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

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 21/10/05

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 Unannounced Inspection 6th June 2006 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.V294457.R01.S.doc Version 5.1 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.V294457.R01.S.doc Version 5.1 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.V294457.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 Staffing notice 19/3/2001 applies Date of last inspection 12th October 2006 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.V294457.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Current fees: £527.66 - £843.05 This key unannounced inspection took place in the presence of the manager Mrs J Bracegirdle over six and a half hours, the atmosphere in the home was pleasant and relaxed. Care records and staff personnel records were reviewed, residents spoken to and working practices observed throughout the day. Surveys were sent to residents and relatives requesting their views. Since the last Announced Inspection in October 2005, five monitoring visits have been carried out; these had identified shortfalls in person centred care and safe recruitment procedures. This key inspection identified that the manager and staff have worked very hard to improve the service provided to the residents at Annabel House. Those residents who could express an opinion were happy with the home and the care they received they said staff were kind and considerate. Staff were observed to interact well with residents and showed an awareness of the need to communicate with residents when carrying out interventions. Residents were observed to be relaxed and to have a friendly rapport with the staff they were talking to. What the service does well: What has improved since the last inspection? The manager and staff have worked hard to improve the provision of care in the home over the last 10 months. Improvements include: • A meaningful programme of activities run by an activities organiser who also knows the residents needs. • Staff are more interactive with residents they are not concentrating so much on tasks but on individual needs. • The care plans are now more person centred and individual to the resident rather than generic. • Menus have been reviewed and include fresh ingredients. • Recruitment procedures have been improved and now protect residents from potential abuse. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 6 • • Improvements to the laundry facilities and provision of a new shower room has made the implementation of Infection Control in the home easier for staff to maintain. A new routine for residents going to bed and rising in the morning has been adopted which is more flexible and reflects residents personal preferences. The eagerness of the manager and staff to adopt new ideas over the last 10 months has been commendable and can be seen in the day-to-day running of the home. 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.V294457.R01.S.doc Version 5.1 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.V294457.R01.S.doc Version 5.1 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): 2,3 and 4, Standard 6 does not apply Quality in this outcome group was adequate. All records reviewed contained a contract or statement of terms and conditions between the resident and the home. Evidence reviewed confirms prospective residents have a needs assessment carried out before they are admitted to the home. Care staff have the necessary skills and ability to care for residents admitted, however records do not evidence that they have specific training in dementia care. EVIDENCE: Care records for six residents were reviewed; these included three residents who had been admitted within the last six weeks. All care records reviewed contained a contract or a statement of terms and conditions. These had been signed by relatives on the residents behalf. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 9 The manager carries out preadmission assessments for all prospective residents within travelling distance. If she is unable to carry out the assessment herself there was evidence of social services and hospital care plans. All preadmission assessments seen provided clear information enabling staff to implement a preliminary care plan on admission, however the records for three residents did not contain care plans. This is discussed in the relevant part of this report. The assessment included behavioural and psychological needs they were all dated and signed. Residents spoken to were unable to comment on the admission procedure. During the inspection staff demonstrated an understanding of the needs of the residents however training records did not evidence that care staff have received specific dementia care training. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 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 and 10 Quality in this outcome group was adequate. Revised care plans are individualised and show person centred care, however there were still some care plans that had not been revised. Care plans had not been implemented for new residents. Residents have access to healthcare services that meet their assessed needs both within the home and in the local community. The home has a robust medication policy covering the receipt, storage, administration and disposal of medication. Staff are aware of the need to treat residents respect and considered dignity when delivering personal care. EVIDENCE: The care records for six residents were reviewed, and the records for all residents in the home were looked at for evidence of revision. The deputy manager has worked very hard to revise care plans; he has implemented plans of care to identify individual needs rather than generic tasks. The care plans Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 11 reviewed showed that a lot of thought has been put into how to implement a person centred approach; they identify specific needs and give guidance for care staff on how they should meet these needs. The care plans then go on to show what the outcome for the resident will be if these needs are either met or not met. This is commendable and progress in this area will be assessed in next inspection. When checking how many care plans had been revised 21 of 30 were found to be completed whilst 3 files kept for new residents did not contain any care plans. The manager stated that they had been using the social services or hospital care plan provided on admission. A preliminary care plan must be implemented in the first week of admission this can be obtained from information gathered at the preadmission assessment. Residents spoken to were not able to comment on their care plans. Once all the care plans have been revised it would reflect good practice if the home implemented a way in which to involve residents in agreeing their care plans. Care records reviewed showed that residents are enabled to access health care services; this includes chiropodist, optician, dentist, mental health professionals and outpatient clinics. The manager stated that the home has a new optician who has agreed to come and carry out training for care staff on sight impairment. The home has clear policies and procedures for the ordering, storage, administration and disposal of medication. An audit on the day of the inspection showed no errors, and the administration of medication was carried out within current guidelines. During the inspection staff were observed to treat residents with both dignity and respect. They were observed to have a friendly and respectful rapport. This was noted to be a marked improvement, as staff were not so task orientated as on previous inspections. One comment made by a visitor at a previous visit mentioned the increased interaction between staff and residents. They said staff interaction with residents had been an improvement that they had noted in the home and their relative had certainly benefited from it. Residents spoken to said staff are kind and respectful, one resident said they are always nice and most of them have a nice smile. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 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, 13, 14 and 15 Quality in this outcome group was adequate. Residents are given the opportunity to take part in a variety of activities. The home has open visiting arrangements and residents can entertain visitors in their own room or the activities room. Routines and activities in the home have been revised to enable staff to meet the choices of residents. Revised menus provide nutritious meals produced from fresh ingredients. EVIDENCE: Since the last inspection the home has appointed an activities organiser who had moved into the role from a care position, so knew the residents. The activities organiser had attended a one-day course and was looking at other training options with an emphasis on activities for people with Dementia. She shows an enthusiasm for the role and has many ideas that she continues to develop for residents that are more meaningful and appropriate. She was observed to have a relaxed rapport with residents and visitors. During this Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 13 inspection the visiting aromatherapist was talking with residents and they appeared to enjoy the interaction. Visitors were observed coming and going through out the day. Staff were polite and accommodating they showed a friendly and respectful approach to visitors. The home has revised its routines to fit in with residents preferred times of going to bed and rising in the morning. The manager said that this had worked very well and both residents and staff had benefited. During the day residents were observed exercising choice in where they sat either one of the lounges, the hall or their room, or whether they took part in activities. The cook explained that a new menu had been implemented which provided nutritious and appetising meals produced from fresh ingredients. An awareness of personal likes and dislikes as well as special diets for specific resident was evident. Weights showed that 80 of residents had maintained or increased their weight whilst at Annabel House. Residents spoken to said they enjoyed their meals, one lady said the meals were better and she had eaten everything provided and enjoyed it. The deputy manager is attending a course in Healthy Eating and Nutrition. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome group was adequate. Annabel house has a complaints procedure that meets national minimum standard the procedure is available within the home. The home has satisfactory policies and procedures regarding the protection of residents, which have been reviewed and are in line with current local guidelines. EVIDENCE: The home has a clear complaints policy and procedure which is made available for residents and relatives.Staff record concerns on a form which shows action taken and outcome taken; the manager had received five minor concerns since the last inspection, all of which had been dealt with appropriately. The homes procedures for the protection of vulnerable adults are in line with local guidelines which were been reviewed earlier this year. The manager attended the social services seminar on the revision of the procedures. Other members of staff have attended North Somerset social services training in the protection of vulnerable adults. Staff spoken to share an awareness of the procedure to follow if they felt a resident was at risk. Following previous requirements, new recruitment procedures now protect residents from potential harm or abuse. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome group was good. The home has a well-maintained environment, which provides aids and equipment to meet care needs of the residents. The management has a clear infection control policy and encourage their staff to work to the homes policy to reduce the risk of infection. EVIDENCE: A tour of the premises was carried out. The home continues to be pleasant clean and tidy with no unpleasant odours and with evidence of regular maintenance. The registered provider has plans to increase communal areas and the kitchen area in the near future. Residents spoken to who could express an opinion said they liked their rooms, and rooms contained evidence of personal property. The registered provider had carried out training for domiciliary staff in infection control and staff were observed carrying out the homes policies and procedures to reduce the risk of cross infection. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 16 Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Quality in this outcome group was adequate. Staffing levels within the home are adequate to meet the needs of residents however the skills mix needs to be extended to the care assistants. The home has adopted a robust recruitment procedure, which protects residents from potential abuse, and meets current equal opportunities guidelines. The home recognises the need for and delivers where possible, a programme of training that meets statutory requirements. EVIDENCE: Staffing levels in the home are adequate to meet the needs of the current resident group, residents. Staff and visitors spoken to said that were adequate numbers in the home at most times. Duty rosters showed that alternative staffing was sought when sickness reduced staffing levels. It was noted that although registered nurses maintain their level of understanding in both mental health and general nursing, care staff would benefit from training specific to dementia care. This would enhance their understanding of how they meet the needs of residents in the home. The home has a very robust recruitment procedure adopted since requirements were made at the last inspection. Records for the most recently employed members of staff contained all the required documentation including a POVA Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 18 1st confirmation and an enhanced CRB. One member of staff confirmed that they had waited for the POVA 1st before they commenced work. A record of staff training is maintained by the home. On the day of the inspection a revised way of keeping the records was being implemented. The records showed that the manager encouraged staff to attend all mandatory training, and qualified staff to maintain their personal development. It was difficult to evidence that care staff had received training specific to dementia care. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome group was adequate. The manager is qualified and has the necessary experience to run the home. The home consults service users and relatives on how the home meets their needs. The home has a system in place to record transactions and accounts for residents’ money. The home meets health and safety requirements and legislation, however do not always inform CSCI of incidents. EVIDENCE: Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 20 The manager is a qualified registered mental nurse, and has the support of registered general nurses in the home. She has also obtained the registered managers award. She has experience in the care of the elderly with dementia, and the management of a care home. The home carries out an annual quality assessment by sending questionnaires to the relatives of residents within the home. Comments received were largely complementary, residents spoken to were unable to comment on whether they had completed a satisfaction survey or not. The manager needs to look at ways of carrying out their own quality audit of how the home meets the national minimum standards other than through relative satisfaction surveys. Progress in this area will benefit the home when they need to complete the self-audit required by CSCI later in the year. The home maintains pocket money for some residents who are unable to manage their own finances. An audit was carried out of four accounts maintained by the home. They all had a running total and evidence of transactions were kept for each resident. The manager carries out supervision with all staff in the home. Evidence was seen of issues being discussed and training identified. Staff members spoken to said they felt they could raise issues at supervision. One staff member said that her induction when she started work had been carried out competently. The implementation of health and safety in the home is satisfactory, current COSHH records are maintained; the firelog showed that all checks were being carried out following current guidelines and all staff had attended training and a fire drill. All service records were up to date and available for inspection. Staff are observed to be following the homes infection control policies, and adequate protective clothing was provided. It was noted that accidents that resulted in residents visiting the accident and emergency department had not been reported to CSCI under regulation 37. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 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 3 Standard OP3OP7 OP7 OP38 Regulation 15(1) 15(2b) 37 Requirement Interim care plans must be implemented within the first week of admission. Care plans must be reviewed monthly. CSCI must be informed following an accident, which results in a hospital visit. Timescale for action 06/06/06 06/06/06 06/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP4 OP27 OP30 OP7 OP33 Good Practice Recommendations The home needs to provide specific dementia care training for care staff The deputy manager needs to continue the revision of care plans The manager needs to implement a quality audit of how the home meets the national minimum standards. Annabel House Care Centre DS0000020226.V294457.R01.S.doc Version 5.1 Page 23 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.V294457.R01.S.doc Version 5.1 Page 24 - 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!