CARE HOMES FOR OLDER PEOPLE
Anley Hall Nursing Home Anley Hall Skipton Road Settle North Yorkshire BD24 9JU Lead Inspector
John McGarva Key Unannounced Inspection 15th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Anley Hall Nursing Home Address Anley Hall Skipton Road Settle North Yorkshire BD24 9JU 01729 822268 01729 822123 matron@anleyhall.co.uk www.anleyhall.co.uk Mr Malcolm Haigh Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Felicity Ann Kirby Care Home 47 Category(ies) of Dementia (47), Mental disorder, excluding registration, with number learning disability or dementia (47), Old age, of places not falling within any other category (47), Physical disability (47), Terminally ill (47) Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Age Range 45 years upwards Service Users to include up to 47(OP), up to 47(PD), up to 47 (DE), up to 47 (MD) and up to 47 (TI) up to a maximum of 47 Service Users 22nd August 2006 Date of last inspection Brief Description of the Service: Anley Hall is a care home providing nursing care for up to 47 residents who are elderly and may suffer from; Dementia, Physical Disability or be Terminally Ill. It is a Georgian, circa 1830, stone built country house, previously a private dwelling and is situated in a rural setting on the outskirts of the market town of Settle in the Yorkshire Dales. There are two floors including ground floor and a vertical lift provides level access to the first floor. It retains many of its original features including high ceilings and chandeliers and has extensive gardens, which are well maintained. It was converted for its present use in 1986 / 87. The fees charged at 25/04/07 are £500 - £670 per week. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Tuesday 15th May 2007. The manager, Mrs Felicity Ann Kirby was available to assist with the process throughout. The inspection lasted 4.5 hrs (10.00 am to 3.30pm). There were 31 residents in the home and all were in receipt of nursing care. The inspection focused on the key standards as well as addressing issues, which were identified at the last inspection. The manager and staff spoken to provided information in an open and professional manner. An inspection of some areas of the premises took place, including bedrooms, lounge and dining areas, bathrooms and kitchen. Discussions took place with the manager, carers, and residents. What the service does well:
The home provides a good quality of care in a homely and professional manner. All the staff works as a well-integrated team and the rapport between the staff and manager was observed to be very positive. The assessment and care plan documentation continues to be of good quality this helps ensure that all the residents’ health and social care needs are identified and met. Residents spoken to were content with the quality of their care and continue to speak highly of the care and nursing staff. The input from the activities person is positive and subtle, adding real value to the quality of the resident’s experience in the home. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
All the care staff should be further encouraged to record the care they give in the care plan and daily statement documentation. This will make their contributions pertinent and give them greater ownership of their input into the care of the residents. RMN qualified nurses should be provided so that the residents suffering from dementia and mental illness can have all their needs fully identified and met. An RMN nurse has been recruited since the inspection took place. An additional sluice-room and disinfector would help ensure safety from cross infection in the home. More height adjustable profiling beds would make the management of the nursing cases easier and safer. Loop systems should be provided for the residents with hearing deficits. More modern power assisted hoisting equipment in the bathrooms would make bathing procedures less stressful for the residents and staff alike. An additional assisted shower should be considered, as many residents would benefit from the ease of showering set against the effort required in accessing a bath.
Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 7 ‘Stand-aids’ should be provided to facilitate the resident’s transfer from one surface to another. An annual development plans needs to be produced and should include planned improvements to the environment and equipment available in the home. The environmental and equipment issues will be addressed as part of the redevelopment and refurbishment of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed prior to and after admission and these assessments provide the basis on which the care plans are developed. EVIDENCE: Evidence from the case tracked residents records confirmed that pre-admission assessment sheets are completed prior to admission. The manager or a senior nurse usually undertakes these either in hospital or the resident’s place of residence prior to admission. Intermediate Care (Standard 6) is not provided in this home. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The resident’s needs are being met in a professional, sensitive and programmed manner. EVIDENCE: The home utilise the Kardex system of documentation and individual plastic folders are available for each of the residents and into which all information relating to them is located. The documentation includes admission details, assessments, care plans, daily statements, nutritional assessments and weight charts. The Waterlow assessments for risk from pressure sores are relevant and appropriately documented. There is a key worker system whereby the nursing and care staff is allocated a small group of residents to care for.
Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 11 Some of the care staff as well as the nursing staff are now contributing to the daily records of care and this will become more established in the future. Care staff spoken to indicate that recording their interventions was not yet routine and are mainly limited to recording ‘turn-sheets’ and fluid balance charts. The importance of the carers recording the care they provide was further discussed with the manager who agreed to promote this further. The care staff spoken to indicate a high degree of motivation and felt that all the residents were provided with everything that they could need, including baths and showers at the time of their choosing. There are four residents in the high banding for nursing care and twenty-five in the medium range with only one in the lower banding. Seven of the residents are bedfast and the majority require assistance with washing, dressing and assistance with feeding. There is one resident who is bedfast and whose first language is not English. The medications are stored and administered in accordance with recommended practice. The seven-day NOMAD blister pack system is used and is working satisfactorily. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is meeting the resident’s social and dietary needs in a sensitive and caring manner. The quality of the meals provided is good and commented on favourably by staff and residents alike. EVIDENCE: The resident’s routines of daily living are tailored to their needs and choice and there is an activities organiser for 20 hrs per week to assist with in social activities. The activities organiser’s work is important and particularly well appreciated both by the residents and staff. The organiser makes it her job to identify those who may require a visit in their rooms and help, either with conversation or assistance with letters or other private matters. She has developed biographies of the residents so that the staff can relate to them on a more personal basis.
Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 13 Entertainers are arranged on a regular basis and outings are also organised with the use of a mini–bus that is made available on request. During the inspection there was a residents and relatives / friends meeting taking place and several issues relating to the management and future developments of the home were raised. Discussion on the home’s activities programme was discussed and at present this includes: sitting down exercises, cake decorating, card games, feely bags, smelly bags, reading group and poetry reading. Particular interest was expressed about the planning application presently before the local Council in regard to the development of the home. A hope was expressed that an enclosed garden area with raised beds and other features accessible to wheelchairs would be provided. When completed all the rooms will be single, with en-suite toilet facilities. Visitors can attend at any time they choose, day or night with drinks provided for them routinely and also meals when required. The residents were very complimentary about the quality of the food provided, and the staff spoken to also confirm that the meals were of consistently good quality. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a relevant complaints procedure and the staff has received abuse awareness training. EVIDENCE: The complaints procedure of the home meets the required standard and care staffs are aware of how to respond to any complaints made by either the residents or their representatives. There have been no complaints made about the service either to the home or the CSCI in the past year. Staff confirmed that they had received recent training in abuse issues. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment is clean and comfortable but requires some improvement in the general décor, bathing facilities and equipment. EVIDENCE: The environmental standards for homes registered before 2002 are met. The home is set in very pleasant grounds and these are kept in a good condition with access by wheelchair being provided. There are thirty-three single rooms, twenty-five of which have en-suite toilet facilities and four shared rooms also with en-suite facilities. The décor of the environment looks tired in places and in need of redecoration.
Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 16 The provider has submitted a planning application to the local authority, which will significantly improve the facilities and provide for all rooms to have ensuite toilet facilities. Some improvements and provision has taken place since the last inspection and these include: Eight newly acquired adjustable ‘profiling beds’ have been provided. Two new power assisted hoists have been provided thereby making the transfer of the residents more safe and less stressful. ‘Turntables’ have been provided and these help facilitate the easy transfer to different surfaces of the more ambulant resident. Issues, which need to be addressed, include: The provision of an additional sluice room with another disinfector on the ground floor as there is at present only one provided on the first floor. Power assisted hoists in the bathrooms are required to replace the mechanical’ wind-up’ variety presently in use. This will make bathing more accessible and less stressful for residents and staff alike. A ‘island bath’, that is located in the centre of the bathroom and permits access to three sides is required for the increasingly debilitated residents. An additional assisted shower is needed, as these are popular with the residents and easier to access than baths. A ‘Stand aid’ should be provided as this will make transferring residents between surfaces speedier and less stressful than deploying hoist slings. Although there are five residents with hearing deficits there is no loop systems provided to assist them when listening to television or radio. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Satisfactory recruitment practices are followed. There is sufficient general staff to provide personal care. However, there should be RMN qualified nurses employed to help improve the quality of life of resident’s suffering from dementia and mental illness. EVIDENCE: The staff spoken to felt that they were able to provide a good level of personal care and that the residents confirmed this when spoken to. The numbers of care staff with NVQ qualifications is 70 , thereby exceeding the 50 minimum standard. One of the care staff has commenced NVQ Level 2 training with another to start in July. Several of the care staff has trained to the higher NVQ Level 3 standard. Three of the care staff has a first –aid certificate. There is a key worker and named nurse system on place whereby there is identified staff allocated to particular residents and helps ensure the continuity of care.
Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 18 There is a dedicated activities person provided for 20 hrs per week. The care staffs were able to confirm that mandatory training episodes in Health & Safety, Fire Safety, and First aid, Basic food hygeine, Moving & Handling and Abuse awareness had taken place. This is arranged through ‘Tyro’ training organisation. The home is registered to receive residents suffering from dementia, and the mentally ill and at present have fifteen residents suffering from dementia, and sixteen with mental health needs. However, there is no specialist RMN trained nurses on the staff. The manager said that they have tried to recruit appropriately trained staff but to no avail. The care staff confirmed that they had attended training in dementia care and challenging behaviour. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home is focused on benefits to the residents and there is a caring ethos in the home. EVIDENCE: The manager has been in post for several years and it is clear that she enjoys the respect and support of the staff. She has obtained the NVQ level 4 in care management in addition to her first level nurse qualification and Diploma in care of older people. These qualifications and her experience help ensure the home is well managed. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 20 Regular meetings are held monthly with the staff to help keep them informed about the running of the home. The care staff spoken to were still unaware of an annual development plan for the home. They are aware about the planning submission regarding future development of the site. Questionnaires are routinely distributed to elicit the views of the residents and relatives about the running of the home. The home are planning to use the CSCI AQQUA self-assessment system, which is shortly to be introduced and will help judge the quality of the care . Regular servicing of gas boilers, lifts, hoists and other equipment takes place and the records of these are kept in an easily accessible ring folder. Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 Standard No Score 16 3 17 X 18 3 2 3 2 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 3 Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard OP8 Good Practice Recommendations All the care staff should be further encouraged to record the care they give in the care plan and daily statement documentation. An additional sluice-room and disinfector should be provided on the ground floor. Consideration should be given for the provision of power assisted hoisting equipment in the bathrooms. An additional assisted shower should be considered. ‘Stand-aids’ should be provided to facilitate the resident’s transfer from one surface to another. Loop systems should be provided for the residents with hearing deficits.
Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 23 2. 3 OP21 OP22 4. 5. OP24 OP27 More height adjustable profiling beds should be provided. RMN qualified nurses should be provided so that the residents suffering from dementia and mental illness can have all their needs identified and met. The provider should present an annual development plan for the home. 6. OP33 Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Anley Hall Nursing Home DS0000027923.V335916.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!
