Inspection on 05/07/05 for Annandale

This inspection was carried out on 5th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Annandale 13/04/07

Annandale 09/12/05

Annandale 03/07/05

Annandale 16/12/04

Annandale 01/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Annandale 1 Victoria Road West Crosby Liverpool, Merseyside L23 8UG Lead Inspector Trish Thomas Unannounced 5th July 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. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Annandale Address 1 Victoria Road West Crosby Liverpool L23 8UG 0151 924 3162 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) Mrs Eila Voce Mrs Pamela Dunn Care Home 10 Category(ies) of OP - Old Age registration, with number of places Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 10 OP Date of last inspection 16th December 2004 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 double and one single bedroom. There are toilets on the ground and first floors. 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 F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection started at 11.30am over a three hour period. Methods used during the inspection were, discussions with six residents, discussion with two members of staff, reading documents, examining care files and walking the premises. The home manager, Mrs. Pamela Dunne, was on holiday leave at the time of this inspection. There were two members of care staff on duty and Mrs. Brenda Brown introduced herself as the senior person. The home was accommodating 10 residents. One lady was poorly in her bedroom and the G.P. had attended. Three care plans were read in detail and shortfalls were noted in the care planning and review processes. Mental health and pressure care needs were not fully addressed in the care plans. Care staff have not been trained in supporting elderly people who have dementia, and there was a lack of structured activities in the home, where practice appeared task centred, due to lack of ancillary staff. A number of residents have limited capacity to make decisions and there was little evidence of consultation with them, regarding their life in the home. Shortfalls were noted in aspects of health & safety in the home and there was a lack of appropriate risk assessments. What the service does well: Annandale provides a homely environment, being registered for only ten residents. Their bedrooms are highly personalised and the building is generally well maintained and comfortable. Mrs. Dunne has managed the home for many years and is registered with CSCI. The staff are experienced and provide a good standard of personal care, which was evident in the attention paid to residents’ individual grooming. Staff have undertaken training in direct care and administration of medication. NVQ training has been arranged. The home has in place, a series of written policies and procedures in accordance with National Minimum Standards. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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 Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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) 3,4 The home was meeting standard 3. Annandale registered for dementia (being in the category of General Elderly), and there was no evidence to suggest that the home has admitted residents in advanced stages of dementia. A number of residents have lived in the home for a several years and have become increasingly dependent, some were seen to be displaying short-term memory loss and repetitive behaviour. The home was not meeting Standard 4 and a requirement is made under Regulation 14 (2) (b) that appropriate professional assessments will be obtained following a general review of all care plans. EVIDENCE: One care file inspected contained a social work assessment and a community care review had been carried out attended by the resident, their representative and social worker and the home’s manager, Mrs. Dunne. Each of the files which were read, contained an internal assessment of personal care needs, mobility, and a tick box mental health assessment. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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. The home was not meeting Standards 7, 8, and 9. Care plan reviews were out of date and were not in accordance with levels of the levels of confusion, which were observed amongst the residents. Shortfalls were noted in lack of risk assessment and provision of equipment to meet one resident’s needs. Requirements are made under Regulations 15 (2) (b) and 12 (1) with regards to maintenance of care plans and pressure care assessment and provision of pressure relieving equipment. Medication records were not up to date. A further requirement is made under Regulation 13 (2), as to accurate recording of administration of prescribed medication. EVIDENCE: The primary evidence was obtained by speaking with residents and by reading care plans and medication records. Three care plans were studied in detail and a further three referred to with regards to points raised by staff. For those residents presenting short-term memory loss, there was little evidence in their care plans that their mental health needs and behaviour patterns, are addressed through suitable intervention. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 10 The home is not registered to provide dementia services. The majority of those in residence have lived in Annandale for several years and their needs have changed considerably over time, regarding their physical and mental state. The home’s care planning format makes provision for ongoing internal assessment and review of needs, but the format was not being used effectively. The home was not meeting this standard with regards to care planning and care plan reviews. Care plans were in place for all residents but the identified needs had not been addressed in the plan of care and monthly reviews had not been carried out. Care plans, which were tracked, did not fully reflect mental health support needs. Preventative pressure care had not been recorded, for one resident who is very frail. There were shortfalls in the risk assessment process with regards to use of bedrails. The scales were broken and it was not possible for staff to monitor weight loss, particularly for one resident who looked unwell and was very thin. The home has adopted a blister pack system for prescribed medication, which is supplied by a local pharmacy. Staff who administer medication have achieved a certificate in the safe handling of medication. Shortfalls were noted in the records of prescribed medication, as a number of signatures were missing for medication, which had been administered by staff. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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) 12,13,14,15 The home was not meeting standards 12,13,14. The needs of residents have changed over time and the service has failed to develop accordingly. Staff are experienced in providing personal care and support to older people, but have not been trained to fully appreciate or address the needs of people with dementia and the means by which their quality of life may be improved. The home was meeting standard 15. The meal which was served at the time of inspection, was well presented, and the dining room suitable to accommodate the residents in comfort during the meal. Requirements are made under Regulation 16 (2) (m) (n), with regards to provision of appropriate social activities. EVIDENCE: The primary source of evidence was by discussion with one resident and with the staff on duty. Four residents did not respond or become involved in the conversation. The staff said it was hard to motivate residents in social events and the main activities on offer are videos and sing songs. One resident entertains friends, who visit for a game of bridge in the dining room. One resident was described as having good support from the family who visit regularly. One resident said that she watches television for most of the day in the lounge, and this was the case during the inspection. She said she was satisfied with her meals and personal accommodation. There was no evidence that residents have been on outings organised by the home in recent weeks. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 12 When asked, staff said they have not received training in providing a dementia service. There was no evidence in care plans of consultation with residents with regards to the choices available to them. A resident spoken with said she could not remember recently attending a residents’ meeting. Staff confirmed that there had not been a recent residents’ meeting. Care staff, in addition to supporting residents, cook and clean the home and there is little capacity for them to spend time in supervising and socialising with them. One member of care staff is allocated each day to cook the meals. There were good food stocks in the home, which, were observed in the dry food store adjacent to the kitchen, and fridge/freezer rooms in the basement. The dishwasher was out of order at the time of inspection. Staff said that some residents require motivating or assistance with their meals. The weighing scales were broken at the time of inspection and it was not possible for staff to maintain an accurate record of residents’ weight gain/loss. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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 standard(s) 16,17,18 The home was meeting standards 16, 17, and 18. Procedures are in place regarding complaints and protection. EVIDENCE: The home has a complaints procedure and a record of all complaints was seen to be maintained in the home. There have been no recent complaints via CSCI. The home arranges access to advocacy services for residents who may require representation, as stated in the Service Users’ Guide. The home has adult protection policies and procedures in place and staff were aware of the procedures. Records of resident’s personal allowances were not available for inspection, as the manager was not on duty. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 14 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) 19,20,22,23,26 The home was meeting standards 19, 20, 23 and 26. The home was not meeting standard 22, as risks were observed in use of bedrails for one resident and a requirement is made under Regulation 13 (4). EVIDENCE: Ground and upper floors, four bedrooms, toilets and the bathroom were seen during this inspection. The home was seen to be clean and odour free. This is to the credit of care staff, who also do the cleaning and cooking. Staff have access to protective aprons and gloves, and there were good stocks of cleaning materials in the home. Bedrooms are highly personalised and generally in good decorative order. Bedding in the rooms visited, was in good condition and well laundered. Screening was in place in the double bedroom to ensure residents’ privacy. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 15 There are shallow steps to the front entrance of this home and several steep steps (accessed through the kitchen) to the rear garden. The majority of residents are ambulant (though some are frail) and staff said they would be able to access the back garden by either the front or rear doors. Risks were noted in use of bedrails for one resident. A gap was evident between the bed and the rail and there were no bumpers in place. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 16 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) 27,28,29,30. The home was not meeting standards 27, 28,29 and 30. Staff numbers are in question when the manager is on duty to cover care hours (as her management hours are not stated on the rota). Care staff lack the specialist training to meet the changing needs of a number of residents. Staff files were not available at the time of inspection. Requirements are made to address shortfalls noted under Regulation 19 (Schedule)2, and Regulation 18 (1) (a) and (c). EVIDENCE: The needs of residents have changed as they have become more dependent, over recent years, and staffing levels should reviewed accordingly. There are two care staff on duty for ten residents and staff also cook and clean. Staff said that the manager is now included on the care roster (having been previously supernumerary). As it was not clear from the staff rota and the manager was not on duty, it was not possible to clarify whether Mrs. Dunne’s management hours are supernumerary, or within her allocated care hours. It would be cause for concern if the manager was spending time in the basement office undertaking management duties during her care hours. This would leave one member of staff to supervise residents and undertake cooking and cleaning duties. Staff are experienced in caring for older people. Their expertise in caring for elderly people who are confused is limited. Staff confirmed they have not received dementia training or courses in managing challenging behaviour. The home is not meeting the minimum ratio of 50 trained staff (NVQ2). Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 17 Staff have undertaken a Care Practices course and NVQ training has been arranged via St. Helens College. A recommendation from the last inspection that staff undertake Basic Food Hygiene training, had not been carried out. Staff said they had not had recent training in this. It was not possible to fully assess Standard 29, as staff files were not available due to the manager being on holiday. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 18 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) 31,36 and 38 The home was meeting standard 31 as the manager is registered with CSCI and is suitably qualified and experienced. The home was not meeting standard 36 as staff, when asked, said they had not recently received formal supervision and staff files were not available to check their qualifications, vetting and appraisals. A requirement is made under Regulation 19 Schedule 2. The home was not meeting Standard 38 as shortfalls were noted in fire safety procedures and a tripping hazard observed in the laundry. To address the shortfalls noted, requirements are made under Regulations 13 (4) and 23 (4). EVIDENCE: Evidence of Mrs. Dunne’s managerial experience and qualifications is held on file in CSCI Crosby Area Office. Mrs. Dunne has managed Annandale for about twenty years and her qualifications include NVQ4 and Assessors Award. Mrs. Dunne is currently undertaking the Registered Managers Award. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 19 Staff were asked if they had received formal supervision recently and they said they had not. Staff were asked if there had been a recent staff meeting and they said there had not. They said they see Mrs. Dunne regularly in the course of their work, and they have approached her for advice when needed, specifically in relation to the presenting needs of residents who are confused. The fire book was checked and there was no evidence of recent fire systems checks in the home. In the laundry room, the flex from the dryer was seen to trail across the doorway when plugged in. This constitutes a tripping hazard. Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 20 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 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION 3 3 x 2 3 x x 3 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x x 1 x 2 Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP38 OP38 Regulation 13(4) 23 (4) Requirement The manager must ensure that a CRB check is obtained for the tenant of the private flate The manager must ensure that fire systems tests are carried out weekly in the home and that fire drills, instruction and system tests are recorded in the fire book. The manager must seek advice from the Fire Safety Officer regarding the lock on the cellar door and use of the cellar as a smoking area. The manager must ensure that care plan reviews are carried out monthly. The manager must ensure that identified needs are addressed in a written plan of care. The manager must arrange training in dementia care and challenging behaviour for all care staff. The manager must carry out a pressure care assessment/obtain guidance from community nursing services for one resident and ensure pressure relieving equipment is provided and the care plan is fully updated. Timescale for action By 13/8/05 By 13/8/05 3. OP38 23 (4) By 13/8/05 4. 5. 6. OP7 OP7 OP30 15 (2) 15(1) 18 (1) By 13/8/05 By 13/8/05 By 31/8/05 7. OP8 12 (1) 13/8/05 Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 22 8. 9. OP9 OP36 13(2) 18(2) 10. OP29 19 (schedule 2) 18 (1) 11. OP27 12. OP22 13 (4) 13. 14. 15. OP15 OP38 OP38 23 (2) 23 (2) 23 (2) 16. OP4 14 (2) (b) 17. OP12 16(2) (m)(n) The manager must instruct staff that medication must be signed for as it is administered. The manager must ensure that all staff receive formal supervision at least six times a year, commencing by the given date. The manager must arrange for staff files to be available for inspection by CSCI at all times in accordance with the schedule. The manager must review staffing levels with regards to resident dependency and care staff duties and amend staff rotas to include supernumerary management hours. The manager must carry out a bedrail assessment for a resident as discussed with staff on duty during the inspection and ensure the bedrails are free from risk. Advice may be obtained from Community Nursing Services. The faulty scales must be replaced. The dishwasher must be repaired. The manager must make arrangements for an electrical socket to be fitted adjacent to the dryer in the laundry room. Following a review of all care plans the manager must arrange professional assessments for residents who require ongoing mental health support, to ensure that the training, staffing and resources available in the home can fully meet their needs. The manager must consult with residents as to their social interests and arrange for provision of appropriate in-house and community based activities. By 13/8/05 By 31/8/05 By 31/8/05 By 31/8/05 By 13/8/05 By 31/8/05 By 14/9/05 By 14/9/05 By 30/9/05 By 30/9/05 Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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 OP15 OP26 OP12 Good Practice Recommendations The manager should arrange Basic Food Hygiene Training for staff. The home should provide water-soluble laundry bags. The manager should provide residents with a social activities programme Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Burlington House Crosby Road North Waterloo, Liverpool L22 0LG 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 Annandale F53 F03 S5370 Annandale V239285 050705 Stage 4.doc Version 1.40 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. 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