Inspection on 14/11/07 for Anson Court

This inspection was carried out on 14th November 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Anson Court 06/11/08

Anson Court 13/09/06

Anson Court 30/09/05

Anson Court 15/04/05

Anson Court 09/11/04

Anson Court 18/05/04

Anson Court 16/12/03

Anson Court 22/07/03

Anson Court 28/08/02

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

CARE HOMES FOR OLDER PEOPLE Anson Court Harden Road Leamore Walsall West Midlands WS3 1BT Lead Inspector Sue Jordan Key Unannounced Inspection 14th November 2007 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 Anson Court DS0000020842.V350949.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. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Anson Court Address Harden Road Leamore Walsall West Midlands WS3 1BT 01922 409444 01922 409111 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) Manor Court Health Care Limited Mrs Mandy Jane Halls Care Home 33 Category(ies) of Dementia (33) registration, with number of places Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: Anson Court is a purpose built two-storey care home in the Harden area of Bloxwich. The Home provides accommodation for 33 residents who are over 55 and whose mental health has deteriorated (as a result of dementia). At the time of this inspection the Home had seven vacancies. The Home is situated close to local shops. Each person using the service is able to have a single bedroom with an en suite toilet facility. The communal areas consist of a large lounge, one smaller lounge, a conservatory and a separate dining room. The Home has an enclosed, secure courtyard garden area with raised flower beds. Entrance and exit to the main door of the home is via a security system and service users are unable to leave the home without staff assistance. The current charges are £353.48 to £373.36 per week. Prospective residents and/or their relatives are fully informed of what is included in the fees. Extras that the people using the service must buy themselves include personal toiletries, newspapers, chiropody, private healthcare, dentist, dry cleaning and hairdressing. The fee information was correct at the time of this inspection and the reader may wish to obtain more up to date information from the care service. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulation Inspectors carried out this unannounced Key Inspection, which between them took a total of eleven hours. Sue Jordan looked at outcome groups: Choice of Home, Health and Personal Care, Staffing and Management and Administration. Keith Salmon looked at outcome groups: Complaints and Protection, Environment and the Health and Safety element of Management and Administration. The methodologies used were: A day of pre-inspection preparation, including scrutiny of the Commission for Social Care Inspection Annual Quality Assurance Assessment completed and returned by the manager and of the fourteen surveys completed by staff. The last inspection report and the history of the service were also taken into consideration when planning this inspection. During the visit observations were made of non-personal care tasks, including lunch. Discussions were held with four of the staff on duty and one visiting relative. Discussion and feedback was given to the manager and assistant manager. The responsible individual attended half of the feedback. The medication systems were examined, including observation of the lunchtime administration and a tour of the environment undertaken. This included inspection of the kitchen and a discussion with the cook about the food provided. Two residents’ care records were checked in detail, including pre-admission information, care plans and risk assessments. We looked at the recruitment records of three staff members. Training and staff supervision records were also seen. Health and Safety and maintenance records were checked. We sent the manager our Annual Quality Assurance Assessment, (AQAA) to complete on 14/09/07. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some statistical information about the service. It is a legal requirement to return this document and it should have been returned by 12/10/07. Despite a Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 6 reminder this document was not returned and a Statutory Notice was sent. The AQAA was received on 02/11/07. Thirteen requirements and eight recommendations have been made as a result of this visit. What the service does well: The manager does not admit anyone into the Home unless his or her needs have been assessed. If the person has been referred by a Local Authority, she obtains their assessment and care plan before going to undertake her own. Consideration is given as to whether the Home is able to meet the person’s needs and if so, they are notified in writing. Prospective residents and/or their families are given clear details of what they may be expected to pay above and beyond the actual fees. They are given information about the Home in a basic format, although these documents are available in bold print. The staff monitor the health and well being of the residents and provide access, when necessary to a range of medical professionals. Families and visitors are made welcome at any time. The environment is clean and well maintained. There is an on-going programme of redecoration and refurbishment. The people using the service are provided with traditional, home-cooked food. Mandatory Health and Safety training is provided to the staff at regular intervals and fifteen of the twenty four staff have National Vocational Qualification 2 or above. National Vocational Qualification training is ongoing and continuous. The people using the service benefit from a consistent staff team, many of whom have worked at the Home for many years and as such have got to know them very well. The manager has also worked at the Home for many years and has been managing it for seven years. Staff do not work in the Home until the results of a Protection of Vulnerable Adults check have been obtained, ensuring the safety of the people using the service. The staff work well together as a team and say that they can approach the management with any problems. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 7 The procedures for holding, storing and recording residents’ finances and transactions are safe and secure. There are opportunities for the relatives to give their views about the Home. The Commission for Social Care Inspection has not received any complaints about the Home. What has improved since the last inspection? What they could do better: The staff are kind and patient towards the people using the service and rely on their knowledge of the person to provide support and offer choice. However this needs to be backed up by more comprehensive training. All of the people living in Anson Court have dementia care needs and the Home needs to place more emphasis on meeting their individual, specific and specialised needs. This includes developing care plans and risk assessments relevant to the individual to ensure that care is focussed on their needs. Records should be filed individually to ensure confidentiality. Five requirements have been made with regard to the medication practices in the Home. The manager must review the medication systems to ensure that the requirements are met and implement a monitoring system to ensure continuous compliance. The Home need to consider how they can expand the activities and recreation provided and ensure that it is appropriate for people with dementia care needs. The manager was asked to monitor and keep under review the staffing levels at night. Generally staff recruitment safeguards the people using the service, however the manager needs to make sure that she always obtains and holds the information required by legislation and listed in Schedule 2 of The Care Homes Regulations. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 8 The manager was absent from the Home for some months during 2007 whilst she worked at another Home belonging to the same organisation. This did appear to have had a negative impact on the service provided at the Home. All staff must be adequately supervised to ensure that they fully understand their roles and responsibilities and are kept up to date with any changes. 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. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 9 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 Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about the service in a basic format, which enables them to make a decision as to whether they wish to move into the Home. The Home needs to explore how they can further meet the needs of people with dementia and provide person centred care. EVIDENCE: The manager has developed a Statement of Purpose and Service Users Guide in ordinary and bold formats. She was advised to date these documents when they are reviewed and amended as evidence that they contain current information for the people using the service or their relatives. Anson Court supports people with dementia care needs and therefore she should also consider how she could develop some of the home’s information into alternative formats, which would help them to know and understand what they Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 11 can expect from the home. The manager has put an assessment pack together, which contains various tools for assessing prospective service users. An assessment is always received from the referring agency prior to a person being admitted into the home and if possible the manager obtains this before she goes to conduct her own assessment. She tries to gather as much information about the prospective service user so that as far as possible she can be sure that the home can meet their needs. Once the assessment process is complete and admission agreed the manager writes to confirm this to the service user or their family. The home has a contract with each person using the service, which contains the room to be occupied and the fees to be paid. The people using the service are also given a list of items not included in the fees. All of the people using the service have dementia care needs and require support with personal care. The staff receive regular training on care and Health and Safety issues, however it was ascertained that the dementia course content is very basic. The manager was asked to access a more detailed course for the staff. The inspection evidence suggests that the staff are kind and caring to the people using the service, but would benefit from understanding more about dementia care needs. There are very few aids available to enable and assist the people using the service with dementia care needs, for example symbols or signage, pictures, photographs or finger foods that they can choose from. The staff rely on their knowledge of the people using the service to help them make a choice, but recognise that they may be ‘taking it for granted’. The care records do not identify individual needs or provide information that sets them aside from anybody else. There is however an open door policy in the Home and staff confirm that where possible they offer choices. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home monitors the health needs of the people using the service and takes appropriate action and intervention. The care records do not focus on the needs of the individual person using the service, which means that the staff do not have access to pertinent information about that person’s needs, how they are to support them and any risks involved. The medication systems require improvement to ensure that the people using the service are fully safe guarded. EVIDENCE: Two sets of care records were checked in detail as part of this inspection. The Home has developed standardised care plans, which are placed in all of the service users’ files. Whilst the information contained in them is correct, it is Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 13 very general and could relate to any of the people using the service. The manager was advised that she must develop the care plans so that they contain information pertinent to the individual. These need to describe the needs of the person and the actual support required by staff to meet these needs. The risk assessments were checked and these are also too generalised. The manager was firstly advised that the generalised risk assessments should not be placed into individual files unless the person is actually at risk, to ensure that people are not disabled by these assessments. The manager has created a checklist to identify any risks but some of the issues ticked do not have a subsequent risk assessment. For example one of the service user’s checklists indicates that the person displays aggressive behaviour, but there is no information about the nature of the behaviour and what staff must do to manage the situation. One of the risk assessments identified that the person is at a high risk of falling, however there is no more information about what staff have to do to keep the person safe. The manual handling assessment of the same person states that assistance is needed with mobility, but there is no information as to what assistance is needed and how this is to be provided. As a result, the risks are not being properly identified or staff being provided with enough information about the risks relating to individual people and their needs. This could potentially put the people using the service and the staff at risk. The manager was informed that risk assessments must also be created which focus on the individual. Some of the risk assessments were not dated, including the risk of falls and manual handling assessments. All care records should be dated to enable effective monitoring and review. Although there is a check list which indicates that the care records are reviewed monthly, this does not have any real meaning because of the generic nature of the information. The care records are being stored collectively. The manager was reminded that each person’s records must be stored individually in accordance with the Data Protection Act 1998. Discussions took place with four members of staff and the manager at this inspection and the handover between the morning and afternoon staff observed. This provided evidence that the staff know and understand the people using the service and are able to give verbal updates on their needs. The people using the service benefit from having a consistent staff team to Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 14 support them, some of who have worked at the Home for many years and the manager does not use agency staff. The care records do contain ample evidence that the home monitors the health of the people using the service and organises access to the appropriate health professionals. There was limited evidence that the service users have been weighed on a regular basis. However, the manager reported that new ‘sit on’ scales have been purchased and provided evidence that all of the people using the service have been recently weighed. The medication systems were examined, including administration, recording, storage and stock control. The Home has two medication trolleys and a separate treatment room. The manager needs to ensure that the trolley is taken to the person when administering medication to ensure that the staff can check the prescriber’s label at the point of administration and that the people using the service are not given the wrong medication. There were no gaps on the administration recording sheets however there were a number of occasions when the staff had not defined why medication had not been administered. The staff need to use the codes, which show the reasons why medication has not been given, so that this can be monitored and advice sought from the appropriate professionals. The home has a fridge specifically for medication, however the staff must monitor and record the temperatures on a regular basis. Some of the medication has been prescribed with an ‘as required’ direction. However there is no information as to when this medication is to be administered and in what circumstances. The manager was informed that the staff must not take this responsibility and that it is the prescriber’s responsibility to determine the circumstances when medication is to be given. She was advised to contact the general practitioners and ask them to change the prescriptions and/or provide staff with the required information. Staff administering medication have received training and are booked to complete the module based distance learning ‘Safe Handling of Medicines’ training. The manager was advised that she should undertake a periodic assessment of the staff to ensure that their continuing competency to administer medication correctly. She was advised to do this six monthly. The Home is holding too much stock and the manager was informed that they need to have an audit trail of all medication in the Home so that they know what stock they are holding at any given time. This will also prevent over ordering. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 15 Medication is safely stored away and the lunchtime administration was observed to be completed in a professional and sensitive manner. We observed staff supporting the people using the service in non-personal care tasks and they were seen to promote and respect their privacy and dignity. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home provides attractive and nutritious meals, which meet individual resident’s preferences, and is very supportive in enabling active contact with relatives and friends. Recreational and leisure activities are currently minimal and require development. EVIDENCE: Whilst it is accepted the assessing, provision and meeting of an effective programme of social/leisure activities, appropriate to the Home’s client group, presents a challenge, considerably more could be achieved than is currently evident. That said, it is an issue, of which the Manager is aware, through discussion with Relatives and via completed questionnaires and it is acknowledged there is a firm commitment to develop this area of care so as to meet the needs of the client group. Plans currently in train include: - Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 17 The intention to purchase a karaoke machine to facilitate ‘old-time’ singalongs - something that some Residents are able to participate in and greatly enjoy The hanging of photographs of ‘Old Walsall’ along the corridor walls as an aid to ‘reminiscence’ activities (the photographs have been purchased and await framing) Further plans stated in the AQAA included provision of day trips An area in which the Home does well is in its commitment to maintenance of relationships with Relatives, conducted through daily contact with some and formal ‘Relatives’ meetings – evidence of which was gleaned from direct conversation with relatives on the day of the Inspection, through comments in questionnaires and perusal of minutes from the formal meetings. The staff rely on their knowledge of the people using the service to help them make a choice, but recognise that they may be ‘taking it for granted’. Provision of meals is good. A tour of the kitchen and pantry showed them to be very clean, very tidy, and very well organised. The Cook is a long serving staff member who has worked as a Carer, Senior Carer, and Deputy Manager prior to becoming the Cook. During these varied posts, over such a lengthy time period, she has developed a very sound understanding of the overall dietary needs and preferences of the client group. This enables meals provision to meet individual preferences rather than needing to provide a last minute replacement meal for those who wish something other than the menu option. The Menu, based on a 4 weekly cycle, mainly features traditional fare though the Cook has tried to introduce the occasional innovation, e.g. pasta bake, but found these were not well received. Drinks/snacks are available all day and were observed being distributed at various times throughout the visit. It was noted that Residents requiring direct support with their lunchtime meal readily received assistance from Care Staff, who conducted this task with kindness, sympathy, and patience. Evidence was observed which demonstrated 22 of the 24 staff have received training in Food Hygiene. The Home received an inspection visit from the Environmental Health Officer during July 2007 and no problems were identified. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 18 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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system and, whilst few if any of the residents are able to make a complaint, relatives/supporters feel their views are listened to and acted upon. Care Staff possess the relevant knowledge, through well-planned induction and on going training, to safeguard service users from abuse. Service Users are provided with up to date information about adult protection. EVIDENCE: There is a clear complaints procedure at Anson Court, a copy of which is made available to Service Users and their Relatives/Representative. Relatives informed the Inspector they were aware of whom they should approach to raise any issues, both immediately within the Home and beyond the Home, i.e. the Commission. They also felt confident the matter would be dealt with promptly by the Manager, although one stated they did not expect to have to complain as the Home was doing an …”excellent job for their Relative”… and as far as they could see “…for all the other Residents too.” Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 19 The home maintains a robustly bound book in which to record complaints with none having been received by the home, or the CSCI, since the previous inspection. There is an Adult Protection Policy and Procedure in place, and a Requirement relating to this was cited at the previous Inspection, i.e. • “The home must ensure that its policy and procedure with regard to Adult Protection is in line with the local Social Services Policy and the Department of Health document ‘No Secrets’.” The policy has been amended and is now in line with current guidance with regard to the investigation of allegations. This Requirement is met. The Registered Manager appears aware of her responsibilities under the Protection of Vulnerable Adults guidance and Staff have attended training on Adult Protection issues. Fourteen members of staff completed a Commission for Social Care Inspection Survey with all stating they know what to do if a person using the service, or relative, has concerns about the Home. Furthermore, those spoken with, during the inspection, were clear of their responsibilities with regard to ‘Whistle-blowing’. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 20 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): 19, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, clean and well-maintained Home that is suited to their care needs. EVIDENCE: The tour of the Home demonstrated it offers comfortable and homely accommodation with separate lounge and dining provision. A random sample of bedrooms seen (i.e. ten) evidenced them to be comfortable, with each bedroom having an en-suite toilet and wash hand basin. The people using the service are able to bring their own personal possessions into the Home. It was noted at the previous Inspection that some of the corridors were in need of repair and redecoration. At this Inspection it can be reported work has almost been completed on redecorating all bedrooms and corridors on the first Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 21 floor. This has involved repainting walls and woodwork plus replacement of all carpets. All that remains to be done is for the curtains to the corridor windows to be re-hung. Two Requirements relevant to this ‘Outcome Group’ were issued at the previous Inspection: • • “The floor covering to the en suite toilet in Room 12 must be replaced.” “The home must, as far as possible, be kept free of offensive odours. Carpets in individual bedrooms must be regularly shampooed. (This was being dealt with on the second day of the inspection).” During the tour of the Home the inspector observed replacement floor covering to the toilet area in Room 12 has been satisfactorily completed and the Requirement met. Additionally, the Inspector is able to report that, with the exception of one area, the Home is ‘free of offensive odours’. This has been achieved through the use of a carpet-cleaning machine, used on a programmed twice-weekly basis, plus for the occasional continence accident. In addition, all upstairs carpets have recently been replaced. The one exception where a malodour is detectable is on entering the building, but localised around that area. This is due to the toilet immediately adjacent to the entrance hall and, in the view of the Manager, is a design fault in the layout of the building (a sentiment with which we agree). This is particularly unfortunate as it may present a false picture when entering the home. It is recommended that a plan for the redesign be raised and implemented so as to eradicate this problem. Notwithstanding this, the above Requirement is met. The previous Inspection report also noted …“There is a chipped toilet seat in Room 5 and Room 35 needs the wall repairing where the bed has knocked against it.” At this Inspection it was found all necessary remedial/repair work has been satisfactorily competed. All bedrooms are fitted with suitable locks, and although the home’s policy is that Residents will be provided with keys following risk assessment, no Residents have been assessed as being capable of holding the key to their bedroom. The temperature of the water at outlets accessible to Service Users is tested each week and recorded. Several rooms were tested at the time of the inspection and none were in excess of 43 degrees C. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 22 There is a well-equipped laundry, which has recently undergone full replacement of all washers and driers, and a separate sluice facility. There are policies and procedures in place for the control of infection. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough competent and experienced staff to meet the health and welfare of people using the service. The recruitment procedures protect the people using the service. EVIDENCE: At the time of this inspection the Home employed twenty-four care staff, fifteen of which have National Vocational Qualification 2 or above. The Home also employs one cook, one laundry assistant and two domestic staff. Only one part-time member of staff has left in the last twelve months. The rota shows that there are between five and six care staff available in the morning, four in the afternoon and two at night. Thirteen of the fourteen staff completing a Commission for Social Care Inspection survey said that there is always enough staff to meet the individual needs of the people using the service, one said there usually is. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 24 The manager was asked to monitor and keep under review the staffing levels at night. We expressed concerns that due to the logistics of the building, the two night staff may be attending to an individual service user leaving the people on the other floor unattended. The manager was also asked to take safe fire evacuation into account. The training records were checked and discussions held with four staff. These provided evidence that they regularly attend training and courses are booked in advance to ensure that staff are constantly updated. Some staff still require training in adult protection and abuse and food and hygiene but there is evidence available that these courses have been arranged. All staff have attended basic awareness of dementia care needs, however given the needs of the people using the service more comprehensive training is required. This was confirmed in discussions with staff who said that they would like more training in this area. New staff undertake induction training. Twelve of the fourteen staff completing a Commission for Social Care Inspection survey said that their induction covered everything they needed to know very well, one said partly and one said mostly. All fourteen said that they received training relevant to their role, which helps them to understand and meet the needs of the service users. Three recruitment files were checked. Generally they are well organised and safe recruitment is given appropriate priority. The Home obtains the results of the Protection of Vulnerable Adults checks before allowing staff to work in the Home and references are sought. The manager was reminded that ‘To whom it may concern’ references are not suitable, although she did report that she had telephoned the referee. There were no records of this. All prospective staff complete an application form. The manager was advised that she must check any gaps in employment with the proposed staff member. Proof of identity must be available in all files. The staff interviewed confirmed that they work well as a team. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 25 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): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a Home, which is managed in a way that keeps them safe and well but does not always meet their individual and specialist care needs. EVIDENCE: The manager, Mandy Halls has worked at Anson Court for many years and has been manager for seven years. She has almost completed the Registered Managers Award and is a National Vocational Qualification Assessor. The staff spoken to said that they found the management approachable and all said that they had enough support. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 26 The manager has sent questionnaires out to the families twice in 2007 and when they are returned she collates the results. The surveys were seen for October 2007 and generally they are very positive about the care provided at the Home, although a number commented on the lack of activities. The manager is aware of the need to provide more activities and stimulation. The responsible individual visits the Home on a regular basis to carry out a general audit of the Home. We recommended that the manager give relatives the opportunity to complete the questionnaires anonymously and also extend the giving of surveys to other professionals, stake- holders and staff. The manager was sent the Commission for Social Care Inspection Annual Quality Assurance Assessment, (AQAA) to complete on 14/09/07. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some statistical information about the service. It is a legal requirement to return this document and it should have been returned by 12/10/07. Despite a reminder this document was not returned and a Statutory Requirement Notice was sent. The AQAA was received on 02/11/07. The content was very brief and discussed with the manager at this inspection. A residents and relatives meeting was held in July 2007, where some relatives expressed concerns that the manager had been absent from the Home for a few months working in another Home belonging to the same organisation. This was discussed with the manager who said that she had returned to Anson Court on a regular basis and that she is now there permanently. The manager, assistant manager and senior staff share the responsibility for staff supervision. The records examined at this inspection confirmed that staff supervision has become lapse and is dependent on the person carrying out the supervision. This was also confirmed in the surveys completed by staff. This needs to be addressed. The last staff meeting was in February 2007. Staff supervision needs to be formalised and recorded. The manager needs to demonstrate that the staff are adequately supervised and this can include a mixture of individual supervision sessions, appraisals, team meetings and observations. The manager should also receive supervision. The care records are being stored collectively. The manager was reminded that each person’s records must be stored individually in accordance with the Data Protection Act 1998. The manager must also make sure that records are dated as evidence that they are kept up to date. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 27 The home retains nominal amounts of cash on behalf of a small number of Service Users, and left by Relatives to cover incidental items. Each individual Resident’s cash amount is securely stored in a separate plastic cash packet, and subject to regular audit. A Requirement relating to this ‘Outcome Area’ cited at the previous Inspection was: • “Staff must receive updated training in moving and handling.” Through conversations with Care Staff, and perusal of staff records, there is clear evidence that appropriate induction, foundation training, and training updates take place in the key areas of moving and handling, fire safety, first aid, food hygiene, and infection control. All new staff receive induction training to Skills for Care specifications. The Requirement is met. With regard to infection control, a particular plus point for the Home, is that hand wash basins, in areas not accessible to Residents, have thermostatic temperature controls on hot water taps e.g. kitchen, laundry, sluice - thus facilitating ease of thorough hand-washing. Records were observed confirming fire safety checks take place at the required intervals with fire fighting equipment and alarm systems regularly maintained. There is a satisfactory fire risk assessment in place. To ensure all fire safety areas are regularly monitored the home has a Fire Procedures checklist in place. Up to date certificates evidenced the following: Annual gas safety check Maintenance of the lift and hoists Checks for Legionella contamination including preventative action Checks and the testing of electrical equipment including portable appliances The temperature of water at outlets accessible to Service Users is measured each week and recorded with records demonstrating temperatures to be in accordance with the Standard. The home complies with COSHH regulations and has analyses of all products used. Documentation reviewed evidenced an outside company carries out regular health and safety checks. The home’s Accident Book is completed appropriately, although the records should be stored individually. A review of Care Plans relating to two Residents who had several entries in the ‘Accidents/incidents Book’, reporting falling incidents, evidenced the home had undertaken a risk assessment for each Resident in respect of mobility/risk of falling. However as reported previously, Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 28 the manager needs to improve the area of risk assessment and ensure that they focus on the individual and provide staff with the specific information required to keep the person using the service safe. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 29 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 3 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 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 2 3 3 X 3 2 2 3 Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 30 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 12 (4) (b) Requirement The Home needs to consider how they can better meet the needs of people with specialist needs, including dementia. This includes activities, training for staff and individual care planning and risk assessment. This will ensure that the care provided focuses on the individual person and their specific needs. Care plans must be developed, which focus on the individual, their needs and any risks associated with providing their care. This will ensure that the care provided focuses on the individual person and their specific needs. The temperature of the medicines’ refrigerator must be taken daily with a maximum/minimum thermometer and recorded. Previous Requirement 30/09/06 4. OP9 13 (2) The medication trolley must be taken to the person when DS0000020842.V350949.R01.S.doc Timescale for action 01/01/08 2. OP7 15 (1) (2) 13 (4) (b) (c) 01/01/08 3. OP9 13(2) 14/11/07 01/12/07 Anson Court Version 5.2 Page 31 5. OP9 13 (2) 6. OP9 13 (2) 7. OP9 13 (2) 8. OP9 13 (2) 9. OP12 16 (2 m, n) administering medication to ensure that the staff can check the prescriber’s label at the point of administration and that the people using the service are not given the wrong medication. The staff need to clearly define the reasons why medication has not been given on the recording sheets, so that this can be monitored and advice sought from the appropriate professionals. More information is required as to the exact circumstances for the administration of PRN or ‘As Required’ medication. As well as the recognised triggers for that individual, this should also include information about the medication itself, for example how many doses can be given in a 24 hour period and the gap to be left between doses. This will ensure that all staff are consistent and that the people using the service always get this medication in the correct circumstances. The manager must make sure that there is a clear audit trail of medication brought into, administered and leaving the Home. This will ensure that all times they know exactly what medication and how much is held. The Home must ensure that there is proper stock control. There is too much medication stock in the Home and a new ordering system must be implemented. The Home should consider how they can improve the provision of activities, to ensure that the people using the service have more opportunity for stimulation DS0000020842.V350949.R01.S.doc 01/12/07 01/12/07 01/12/07 01/12/07 01/01/08 Anson Court Version 5.2 Page 32 10. OP29 19 (1) (b) (c) Schedule 2 11. OP30 18 (1) © (i) 12. OP36 18 (2) and recreation. The manager must not employ a person unless he has obtained the information and documents specified in Schedule 2 and is satisfied as to the authenticity of the references for that person. This will ensure that the people using the service are safeguarded. The staff must receive more instruction and training as to how to meet the needs of people with dementia, to ensure that their needs are met. The manager must ensure that the staff are adequately supervised so that the people using the service are supported consistently. 01/12/07 01/02/08 01/12/07 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. Refer to Standard OP1 Good Practice Recommendations The manager should consider developing the Home’s information into alternative formats to enable the people using the service to have access to information about the service provided. The manager should assess the ongoing competency of staff to administer medication on a regular basis to ensure that they continue to do so in a manner which safe guards the people using the service. Following compliance with the medication issues identified during this inspection, the manager will need to review their medication policy and procedures and ensure that they follow legislation and good practice. It is Recommended that action be taken to eradicate the odour encountered in the entrance lobby area. This will provide the people using the service and their visitors with DS0000020842.V350949.R01.S.doc Version 5.2 Page 33 2. OP9 3. OP9 4. OP26 Anson Court 5. 6. OP27 OP33 7. OP37 8. OP38 a more pleasant environment. The manager must keep the staffing levels under review to ensure that at all times the people using the service are kept safe. This includes through the night. The manager could consider giving relatives the opportunity to complete the satisfaction questionnaires anonymously and also extend the giving of surveys to other professionals, stake- holders and staff. Records should be individualised. This includes storage, which should comply with the Data Protection Act 1998. This will ensure confidentiality for the people using the service. Those people responsible for the assessment of risks should receive training, to ensure that the people using the service are kept safe. Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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 © 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 Anson Court DS0000020842.V350949.R01.S.doc Version 5.2 Page 35 - 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. 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