Inspection on 21/10/05 for Annabel House Care Centre

This inspection was carried out on 21st October 2005.

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 Care Centre 02/08/07

Annabel House Care Centre 06/06/06

Annabel House Care Centre 24/06/05

Annabel House Care Centre 25/11/04

Annabel House Care Centre 03/08/04

Annabel House Care Centre 17/03/04

Annabel House Care Centre 06/08/03

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Annabel House Care Centre 57 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX Lead Inspector Juanita Glass Announced Inspection 21st October 2005 09:30 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 Care Centre DS0000020226.V249858.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. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Annabel House Care Centre Address 57 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX 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) 01934 416648 01934 415922 Dr Martin Thomas Wyatt Mrs Pamela Delphine Wyatt Ms Jean Bracegirdle Care Home 32 Category(ies) of Dementia (32), Dementia - over 65 years of age registration, with number (32), Mental disorder, excluding learning of places disability or dementia (32) Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Staffing notice 19/3/2001 applies May accommodate up to 32 persons aged 50 years and over with mental disorder requiring nursing care May accommodate up to 32 persons aged 50 years and over with dementia requiring nursing care. Manager must be a RN on part 3 or 13 of the NMC register Date of last inspection 26th June 2005 Brief Description of the Service: Annabel House is a Victorian building with a purpose built two-floor extension at the rear. The home is registered with the Commission for Social Care Inspection for 32 residents with dementia or mental health problems. Resident’s rooms are on the ground and first floor, access is provided by a lift. Whilst the office and staff room are in the basement. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over four days. On the first day two inspectors were present, whilst a third Inspector reviewed progress made regarding residents finances on the third day. This was to review requirements made at the inspection, which took place in November 2004. The inspectors were still concerned regarding high levels of bronchial pneumonia that had previously occurred in the home. Therefore one inspector concentrated on the care records of residents currently residing at Annabel House. Whilst the other inspector looked at care records for residents who had died in the last 12 months. The emphasis on reviewing care records at this inspection meant that the inspectors were unable to spend a lot of time talking with residents, relatives and staff. A further inspection will take place in approximately 1 month, to (a) look at the progress made following the requirements identified at this inspection, and (b) to talk with residents, relatives and staff. The inspectors discussed with the manager and owner the poor recruitment practices that were being followed by the home, and the managers lack of understanding of the policies and procedures for the protection of vulnerable adults. The inspectors made one immediate requirement, eight requirements and one recommendation; these are discussed in the relevant sections of this report. What the service does well: What has improved since the last inspection? The homes policies and procedures for the receipt, storage, administration and disposal of medication has improved and current guidelines were being followed, with the exception of two areas which are discussed in the relevant section. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 6 Residents records showed specific risk assessments and care plans identified changes in condition. Full time activities organiser has been employed and a range of meaningful activities are being provided regularly. The residents finances are managed appropriately. What they could do better: 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 Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 7 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 Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 8 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): 1,3 and 5, and 6 does not apply. Prospective residents/relatives are provided with adequate information to make an informed choice. All prospective residents needs are assessed prior to admission, and representatives are offered a chance to visit the home. EVIDENCE: The Statement of Purpose and Services User Guide was not reviewed during this inspection, however they have contained the relevant information at previous inspections and had not been reviewed recently. All residents records reviewed contained clear dated pre-admission assessments, the manager confirmed that she would visit the prospective resident or discuss their needs over the phone if the distance to travel is too far. All prospective residents are offered the chance to visit the home, however this is usually carried out by a relative on their behalf. None of the residents spoken to expressed an opinion regarding the admission process. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 9 Each resident has a contract or statement of terms and conditions, however these were not reviewed at this inspection. At the last inspection a requirement was made that these documents must include the room number agreed on admission, progress in this will be reviewed at the next inspection. Annabel House Care Centre DS0000020226.V249858.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, 9, 10 and 11. Resident’s health and social needs are clearly set out in individual care plans, and are fully met, however records need to be consistent. The policies and procedures for the receipt, storage, administration and disposal of medication meet current recommendations. Residents are treated with respect and dignity, however the home does not respect their privacy. Staff meet the needs of dying residents with care, sensitivity and respect. EVIDENCE: Six care records for residents currently residing at Annabel House were reviewed, they were very clear and showed concise guidelines for staff. The deputy manager has introduced specific care plans for short-term changes of conditions, these were evident in existing care plans, along with risk assessments specific to the individual. All residents had clear records of weight loss and gain, which also showed action taken if a problem was noticed. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 11 It was noticed in the daily records that a number of accidents were not being recorded on the relevant documentation and that there was a high incidence of unexplained injuries, such as swollen wrists and black eyes. This was discussed with the manager who stated that they currently had a number of residents who were ‘wrist pullers.’ The inspectors made two requirements regarding the recording of all accidents and requiring the manager to investigate all unexplained injuries. It was particularly noticed that one resident was regularly ‘catching’ her leg on the stair lift resulting in skin tears, this was discussed with the deputy manager who agreed to look into protective measures for this resident. Staff were observed during the day to have a friendly and caring approach to the residents. Most of the residents spoken to were unable to express an opinion, however those who could said, that most of the staff were nice. Staff were observed moving residents to the dining room at lunchtime, they were caring and respectful, however it was noted that they were transporting residents in wheelchairs and not using the footplates; this is a very dangerous practice and could result in serious injury to the resident. One resident’s room was noted to have a very large notice stating they had MRSA. This practice does not respect the residents right to privacy or confidentiality. The inspector discussed the reasons for the notice with the manager and it was agreed that an appropriate hand over to staff should be adequate to alert them to the needs of individual residents and that the notice should, if necessary, be placed inside the wardrobe door as a reminder to staff, but not displayed for all to see. Following requirements at the last inspection the policies and procedures for the receipt, storage and administration of medication, were clearly being observed. It was noted that the MAR sheets contained a few gaps where a signature should have been, this was discussed with the deputy manager, and a reminder was made that all medication must be signed for at the time of administration. It was also noted a container of ointment for one resident had been used for another resident. Care plans for residents who had died contained clear records, which showed that pressure area care, fluid balance and nutritional needs had been taken into account, a record of family involvement and wishes were also included. Annabel House Care Centre DS0000020226.V249858.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 and 13 The home provides meaningful activities for residents. Residents are helped to maintain links with their family. EVIDENCE: Since the last inspection Dr Wyatt has employed a fulltime activities organiser who concentrates only on providing meaningful activities for the residents. During the inspection the organiser was observed to carry out 1-1 sessions and small group work in the morning, hand massage during lunchtime and singing in the afternoon, staff were observed to be encouraging and enabling residents and they were all very enthusiastic. One resident who could express an opinion stated that the 1-1 sessions were really nice as they preferred to remain in their room, they enjoyed chatting and playing cards. There are no restrictions on visiting and residents are assisted to maintain contact with their families. The provision of nutritional needs will be reviewed at the next inspection, however most of the residents were observed to take lunch in the dining room during one of two sessions. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 13 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 and 18 The home has a very clear complaints policy and procedure, however a relative did not feel a complaint had been dealt with adequately. Residents are not protected from abuse by the homes policies and procedures. EVIDENCE: The home has a very clear policy and procedure for the receipt and actioning of complaints however the CSCI is currently investigating a complaint made by a relative to the commission, who did not feel that the home had taken her complaint seriously or acted on it appropriately. This complaint is still under investigation and a full report will be made on completion. The home has clear policies and procedures for the protection of vulnerable adults however the recruitment procedure followed by the manager does not protect the residents from abuse, staff had been employed without two references and a POVA 1st confirmation, this leaves residents open to potential issues of abuse and is discussed further in the relevant section of this report. Following discussions with the manager it was evident to the inspectors that the manager did not show an awareness expected of her position regarding the North Somerset policies and procedures for the protection of vulnerable adults, and the reporting of potential abuse. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 14 An adult protection investigations was being carried out at the time of the inspection, the home had protected the residents from abuse by acting appropriately and suspending the member of staff concerned. Annabel House Care Centre DS0000020226.V249858.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): 22 and 26 Residenst have the specialist equipment needed, with the exception of access to call bells. The home is clean, pleasant and hygienic. EVIDENCE: These standards will be assessed at the next inspection. It was noted that the majority of residents do not have access to a call bell system; this was discussed with the manager who felt that the residents in question were not considered suitable to have access to cords as they posed a threat to the resident. It was agreed that individual risk assessments must be carried out to show which residents cannot have a call bell cord, and that each resident must be considered on an individual basis not as a generic risk assessment. The inspectors did find the home to be clean, pleasant and hygienic. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 16 Annabel House Care Centre DS0000020226.V249858.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 and 29 Residents are supported by the numbers and skill mix of staff. The homes recruitment procedure place residents a risk of potential harm or abuse. EVIDENCE: Staff duty rotas for the last six months confirm that the residents are supported by adequate staffing levels, however it was noted that some staff are carrying out very long shifts. In particular one qualified member of staff had actually been in charge of the home for 36 hours over a weekend, and regularly does an afternoon shift followed by a night shift. One resident commented on the amount of time the particular member of staff spent in the home and stated they appeared to be there for 24 hours on occasions, the resident also commented that the member of staff can be rude especially after such a long shift. Staff working for such long shifts is not good practice, especially when the staffing notice states the qualified night nurse is a waking post, this is not possible over a 36 hour period. Staff personnel records were reviewed and showed that the home does not follow an appropriate procedure to ensure residents are protected from abuse. Staff records showed that they had been employed before the home had received two references and a POVA 1st confirmation; in fact the CRB requests were not made until the member of staff had worked several shifts at the home. This was discussed with both Mrs Bracegirdle and Dr Wyatt who felt Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 18 that staff needed to work a shift before deciding to stay at the home on a permanent basis, therefore a CRB would not be appropriate if they left straight away. The inspectors reaffirmed that they must have two references and a POVA 1st before they enter the home for a shift, they must then work supervised until the full CRB is received by the home. This is very poor practice and an immediate requirement was made. Annabel House Care Centre DS0000020226.V249858.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): 35, and 37 Management of resident’s finances has improved and resident’s financial interests are safeguarded. Resident’s rights and best interest are not safeguarded by the homes record keeping and policies and procedures. EVIDENCE: A third inspector spent a few hours reviewing the management of resident’s financial records. This was a follow up of requirements and recommendations made at the inspection in November following discussion with Dr Wyatt. The inspector was pleased with the progress made and the records were clear and concise with receipts and balances correct. It was recommended that the home does not keep large amounts of cash on behalf of individual residents. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 20 As previously discussed in the relevant sections of this report, the homes record keeping and their policies and procedures do not safeguard the residents. The recruitment procedure followed leaves residents open to potential harm and abuse. The recording of MRSA does not give due consideration to the privacy and confidentiality of the specific resident involved. Staff do not record all accidents in the appropriate format. Staff are not consistent at signing for medication when administered. An overall review of the implementation of health and safety within the home was not carried out at this inspection however the inspectors did point out to the manager that the bed head board in a specific room was loose and had fallen of in the inspectors hand. As previously stated under standard 8: It was noticed in the daily records that a number of accidents were not being recorded on the relevant documentation and that there was a high incidence of unexplained injuries, such as swollen wrists and black eyes. This was discussed with the manager who stated that they currently had a number of residents who were ‘wrist pullers.’ The inspectors made two requirements regarding the recording of all accidents and requiring the manager to investigate all unexplained injuries. It was particularly noticed that one resident was regularly ‘catching’ her leg on the stair lift resulting in skin tears, this was discussed with the deputy manager who agreed to look into protective measures for this resident. Annabel House Care Centre DS0000020226.V249858.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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 X X X 2 X X X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 3 2 Annabel House Care Centre DS0000020226.V249858.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 2 Standard OP8 OP9 Regulation 12(1) 13(2) Requirement Footplates must be used on wheelchairs when transporting residents. Staff must ensure that prescribed creams and ointments are only used for the person named on the prescription. Staff must sign the MAR sheet when medication administered or enter a reason why omitted. The manager must revise the positioning of the MRSA notice in the identified residents room. The manager must attend the investigators training for POVA run by N Somerset SS. Residents must have access to the nurse call system, or be clearly assessed as unsuitable. The manager must obtain a POVA 1st confirmation and two references before employing new staff. All accidents must be recorded on the appropriate forms. All unexplained accidents must be recorded and the cause investigated by the manager DS0000020226.V249858.R01.S.doc Timescale for action 26/10/05 26/10/05 3 4 5 6 7 OP9 OP10 OP18 OP22 OP29 13(2) 12(4a) 13(6) 16(2c) 19(4c) 12(1a) Sc 2 12(1) 17(1) Sc 3 12(1) 26/10/05 26/10/05 26/02/06 26/10/05 26/10/05 8 9 OP38 OP38 26/10/02 26/10/05 Annabel House Care Centre Version 5.0 Page 23 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 2 3 Refer to Standard OP35 OP27 OP22 Good Practice Recommendations Arrangements should be made to ensure that residents’ cash looked after at the premises is not excessive The manager should monitor the staff rota to ensure that staff do not work shifts which are excessive and jeopardise patient care The manager needs to check the headboard attachment in the specified room. Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Annabel House Care Centre DS0000020226.V249858.R01.S.doc Version 5.0 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. 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