Inspection on 15/12/09 for Anjulita Court

This inspection was carried out on 15th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Anjulita Court 08/04/10

Anjulita Court 29/01/10

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: Anjulita Court Anjulita Court Bramley Way North Brickhill Bedford Bedfordshire MK41 7GD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Nicky Hone     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Anjulita Court Anjulita Court Bramley Way North Brickhill Bedford Bedfordshire MK41 7GD Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Darlington Type of registration: Number of places registered: care home 62 www.mha.org.uk Methodist Homes for the Aged Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 62 The registered person may provide the following categories of service: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE Date of last inspection Brief description of the care home Anjulita Court is a stunning new building which has been designed to give a feeling of space throughout, and has been built round a large enclosed courtyard. On their website, the MHA describes it as: The impressive new building has a dramatic triple arch frontage to welcome residents and visitors into an interior full of open spaces, as Care Homes for Older People Page 4 of 32 Over 65 0 62 62 0 Brief description of the care home well as facilities that include a hydrotherapy room, hairdressing salon, and a range of lounges - one of which is set up to allow film screenings. The spectacular entrance hall has a very high ceiling, and two walls are almost completely glass. The accommodation is divided into 4 units, each of which is selfcontained with a lounge, quiet room, sitting areas, dining room, kitchenette, bedrooms, and bathrooms. All bedrooms (a few of which are double rooms) have an ensuite shower room. There are 2 units each side of the hall, 2 on the ground floor and 2 on the first floor. The first floor units are accessed by stairs and lifts, and there is a walkway at first floor level across the hall so that people can walk from one unit to the other. There is a main kitchen on the ground floor, and a very large laundry, as well as offices, and staff facilities. The Gordon Ibbett room is on the first floor above the main entrance, and there is a coffee shop in the entrance hall. This is open to the general public and staffed by volunteers, and it is hoped will be used more and more once the flats next door have been completed, and the surrounding area has been developed into a country park. There are fenced gardens all round the building, with a series of pathways and seating areas, and a large landscaped courtyard opening off the entrance hall. There is adequate parking to the front of the building. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the first inspection of Anjulita Court following its registration with the Care Quality Commission (CQC) in August 2009. On the day we visited the home there were 29 people living here. The residential and nursing units were open with a number of people in each unit. The residential dementia unit was also open but with only 3 people, and the 4th unit has yet to open: the manager said she has no plans to do this yet as she wants to make sure things are going well in the other 3 units first. For this inspection we (the Commission) looked at all the information that we have received, or asked for, since Anjulita Court was registered. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in November 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and Care Homes for Older People Page 6 of 32 how the home can improve to make life even better for the people who live and stay here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who live and stay here, to their relatives, and to staff. We received 10 replies from residents, 4 from relatives, and 6 from staff. - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Information we asked the home to send us following our visit. This inspection of Anjulita Court also included a visit to the home on 15/12/09. No-one who lives or works at the home knew we were going to visit on this day. We spent time talking with the manager, and with some of the other staff. We looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. We looked at the way the home handles medicines and we spoke with a relative of someone who lives here. Some of the views and comments from people we spoke with are included in this report. We were assisted with this inspection by an expert-by-experience (referred to in this report as the expert). This is a person who, by having a shared experience of using services, helps us to get a picture of what it is like to live in this home. The expert spent three hours at Anjulita Court. The expert spoke with a number of people who live here, and some relatives, had a look round, and spoke with some of the staff. Following the inspection she wrote a report of her findings: some of that information is included in this summary and in the body of the report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 32 Anjulita Court has only been open 3 months. The manager said that things are changing and improving all the time. One person who responded to our survey, wrote The main structures are in place but the staff and service is still very new so, e.g. sometimes communication is not quite perfect What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information about the home is available for people who are thinking about moving here, and people know their care will be based on a thorough assessment of their needs. Evidence: Methodist Homes for the Aged (MHA) produces a statement of purpose and service user guide which each home personalises. The personalised service user guide for Anjulita Court is full of useful information so that people who are thinking of moving here know what to expect. It needed only a very minor update. Anjulita Court has also produced a pack of information for people, which includes the service user guide. The manager told us that a full assessment of each persons needs is carried out before the person is offered a place at the home. The manager, deputy or one of the senior carers go and visit the person where they are living, and people are invited to visit the home as often as they want to. If people live some distance away, a manager Care Homes for Older People Page 11 of 32 Evidence: from another MHA home will carry out the assessment. We looked at the records the home keeps about two of the people who live here and we saw that assessments had been carried out, and each person has received and agreed a contract with MHA. We also saw that living skills assessments had been started, to find out how much people can do for themselves, so that peoples skills can be maintained or enhanced. Intermediate care is a service offered by some homes, which gives short-term, intensive rehabilitation for people leaving hospital before they return to their own homes. This service is not offered at Anjulita Court therefore standard 6 is not applicable. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not give staff enough detail or guidance to make sure they can meet peoples care needs, and medication is not handled well enough to make sure people get their medicines in a safe way. Evidence: We chose the personal records of 2 residents to look at. Each person has 14 support/care plans covering different aspects of their care. These did not include enough detail about the persons needs, nor what they could do for themselves. And there was not sufficient guidance for staff so that staff could be sure of meeting the persons needs fully. Staff had not written on the daily records every day, and there was very little personal information, so we had no idea what people had done or what sort of a day they had had. Most of the entries were refer to support plan with the plan number. For one person, 2 other entries in a month were nothing to report and no change. In feedback to the manager, we picked an entry at random, which said refer to sp 11: when we looked at support plan 11 there was no entry for that date on that support Care Homes for Older People Page 13 of 32 Evidence: plan. When we spoke to staff on one unit, they told us that each resident has at least one bath or shower each week, and more if they want them. The staff showed us that they keep a bath record so they know which residents have had a bath and when. This record showed that for the 13 people in the unit, in the 15 days in December, 7 baths or showers had been done in total (even once a week this should have been at least 26). In November staff had recorded they had done a total of 11 baths in the whole month (again, at one bath per resident per week this should have been at least 52). We were also disappointed that the record was based on room numbers, not names. One staff member we spoke with had just completed a bath but had to go and check which room the person was in before she could complete the record. The manager said these were not MHA records and should not have been in place. The manager told us she had already identified that the support/care plans were not satisfactory and said she had arranged training for staff in the New Year. She said weve got a bit of work to do. We talked to the manager about medication. She told us that the main medication rounds are done after meals, so that people (especially those with dementia) do not associate having to take something which might be unpleasant, with meals which should be enjoyable. Certain medicines are given at 07:00, then rounds start at 10:00, 14:00, 18:00 and 22:00. We looked at the medication for the residential unit. We found some positive things, such as staff were recording on the MAR (Medication Administration Record) charts the quantities of medicines received, and they had noted one person had been sent a drug which they had not had before, so staff were checking with the doctor before administering it. However, we found a high number of errors in the recording, handling, safe-keeping, safe administration and disposal of medication. We looked at medication for 7 people and found mistakes in every one, plus an issue with controlled drugs. We wrote to the provider and manager immediately after the inspection and gave them details of the issues we found. For example: 1) Controlled drugs are stored in a separate CD cupboard, and the home has a CD record book. Only one person had needed CDs since the home opened. This person had a holiday stay at Anjulita Court in October and had brought Temazepam with them which had been recorded in the CD record book. According to the book there should have been 23 tablets in the cupboard; there were 84. The 84 tablets had been delivered after the person left and had not been entered in the record book. The balance on the record was not correct when we audited the number of tablets taken, and there was no record of where the remaining tablets (23 on the record) were; Care Homes for Older People Page 14 of 32 Evidence: 2) Staff had signed the MAR charts to show that they had given tablets but the tablets were still in the blister packs; 3) Staff had signed that they had given tablets on the day of the inspection, before the medication round had started; 4) We were unable to audit medicines in original packets because there was no record of any amounts carried forward from previous cycles; 5) Tablets were missing from the blister packs for days before the records started, and, in one case, for the 2 days following the day we visited; 6) For one person there were the same 2 medicines recorded on 2 different MAR charts. For one day the member of staff had signed both charts for the same drug: we could not carry out an audit to find out if the person had received an overdose of the drug for the reasons stated at 4) above; 7) One person had been prescribed a cream: staff had not signed the MAR chart so we did not know whether the cream had been administered or not. In the letter we wrote to the provider, we required them to rectify all the issues with medication by 31/12/09. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would like more opportunities for activities, and more choice in the meals they are offered. Evidence: Anjulita Court has employed a volunteer coordinator who has been very successful in finding volunteers to help with some of the activities in the home. She has started off by finding enough volunteers to open the coffee shop in the entrance hall. This coffee shop is open to the general public as well as to the people who live here, and serves drinks and a selection of snack foods which are prepared in the kitchen. There is also a small shop in the entrance hall, which is opened one morning a week by some of the people who live here. No newsagent does deliveries in the area, so staff collect newspapers for the residents on their way to work. Residents and staff said there has been a lot of activity leading up to Christmas, with a lot of visitors coming into the home. For example, the weekend before our visit a carol service took place for residents and their families, staff and their families, and people from the local community: the manager said over 100 people took part. On the afternoon of our visit children from a local school came in to sing carols and seasonal songs, and a surprise party for one of the residents was being held that evening. Care Homes for Older People Page 16 of 32 Evidence: The manager told us that an activities coordinator had been employed but had to leave suddenly for personal reasons. The home plans to advertise for another activities coordinator in the New Year: until then the activities might be fewer, but some activities already set up will continue. For example a church service is held in the home every week and students from a Bedford school make coffee afterwards; and a school group comes in to do games each Friday. The expert saw a list of activities in one of the units for December which only had Christmas and the church service on it. A chaplain is employed for 15 hours a week, to offer support to any of the residents or staff who need it. She told us she is currently putting together information about all faith festivals. On the first floor is the Gordon Barritt room, which is arranged like a chapel, and used for the church services, but is also a quiet room for people to use whenever they want to. Also on the first floor, the Clifton room is a large lounge which has been set up to be used as a cinema. Films are shown here, or there is a collection of videos and DVDs which people can use in their own rooms. One of the people who lives here has numbered and catalogued all the videos/DVDs and he goes round to the residents every day to find out if anyone would like to borrow any of them. A quiet room on the ground floor has a computer for people to use, and a selection of library books. There is a hydrotherapy pool at Anjulita Court. Sadly, this has not been used much as a risk assessment carried out by an independent body has said there must be one member of staff in the water, and one on the side of the pool, for each person using the pool. However, the manager has plans to make better use of the pool when staffing allows. A therapy room, currently used for chiropody, is going to be equipped as a snoozelen with soothing lights, music and moving pictures for people to enjoy. This room will also be used for aromatherapy sessions. In their responses to our survey a number of people mentioned that they would like more activities. There is no local bus service to the area but the manager has worked with other people in the local community to persuade the council to use one of its school buses. Each Thursday a bus goes round the area at about 10:30 picking people up to take them to the town centre, and brings them back from the bus station at 14:00. Meals are intended to be flexible, to meet each persons needs. Breakfast is served from about 08:15 to 10:30/11:00; a light lunch is available from 12:30 till about Care Homes for Older People Page 17 of 32 Evidence: 14:00; and the main meal of the day is served from 17:45 onwards. On the day we visited, lunch consisted of soup, beans on toast and jelly. The evening meal was to be chicken in a white wine sauce, with a sponge pudding to follow. Some of the people who completed our survey wrote about the food: one relative wrote The food seems to be of good quality - lots of home made cakes!; My [relative] enjoys the meals; and The service at meal times is first class - much depends on the cook but we seldom have to wait to be attended to....smaller portions are provided on request. We spoke with the chef. He told us that he uses all fresh ingredients, and all meals are freshly prepared each day, including cakes which are baked daily. He says he talks to the residents to find out what they would like on the menus, and asks each day whether people would like a cooked breakfast. The menus showed a variety of nutritious meals, but there seemed to be not much choice. The expert wrote residents informed me that if thats what you get, thats what you eat. Tables in both dining rooms were nicely set, including condiments and serviettes. There is only room for 12 people to sit in the dining rooms in each unit. This means once the home is full there will be 2 sittings for each meal. Although this is not so much of an issue at the present time, we hope people will be able to choose when they eat their meal, when the home is fully occupied. We were able to observe lunch in 2 of the units. In one we noted that 3 people were sitting at one of the tables. 2 people had almost finished their soup but the third persons soup was untouched and getting cold: this person needed some assistance but there were no staff around. In the other unit, one of the residents asked for a small spoon for her jelly. Staff told her there werent any. One staff member went away and came back with some small spoons, but instead of offering one to this person, she put them in the kitchen drawer. We checked the main kitchen and found it was not as clean as it should be. The manager explained she was aware of this and had already arranged for MHAs hospitality catering manager to visit the day after our inspection. She had discussed this with the homes catering manager the week before, and he had decided to walk out. Cover for the kitchen was being done by agency staff. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident their complaints will be listened to and acted on, and staff know how to keep them safe. Evidence: One relative we spoke with was very happy with everything, and said they would be happy to speak to the manager if things werent going right - they felt sure it would be sorted. The home has a complaints procedure, which explains how people can raise their concerns, and a record is kept of any complaints. The manager aims to resolve any issues as they arise, however minor, so that they dont turn into complaints. In the AQAA she told us that she had received one complaint which was upheld and which had been resolved within 28 days. In November, the manager informed us of a number of incidents that had taken place when money and jewellery had gone missing. The notifications showed that the home had acted correctly, involving the police and social services. The incidents stopped, which seemed to be in line with a member of staff leaving, and there have been no further incidents. The manager showed us that she is fully aware of the procedures and protocols that she has signed up to with the local authority around safeguarding (SOVA). She has made a referral to the SOVA team regarding one resident where there is family Care Homes for Older People Page 19 of 32 Evidence: conflict affecting the persons care. Staff receive SOVA training during their induction, and then have a more in-depth course. Staff we spoke with were aware of their responsibilities. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anjulita Court provides a very comfortable, clean, spacious home for people to live in that has been furnished and decorated to a very high standard. Evidence: This brand new building is light and airy, with lots of space for residents to walk around, and several areas for people to sit quietly or meet with friends and relatives. There are wide corridors and lifts so that all parts of the building are accessible. The building has been decorated in a modern style, and comfortably furnished, and the lounges, which have a fireplace, are already looking homely. A lot of thought and good ideas went into the building of Anjulita Court. There are a number of additional rooms not always found in care homes. For example, there is a therapy room; a hairdressing salon; a lounge that is set up for watching films; a quiet room used as a chapel; the hydrotherapy pool and changing room; a quiet lounge which has computer equipment and library books; and the shop and coffee shop in the entrance hall. The entrance hall itself is large enough for entertainment to take place, with space for everyone who wants to join in. Bedrooms are large and well-furnished, but people have the opportunity to bring in items of their own furniture if they wish. A married couple showed us how comfortable and personal they have made their room, with their own furniture, pictures and Care Homes for Older People Page 21 of 32 Evidence: mementos. The main kitchen is very well equipped, and there is a large laundry, as well as changing rooms for staff and a staff room, and offices. Most rooms (except bedrooms) have automatic lighting, and each bedroom has a sensor system that can be enabled if the persons movements need to be monitored. There is a large central courtyard which has been attractively landscaped, including a large water feature, to provide a comfortable, protected outdoor space for people to sit in. All round the building landscaped gardens include seating areas and flat paths for people to be able to walk round safely. Apart from the kitchen, the home was spotlessly clean and smelt fresh throughout. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited well, and receive a good induction, but there are not enough staff on duty to make sure the needs of people who live here are fully met. Evidence: A number of people who wrote to us made some very positive comments about the staff. These included The staff portrays genuine caring at all times....this makes it very happy and contented being a resident; There is a lot of staff who go out of their way to make sure the residents are comfortable; and The staff show patience when some residents are difficult, and they work well together as a team. From the AQAA we know that there were 21 members of the nursing/care staff at the end on November, 9 of whom have a National Vocational Qualification (NVQ) in care. The manager told us there are enough staff for the needs of the current residents, but she continues to recruit as more staff will be needed as the home increases its occupancy. The manager is able to use agency staff if cover is needed. However, our observations, including the experts observations, the majority of people we spoke with, and a number of residents, relatives and staff who returned our surveys, told us that there are not enough staff. The volunteer coordinator told us that she has already found about 20 volunteers who help with various aspects of activities in the home. All volunteers go through a Care Homes for Older People Page 23 of 32 Evidence: thorough recruitment process, including a Criminal Record Bureau check, which has unfortunately put some people off. She told us that she herself had all the right checks carried out before she was offered the job, and she felt she had a good induction which included fire, health and safety, and safeguarding training. We looked at the personnel records for 2 of the staff. The files were very neatly organised, and all the information the home has to get before the staff can start work, for example CRB check, references, proof of identity, health declaration and so on was in the files. However, the manager did not have any information in the home about the agency staff member working in the kitchen on the day we visited, and said she had not had any information from the agencies when she had employed carers and/or nurses from them in the past. The manager explained that much of the training offered to staff is e-learning, done by each individual on the computer. Each staff member has a site coach who will assist them with training, or they can (and do) talk to the chaplain. The manager offered to email updated training records to us, but we had not received these by the time of writing this report. We will check staff training records at our next inspection. 3 of the 6 staff who returned our survey wrote that they need more training. The manager told us that she is developing a core team of staff to work on the unit for people with dementia: staff have not yet had dementia care training. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of requirements we have made indicates that the management of the home must improve so that people receive the quality of care they need and deserve. Evidence: The manager, Karen Darlington is a qualified nurse and has had many years experience in managing care services. She will also manage the extra care scheme flats which are being built next to Anjulita Court. Karen is very enthusiastic and has a wealth of innovative ideas on the way a care home should operate. As always with a new service, these will take time to put in place. Several people who returned our surveys commented on the high quality of the management of the home. The manager sent us the AQAA when we asked for it. MHA has a quality assurance system which is being developed at Anjulita Court. It includes a written questionnaire being sent to each resident every year, which will start here in 2010. Regular meetings are held for staff, both as a whole group and in smaller teams (such as housekeeping, catering, nursing, care staff and so on). Care Homes for Older People Page 25 of 32 Evidence: Residents meetings are held and the manager is working out the best way to get the views of other people (relatives/friends/other professionals and so on) on how the home should run. A representative of the provider is required to carry out an unannounced visit to the home each month, and write a report which should be available for inspection: only one visit had taken place, but the representative had gone off sick before being able to write the report. The plan for staff supervision is that the manager supervises the senior staff, and between them they supervise all other staff. This is still being developed. Staff we spoke with, and some of the responses to our survey, indicate that the manager is very supportive. A small amount of cash is held for some people who prefer not to (or are unable to) look after it themselves. Good records are kept: we checked the cash and records for 2 people and both were accurate. We looked at the records the home keeps about tests of the fire alarm system. The fire alarms are tested weekly, and the emergency lighting monthly, as required. A folder is kept in the foyer which includes a plan of the building, and indicates where any oxygen is being used or stored. One fire drill has taken place: the manager intends to hold further drills so that all staff are involved in at least one drill each year. On the day of the inspection we received a letter from the fire authority informing the home that their fire risk assessment was not sufficient and satisfactory. The home must meet the requirements of the fire authority. Care Homes for Older People Page 26 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 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 1 9 13 An accurate record of disposal of medicines must be kept. So that we know medicines are disposed of correctly. 31/12/2009 2 9 13 The quantity of all medicines 31/12/2009 received, and any balances carried over from previous cycles must be accurately recorded. So that audits can take place to demonstrate the medicines are administered as prescribed. 3 9 13 All medicines must be administered as prescribed. So that peoples health is maintained. 31/12/2009 4 9 13 A system of auditing medication must be developed. So that proper audits can be carried out to ensure people are receiving their medicines as prescribed. 31/12/2009 5 9 13 Medicines must be signed for 31/12/2009 at the time of administration on one MAR chart only. If not given, the correct endorsement must be used so that we know the reason for not giving. So that it is clear that medicines have been Care Homes for Older People Page 28 of 32 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 administered correctly, and we know why any medicines have not been given. 6 9 13 The controlled drugs (CD) 31/12/2009 record must be accurate and must detail what medicines are in the CD cupboard. So that we can be sure CDs are handled correctly. 7 9 13 All staff who administer medication must receive appropriate training and there must be evidence to show that their competence has been monitored. So that people who live here receive their medication safely. 31/12/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 7 15 Care/support plans must give sufficient information and guidance for staff. So that each person can be sure their individual needs will be fully met. 28/01/2010 2 8 12 There must be evidence to show that peoples healthcare needs are monitored and met. 28/01/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 So that peoples health is maintained. 3 12 16 The choices available to people at mealtimes, and the way meals are served, must improve. So that mealtimes are pleasant occasions for everyone. 4 12 16 The level of activities offered 28/02/2010 to people who live here must improve. So that people are able to lead satisfying and fulfilling lives. 5 27 18 There must be enough staff on duty at all times. So that peoples needs are fully met. 6 30 18 Evidence must be available to show that staff receive adequate training. So that we know that staff are equipped to do their jobs properly. 7 37 26 The provider (or representative) must carry out visits as required by this regulation. The reports of the visits must be available for inspection. 28/01/2010 28/01/2010 28/01/2010 28/02/2010 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 So that the provider can monitor the service the home is providing. 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 Care Homes for Older People Page 31 of 32 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 32 of 32 - 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!