Inspection on 24/06/05 for Annabel House Care Centre

This inspection was carried out on 24th June 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 21/10/05

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 Unannounced 24 June 2005 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 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 D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Annabel House Care Centre Address 57 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX 01934 416648 01934 415922 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Martin Thomas Wyatt Ms Jean Bracegirdle Care home with nursing 32 Category(ies) of Mental Disorder (32) registration, with number Dementia (32) of places Dementia - over 65 (32) Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 32 persons aged 50 years and over mental disorde requiring nursing care. 2. May accommodate up to 32 persons aged 50 years and over with dementia requiring nursing care. 3. Manager must be a RN on part 3 or 13 of the NMC register. 4. Staffing notice 19/3/2001 applies. Date of last inspection 25 November 2004 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. Residents rooms are on the ground and first floor, the office and a staff room are in the basement. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in the presence of the matron, Mrs J. Bracegirdle, and Dr Wyatt. Concerns had been raised of the high levels of bronchial pneumonia experienced in the home, so the outcomes of resident’s health and welfare were the main remit of this inspection. Three inspectors were present during this inspection - a pharmacy inspector, an inspector with general nursing experience and one with dementia care experience. Due to the narrow remit of this inspection not all standards were assessed. The pharmacy inspector’s full report is attached with this report. What the service does well: What has improved since the last inspection? What they could do better: The home needs to introduce a method of maintaining a clear audit trail of medication being used; the medication policy and procedure needs to be made more specific to the home. There needs to be clear triggers to identify when and how much PRN medication is used. Care plans need to reflect changes in condition and temporary care plans need to be put in place if identified. The language used in care plans needs to be considered. All residents must have a clear risk assessment where a specific risk is identified. Terms and conditions documents must identify the room number the resident is occupying. Care records need to identify pressure relief provided when the need has been identified. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 6 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 D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 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 standard(s) 2,3 and 5 Prospective residents/relatives are provided with adequate information to make an informed choice. Written contract/statement terms and conditions are not concise enough. EVIDENCE: Some care records seen did not contain clear pre admission assessments. This had been discussed at the last inspection and in discussion with the manager it was confirmed that new forms showing clear assessment had been devised and were now in use prior to each admission. A recent admission showed evidence of an assessment being carried out over the phone. Each resident has a clear contract or statement of terms and conditions; copies of these were seen in their records, however it was noticed that they do not state clearly which room the resident is occupying. The manager confirmed that relatives usually visit the home prior to admission on behalf of the resident. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9 and 11 Individual plans of care show clear guidelines however more information is needed. Medication policies and procedures need revising. EVIDENCE: Care records reviewed were very clear and showed concise guidelines for staff. The deputy manager has recently taken on a full review of care plans and their documentation which showed a clear improvement. It was noted that although the care plans were full they lacked specific plans for short-term changes of conditions;it was suggested that the home could use a core care plan for such things as chest infections. All residents had clear records of weight loss or gain, which also showed action taken if a problem was noticed. Care plans for residents who had died contained records that showed pressure area care, fluid balance and nutritional needs had been taken into account. A record of family involvement and family wishes were also included. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 10 Residents were unable to express an opinion on their care, however staff were observed to approach residents in a polite and respectful manner and knock before entering rooms. The pharmacy inspector’s full report is attached however it was noted that the home needs to revise the medication policy and procedure to be specific to the home. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12 and 15 The home provides meaningful activities for residents. Nutritional needs of residents are considered and met. EVIDENCE: Following the last inspection a clear record of activities attended by residents is now kept and this shows that residents do take part in meaningful activities. Records show that residents attended sessions in music, dance, hand massage, indoor games and outside entertainments. During the inspection care workers were observed to be talking with residents and reading newspapers with them. A small number of residents go for a walk in the park, it was noted that this was usually the same group of residents. Menus in the home were not looked at during this inspection however a monthly check of resident’s weights is recorded and any nutritional needs are identified. It was noted that residents had tended to gain weight on admission. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 12 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 standard(s) Not assessed. EVIDENCE: These standards will be assessed at the next inspection. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 21, 24 and 26. Residents live in a safe, homely and well-maintained environment. EVIDENCE: A tour of the premises was carried out during this inspection and the cleaning programme was discussed with the cleaner present on the day. The home is clean and tidy with no offensive odours, the residents’ rooms showed evidence of personal belongings and preferences in place. One resident spoken to whilst sitting in her room said she had a nice room and her own possessions and pictures. The cleaner was observed to have adequate cleaning materials and protective clothing. In discussion with the cleaner it was confirmed that when a resident leaves the home or dies the room is given an extra ‘deep clean’ before being reoccupied. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staffing levels and skill mix are appropriate to meet the needs of the current resident group. EVIDENCE: Staffing levels were discussed as concerns had been raised regarding the continuity of care at the weekends, the matron confirmed that qualified cover at the weekends did not promote continuity and that they had now employed another qualified member of staff to overcome this. This will be assessed at the next inspection. The home has employed qualified staff with experience in general nursing and mental health to provide a skill mix of staff that meets both the physical and mental health needs of the residents. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 and 38. The manager is qualified and demonstrates an awareness of her roles and responsibilities. Record keeping and policies and procedures need revising. Health and safety of residents is not completely identified through risk assessments. EVIDENCE: The manager has completed a registered managers award she is also an NVQ assessor and is a manual handling and health and safety trainer. Records maintained by the home were clear and appropriate storage is available, however it was discussed with Mrs Bracegirdle and Dr Wyatt that some of the entries in the care plans used inappropriate or ambiguous language and did not show a professional approach to record keeping. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 16 As previously mentioned the pharmacy inspector stated that the policy and procedure for the storage, receipt and administration of medication needed to be revised to be specific to the home. In discussion with the manager, deputy manager and Dr Wyatt the high level of coughs, colds and pneumonia in the home was mentioned. The home had looked into possible causes such as staff sickness and relatives visiting with colds. The water system had been checked for Legionella and the result returned negative. Relatives have been asked not to visit if they felt they had a cold. Some residents’ care records did not have clear risk assessments for specific needs identified, such as risk of falls, Sundowners’ Syndrome, use of Warfarin or Grand Mal seizures. The home has very clear infection control guidelines, which showed evidence of an audit which had been carried out by the manager. Clear records are maintained of accidents within the home and a fall’s audit has been carried out identifying high-risk areas or times of day. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x 2 2 Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 18 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. 3. 4. 5. Standard 5 (1) 13 (4) 15 (2b) 13(2) 13(2) Regulation OP 2 OP 7 OP 38 OP 7 OP 9 OP 9 Requirement Residents terms and conditions must state clearly which room the resident is occupying. All residents must have risk assessments for identified need specific to the resident. A care plan must be put in place for identified changes in conditions. The medicines fridge must be kept locked. All medication must be secure at all times. A statutory warning sign must be visible if oxygen is stored. Masking tubing must be kept clean. Timescale for action From 24/06/05 From 24/06/05 From 24/06/05 By 01/08/05 By 01/08/05 6. 7. 8. 13(2) 13(2) OP 9 OP 9 The receipt of all medicine into Annabel House must be recorded. For medicines prescribed with a variable dose, the dose given must always be recorded. From 01/07/05 From 01/07/05 Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 19 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. 4. 5. 6. 7. 8. 9. Refer to Standard OP 7 OP 7 OP 9 OP 9 OP 9 OP 9 OP 9 OP 9 OP 9 Good Practice Recommendations Language used in written care plans needs to be revised. Need to identify all pressure relief is being provided when the need is identified. It is strongly recommended that medicines are transported around the home securely using the medicine trolley. A minimum/maximum thermometer should be purchased and used to monitor daily fridge temperatures; a record of the readings should be kept. It is strongly recommended that action be taken to ensure that medication not received in monthly blister packs can be audited. The medication policy available in the home should be reviewed to ensure that it accurately reflects the procedures used in the home. Changes to medication on the medicines administration record sheet should be signed and dated by the person making the change. Clear written guidance should be available to staff as to the indications for administering when required medicines and how much to give if the dose is variable. Confirmation of Warfarin doses following blood tests should be received in writing to reduce the risk of errors. Annabel House Care Centre D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Castle Street Tangier 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 D53 - D02 S20226 Annabel House Care centre V222279 Stage 4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!