CARE HOMES FOR OLDER PEOPLE
Annandale 1 Victoria Road West Crosby Liverpool Merseyside L23 8UG Lead Inspector
Mrs.Trish Thomas Key Unannounced Inspection 10:30 13 and 16th April 2007
th 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 Annandale DS0000005370.V336320.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. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Annandale Address 1 Victoria Road West Crosby Liverpool Merseyside L23 8UG 0151 924 3162 0151 931 1569 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 Eila Henny Voce Mrs Pamela Veronica Dunn Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 10 OP. Date of last inspection 18th December 2005 Brief Description of the Service: Annandale is a care home registered to provide support to 10 elderly people. The home is owned by Mrs. E. Voce and the registered manager is Mrs. Pamela Dunne. Annandale is situated in a residential street, close to a bus route and shops. The building is a converted Victorian villa with well-maintained front and rear gardens, having steps to the two entrances. Communal areas include a large lounge and a separate dining room. There is a chair lift to upper floors where most bedrooms are situated. The accommodation consists of eight single and one double bedroom. There is a toilet on the ground and one on the first floor. Additionally the home has an assisted bath, and a shower. Grab rails and call buttons are placed throughout the home for residents convenience. The home is staffed throughout the day and night and the service includes personal care and support, home cooked meals and an in-house laundry service. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two visits for a six-hour period. The methods, which were used were as follows, discussion with residents, staff and the manager, Mrs. Pamela Dunn. A tour of the premises was carried out and records compiled in the home, relating to care practice, health and safety and staffing were read. A sample of quality assurance questionnaires was read. What the service does well: Residents’ pre admission assessments (carried out by social workers and home staff), cover a range of physical, social and health care support needs and form the basis of their care plans. The social worker’s minutes of a recent review for a resident state, “The statement of needs has been provided and is adhered to by Annandale. No concerns or issues raised.” Residents said they were satisfied with the care and support they receive. One resident said she feels five years younger since moving in to Annandale. Staff respect residents’ religious affiliations by making arrangements for ministers to visit Annandale or for residents to attend local churches, in accordance with the needs and preferences of those in residence. Residents are enrolled on the electoral register and their right to vote in local and general elections is supported through arrangements for postal votes. Residents said they get up and go to bed at times of their choosing and that there are choices and alternatives of meals on offer. Residents are consulted daily regarding their meals and the dining room is attractive with the menus clearly displayed and nicely laid tables. Annandale has a complaints procedure, which is clear and accessible for residents and their representatives. Residents said they have not had cause to complain but said the manager, Mrs. Dunn, is approachable and they would tell her if they had any concerns. The lounge and dining room are pleasant and comfortable. Residents’ bedrooms are personalised to their preferences. Care staff carry out domestic work in addition to care duties and it is to their credit that the building is maintained to such good hygiene standards. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 6 Annandale provides a small and friendly home for ten residents in a residential area of Blundellsands. There is a low staff turnover and they have the training and skills to meet residents’ needs and staffing levels have been constantly maintained. Staff have progressed well with NVQ training and mandatory training updates have been planned for coming months. The home is well managed in consultation with residents through quality assurance questionnaires and residents’ meetings. What has improved since the last inspection?
Regarding requirements made during the last inspection, under Regulation 14 (1) and 14(2) (b), as to assessment and the needs of residents. The assessed needs of residents admitted to Annandale must be within the terms of the home’s registration. Staff said that there had been no admissions to Annandale since the random inspection of December 2006. It was therefore not possible to check recent admissions assessments against the registered category of Annandale. The manager, Mrs. Dunn, has been advised during previous inspections regarding admissions being only for those people whose needs are within the registered category. The home is not registered to admit residents who have dementia. For residents who are living in the home who have become mentally frail over time, care plans were read and the home was meeting their needs at the time of this visit. It was recorded that their needs had been reviewed at least monthly and staff have received training in dementia care. Two requirements from the last inspection were made under Regulation 14 (2) (a) and (b) regarding frequency of care plan reviews and pressure care monitoring, and have been met. Care plans which were read, had been reviewed at least monthly, including a pressure care plan for one resident. A sample of staff files which was read, was satisfactorily maintained. These are held in a locked cabinet and the manager holds the key. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are admitted on the basis of an assessment of needs which covers physical, social and health care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 3 was assessed. Annandale does not provide intermediate care and is not assessed against standard 6. Reference was made to residents’ care files where social work and home’s preadmission assessments were read. The assessments covered a range of physical, social and health care support needs and formed the basis of the individual’s care plan. There had been no recent admissions at the time of this visit. The manager, Mrs. Dunn, has been advised during previous inspection regarding admissions being only of those people whose needs are within the registered category.
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 10 Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are treated with respect and their social, health and personal care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7, 8, 9, 10. Three care plans were read. The outcomes of needs assessments were checked against action plans and were satisfactory as there were records of action to be taken to support residents, physical, health and social needs. There were records of monthly reviews and adjustments to care plans, in accordance with any change in need. All residents are registered with G.Ps. and there was evidence in care plans of G.P. visits and of access to district nursing and paramedical services. A record is made of the reason for medical interventions and the outcomes.
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 12 During her recent review, a resident is recorded as saying that she feels five years younger since moving into Annandale. The records of the social services review of another resident states, “Annandale is meeting mother’s needs.” The social worker concluded, “The statement of needs has been provided and is adhered to by Annandale. No concerns or issues raised.” The arrangements in place for mobilising two residents were discussed with Mrs. Dunn and she confirmed that these continue to be reviewed at least weekly. Annandale does not have a hoist or ramp, which affects the levels of mobility which may be safely supported by staff. There were records of preventative pressure care for one resident who was visited in her bedroom. She appeared very comfortable and content, pressure relieving equipment was in place. A jug of juice was placed in her bedroom and staff were recording this resident’s fluid intake. To provide guidance for staff in managing residents’ prescribed medication, the home’s procedure was reviewed and re-written last year by Mrs. Dunn. The medication of three residents was tracked during this visit. There were supplies of all the drugs on the Medication Administration Record and the amounts in stock balanced with the numbers recorded as administered. There is a system in place for the audit and return of refused/non administered medication. Medication is stored in a locked cupboard and staff have received training, and are due for updates in medication management. Residents’ privacy and dignity was respected during the inspection. Annandale has one double bedroom with screening in place to protect both residents’ privacy. Residents said the staff are very helpful, one resident said, “I have no problems, I have all I need.” Residents looked well cared for and there are arrangements in place for their clothing to be returned to their bedrooms after laundering. Staff were seen to be addressing residents with respect and two residents who commented said, “The ‘girls’ are always friendly and go out of their way to be helpful.” Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ diversity is respected and the lifestyle in the home meets their needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. The religious beliefs of residents are recorded and held in their care files. Staff respect residents’ religious affiliations by making arrangements for ministers to visit Annandale or to attend local churches, in accordance with the needs and preferences of those in residence. Residents are enrolled on the electoral register and their right to vote in local and general elections is supported through arrangements for postal votes. Residents said they keep in contact with their families and friends and those who wish to, go out regularly and are fully involved in the community. Residents’ daily records show that they have their hair done regularly, receive visitors and take part in arranged leisure activities. One resident said she likes
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 14 a quiz and word puzzles. Annandale provides a range of craft materials and one resident loves working with her hands and has produced a number of colourful and interesting ornaments, which are in evidence throughout the home. Residents said they get up and go to bed at times of their choosing and that there are choices and alternatives on offer. Residents are consulted daily regarding their meals and the dining room is attractive with the menus clearly displayed and nicely laid tables. Residents may eat in their bedrooms or the lounge if they prefer. There were good food stocks, appropriately stored, at the time of this visit. Fresh fruit and vegetables are bought in as needed and there were choices of hot and cold drinks and breakfast cereals. There are two staff on duty at all times and one is allocated as cook for the day, in addition to care and domestic duties. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Residents know their complaints will be listened to but training in Protection of Vulnerable Adults for staff is overdue. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16, 18. Annandale has a complaints procedure, which is clear and accessible for residents and their representatives. Residents said they have not had cause to complain but said the manager, Mrs. Dunn, is approachable and they would tell her if they had any concerns. There have been no complaints received at CSCI about Annandale in the last twelve months. The home has an adult protection procedure and a copy of Sefton’s procedure is held on the premises. Staff who were asked had not received training in Protection of Vulnerable Adults recently. Mrs. Dunn also said that some staff have yet to complete this training and the home has videos on the subject. A copy of Sefton Council’s Adult Protection Procedures is held on the premises for staff reference. To ensure that staff are aware of the indicators of abuse and the procedures to be followed if abuse is suspected, it is necessary for staff to receive updates and training in POVA Procedures. A requirement is given under Regulation 13 (6).
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 16 Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Annandale is comfortable, homely and hygienic, improved access to the building and upgrading of the kitchen will be necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19 and 26. Annandale is a converted dwelling house and the building is homely and well maintained in most areas. There are shallow steps at the front of the building and steep steps at the rear. Annandale does not have a passenger lift but has a stair lift. There are gardens at the front and rear of the property and a patio. Mrs. Dunne said that residents who have poor mobility are wheeled or assisted down the front steps to the garden. She said the front steps are easily negotiable by wheel chair and the majority of residents are able to use them
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 18 on foot, some with assistance. Remedial work is planned in the rear garden where storms over the winter period caused damage. Annandale has one lounge and a dining room. Both rooms are pleasant and comfortable. Residents’ bedrooms are highly personalised and comfortable. One resident invited me to her bedroom where a number of ornaments, which she has made during her stay in Annandale, were on display. She also had photos of her family, and she said the room was to her liking. The home has a bath and a shower for residents’ use, and there are toilets on the ground and first floor. The kitchen, though functional, is looking tired, two of the wall cupboard doors are missing and the kicker board at the base of the cooker and units has damage caused through wear and tear. The work surfaces are pitted in places and the wall tiles grouting is discoloured through age. A recommendation is made under Standard 19 that refurbishment of the kitchen be prioritized in the home’s refurbishment programme. Although in need of some remedial work, the kitchen, was clean and well organised. Staff said the equipment was in working order, including the dishwasher. This was purchased recently, and staff said they found to be useful. The laundry, situated in the basement, was seen to be well equipped and organised. Care staff carry out domestic work in addition to care duties and it is to their credit that the building is maintained to such good hygiene standards. Staff who were cooking were wearing protective clothing and there were plenty of cleaning materials on the premises. Annandale has procedures for COSHH and infection control and staff receive related training and instruction. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff have the training and skills to support residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27, 28, 29, 30. The rosters were satisfactorily maintained. There are two staff rostered throughout the day and night. Mrs. Dunne said she is allocated hours for management duties, in addition to her rostered care duties. Staff carry out domestic and cooking duties in addition to their roles as carers. Staff said the home was meeting residents’ needs and they had time to fulfil their duties, care and support of residents being a priority. NVQ training for staff has progressed very well in the past months. Four staff have NVQ2 and three were awaiting certification, a further two were due to start their training in May 07. Mrs. Dunne said that Moving and handling training was carried out in February 07 and mandatory updates planned include Fire Awareness and Food Hygiene in April and June 07 respectively. Staff have also received training in First Aid and Dementia Care. There was no recent evidence to track the home’s recruitment procedures. Staff are mainly long-term employed, the latest appointments having been
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 20 made before the last visit. Two staff files were seen and were satisfactorily maintained. All staff have CRB clearance and references on file. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home is well managed in consultation with residents and arrangements had been made to renew the gas certificate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33, 35, 38 Mrs. Pamela Dunn has managed Annandale for several years and has a management qualification. In conversation, she demonstrates a broad knowledge of residents’ needs. She has reviewed care plans each month and has made recent improvements to the Annandale medication policy.
Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 22 Mrs. Dunne explained the home’s quality assurance system and records were seen. Questionnaires are distributed twice yearly to residents and their representatives. The questionnaires have an easy-read, pictorial format and the responses on the sample, which was read, were positive with regards to meals, staffing, accommodation and care. Mrs. Dunne also carries out a monthly quality audit. A sample was read and covered checks on a range of care and management aspects in the home. Mrs. Dunn said that residents also have regular meetings where their views may be aired, or she is available through her open-door management style. Mrs. Dunn confirmed that the home does not become involved in residents’ financial affairs and those who have no family have access to advocacy services and power of attorney. The fire book was in good order and checks and testing had been carried out within safe time limits. Health and Safety certificates were in good order, other than the Gas Certificate, which was due for renewal on 4/04/07. Mrs. Dunn said the engineer was due to visit to test gas safety. A record of accidents to residents and staff is maintained in the home. The sample which was read, was satisfactorily maintained. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 13 (6) Requirement Training must be provided for all staff in protection of vulnerable adults. Outstanding from the last inspection, extended time limit given. Timescale for action 15/06/07 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. Refer to Standard OP19 OP19 Good Practice Recommendations Provision of a ramp should be included in the home’s improvement programme. The kitchen units/work surfaces and wall tiles should be replaced/ repaired as needed. Annandale DS0000005370.V336320.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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