CARE HOMES FOR OLDER PEOPLE
Annandale 1 Victoria Road West Crosby Liverpool Merseyside L23 8UG Lead Inspector
Mrs Trish Thomas Unannounced Inspection 9th December 2005 10:00 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.V273269.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Annandale Address 1 Victoria Road West Crosby Liverpool Merseyside L23 8UG 0151 924 3162 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.V273269.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 10 OP. Date of last inspection 05/07/05 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 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 DS0000005370.V273269.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection concentrated on discussion with seven residents and two members of staff, checking requirements from the last inspection and tracking the care plan of a recently admitted resident. The lounge, dining room, kitchen and basement were visited. The manager, Mrs. Dunne, was not on duty. Mrs. Brenda Brown was the senior person on duty and assisted with the inspection. Her colleague, Mrs. Claire Doyle was the cook for the day in addition to her care duties. What the service does well: What has improved since the last inspection?
A number of requirements from the last inspection have been addressed. The minority, which remain outstanding or could not be fully checked due to the manager’s absence, have been repeated in this report with extended timescales.
Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 6 Three staff have increased their contracted hours to cover vacancies and staff on duty said this arrangement appears to be working well to support the needs of the home. In response to requirements from the last inspection, the manager, Mrs. Dunne, has arranged training and supervision, addressed identified risks and provided new equipment. 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 DS0000005370.V273269.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 The home was meeting standard 3 but, for the reasons stated in “Evidence”, was not meeting standard 4. The home does not admit residents without having obtained an assessment of their needs. The needs of some residents have changed since being admitted to the home. There was no evidence that updated professional assessments had been obtained for these residents and that the home could provide a suitable service (particularly with regards to dementia/short term memory loss). The home does not provide intermediate care and will not be measured against standard 6. EVIDENCE: The manager was not on duty at the time of inspection and her responses to matters inspected could not be obtained at this time. Standard 3. The care file of a resident recently admitted to the home was inspected and obtained an assessment and referred to social/personal care and support and health care. Standard 4. There was no evidence that the home had met the requirement from the last inspection, under Regulation 14 (2) (b). Namely, that appropriate professional assessments of residents’ mental health needs will be obtained, following a general review of all care plans.
Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 9 In accordance with assessment, the manager must ensure that the needs of residents can be met within the facilities and skills available in the home. The requirement is repeated in this report, with an extended time limit. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 The home was meeting standards 7,8 and 10. All residents of Annandale have a care plan. The care plan which was seen was satisfactorily maintained at the time of inspection. Residents’ privacy was respected during the inspection. The home was not meeting standard 9 with regards to maintenance medication administration records. EVIDENCE: Reference was made to the care plan of a recently admitted resident. The care file contained an assessment carried out at the time of admission, which included personal care, health, social support and mobility needs. The care plan had been recently established and was up to date at this time. In speaking with this resident, she said that she was contented in the home and staff were very kind. Her presentation and comments supported the information contained in her assessment and care plan. Staff said that a pressure relieving mattress had been obtained for a resident (as referred to in the previous inspection) and the care plan had been updated. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 11 As in the previous inspection, gaps were noted in the medication administration records. Staff are required to sign as medication is administered. If a resident, for example, refuses medication or is in hospital, the code letter must be inserted. Residents who commented expressed the opinion that their right to privacy is respected in the home. Bedroom and bathroom doors are kept closed and staff knock and wait before entering. Staff were observed speaking respectfully with residents and using their preferred name or term of address. One lady who was asked, said she receives her mail unopened, she has a single bedroom, and has never felt that staff intrude into her affairs. Screening is provided in the double bedroom. The remainder of bedrooms are singles. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The home was meeting standards 12,13 and 15. Improvements were noted for the residents regarding recreational interests and contact with the local community. The home provides wholesome and balanced diet, which is served in pleasant surroundings. The home was not meeting standards 14, with regards to choice and control for residents. EVIDENCE: The inspection concentrated on spending time in the lounge with residents and obtaining their opinions through discussion with them. One lady said she was spending Christmas with her family and was looking forward to being with them. A resident said she has her own transport and enjoys going out and visiting friends who live locally. Two visitors arrived for her, during the inspection. She said she had only recently come to live in Annandale and she found the staff to be helpful and the meals and accommodation “very good.” Residents appeared relaxed and said they thought staff had worked hard to decorate the home for Christmas. There was a warm and relaxed atmosphere in the home and the lounge and dining room looked attractive and comfortable. Some of the long-term residents have developed memory loss/dementia, since moving into Annandale. Staff said that training in dementia care has been arranged, (to commence in January 06).
Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 13 Until this is undertaken, staff do not have the necessary skills and confidence, to fully support people with dementia, in exercising choice and control over their lives in accordance with individual capacity and abilities. A requirement is made under Regulation 12 (2) and (3) regarding consultation with residents. Staff said that laminated activities calendars have now been placed in residents’ bedrooms, to keep them informed of arrangements for leisure and social events. Five residents commented on the meals provided in the home and they were all satisfied. The dining room is comfortable and well presented. A designated member of care staff cooks the meals, leaving the remaining staff member to supervise and support the residents. There were good stocks of fresh, dry, chilled and frozen foods in store and staff said that the food store is always well stocked. The faulty scales have been replaced and residents may now be weighed regularly to ensure they are receiving a healthy and adequate diet and monitor weight loss/gain. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 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): Standards not assessed during this inspection. EVIDENCE: Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,26 The home was meeting all four standards. Areas of the home, which were seen were warm, well lit and accessible to residents. Requirements relating to risk management, (from the last inspection) had been addressed. The home was clean and well organised at the time of inspection and ongoing attention to infection control was noted through training and provision of equipment. EVIDENCE: There is adequate communal (lounge and dining space) for ten residents. 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 during the last inspection. A gap had been seen between the bed and the rail and there were no bumpers in place. Staff said that in response to the requirement, which was made, a risk assessment has been carried out and bumpers fitted to the bed rails.
Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 16 The home was seen to be clean and odour free in the areas which were seen on the ground floor and basement. This is to the credit of care staff, who also do the cleaning and cooking in addition to their care duties. Staff have access to protective aprons and gloves, and there were good stocks of cleaning materials in the home. Staff were undertaking training in infection control at the time of inspection. A new dishwasher has been purchased and was due to be plumbed in. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The home was meeting standard 27 and 28. Problems encountered in recruiting suitable care staff have been addressed through alternative arrangements for existing staff. Staff have undertaken a care practice course and NVQ training has been arranged. The home could not be assessed as meeting standards 29 and 30 as the records were not available for inspection. EVIDENCE: The needs of residents have changed as they have become more dependent, over recent years, and staff said that three of their colleagues have recently increased their duty hours to support the needs of the home. 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). It was not possible to discuss arrangements for managerial duties in addition to care duties, with Mrs. Dunne, as she was not on duty. 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 yet, as required in the last inspection, but that this has been arranged for January 06. The home is not meeting the minimum ratio of 50 trained staff (NVQ2). Staff have undertaken a Care Practices course and NVQ training has been arranged via St. Helens College. It was not possible to fully assess Standard 29 and 30, staff files were not available as the manager was not on duty and care staff do not have access.
Annandale DS0000005370.V273269.R01.S.doc Version 5.0 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 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): 33,35,36, 38. The manager was not on duty and there was no evidence available that the home was meeting standard 33 and 35. A requirement in relation to standard 36 as to staff supervision had been addressed. There was evidence that a number of requirements in relation to standard 38 had been addressed other than one relating to a CRB clearance, which could not be evidenced as the manager was not on duty. EVIDENCE: There was no evidence available regarding quality assurance and residents’ personal allowance management and standards 33 and 35 could not be assessed. Records are locked in the basement office when the manager is absent. None of the residents spoken with expressed concerns about access to their personal allowance. Staff on duty said that they were receiving one to one supervision in accordance with standard 36.
Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 19 Staff were of the opinion that a CRB clearance had been obtained (as required during the last inspection) but records of this could not be seen as the manager was not on duty. The requirement is repeated in this report and an extended timescale given. The following requirements from the last inspection have been addressed. A new dishwasher has been purchased to replace that which was out of order. An electric socket has been fitted adjacent to the clothes dryer. The fire officer has been consulted and advised that sand pots are provided in the staff smoking area. Fire systems tests are being carried out weekly as recorded in the fire book. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No S3core 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 3 X 2 Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 21 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 OP4 Regulation 14.2(b) Requirement Timescale for action 06/03/06 2. OP9 13 (2) 3. OP14 12 (2),(3) 4. OP29 19 (1) Schedule 2 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. Requirement outstanding from the last inspection, extended timescale given. The manager must instruct staff 13/01/06 that medication must be signed for as it is administered. Requirement outstanding from the last inspection, extended timescale given. The manager must ensure that 06/03/06 residents are supported in exercising choice and control over their lives in accordance with individual capacity, and this is recorded on the care plan. The manager must ensure that 13/01/06 staff files are available for inspection by CSCI at all times, in accordance with the schedule. Outstanding from last inspection, extended timescale given.
DS0000005370.V273269.R01.S.doc Version 5.0 Annandale Page 22 5. OP38 13 (4) The manager must ensure that a satisfactory CRB clearance is obtained for the tenant of the private flat on the premises. Outstanding from last inspection extended timescale given. 06/02/06 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. Refer to Standard OP33 OP35 Good Practice Recommendations The manager should arrange for quality assurance records to be available for inspection by CSCI in her absence. The manager should arrange for records of residents’ personal allowances to be available for inspection by CSCI in her absence. Annandale DS0000005370.V273269.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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