support them in gaining feedback on the standard of care they are providing. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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