CARE HOMES FOR OLDER PEOPLE
Anna Victoria Nursing Home Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH Lead Inspector
Diana Green Unannounced Inspection 7th October 2005 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Anna Victoria Nursing Home Address Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH 01255 675609 01255 673791 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) Anna Victoria Nursing Home Mrs Carol Nunn Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (2), Physical disability over 65 years of age of places (28), Terminally ill over 65 years of age (2) Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 28 persons) Persons of either sex, aged 65 years and over, who require general palliative care (not to exceed 2 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 2 persons) 17th January 2005 Date of last inspection Brief Description of the Service: Anna Victoria provides nursing and personal care with accommodation for up to 28 older people. The home is also registered to care for service users with a terminal illness. Anna Victoria is owned by a charitable organisation, named Anna Victoria Nursing Home. The home is founded on Christian principles and a weekly church service and monthly prayer meetings are held. The home is located within walking distance of Frinton-on-Sea High Street, Essex The home is a two-storey building that was purpose built and first opened in 1992. There are 28 single en-suite bedrooms on two floors that are accessible by stairs and a lift. Four rooms have screening that can be opened to provide two shared rooms. The home offers large communal areas. The rear of the home has an enclosed well-maintained garden and is accessible by ramps. The open plan sensory garden to the front of the premises provides a pleasant outlook from the home. The home has a visitors’ room and overnight accommodation can be arranged. There is a loop system installed at the home for the benefit of those with a hearing impairment. The home is accessible by car and the nearest railway station is nearby. Parking is available for staff and visitors in the large car park located to the front of the home. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 7/10/05, lasting 5 hours. The inspection process included: discussions with the registered manager, activities coordinator, five staff, the maintenance person, six residents, four relatives and feedback from health and social care professionals; a partial tour of the premises, four bathrooms, the sluice, communal areas and the laundry; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Twenty-one standards were covered, and five requirements and one recommendation made. The inspection found that action had been taken promptly to address previous requirements and recommendations. It was evident that Anna Victoria Nursing Home aims to provide and is successful in achieving a high standard of personal and nursing care for residents. The registered manager and staff were welcoming and helpful throughout the inspection. What the service does well:
The home provides a welcoming, homely environment and consistently high standards of nursing and personal care: residents and their relatives were unanimous in their praise of the manager and staff and said they were very caring. The relative of one service user said they frequently visited the home and found staff very attentive and caring. Another relative said “I cannot fault Anna Victoria for anything, I recommend it to all my friends”. Further comments made by a relative were “the manager and staff are very approachable and helpful and very supportive” to their spouse. Residents’ health and personal care needs are met appropriately and well monitored and prompt referrals are made to GP’s and relevant health professionals where required. Care plans are regularly reviewed in consultation with residents and their relatives and risks closely monitored. From previous knowledge of the home and feedback from health professional it is evident that Anna Victoria provides good standards of palliative care. Communication with relatives is good and those spoken with welcomed the support and regular contact made with them. Staff are employed in sufficient numbers and are skilled to care for the needs of residents through regular training and supervision by the manager and senior nursing staff. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 6 There is a varied activities and entertainment programme organised. Residents and relatives were complimentary of the activities available and one said they gave ‘top marks’ to the activities coordinator who was “so patient and so good”. Religious cultural needs are well met with regular prayer meetings and communion services held for those who wish to attend and religious representatives from other faiths welcomed into the home. The premises are clean, well decorated and well maintained. Risk assessment for fire safety has been undertaken and there are good monitoring practices for fire safety in place. What has improved since the last inspection? What they could do better:
There have been some problems in recent staff sickness that has resulted in the employment of agency staff. The induction of agency staff could be improved to ensure they are fully informed on residents’ needs. Two residents said they were very happy at Anna Victoria apart from when agency staff were employed, as they did not understand their needs.
Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 7 Care plans could be further improved to ensure that the wishes and feelings of residents are adequately reflected as well as their needs. There needs to be more emphasis on assessing residents as individuals, for instance when discussing gender and sexual needs with them. There are some health and safety issues that need to be addressed including excessively hot water in one area, unlocked clinical waste bins and maintenance cupboards but overall there are safe health and safety practices in place. 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. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The service operates a thorough and responsible pre-admission assessment process: care and attention is given ensuring that the home can meet the individual’s needs, resulting in appropriate admissions. This home does not provide intermediate care. EVIDENCE: The manager or deputy manager, both registered nurses, assess all prospective residents either at home or hospital wherever possible. Evidence of pre-admission assessments was present on two of the three files inspected. Copies of care management assessments were held on file where relevant. Assessments covered all care needs and were detailed. The manager and staff demonstrated a good understanding of residents’ needs. Two residents spoken with confirmed their needs were fully discussed prior to admission. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 Residents health and personal care needs are consistently well met within the home. Staff treated residents with dignity and respect. EVIDENCE: Three care files were inspected. All three contained care plans that covered all key needs (physical and social) and provided good detail of the action required of staff to meet residents’ needs. However there was limited reference to residents’ preferences or to gender/sexuality needs. Care plans had been reviewed monthly and confirmed by signature but there was some inconsistency in the revision of care plans. For instance, one care plan had not changed since 2002 and there had been no agreement with the resident recorded since that date. Assessments for moving and handling/mobility, pressure areas, continence needs and risk assessments for falls were recorded in the files inspected and had been regularly reviewed. Residents spoken with said that felt that staff gave them the level of support and assistance they required, and provided care in an appropriate way. One relative said that care staff were very attentive and caring and communication was very good. Another relative said that staff were gentle and caring. Staff were observed to professional, polite and respectful towards residents and to address them by
Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 11 their preferred name. Positive feedback was received from health and social care professionals who said they found the home provided a good standard of care. The standard of personal care was observed to be good and several relatives confirmed that was their experience. Records showed appropriate and prompt referrals to GP’s and health and social care professionals. The local GP practice attended the home regularly to review residents’ needs and on request. Staff spoken with said they received regular supervision and training and discussed care practice at these sessions including respecting residents’ privacy and dignity. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 Daily routines are flexible, and choices are actively promoted. A good and appropriate range of therapeutic and social activities takes place in the home. The home supplies sufficient quantity and quality of food, and provides a well balanced diet that meets individual needs and choices. EVIDENCE: From discussion with residents and with staff, routines in the home appeared flexible and residents’ individual choices were accommodated. Where able, service users were seen to be encouraged to exercise control and choice over their lives (e.g. through personalising their rooms, maintaining previous contacts outside of the home, etc.). The home has an activities coordinator who was observed leading a memory bingo game with six residents. One relative said they found the coordinator “so patient and good” and gave “top marks”. There was a programme of activities on display that included regular prayer meetings, communion services and entertainment. Musical entertainment with a pianist and sing a long session was provided during the afternoon. Residents confirmed this was a regular event that they enjoyed. Library books were available in large print and changed periodically by a visiting mobile library.
Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 13 The main meal on the day of the inspection was well balanced, looked appetising, and was eaten well by residents; nutrition records showed a good range of meals being provided and good monitoring of nutritional intake. Two residents spoken with said the food was good and there was always plenty to eat and drink. There was evidence that individual choices of food were accommodated. However, one relative said the supper menu lacked variety and consisted mainly of soup, sandwiches and cake. Staff assisted service users in an appropriate and respectful way during their lunch, and the dining room was pleasantly laid out. Service users were encouraged to eat in the dining room but could also choose to eat in their room. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. The manager actively promoted awareness of protection issues through staff training, recruitment practices and respecting individual rights. EVIDENCE: The home had a complaints procedure that included timescales within which complainants can expect a response and their right to complain directly to the CSCI at any stage. No complaints had been received by the CSCI about the home since the last inspection. The procedure was included in the statement of purpose and displayed in the home for resident and representatives’ information. Feedback from residents was generally very positive about the care and staff at the home. The home’s policy and procedures for the protection of vulnerable adults and whistle blowing had been developed since the last inspection. The manager had attended a training workshop held by Essex Vulnerable Adults Protection Committee and had obtained guidance books for distribution to all staff. A training programme on prevention of abuse had also commenced for all staff to attend. Records inspected showed that appropriate pre-recruitment checks on new staff were undertaken prior to appointment (see standard 29). Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 Anna Victoria Nursing Home aims to provide a safe, well maintained a homely environment but some health and safety risks prevent this always being achieved. The home has a good supply of well-maintained equipment to meet residents’ needs but would benefit from a review of hoisting equipment to ensure there is no delay in residents’ personal care needs being met. The home was clean and hygienic with good standards of infection control, however health and safety was compromised by unlocked storage of clinical waste. EVIDENCE: A partial inspection of the premises was made that included communal areas, bathrooms, a number of residents’ rooms, the sluice and the laundry. The home was in a good state of maintenance and decoration. There was a programme of regular maintenance in place. Communal rooms were clean and well decorated and furnished to provide a homely environment for residents. Residents spoken with said their rooms were always kept clean. The gardens were attractive and well maintained and provided a pleasant outlook with good
Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 16 access for residents. Records provided evidence that the building complied with the requirements of the local fire and environmental health department. Standard 22 was not fully inspected, however from discussion with residents it was evident that they were sometimes required to wait to receive personal care as one hoist was used for several residents. The manager clarified that whilst the home had five hoists, one specific type of hoist was required to be used to assist four residents. The heating, lighting, water supply and ventilation met the relevant environmental requirements as evidenced from the home’s records. However the water temperature of the sluice washbasin was confirmed at 59°Centigrade and the door was unlocked and maintenance equipment was observed stored in an unlocked cupboard posing a potential risk to residents as well as staff. Checks to minimise the risks from legionella were undertaken annually and confirmed from the records. Rooms were centrally heated with controls in individual rooms and radiators were guarded as part of a risk assessment. The home was clean and hygienic throughout with no odorous smells but some areas would benefit from descaling. The infection control practices in the home place were observed to be safe, with exception that an external clinical waste bin was unlocked. The home had two sluice disinfectors, one on each floor of the premises that were well maintained. The laundry was equipped as required and well organised. Laundry and sluice facilities were located away from areas where food was prepared or eaten. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 The staffing levels (skill mix, number and competence) were appropriate to the needs of residents. Recruitment practices were thorough and promoted the protection of service users. Staff benefit from a supportive management team that develops skills and qualifications through an established training programme. EVIDENCE: There were twenty-seven residents at the home. Staffing numbers and skill mix met the levels agreed with the CSCI; from inspection of the staff duty rota and discussion with staff and residents, there was evidence that staffing levels were well maintained, and met the needs of residents. The manager reported some recent staffing problems due to sickness and agency staff had been employed to provide cover. The files of four staff members were inspected: these contained evidence that all the required checks had been obtained (two satisfactory references, CRB/POVA checks) and copies of birth certificates, passports, photographs obtained before the individuals commenced employment at the home. All had received a statement of terms and conditions of employment. Individual training records and evidence of induction training were not inspected on this occasion. Records summarising training were seen, and showed that most staff were up-to-date with all mandatory training including health and safety, fire safety, basic first aid and moving and handling. From staff discussion it was evident that emphasis was placed on reflective practice
Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 18 and they were supported in developing their skills by attendance at training courses and study days. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36 & 38 The manager is supported well by senior staff in providing clear leadership throughout the home with all staff demonstrating a good understanding of their roles and responsibilities. The manager aimed to ensure good health and safety standards but some practices were evident that pose risks to service users and staff. EVIDENCE: The registered manager, who is a registered nurse, has managed the home for several years and is supported by a deputy manager. There was evidence of regular updated training from discussion with the manager and inspection of records. Care staff said that regular handover meetings were held between shifts to discuss residents changing needs. Supervision was therefore provided on a continuous basis enabling staff to feel confidant in approaching the manager
Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 20 and supported in their practice. The manager was well known to residents and their relatives. One relative said they found the manager and staff very approachable and helpful. From discussion with the manager and inspection of records it was evident that staff had an annual appraisal where training and development needs were discussed and agreed. Care staff spoken with described the bi-monthly system of group supervision that had been established led by a registered nurse with counselling/supervision skill. Subjects discussed centred on the home’s philosophy of care and residents rights and included reflective practice. The home was in the main safe, well managed and had the relevant health and safety practices in place. There was evidence from observation, inspection of the records and in discussion with staff and residents that the manager aimed to ensure the health and safety of staff and residents. However, the water temperatures in the sluice washbasin were confirmed at 59 ºCentigrade, a maintenance cupboard containing tools was found unlocked and the external clinical waste bin was also unlocked. The premises were secure and there was evidence of risk assessments of the premises having been undertaken and appropriate action taken. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 X 2 Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 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. 1 Standard OP7 Regulation 12(3) Requirement The registered person must ensure that care plans adequately reflect residents’ wishes and feelings. The registered person must ensure that there are sufficient hoists to appropriately meet residents’ needs. The registered person must ensure that water temperatures are near to 43°Centigrade to prevent risks from scalding. The registered person must ensure that clinical waste bins are kept locked at all times. The registered person must ensure that maintenance cupboards are kept locked when not supervised. Timescale for action 31/12/05 2 OP22 13(5) 31/12/05 3 OP38OP25 13(4) 11/11/05 4 5 OP38OP26 OP38 13(3) 13(4) 11/11/05 11/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000015319.V258312.R01.S.doc Version 5.0 Page 23 Anna Victoria Nursing Home 1 Standard OP15 The registered person should review the supper menu to provide more variety. Anna Victoria Nursing Home DS0000015319.V258312.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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