CARE HOMES FOR OLDER PEOPLE
Anville Court Nursing Home Anville Court Goldthorn Hill Penn Wolverhampton West Midlands WV2 4PZ Lead Inspector
Pat Scott Unannounced Inspection 7th March 2006 10:30 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 Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Anville Court Nursing Home Address Anville Court Goldthorn Hill Penn Wolverhampton West Midlands WV2 4PZ 01902 621771 01902 621498 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) BUPA Care Homes (BNH) Limited Ms Elizabeth Ann Bevan Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (50), Terminally ill (5) of places Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No number division between categories (except 5(only) beds Palliative Care) 25th October 2005 Date of last inspection Brief Description of the Service: Anville Court is a privately owned care home that provides nursing, personal care and accommodation for fifty older people. It is also registered to provide services to people with a physical disability and for people requiring palliative care. Anville Court is a purpose built, two-storey building standing in its own secluded gardens. All bedrooms are single with en suite facilities. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 7th March 2006 and commenced at 10.30am for the duration of the morning. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 6 service users). The statement of purpose was used to assess how far the home’s objectives to be able to meet service user requirements and expectations were being met. Outcomes from the previous inspection and CSCI’s risk assessment of the home were taken into account to determine the core standards focused on and depth of inspection this time. What the service does well: What has improved since the last inspection?
The format for recording risk assessments is more clear and reflects current guidance from the health and safety executive. The maintenance person
Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 6 ensures that bed rails are safe to use and continue to be safe once in place on service users beds. 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. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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 Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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): These standards were not assessed at this inspection EVIDENCE: Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 The quality of the completion of care plans is variable and as such cannot be relied upon to gauge whether appropriate care is delivered to an individual. The procedures and policies for medication at this home give clear direction to staff in order to promote good health but are not consistently followed. EVIDENCE: Individual risk assessments are conducted and recorded. However, bed rail risk assessments did not record any consultation with other parties, i.e. GP, relative or other supporter and staff were unclear that new formats had been introduced. Wound care was recorded for one service user but the plan gave no direction as to how often dressings were to be carried out. Weight record charts were seen but the monthly weights of one service user had not been transferred onto the nutritional risk assessment. Other care plans were adequately completed. Gaps were noted on the MAR charts which suggests the medication has not been administered. Liquid medicines had not been dated on opening in one drug trolley seen. Stock medicine is checked but not dated as to when this was conducted.
Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 10 Service users who self medicate sign a consent form and have a lockable facility in their room. A hand transcribed prescription on one chart was vague in its direction of dosage to be given stating “ 1 and 2 and so on”. A bag of medicines for disposal had been recorded but left on top of the disposal bin as the staff said it was full. Service users commented that staff look after them well and receive the support they need. The minutes of a staff meeting in February 2006 raised some issues re staff performance and quality of care provision that is being addressed by the management team. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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 the following standard(s): 13,14,15 Staff have an understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. Dietary needs of service users are catered for with a balanced selection of food available that does not always meet service users tastes and choices. EVIDENCE: The hairdresser was in the home at this inspection and many service users were attending. The activity co-ordinator was also on duty. There is no imposition of rules or routines within the home. A service user commented that she had wanted to spend the morning in her room and that staff had been respectful of this. She stated that staff pop in from time to time and that she is never been left for long periods. Her call bell was within reach. Menus seen demonstrate that the food is provided on a two week rota. Service users have two choices and confirmed that staff ask them what they would like each day. Those spoken with said that the food was variable in its quality and was not always well cooked. Two service users were sending out for meat pies from the local shop for their lunch as they had not liked what was on offer. The manager should be sensitive to this issue.
Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 12 A visit to the kitchen showed that the handling, storage, preparation and serving of food comply with the requirements of Environmental Health. The Chef is reviewing the menu system to operate a four week menu to provide more variety of food. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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 the following standard(s): 16,18 A complaint procedure is in place that provides service users with adequate information as to whom they can express their concerns. Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. The homes adult protection policy conflicts with the multi-disciplinary procedures and is therefore inadequate in safeguarding vulnerable service users. EVIDENCE: The complaint log was seen with evidence that complaints had been appropriately responded to on service user files. Service users spoken with were aware that they could speak to management about their concerns and had felt able to do so. Staff training portfolios showed that regular training/discussion is provided on the subject of abuse. Staff confirmed that information on this topic is provided. The homes policy for adult protection has not been amended to compliment the multi-agency procedures. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 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 the following standard(s): 19 The standard of décor within this home is very good and the premises present as a homely and comfortable environment for service users. EVIDENCE: The standard of hygiene and cleanliness in the home is good. Service users praised the level of domestic input and there were no odours in any part of the premises. Rooms entered into were personalised according to the occupant’s wishes. Equipment is in place to meet the varying needs of service users within the categories the home is registered for. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 15 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): 29,30 The home’s procedures provide a safe framework for the recruitment of staff which is followed consistently in order to protect service users. Staff are provided with training relevant to their job roles to ensure that service users assessed needs are addressed and that they are not put at risk EVIDENCE: The recruitment file was seen of a recent employee. All required checks were in place that demonstrated the home’s vetting procedures were thorough. Staff are appropriately trained with evidence of this seen on staff files. The national minimum standards refer to staff training portfolios and evidence that induction and training are carried out. This was all recorded in the staff files sampled. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 16 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, 38 Service users views have been sought but they do not perceive them as having an effect in changing how the home is run. Health and safety in the home is managed in a way that safeguards service users from risk of harm EVIDENCE: Key standard 31 could not be fully assessed as the manager was not on duty. A quality monitoring survey had been collated for February 2006 which has not, as yet, been made available to service users. Client focus meetings occur with the last one documented as having taken place January 2005. The next meeting had been scheduled for March 2005 but staff stated it did not go
Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 17 ahead. Two service users spoken with said that they liked the “opportunity to have their say” but felt there was no follow up and that problems weren’t always “sincerely addressed”. It is essential that a commitment to providing a forum for service users views is regularly maintained so that they have the opportunity to have a voice in the home. The outcome of the Autumn 2005 survey showed that overall the service at Anville Court was generally very good or quite good but that the percentage was lower than that of Spring 2005. The heads of departments in the home have regular meetings and staff also have the opportunity to meet. The safety of service users is covered by the Health and Safety as Work Act and by the general risk assessment requirements of the Management Regulations. New risk assessments were seen for the use of bed rails with some uncertainty from staff as to the fact that they had been introduced. These documents need to reflect consultation with others such as GP, service user and relatives/supporters. Risk assessments for other individual needs were also seen in the care plans. Staff were seen to use manual handling equipment to move and position service users for which training has been provided. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x x x 3 Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 19 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 OP7 Regulation 15(1)(2) © Requirement Timescale for action 31/05/06 2 OP9 13(2) 3 OP18 13(6) The registered person shall ensure that care plans give clear, consistent information and are developed in consultation with relevant others at all times. The registered person shall 31/03/06 ensure the arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received into the home are followed at all times. The registered person shall make 31/05/06 arrangements to ensure the adult protection policy prevents service users being harmed or suffering abuse or being placed at risk of harm or abuse at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000017176.V275806.R01.S.doc Version 5.1 Page 20 Anville Court Nursing Home 1 2 Standard OP15 OP33 The registered person should ensure that the menus are reviewed as planned to meet service user preference for variety, choice and tastes. The registered person should commit to providing a regular forum for service users to air their views other than the formal quality surveys. Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Anville Court Nursing Home DS0000017176.V275806.R01.S.doc Version 5.1 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
