Inspection on 05/09/06 for Annabel House

This inspection was carried out on 5th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Annabel House 27/09/07

Annabel House 01/03/06

Annabel House 12/09/05

Annabel House 18/01/05

Annabel House 17/06/04

Annabel House 21/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Annabel House 6 Clifton Street Stourbridge Dudley West Midlands DY8 3XR Lead Inspector Mrs Jean Edwards Unannounced Inspection 5th & 6th September 2006 08:30 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 Annabel House DS0000024976.V310493.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. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Annabel House Address 6 Clifton Street Stourbridge Dudley West Midlands DY8 3XR 01384 397104 NONE 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 D L Braham Lisa Braham Care Home 9 Category(ies) of Learning disability over 65 years of age (9) registration, with number of places Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 service users (female) with a dual diagnosis of LD/MD currently living at the home may be accommodated for as long as the home is able to demonstrate that their needs can be met. 4 service users in the category of LD currently living at the home may be accommodated for as long as the home is able to demonstrate that their needs can be met. 2. Date of last inspection Brief Description of the Service: Annabel House is registered to provide care to a maximum of 9 service users. This Home is unusual in that it currently caters for a mixed age range, some being under 65 years the majority being over 65 years. The Homes categories of registration are for people who have a diagnosis of learning disability (LD (E), Mental ill health / disorder (MD (E) or a dual diagnosis. Annabel House is a large detached property located in a residential area, near to the Stourbridge ring road. The Home comprises of two floors, with bedrooms located on each. It has a lounge and dining room, kitchen, laundry, office and toilet and bathing facilities available on both floors. There are seven single bedrooms and one double bedroom. The Home has a staff team of 9 people including the Registered Manager. The level of fees for this home is currently between £380.00 and £ 445.00 per week. There is an additional fee of £13 per month per person for usage of the homes mini bus. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first unannounced key inspection visit for 2006 - 7, undertaken by an inspector from the Commission for Social Care Inspection (CSCI), over two days for approximately 10.0 hours. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to make judgements and obtain evidence includes: discussions with the registered manager, and staff on duty during the visit, together with examination of records and documents and discussions with residents, where possible. Other information was gathered before this inspection visit from the homes pre inspection questionnaire. Eight service user surveys were sent to the home by the CSCI, however none of survey forms have been returned at the date of writing this report. There are currently 8 residents living at the home. During the visit the inspector has spoken to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. Comments indicate that staff are friendly and helpful. There has been a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and a sample of residents’ bedrooms, with their permission. What the service does well: The home has a very committed registered manager, who has worked at the home in various roles for many years and has achieved an NVQ level 4 in Care & Management and the Registered Managers Award. She strives to develop herself and the staff teams professionalism continues to improve the services offered by the home for the benefit of the residents. Staff encourage residents to treat Annabel House as their own home and to develop their independence as far as possible. Residents are encouraged to make their own decisions and choices and there are residents meetings, with notes of discussions and decisions agreed. All aspects of the running of the home are discussed including meals, activities, holidays and celebrations, such as birthdays. One of the carers regularly helps one of the residents to correspond with her sister, for example sharing her news about her activities at the day centre, an outing to the Safari Park, Bewdley and the recent 2-week holiday to Rhyl, pub visits and plans for a beauty night at the home arranged by a member of staff. This person also enjoys regular visits with her family. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 6 Some residents are able to attend daytime activities provided by the Local Authority if they wish. Some of the older residents now choose to stay at Annabel House and generally spend their time being taken out and about by the registered manager, proprietor or members of staff. The premises are maintained to high standards and the home is clean, tidy and homely. Annabel House continues to have a small group of staff that have worked at the home for a long time and know the residents well. They are caring, committed and flexible, often willing to work extra shifts for the benefit of residents. This inspection was conducted with full co-operation of the Registered Manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The registered manager has introduced improvements to contracts, terms and conditions of residence, with additional and clearer information, especially about the individual contribution of £13.00 each month, which each resident makes towards the running costs of the homes minibus. There are improvements to the way each residents care is planned and provided, with clearer short and long-term goals. For example one person would like to access more community activities and another person is aiming to take more responsibility for her own bedroom, doing more cleaning and tidying tasks. Improvements have been made to the written guidance for staff about reducing or minimising known risks. Examples are where someone may eat too much, too fast and risk choking or behave in ways, which would cause harm to themselves in other ways. Some further improvements are needed mainly for the younger residents and those unable to read. The homes system for managing the residents medication has been improved and there are only a few further minor improvements needed, to provide as many as safeguards as possible for the residents. Examples are interim medication training for all staff, waiting to access accredited medication training and revision and expansion of the homes medication policy and procedures. The registered manager has improved and simplified the wording of the complaints procedure, making the print larger and easier to understand. She has also produced written information to explain to residents that they have the right to access and see their own records. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 7 There is an on-going redecoration programme, currently with residents bedrooms being redecorated and refurnished. The home has one vacant bedroom, which is used on a temporary basis whilst each bedroom is completed. Minor repairs to the premises have been put in place since the last inspection, such as the repairs to the ground floor bathroom. The registered manager has the results residents questionnaires, which she is planning to analyse and take action in any area requiring improvement. The registered manager has improved the way that residents are assisted with their finances. Improvements are being put in place to improve the control of potential infections and staff now have colour coded disposable aprons for different tasks, for example blue for food handling, white for personal care. All staff are currently completing an accredited distance learning infection control course. What they could do better: Although there is an activity programme, with records of individual residents participation or refusals, the recommendation that this is produced in other formats, such as pictures has not yet been actioned. Care plans for younger people living at home must show that they are person centred and the residents and their relatives must be actively involved in planning all aspects of care required. The registered person must continue development of the home’s complaints procedure in forms understandable to the people needing to use it. For example for people unable to read or understand written information, pictures, video or audio information must be provided. Similarly the home must develop alternative formats for residents to understand the choice of activities, menus and their rights to see their own records. The registered person must continue progress to show that all staff are supported and trained to be aware of the needs and rights of vulnerable people. Additionally training needs to be put into place for staff to be able to respond appropriately to any behaviour from residents, which can be described as challenging. During the tour of the home a number of repairs and improvements are now needed, for example the reason for areas of damp and peeling wallpaper in the ground floor corridors must be investigated and rectified. The registered person must take action to deal with the staff call system within the home, which is not in working order and is currently deactivated. This must be modernised or replaced, though individual risk assessments have been carried out relating to each residents needs as an interim measure. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 8 The staffing levels at the home must be kept under review to make sure that there are sufficient numbers of competent, trained staff for all residents to have opportunities for stimulating social activities, because staff at the home continue to undertake many duties, which include caring, cleaning, catering, laundry and activities. The registered person is required to provide formal staffing proposals to the CSCI for consideration. The registered person must continue with improvements to systems for dealing with residents financial affairs to show that all possible safeguards have been put in place. The home is required to make improvements to a small number of areas of health and safety practices and records. Two new staff must undertake food hygiene training as a priority because all staff are involving in preparing and serving residents food. 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. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 9 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 Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 10 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): 2,3,5, The overall outcome for this group of standards is judged to be good. There is an up-to-date statement of purpose and service user guide and all residents have contracts / terms and conditions of occupancy. This has the effect that residents and their advocates have adequate information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. This home does not provide intermediate care; therefore Standard 6 is not applicable. EVIDENCE: The home has a statement of purpose, which clearly sets out the objectives and philosophy of Annabel House and this is supported with a service user guide, providing good clear information about the home. Discussions with the registered manager confirm that residents or their families are given a copy of the service user guide. There is documentary evidence, such as residents or Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 11 their relatives signatures to demonstrate receipt of documents, on the sample of residents case files assessed. Recent CSCI inspection Reports and information about advocacy services are located in the office, which provides easy access. Each resident is provided with a contract or statement of terms and conditions. This needs to set out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. The registered manager has included the management of each persons finances in their individual contract and there is documentary evidence that the £13 .00 per month mini bus charge has been discussed with each persons social workers. Advice has been given about the very recent revisions and additions to the Care Homes Regulation 5, which needs to be incorporated into the next review. The home has not admitted any new residents since the last inspection visit in February 2006. Evidence from examination of residents records and discussions confirm that each person was regular review and re-assessment is conducted professionally and sensitively and has involved the family or representative of the resident, wherever possible. Individual preferences are recorded such as rising, retiring, preferred activities, likes and dislikes. These have been signed by the resident where it is meaningful for them to do so or their nearest relative. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 The overall outcome for this group of standards is judged to be adequate. There is improved care planning and monitoring in place, which provides staff with the information and guidance needed to adequately meet residents needs. There is good evidence of multi disciplinary working taking place on a regular basis, which results in the health needs of residents being appropriately met. The home has made generally very good progress with regard to the arrangements for administration of medication, which means residents are safeguarded. EVIDENCE: Each resident has a care plan, in a new care plan format and there is improved evidence showing good practice of involving residents in the development and review of the plan. The plan in most cases includes essential basic information necessary to plan the individuals care and includes a risk assessment element. Improvements have been made to identify individual care needs, with short and long term goals. The registered manager has devised and implemented risk assessments and risk management strategies for all areas of risk, such as risks of self-harm, agitated behaviour and swallowing food whole. From observations and discussions it is evident that documented risk assessments are now available in the home for staff guidance at all times. There are also Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 13 risk assessments in place to manage behaviours from two residents, which challenge the service, with behaviour monitoring charts, which are evaluated. The registered manager acknowledges that no further progress has been made to develop person centred planning in appropriate formats for the residents who are under 65 years. Following the previous inspection visit the registered manager made initial contact with the Dudley Learning Disability Forum but has not yet attended any meetings or sought formal support with developments needed at Annabel House. Care staff have made some additional improvements when completing daily notes, however there is still insufficient detail to show what level of assistance and care is provided and any outcomes linked to goals in care plans. There is generally good evidence of updated information and changed actions in care plans. However the moving and handling assessment and other health screening tools have not been updated for one resident, who has recently returned from hospital who has deteriorating mobility and now requires wheelchair assistance outside of the homes environment. Some residents are able to confirm their involvement in developing the plan and receive feedback on decisions made during reviews. All residents have good access to health care services to meet their assessed needs both within the home and in the local community. Each resident now has a health passport from priority health. CTLD nurses have completed their part of the document and appointments have been arranged with the practice nurse for residents to have a full health assessment. All residents are registered with a GP sensitive to their needs, and there is documentary evidence that all residents have access to individual dentists, either in the community or at day centres. The registered manager has recently arranged for all residents to see an optician. However there are difficulties in accessing NHS chiropodist services, resulting in some residents having to pay for private chiropody care. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. There are currently no residents who able to administer their own medication. Where medication systems are in need of action the registered person is working towards improvement. For example there are no documented pharmacy audits and the registered manager has made a commitment to contact the pharmacy provider to ensure that these are carried out in accordance with the contract. Although accredited medication training has not been provided for staff involved in the administration of medication, training has been provided by Lloyds pharmacy as an interim measure. The manager explained that all staff are currently undertaking accredited infection control training and would find it difficult to cope with additional comprehensive medication training. However Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 14 she has made a commitment to ensure that staff will follow up with accredited medication training. From discussions it is evident that staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms and has offered screens in a shared room, though both residents have declined the offer and this is documented on both residents case files. Observations during the visit and discussions with residents who are able to verbally communicate indicate that they are happy with the way that the staff respect and care for them. One persons states, I like all the staff and especially Lisa the manager and like living here at this home. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 The overall outcome for this group of standards is judged to be adequate. There is evidence of some progress to make planned and spontaneous activities available on a regular basis, which gives some residents some opportunities to take advantage of and develop socially stimulating activities. Residents are offered some opportunities to exercise choice and control over their personal environment and lifestyle at this home. EVIDENCE: From observations and discussions it is evident that the residents at Annabel House let the manager and staff know what makes them happy and also what they dislike and want changed. The registered manager and staff take residents feedback seriously and make changes where possible. The manager and staff can see benefits of developing the homes quality assurance systems to confirm that practice reflects the policies, procedures and guidance. The home has a key worker system, which enables closer resident / staff relationships where residents likes, dislikes and needs are shared. Key workers could use the information to plan activities, which residents will enjoy. There is a good understanding for the need to increase the level and variety of activities and improve access to social stimulation. There is evidence that some residents prefer to spend some time on their own or choose not to be involved Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 16 in group activities. These choices and decisions are well understood, respected and supported by staff at the home. There is an activity programme, records maintained of individual residents participation, including a record of refusals. However the activity programme is not always followed, as it is stated that the residents may not wish to participate. The previous recommendation that activity planners are produced in alternative formats, for example pictorial, to assist residents to make meaningful choices has not yet been actioned. It is positive that all of the residents have had a two-week holiday at a holiday camp in Rhyl, during the first two weeks of August 2006. Although none of the residents are assessed as being able to go out into the community and accompanied individual residents are escorted on shopping trips, mainly to the Merry Hill shopping centre and occasionally to the pub for lunch. One resident attends local Free Church for Sunday services and to residents attend church services held at the Local Authority day centre for older people. There is evidence that family and friends of the residents feel welcome and know they can visit the home at any reasonable time. It has been indicated that staff always make time to talk to visitors and share information with the agreement of the resident. There are written guidelines, as part of each persons plan, for the level of assistance required to deal with post. It is noted that one person enjoys receiving letters and cards and needs staff to help with reading and writing. From evidence on the case file and discussions the resident has regular contact with her sisters and her key worker at the home has started written correspondence, which all parties value and find enjoyable. Residents are able to have personal possessions in their room, but may be not always be able to bring large items of furniture due to, space restrictions or health and safety considerations. There are inventories of residents personal possessions on the sample of files examined, which are updated regularly, and signed and dated by staff, the resident or their representative. Residents enjoy the flexibility of meal arrangements and are able to eat by themselves if they wish. Regular drinks are available and staff are always willing make drinks at any time. The food in the home is of good quality, well presented and generally meets the dietary needs of residents. The majority of staff are experienced, consult on a daily basis with residents and try to meet the preferences and suggested dishes when preparing the menu. During the inspection visit the residents at home at lunchtime requested fish and chips, which the senior member of staff home cooked for them. The empty plates at the end of the meal seemed to indicate that the meal had been enjoyed. The home needs to introduce menus, which include suppertime choices as well as soup and other alternatives. These should be displayed in large print and pictorial formats appropriate to residents understanding. Staff have received training to help those residents who need help when eating and are sensitive in their approach. It has been recommended that consideration be given to the introduction on a trial basis of fresh fruit or vegetable juices and smoothies to Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 17 encourage people to have their five portions of fruit or vegetables as part of a healthy diet. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 18 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 The overall outcome for this group of standards is judged to be adequate. Residents generally feel complaints are listened to and action is taken to look into them, though action is needed to make sure all residents are aware of the complaints process. There are policies, procedures, guidance and progress in place and there is ongoing staff training to safeguard residents from abuse. Good progress continues to be made to improve arrangements for protecting residents. EVIDENCE: The home has complaints procedure displayed in the dining area and contained in the service user guide. The registered manager has improved the homes complaints procedure producing it in a simplified and large print format. As discussed at previous inspection visits the complaints procedure now needs to be developed with further alternative formats, such as pictorial, for people who cannot read or understand the written word. The home has not received any complaints since the last inspection in February 2006. The home has not received any allegations relating to abuse of vulnerable residents. There is a copy of the Dudley MBCs multi-agency procedures for the protection of vulnerable adults, Safeguard and Protect at the home. The homes policies and procedures regarding protection of residents are generally satisfactory and are generally in line with regulations and other external guidance. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 19 It is evident from discussions and documents evidence that all staff have been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. Progress is being made to provide all staff with appropriate adult protection training. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 20 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): 19,21,22,24,26 The overall outcome for this group of standards is judged to be adequate. Significant and positive changes to the décor and furnishings continue to be introduced. The incremental improvements contribute to creating a pleasing and pleasant environment for residents to live in. EVIDENCE: Annabel House is a traditional detached property situated in a residential area of Stourbridge, local amenities are within walking distance and local towns are accessible by public transport. The interior and exterior of the premises are generally maintained to a satisfactory standard. The home is furnished with domestic and comfortable fixtures and fittings and has a homely atmosphere. As identified at previous inspections the staff call system within the home and not in working order and disconnected, must be modernised or replaced. The registered manager has carried out individual risk assessments regarding the staff call facility in the bedrooms as an interim measure, which are documented on each residents file. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 21 The tour of the premises showed that the Home is clean and free of any malodours. There is evidence of on-going redecoration of the residents bedrooms. The vacant room is used whilst redecorating takes place. The completed bedrooms are bright and attractive and arranged according to each persons taste. There are other improvements such as the repair of ground floor bathing facilities. The home does not have a documented audit or planned maintenance programme. The registered manager needs to undertake a written audit of the home from which a prioritised programme of repairs, redecoration and replacement of equipment is devised. It is noted that there are a number of damp patches and peeling wallpaper on the lower areas in the ground floor corridors, which need investigation and resolution. Some joins in the carpet in communal areas are starting to fray, which may become a tripping hazard and there are some areas, which are faded and showing signs of wear. The laundry area is generally well organised and some improvements have been made, examples are cleaning products, which are now stored securely in compliance with The Control of Substances Hazardous to Health (COSHH) Regulations. However, all extraneous items / clutter has still not being removed from the laundry area. The homes kitchen is maintained to high standards of cleanliness, is very well organised, and there is a good variety of fresh, frozen, dried and canned foods. Infection control measures at the home are improving, for example colour coded disposable aprons are used for different tasks, for example blue for food handling and white for personal care. All members of staff are undertaking comprehensive infection control training, through distance learning with Solihull College. Members of staff feel that this is useful and worthwhile and has real benefits, which safeguard the residents. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 The overall outcome for this group of standards is judged to be good. There is a stable, well-motivated staff team and residents receive consistent care. Recruitment practices have improved and provide safeguards for vulnerable adults. EVIDENCE: There are currently 8 residents accommodated, with a variety of dependency levels and diverse needs. Assessment of staffing rotas show an improvement in information provided, such as a breakdown between managerial, care, and catering hours and the actual hours worked by each member of staff. Two members of staff have retired, two new carers have been appointed and there is currently is one staff vacancy. Annabel House has a staff team of 9 people in addition to the registered manager, As indicated at previous inspections an illustration using the Department of Health Staffing Forum Guidance identifies the need for 10.69 staff - Full Time Equivalent (FTE). There is continuing evidence that all staff carry out a range of duties on each shift, such as cleaning, catering, laundry, care and activities. There are no additional ancillary staff employed at the home; and there is no designated activities co-ordinator or designated hours for activities. The registered manager must keep the staffing levels under review and a formal staffing proposal must be forwarded to the CSCI office, Halesowen for consideration. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 23 Random samples of staff files examined are generally satisfactory. Some improvements have been made and there is now contract of employment on each persons file and all staff have been issued with an individual copy of the CSCC (General Social Care Council) code of conduct & practice. However additional areas requiring improvement have been identified during this visit. Examples are, although the personnel files of two new staff contained an application form there was not a full employment history, therefore does not identify any employment gaps. Furthermore to members of staff have been employed on a POVA first basis without any discussion with the CSCI office, Halesowen or evidence of a written risk assessment, with named sufficiently experienced and qualified and competent supervisors. There is evidence that 4 of the 8 care staff have achieved an NVQ level 2 care award, with new candidates about to be registered. This means that the home is now able to demonstrate that it meets the ratio of 50 of care staff with an NVQ 2 (or equivalent) award. The manager demonstrates a strong commitment to staff training and development, together with support measures such as structured supervision. During discussions it is evident that staff are knowledgeable about what residents needs are and how to meet them and there is a warm rapport with residents and relatives. Staff spoken to generally feel that morale is good and that they are aware of their responsibilities, and what is expected of them. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37,38 The overall outcome for this group of standards is judged to be good. The registered manager is effective in providing leadership and good clear communication systems throughout the home. The systems for resident consultation at Annabel House are generally good with some evidence that indicates that efforts are made to ensure that residents’ views are both sought and acted upon. EVIDENCE: Lisa Braham is the registered manager at Annabel House. She has worked at the home for many years, promoted from carer to senior and has developed personally and professionally, achieving the NVQ Level 4 care and management Award together with the Registered Managers Award (RMA), and she continues to demonstrate commitment to her own ongoing professional training and development. Residents and staff say that she is very Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 25 approachable, supportive. Two residents say they can tell her anything and that she will make sure that things are put right. Although there are now clear lines of accountability within the home, the registered provider must provide formal documented supervision and a new relevant job description for the registered manager. She must also demonstrate support and monitoring through regular monthly unannounced Regulation 26 visits and written reports given to the home and submitted to the CSCI office, Halesowen. The registered manager is continuing with the process of devising a new annual development plan for the home, which must be forwarded to the CSCI office, Halesowen. There are regular residents meetings and questionnaires have recently been distributed to residents and families and completed forms have been returned and views are now being collated. The manager plans to feed back the results and take action in any area where there are concerns or where performance needs improvement. Informal residents meetings and discussions are held on a monthly basis with the registered manager, who produces notes of the topics discussed. Staff meetings are held regularly, with minutes available. Staff consulted state that they find the meetings useful and helpful. None of the residents are able to manage their own finances. The registered person continues to act as an agent for 6 residents, and the registered manager has arranged a system with the help of the Local Authority for residents monies to be transferred to the home, invoices to be raised for the payment of fees, the remaining funds are then withdrawn as cash and held securely in separate temporary safekeeping accounts for each person. Larger balances are paid into individual investment NS&I accounts opened in April 2006. There are now financial records at the home for each resident, and a sample of records and balances have been assessed. These are generally satisfactory, with clear records of transactions, two signatures and receipts. There are two minor discrepancies with one balance minus 30 pence and one balance in excess by 60 pence. It is recommended that the registered manager should conduct a regular documented reconciliation of residents temporary safekeeping balances. Additionally as previously required the registered person must provide evidence that the residents financial accounts managed by the home are independently audited. Record keeping continues to improve, providing safeguards for residents. However the registered manager must ensure Regulation 37 notifications are submitted to the CSCI office, Halesowen for any event adversely affecting residents, such as illness and hospital admissions. Assessment of the fire safety, maintenance service and mandatory training certificates show that records are generally satisfactory. The manager strives to make sure that all staff receive mandatory training commensurate with their Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 26 roles. For example recently all staff have recently received fire safety training and fire drills and all staff have received food hygiene training in February 2006, with the exception of two new staff. Refresher first aid training has been booked for October 2006 for all staff. The accident records examined are generally satisfactory. There have been 3 accidents involving residents since the inspection visit in February 2006. The registered manager has analysed the reasons, identifying any corrective measures needed. Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 27 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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 2 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 3 2 2 Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement 1) To ensure service user plans are signed by the service user / representative (Timescale of 31/10/04 and 30/11/05 and 01/05/06 Not Fully Met) 2) To develop plans according to the principles of person centred planning, especially for younger service users (Timescale of 31/10/04 and 30/11/05 and 01/05/06 Not Fully Met) 2 OP7 15(1) 17(1) 1) To expand daily notes to provide fuller detail of care provided and outcomes (Timescale of 30/11/05 and 01/05/06 Not Fully Met) To review and update residents moving & handling risk assessment where there are changes to mobility (KT) To explore options for residents to access the NHS chiropody service on a regular basis as necessary for each person 01/12/06 Timescale for action 01/12/06 3 OP7 13(4) 15(1) 01/10/06 4 OP8 13(1) 01/11/06 Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 29 5 OP9 13(2) To ensure that all staff involved in the system of administration of medication have received accredited training for the safe administration of medicines (Timescale of 31/05/05 and 30/11/05 and 01/06/06 Not Fully Met) 1) To request that the Pharmacist Provider conducts regular audit visits, with written reports made available to the home in compliance with PCT contractual obligations 2) To forward a copy of the pharmacists audit, when received 01/12/06 6 OP9 13(2) 01/12/06 7 OP16 22 The Registered Provider/Manager 01/12/06 must ensure that the homes complaints procedure is produced in formats to make it easier to understand by the residents. (for example pictorial) (Timescale of 31/10/04 and 30/11/05 and 01/05/06 Not Fully Met) To provide training for all staff in the use of physical and nonphysical intervention techniques (Timescale of 31/03/05 and 31/12/05 and 01/06/06 Not Met) 1) To undertake a regular audit of the premises and devise a planned programme of maintenance, renewal and repairs, with prioritised timescales and include - Re-stretching first floor corridor carpet - Rectify the fraying joins in 01/12/06 8 OP18 13(5) 19(1) 9 OP19 23(2) 01/11/06 Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 30 carpets in communal areas - Plan replacement of any areas of worn carpet 2) To explore and rectify the damp areas (peeling wallpaper) on the lower areas of the ground floor corridors 10 OP22 13(4) 23(2) The staff call system within the home must be modernised/replaced. (Timescale of 31/10/04 and 31/12/05 and 01/05/06 Not Met) To secure the wardrobe in bedroom 8 To remove all extraneous items / clutter from the laundry area (Timescale of 30/11/05 and 01/05/06 Not Fully Met) To ensure that there are supplies of liquid soap and paper towels readily available in communal bathing and toilet facilities 1) The staffing levels at the home must be kept under review to make sure that there are sufficient numbers of competent, trained staff for all residents to have opportunities for stimulating social activities 2) To forward revised staffing proposals, together with sample rotas to the CSCI office, Halesowen for consideration 1) To ensure that there is a satisfactory signed and dated health declaration on individual staff personnel files 2) To ensure that there is a full Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 31 01/12/06 11 12 OP24 OP26 13(4) 13(4) 23(2) 01/10/06 01/10/06 13 OP26 13(4) 01/10/06 14 OP27 18(1)(a) 01/11/06 15 OP29 17(2) 19(1) 01/11/06 employment history documented on each persons application form, with a satisfactory explanation for any employment gaps 3) To ensure that the CSCI office, Halesowen is made aware of any member of staff employed on a POVA first basis 4) To ensure that there is a written risk assessment in place for any member of staff employed on a POVA first basis and that there is no unsupervised contact with service users 5) To ensure that there are named supervisors, sufficiently experienced and qualified and competent named on the POVA first risk assessment and staff rotas 16 OP29 17(2) 19(1) To ensure that the home has copies of public liability insurance, POVA/CRB, qualifications for the hairdresser and any other independent therapists, such as the Chiropodist and independent optician who may offer services to the residents at the home (Timescale of 01/05/06 Not Fully Met) 01/11/06 17 OP30 18(1)(c) To provide staff training relating 01/12/06 to person centred care planning, especially for younger service users (under 65 years) with a learning disability (Timescale of 31/10/04 and 31/12/06 and 01/05/06 Not Met) To forward a copy of the homes annual training plan and the DS0000024976.V310493.R01.S.doc 18 OP30 18(1)(c) 01/11/06 Annabel House Version 5.2 Page 32 19 OP31 19(1) 20 OP33 24 individual staff training profiles for the two new staff (files sampled at inspection visit) To ensure that the registered manager is issued with an up to date, relevant job description and contract of employment 1) The Registered Provider/Manager must produce and implement quality assurance and quality monitoring systems. (Timescale of 31/10/04 and 31/12/06 and 01/06/06 Not Fully Met) 1) The Registered Provider, who must provide regular formal documented supervision for the registered manager (Timescale of 01/05/06 Not Fully Met) 2) To ensure that documented Regulation 26 visit from the registered provider are conducted consistently on a monthly basis, with reports to the Home and the CSCI Satellite office - Halesowen. (Timescale of 01/05/06 Not Met) 01/11/06 01/12/06 21 OP33 24 01/11/06 22 OP33 24 1) To progress the annual development plan, forwarding a completed copy to the CSCI office, Halesowen 2) To progress the use of service user questionnaires, with collated results forwarded to the CSCI office, Halesowen 3) To progress the use of relatives questionnaires, with collated results forwarded to the CSCI office, Halesowen 4) To progress the use of stakeholder questionnaires, with collated results forwarded to the 01/12/06 Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 33 23 OP35 20(1) Sch 4(9) CSCI office, Halesowen The registered person must provide evidence that the residents financial accounts managed by the home are independently audited (Timescale of 01/06/06 Not Met) 01/11/06 24 OP37 17(2) 37(2) To ensure Regulation 37 01/10/06 notifications are submitted to the CSCI office, Halesowen for any event adversely affecting service users, such as illness and hospital admissions The home must carry out regular environmental risk assessments; record the findings from these and details of any action required/taken. (Timescale of 31/10/04 and 30/11/05 and 01/05/06 Not Fully Met) 1) To provide accredited risk management training for all persons involved in undertaking risk assessments or engage the services of a ‘competent’ person to provide documented risk assessments, with control measures and risk management strategies. (Timescale of 31/05/05 and 31/12/05 and 01/06/06 Not Met) 2) To provide documentary evidence that approved risk assessment awareness training has been arranged for all staff to be delivered within an identified timescale. (Timescale of 31/05/05 and 31/12/05 and 01/06/06 Not Met) 01/12/06 25 OP38 13(4) 18(1)(c) 26 OP38 13(4) 18(1)(c) 01/12/06 27 OP38 13(4) 18(1)(c) 1) To ensure that all areas of risk associated with individual service users are clearly DS0000024976.V310493.R01.S.doc 01/12/06 Annabel House Version 5.2 Page 34 documented, such as challenging behaviours, personal safety within the Home’s environment and on any activities where the Home has a duty of care, especially outside the homes environment. (Timescale of 30/06/05 and 01/06/06 Not Fully Met) 2) To ensure that documented risk assessments and risk management strategies relating to the service users and the environment are reviewed, expanded and implemented. (Timescale of 30/06/05 and 31/12/06 and 01/06/06 Not Met) 28 OP38 13(4) 18(1)(c) The registered person must 01/12/06 provide accredited health & safety training for the designated person (the registered manager) responsible for health & safety in the home (Timescale of 01/06/06 Not Met) The access to the laundry must be restricted on a risk assessed basis (Timescale of 01/06/06 Not Fully Met) To provide food hygiene for two new staff as a priority 01/10/06 29 OP38 13(4) 30 OP38 13(4) 18(1)(c) 01/11/06 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 DS0000024976.V310493.R01.S.doc Version 5.2 Page 35 Annabel House 1 2 3 Standard OP7 OP8 OP10 That a documented checklist is devised and implemented to demonstrate personal care provided That the Home obtains a summary or copy of the National Service Framework for Older People The Registered Provider/Manager should give consideration to providing suitable facilities for service users to meet with visitors in private That activity planners are produced in alternative formats, for example pictorial, to assist residents to make meaningful choices That the home should explore options for increased community contact / involvement / activities outside the home That menus are produced in alternative formats, for example pictorial, to assist residents to make meal choices That the registered person should establish Mulberry House induction package is compatible with the Skills Council for Care Induction requirements That all relevant policies and procedures are developed in alternative formats suitable for residents capabilities That the registered manager undertakes a documented reconciliation of residents temporary safekeeping balances 4 OP12 5 6 7 OP12 OP15 OP30 8 9 OP33 OP35 Annabel House DS0000024976.V310493.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 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. 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