CARE HOMES FOR OLDER PEOPLE
Anson Court Harden Road Leamore Walsall WS3 1BT
Lead Inspector Maggie Bennett Unannounced 15 April 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. Anson Court Version 1.10 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 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 Healthcare Ltd. Mrs Mandy Halls Care Home 33 Category(ies) of Dementia (33) registration, with number of places Anson Court Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09/11/04 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). The home is situated close to local shops. All bedrooms are single, are in excess of ten square metres and have an en suite toilet facility. Communal space consists of a large lounge, one smaller lounge, a conservatory, which is used by smokers, and a separate dining room. The home has an enclosed, secure courtyard 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. Anson Court Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The following is the findings of an unannounced inspection, carried out on a weekday between the hours of 9.10 a.m. and 5.05 p.m. During the inspection the assessment information and care plans were seen for several residents. Discussion took place with the manager, members of the care staff, residents, a relative, a member of the police force (by telephone) and a visiting healthcare professional. A tour was made of the building and social activities were observed. The lunchtime meal was shared with the residents. There was also the opportunity to look through anonymous questionnaires sent to relatives, which had been received by the home. What the service does well: What has improved since the last inspection? Anson Court Version 1.10 Page 6 The home is committed to ongoing improvement. Assessment information was found to be thorough and consistently obtained prior to any new resident moving in. Care Plans are now regularly reviewed and updated. Progress has been made on meeting the majority of the recommendations of the Fire Officer. Although social activities have generally been satisfactory at the home, there are now further relevant activities available. A music session was very much enjoyed during the inspection, with some residents clearly benefiting from the experience. A number of bedrooms have been redecorated and further re-decoration is planned. There has been an improvement in staffing levels and this is of obvious benefit. From the end of the month there will be 3 care staff employed from 9.00 p.m. to 10.00 p.m. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Anson Court Version 1.10 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 Anson Court Version 1.10 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) 1, 3 and 6 Anson Court provides clear information to prospective residents and their families to enable them to make a choice about whether or not they may wish to live in the home. Full assessments are carried out on all prospective residents to ensure that their individual needs will be met. The home no longer offers intermediate care or rehabilitation. EVIDENCE: The minor amendments to the Statement of Purpose and Service Users’ Guide required at the last inspection have now been addressed. Both documents provide comprehensive information. It is recommended that the Service Users’ Guide is available in large print and is accompanied with some pictorial information so that it is more accessible to the residents. On this occasion it was clear from case files seen that residents receive the benefit of a full assessment prior to moving to the home. Assessments are received from social workers and the Registered Manager also carries out her own assessment. This is an improvement from the last inspection, when it was found that a resident had been admitted without the benefit of an assessment. Anson Court no longer offers rehabilitation or intermediate care beds. Anson Court Version 1.10 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 and 10 All residents have individual plans of care, which set out their needs in detail and enable staff to ensure that these needs are met. There are clear policies and procedures in place with regard to medication to protect residents from any mishandling. EVIDENCE: A number of residents’ plans of care were seen at the inspection. These were clear and comprehensive and included risk assessments. Both the care plans and risk assessments are regularly reviewed and updated. Although the care plans contain comprehensive and relevant information, they would benefit from more information on the process of care. It is important that written information is available with regard to residents’ individual likes and dislikes with regard to certain interventions, such as bathing, and how the intervention should be carried out in order to achieve the desired outcome. This detailed information is missing from the care plans, although staff clearly know their residents well. The Registered Manager is in the process of improving the individual care plan review format. Because of the nature of the needs of the residents, it is not always feasible to involve them with their written care planning, but relatives are involved where possible.
Anson Court Version 1.10 Page 10 A member of staff was able to give a clear picture of the needs of a particular resident, which was in line with the care plan, when asked to do so during the inspection. Nutritional screening is undertaken and the majority of residents are regularly weighed. It remains a recommendation that the home purchase a set of seated scales for those residents who are unable to stand on scales. Light exercise sessions to music were observed during the inspection. The medication storage and administration records were found to be in good order. It is a requirement that these records contain a photograph of each individual resident, attached to their administration sheet. All staff who administer medication have undertaken training given by a company who are accredited by Wolverhampton College. Anson Court Version 1.10 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 and 15 Residents are able to exercise choice in relation to social activities and mealtimes. The home provides excellent and appropriate in house activities. The food provided is of good quality, with a variety of nutritious foods being offered. EVIDENCE: Four of the care staff have assumed particular responsibility for organising the social activities. During the course of the inspection residents took part in a music and exercise session. The home have recently purchased a number of appropriate games and musical instruments and these sessions are clearly enjoyed. On resident said: “You don’t have to join in if you don’t want to”. Another said: “We had a lovely Christmas.” A number of outside trips are planned for the summer. It is hoped that there will be an opportunity for gardening, as the secure garden area contains a number of raised beds. In addition to the more “active” sessions, the home has a “Snoezelen” room where residents can relax. Some residents have dictated poems to staff, which have been written down. One resident regularly plays the organ. Residents are able to see their visitors at any reasonable time. A number of visitors arrived during the inspection. Some relatives and visitors regularly have meals with their relatives or partners. One resident attends a Day Centre. Although it was observed during the day that excellent opportunities
Anson Court Version 1.10 Page 12 for leisure activities are provided, residents’ individual participation had not been recorded in their care plans. The main meal of the day was much enjoyed by the majority of residents, all of whom were offered a choice. Menus were seen and they showed that a variety of nutritious foods are offered. Ample food supplies, including fresh fruit and vegetables were seen. The member of staff who was cooking confirmed that residents were always offered choices and this included a cooked breakfast. Where residents need assistance with eating, this is given discreetly. One resident, who did not wish to dine in company, was assisted to a quieter location. Anson Court Version 1.10 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 and 18 The home has a complaints procedure, a copy of which is given to the resident’s representative. This should ensure that any complaints are dealt with promptly and effectively. There is an Adult Protection Procedure in place to protect residents from abuse. EVIDENCE: The home has a Complaints Record Book. No complaints have been received by the home or by the Commission for Social Care Inspection for at least 2 years. The home’s Adult Protection Procedure is robust and is based on the local Social Services Procedure and the Department of Health Guidance, “No Secrets”. Staff are about to attend training in adult protection procedures provided by the Walsall Multi Agency Adult Protection Team. The registered manager is clear of her responsibilities with regard to the Protection of Vulnerable Adults Scheme. The home have policies and procedures in place with regard to the care of residents’ monies. Anson Court Version 1.10 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, 25 and 26 Anson Court is generally well maintained and residents live in a safe and comfortable environment. The home is clean and hygienic, with clear procedures in place to control and minimise the spread of any infection. EVIDENCE: A tour was made of the premises and all interior areas were found to be well maintained, clean and in good order. Some bedrooms have recently been decorated. The requirement that the home forward to the Commission a copy of the programme of routine maintenance and renewal of the fabric and decoration of the premises has not been met. The addition of four extra bedrooms, an additional dining/lounge area and conservatory has greatly enhanced the home internally. The secure gardens to the rear of the property are awaiting spring bedding plants. The front exterior grounds are untidy: grass has not been cut and there is a great deal of litter, making the aspect unsightly. Some of the recommendations of the Fire Officer, made in June 2004, are still not met. All bedrooms have an en suite toilet and wash hand basin. Some of the new bedrooms have an en suite shower. There is a separate sluice facility. Anson Court is centrally heated and the home is warm
Anson Court Version 1.10 Page 15 and inviting. One bedroom, however, was found to be cold. The resident in this room said that he was cold and was unable to control the heating. Radiators in the new bedrooms cannot be controlled without taking off the cover, making it impossible for residents to control and difficult for the staff. Water temperatures are regularly checked and recorded. At the inspection no water temperature at an outlet accessible to residents was found to be over 43 degrees. The laundry was clean and in good order and provided with liquid soap and paper towels. Anson Court Version 1.10 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 and 29 Anson Court is adequately staffed by a team who are committed to ongoing training. This means that the needs of this vulnerable group of people are understood and met. There are robust recruitment procedures in place, which protect the residents. EVIDENCE: At the time of the inspection there were four care staff, plus the Deputy Manager on duty in the morning. In the afternoon there were five care staff on duty. The registered manager’s hours are supernumerary. There are sufficient ancillary staff on duty, with a cook, cleaner and laundry person employed on a daily basis. At present there are two care staff on duty between the hours of 9.00 p.m. and 7.30 a.m. The registered manager intends that from May an additional member of staff will be employed between 9.00 p.m. and 10.00 p.m., making a total of 3 care staff until the nighttime shift. The current number of 2 waking night staff is to be re-assessed when the home is full (33), taking into account the needs of the current residents. There is a stable staff group (no one has left since the last inspection) and all staff have either attained their NVQ2 qualification or are in the process of taking it. 5 care staff have NVQ3, 8 have NVQ2 and 5 are undertaking NVQ2. Criminal Records Bureau checks and Protection of Vulnerable Adults checks are obtained for all new staff. A requirement was made at the last inspection that the registered manager ensures that all the staff records required by Schedule 4, 6 (a-f) are retained in the home. This has only been partly met. Staff spoken to clearly enjoyed their work and gave examples of how the needs of individual residents were met. This demonstrated a good
Anson Court Version 1.10 Page 17 understanding of the needs of people with dementia. They felt that they were very well supported by their manager and that the home provided good standards of care. One staff member said: “I wouldn’t work anywhere where I felt that residents weren’t well looked after”. Those residents able to express an opinion spoke well of the staff. One said: “the girls are fine”. Comments made by relatives following a questionnaire give further examples of the high esteem in which staff are held by visitors. Anson Court Version 1.10 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, 33 and 38 Anson Court is managed by a qualified, experienced and competent person, who displays strong leadership and has the best interests of the residents at heart. This ensures that the needs of the residents always come first. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The registered manager has worked at the home for 4 years and has been manager for 6 years. She has attained the Registered Managers’ Award and NVQ 4 Award, has a Diploma in Dementia Care Mapping and is an NVQ Assessor. She continues to enhance her skills and understanding by regular training. The home has not yet produced an annual development plan, but the manager states that this is in hand. Questionnaires have been sent to residents and their families. Very few of the residents are able to complete the questionnaires themselves and have been assisted by their families. The views
Anson Court Version 1.10 Page 19 of the families are very positive. Questionnaires have also been given to other stakeholders, such as G.P.s and District Nurses, but none of these have been returned. The Registered Person continues to fail to provide the Commission with a monthly report on the conduct of the home. Evidence was seen to confirm that staff receive regular training in moving and handling, fire safety, first aid, food hygiene and infection control. Fire alarm tests, emergency lighting tests and fire drills have been carried out at the required intervals. Staff spoken to confirmed that they received training on safe working practice topics during their induction. Appropriate risk assessments have been carried out. Anson Court Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x 2 3 STAFFING Standard No Score 27 3 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 x 2 x x x x 3 Anson Court Version 1.10 Page 21 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. Standard 9 Regulation 13(2) Requirement The medication administration record sheets must contain a picture of the individual resident for whom the medication is prescribed. The social activities in which residents participate must be recorded in their individual care plans. (Previous timescale of 31/01/05 not met). The home must produce a written programme of routine maintenance and renewal of the fabric and decoration of the premises. A copy of this document must be forwarded to the Commission. (Previously timescale of 31/12/04 not met). The registered person must ensure that all the recommendations of the Fire Officer are met, following his visit of 22nd June 2004. (Previously timescale of 31/01/05 not met). External grounds to the front of the property must be tidied and properly maintained. The heating to individual rooms must be capable of being controlled in the room. This only
Version 1.10 Timescale for action 31/05/05 2. 12 17(1)(a) 31/05/05 3. 19 23(2)(b) 31/05/05 4. 19 24(4)(a)( b) 31/05/05 5. 6. 19 25 23(2)(o) 23(2)(p) 31/05/05 31/05/05 Anson Court Page 22 applies to the new bedrooms. 7. 29 19(1) The registered manager must ensure that all staff records required by Schedule 4, 6 (a-f) are retained in the home. (Previous timescale of 30/11/04 not met). The home must produce an annual development plan, based on a systematic cycle of planning, action and review, which reflects the aims and outcomes for service users. (Previous timescale of 31/01/05 not met.). The registered provider, or his representative, must visit the home at least once a month and prepare a written report on the conduct of the care home. A copy of this report must be forwarded to the Commission. 30/04/05 8. 33 24(1)(2)( 3) 30/06/05 9. 33 26(2)(4) 30/04/05 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 1 8 7 Good Practice Recommendations It is recommended that the Service Users Guide is available in large print, with additional pictorial information. It is recommended that the home purchase a set of seated scales. It is recommended that care plans contain greater detail with regard to the process of care, i.e. how the intervention will be carried out to achieve the desired outcome for the resident. There needs to be written information on what works for whom. Anson Court Version 1.10 Page 23 Commission for Social Care Inspection West Point Mucklow Office Park Mucklow Hill Halesowen. B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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