Inspection on 15/08/06 for Anzac House

This inspection was carried out on 15th August 2006.

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

Anzac House 19/09/07

Anzac House 11/11/05

Anzac House 04/05/05

Anzac House 11/10/04

Anzac House 15/04/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Anzac House London Road Devizes Wiltshire SN10 2DY Lead Inspector Ms Sally Walker Unannounced Inspection 9:10 15 August 2006 th 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 Anzac House DS0000028282.V291002.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. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Anzac House Address London Road Devizes Wiltshire SN10 2DY 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) 01380 722623 01380 730061 The Orders Of St John Care Trust Susann Linsley Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1) Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 30 service users with dementia at any one time One named service user in the category of mental disorder, excluding learning disability or dementia, aged over 65 years of age 11th November 2006 Date of last inspection Brief Description of the Service: Anzac House is situated on the outskirts of Devizes set in its own grounds. It provides care to older people with a diagnosis of dementia with one place for an older person with mental health needs. The home is not registered to provide nursing care. The home was built by the local authority in the 1970s and the accommodation is to 2 floors accessed by a lift and a staircase. The home is divided into separate units, namely Perth, Wellington, Canberra, Hobart and Melbourne. Each unit has its own sitting room, dining room and small kitchen. There is a central dining room and adjacent sitting room. All the bedrooms are single accommodation. The care staffing rota provided a minimum of four care staff and a care leader during the waking day with three waking night staff. The home has 2 beds for respite care made available to people with dementia in the local community. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key inspection took place over 2 days: 15th August 2006 9.10am to 5.15pm and 17th August 2006 9.25am to 12.50pm. Mrs Pat Lavery had recently been appointed as manager and her application to register is in progress. She started in post on the 5th June 2006. The following records were inspected: residents records, pre-admission documentation, staff records, training plan, fire log book, medication administration records, blood sugar monitoring forms, monthly visit reports under regulation 26 and the statement of purpose. Five residents were spoken with and 2 staff. The weekly fees ranged from £486.39 to £495.00, with £410.50 for respite care. Residents would have to pay for toiletries, hairdressing, chiropody, continence pads which were not prescribed by assessment, newspapers, taxis and entrance fees. The inspector sought the views of relatives and GPs. One relative said they had visited before the admission with the resident to view the bedroom and discuss the home. They said that staff were very caring and understanding. Their relative had had an assessment by the home. They said they were kept up to date with progress and any problems had been resolved to their satisfaction. They said the whole family were pleased with the home. Another 2 relatives said they were pleased with the care given to their relative, they had settled down very well. One of the GP practices said they were all happy with the appropriateness and methods of communication regarding residents on their list. They appeared to be well cared for. Another GP said they were very satisfied with the standard and quality of care provided at Anzac House. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Staff try to find out as much as possible about potential residents so they can prepare for the care to be provided. Staff take into consideration all aspects of the person and families are key to the assessment process. Medical diagnosis is expected before assessments can take place. Relatives were very happy with the admission process. Care plans were very detailed but some needed reviewing to provide more information. Residents’ risk of dehydration was acknowledged with regular drinks offered, jugs of juice and water available in sitting rooms and bedrooms and continual monitoring. Residents were also offered ice cream as another form of taking fluids. All residents in their bedrooms had their call bells within easy reach. Residents had good access and support from healthcare professionals and specialists. Staff were prompt in referring any concerns to relevant professionals. The systems for Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 6 administration and control of medication were well managed, although some prescribing guidelines should be recorded in the care plans. Although most residents relied on staff for direction of how to spend their day, those who were able to decide could spend their day as they wished. Those residents who spent time walking round the home were not anxious and did not appear to have the “purposeless wandering” that can occur when people with dementia are not regularly engaged with staff or regularly stimulated by activities. It was not only the care staff who engaged with residents, domestic staff were also seen to talk with residents. Training records showed that most of the support staff had also had training in dementia care. Residents enjoyed the range and quality of meals provided. Residents were able to visually choose each meal as it was served rather than try and remember if they previously ordered what was put in front of them. Staff were confident in using the local procedure to report any allegations of abuse. Staff worked well as a team and all staff were seen to engage with residents. A robust recruitment process was in place. Staff had good access to internal courses that were relevant to the work that they do. Robust procedures were in place for ensuring safety of any money held on residents’ behalf. Mrs Lavery continues to maintain the good standards in the home established by the previous manager. What has improved since the last inspection? What they could do better: Some care plans needed reviewing and revising to provide more detail and guidance so that staff know exactly how to provide the care and support. Monitoring forms need more detail in what exactly is observed or given. A policy must be in place for the provision of intimate personal care by both male and female staff. Residents’ preferences must be recorded in their care plan. If they cannot decide, their family or representative must be consulted to establish what they may have preferred. Male staff must know what care they are permitted to give and should be protected from allegations of abuse. Residents’ risk assessments must be reviewed to ensure that findings are noted in the care plan together with strategies for managing the risks. Medication errors and allegations of staff misconduct must be notified to the Commission. Whilst more hours for cleaning duties had been found, the distribution of cleaning hours during the mornings and reduced at the weekends, mean that care staff are dealing with some cleaning and laundry duties taking them away from the residents. There needs to be a policy in Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 7 place so that residents or their representatives can decide who provides intimate personal care. Male staff need to know whether the resident has agreed to their providing this care and of any restrictions or boundaries to their role with providing care, for their own protection. 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. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 8 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 Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 9 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): 1,3 & 5 The statement of purpose is kept up to date so that prospective residents and their relative can know about the service. Efforts are made to ensure that as much information is gained as possible about prospective residents to ensure their needs can be met. Residents and their families are encouraged to visit to see for themselves what is being offered. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The statement of purpose had been updated to include information about Mrs Lavery as the new manager. The home requires a written diagnosis of dementia in order to consider their assessment of potential residents and whether their needs can be met. Records showed that potential residents were assessed by management prior to a place being offered. The organisation’s format does not lend itself to the complex assessment needed with people with dementia. However the home makes best use of the document and collates other information in order to make a decision. Care management assessments from placing agencies are also required by the home before any decision can be made about meeting needs. There was also good evidence that relatives contribute to the assessment process with details of preferred daily routines Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 10 and social history, necessary where residents with a dementia may not easily be able to explain this themselves. The home writes to residents to say that following the assessment their needs can be met. There was good evidence of planned admissions with check lists of what needed to be in place for a successful admission, including written confirmation from the GP regarding currently prescribed medication. One relative said that they and their family were very satisfied with the resident’s admission to the home. The resident had been visited in hospital for an assessment and visited the home to be shown the bedroom and ask about the home. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The majority of residents have all their care needs identified in their care plans. Healthcare needs are being met and residents have good access to healthcare specialists. Residents have been assessed as not having capacity to manage their own medication. The system for administration and control of medication was being well managed. However policies and procedures for reporting errors were not being followed. Staff uphold residents rights to privacy and dignity. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Each resident had a care plan which generally gave an up to date picture of how their care, medical and social care needs were to be met. Staff need to consider expanding some terms used, for example, “give reassurance”, so that it is clearly stated exactly what intervention should occur. One record described a close relationship with the resident’s partner who still lived in the family home but there was no record of how the resident would be supported to maintain that relationship. In one record there was an instruction that following an increase in medication staff were to observe the resident and report in the daily report. However there was no guidance as to what, if any, changes were likely to occur. There was good information about how staff Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 12 were expected to provide support with washing and dressing with details about what residents liked to do for themselves. There was clear information and a rationale regarding any restrictions which had been agreed with others involved in care provision. There was good evidence of consideration of catheter care, sleeping patterns, where residents like to spend their day and nutrition. However the inspector advised that where residents were diagnosed with diabetes, the care plan must show more details of how blood sugar levels were monitored and by whom, residents’ base line scores and action to take when variations occurred. The district nurse had trained staff in monitoring blood sugar levels. None of the female residents’ records indicated whether they or their representative had been consulted about intimate personal care being provided by one of the male members of staff. However Mrs Lavery said that there was a male and a female resident who had expressed a preference and this was acknowledged. There was no organisational policy in place on residents receiving intimate personal care from staff of another gender, for the protection of residents and indeed the protection of staff from allegations of abuse. Mrs Lavery confirmed that she would discuss the issues with either residents, their families or care managers and develop a local protocol pending organisational policy. She would also discuss the issues with staff. The tissue viability risk assessments showed that staff had some understanding of preventative measures and prompt referral to the district nurse before any pressure damage occurred. There was evidence that these assessments were regularly reviewed. Pressure relieving equipment was in place. Mrs Lavery confirmed that the home had taken part in a recent piloting by the Tissue Viability Specialist Nurse of a format for non nursing staff to easily assess the non clinical indicators of residents’ risk of developing pressure damage. She went on to say that in addition, tissue viability training was planned to be provided by the organisation using a video and multiple-choice questions. Consideration should be given to reviewing residents other risk assessments. One risk assessment was a list of events described as aggressive with no information in the care plan on how to manage the behaviours. Two other risk assessments stated that residents must not be left alone in the bath. Residents had access to drinks in all the communal areas and those residents in their bedrooms had drinks within their reach. Some of the photographs with residents’ files were very small so residents could not necessarily be recognised by those who did not know them well. Body maps were being used to record wounds or marks. The inspector advised that these records should include more information about the nature of the skin: size, colour of area and whether skin was broken, so that healing Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 13 could be monitored. These records were signed and dated. Food and fluid charts were in place where indicated. The inspector advised that staff were not always recording the volume of intake or totalling each daily amount for monitoring purposes. Drinking vessels should be measured to show the quantity rather than record “cup of tea”. There was good evidence that staff were encouraging specific residents to drink throughout the day, even if was small sips. Fluids were also provided in different mediums, for example, ice cream, if residents were finding it difficult to cope with quantities of regular drinks. Whilst residents generally were well groomed, at least 3 ladies had long finger nails which needed cleaning. One of the staff was supporting some of the ladies with shaving facial hair and each had their own razor. All of the men had their own razors and all residents had their own named toiletries. Only one of the residents who were in their rooms did not have their call bells by them; however this person was poorly at the time and staff were monitoring their progress whilst awaiting the GP. One resident said that staff would call the GP immediately if needed and they would be seen in their bedroom. A visiting community psychiatric nurse told the inspector that their team had good relationships with the home. They said that staff would often ask for advice and carry it out. They said that staff would always explain to the resident they were visiting the reason for the visit. They also said that the home did regular reviews with their team. A relative telephoned the inspector to say that they were kept up to date with their relative’s progress. Two relatives wrote to say they were very pleased with the care received by their relative. One of the GP surgeries said they were happy with the appropriateness and methods of communication regarding residents and that they appeared to be well cared for. The care leader with delegated responsibility for medication showed the inspector the arrangements for the administration and control of medication. They said they were new to the responsibility and had had training by the supplying pharmacist as well as in house. Only staff who are assessed as competent, following training and monitoring can administer medication. Staff’s competence is monitored yearly. Staff who were giving medication were identified by the red tabards worn at the time so they should not be disturbed. Records were kept of all medication checked into and out of the home. Written confirmation of currently prescribed medication was obtained from GPs on the day that new residents were admitted. Also as a matter of good practice, prescriptions were filled immediately they were written even if it meant going to an out of hours pharmacy. Records of administration were being satisfactorily maintained. Details of certain medication were not always noted in care plans, for example, Vitamin B12 injections, medication prescribed to be taken when required and details of when 2 pain killers should be taken, although other care plans showed details of medication prescribed to be taken when required and reasons for giving that medication. By the second day the Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 14 care leader had amended the care plans with this guidance. The inspector advised that where medication was currently being cut in half by staff to achieve the prescribed dose, the supplying pharmacist should be requested to do this in order that the risk of staff cutting the wrong dose be eliminated. There was concern that a recent medication error had not been notified to the Commission under regulation 37 however as no medical attention was required this was not required. An investigation had been carried out by the Care Development Manager and Mrs Lavery’s initial investigation was on file. The home must ensure that no member of staff administers medication unless they have been assessed as competent through the organisation’s medication policy. Given that the care leader said they were new to the responsibility for medication, the inspector was of the opinion that they had responded well to the responsibility. They were familiar with residents prescribed medication, and ensured that the system worked well. One of the residents said that they suffered from pain in their neck and staff would always administer their prescribed medication when they asked for it. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Residents have access to a range of activities both at the home and in the locality. Social histories were sought at admission and activities planned accordingly. Families and friends visited regularly. Generally residents can exercise choice over their daily lives. Residents enjoyed the food. The menus showed a good range of traditional choices for each meal. Nutrition and hydration were considered. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Most residents relied on staff for direction and planning for their day, although it was noted that this was when individual residents wanted. The inspector noted many staff conversations with residents about their joining in with various events during the day. Residents could join the day service in the main sitting room or events held in one of the sitting rooms on one of the units. Some of the residents had made their way to this sitting room waiting for staff to discuss the current events in the newspapers. The inspector met with one resident who had chosen to stay in their room and would only join in when they chose. They said they were very happy and that staff did come and see them at different times during the day and brought them drinks when they wanted. They also went for a walk in the grounds when they wanted. They said they did what they liked and also felt at home. They explained when they liked to have a bath and when the hairdresser came to do their hair. Another Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 16 resident said that they joined in with activities when they wanted to. The home employs a member of staff to provide activities for 20 hours each week. All of the morning and afternoon activities were posted on a large board outside the office. Photographs of recent events and activities were displayed in the main entrance: a barbeque and the gardening club. Church services were held every Sunday. Staff had raised money from a sponsored walk for the residents’ amenity fund. This funded entertainment and trips. Residents could walk around the home and chairs and settees had been placed at various points around the home. Those residents who were walking around the home were not anxious and did not appear to have the ‘purposeless wandering’ that can occur when people with dementia are not regularly engaged by staff or regularly stimulated by activities. All staff engaged with residents, not only care staff and staff did not automatically take residents back to a sitting room when they encountered them, but involved them in a conversation. All of the residents spoken with said they enjoyed the food. One resident said they liked the choice of meals and that the chef came and talked to them about what they liked. They said they had their breakfast in their room. One resident said they had all their meals in their room. The home provided a good variety of traditional meals suitable to the tastes of older people. Some residents were still having their breakfast when the inspector arrived. There were at least 2 choices for both courses at lunch and the evening meal with a salad available each lunchtime. Residents were presented with plates of the 2 choices at the dining table so they could see the meal and make their choice. Residents who followed a diabetic diet were catered for and this was recorded in their care plan. Fluids were regularly available and nutrition monitored. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 17 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 Systems were in place for residents or their representatives to comment or complain about the service. Staff were confident in using the Vulnerable Adults referral procedure for the protection of residents. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Most of the residents spoken with did not have any understanding about making a complaint. However some did say that there was a person who would listen to any concerns. One resident said they would go to the lady in the office. Another mentioned the person in charge. A relative reported that problems they had brought to staff’s attention had been resolved to their satisfaction. The home keeps a log of all complaints detailing outcomes of investigations and response to complainant. Copies of the local Vulnerable Adults procedure were available and most of the staff were trained in the process. Some staff had had experience of the process and appeared to be confident in using the procedure if concerns were noted. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 18 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 & 26 Residents live in a comfortable, homely, well maintained environment. Allocation of cleaning time means that care staff are expected to do some cleaning and laundry during the afternoons and weekends. The home was generally clean. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents bedrooms were personalised with items that they had brought from their homes; photographs, ornaments and small items of furniture. Residents could choose to have a duvet or sheet and blankets and all the linen was clean and of good quality. Towels and face cloths were replaced each day. All of the residents had their own named toiletries. There were written, large print and pictorial notes in bedrooms informing residents and families about “Your Bedroom”; to bring personal items from home, that the laundry would be collected by staff and how the call bell operated. There was a similar list of meal and refreshment times. New carpets had been fitted to one of the corridors and new chairs were on order for one area. The previous manager had done some research into best practice for establishing an environment Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 19 suitable for residents with dementia and had come to the conclusion that all of the residents were well orientated, so only room signage had been implemented. The inspector confirmed this when residents knew where their nearest toilet or bathroom was and with one resident taking the inspector to show them their bedroom from one of the sitting rooms. Lists were posted at different points around the home to family or visitors to identify which care staff were responsible for which residents in each area and which housekeeper worked in the areas. Many of the residents talked about the enjoyment they had from looking at the gardens and birds that they could see from their bedrooms or the sitting rooms. The grounds were very well kept with a display of flowering tubs to the main entrance. Mrs Lavery said that the home had won the best kept home competition in the Wiltshire area. Hoists were available on each floor. The requirement that sufficient resources were provided to ensure all areas of the home were cleaned to a good standard at all times was in progress. An additional house keeper had been appointed and general standards had improved. Some areas of the home had a smell of urine and one bath hoist had brown matter in holes in the seat, others had a build up of lime scale underneath. The inspector advised that a plastic patio chair with a cracked seat in one of the bathrooms must be discarded. The jugs in the bathrooms should also be discarded. It was established from the daily notes that at least 2 residents were being treated for urine infections and it was clear that housekeepers were regularly shampooing bedroom carpets to make the room fresh for residents. Some bedrooms had wooden commodes which are difficult to keep fresh smelling and clean. Gloves, single use wipes and protective clothing and proper hand washing facilities were in place in all the bathrooms, toilets and sluice. Foot pedal bins were available for the disposal of clinical waste. Staff were trained in infection control and 2 staff had responsibility for this area. Risk assessments for use of any equipment were posted in each of the bathrooms together with a list of staff responsible for first aid. The inspector spoke to one of the housekeepers who explained their routines and said that the extra member of staff was a great improvement to reducing the workload. However on that day one housekeeper was on holiday and their shift had not been covered. The housekeeping staff rota showed that cleaning staff only worked in the mornings and the hours were reduced at the weekends. This meant that care staff would have to deal with any cleaning that was needed at other times. Mrs Lavery said that she would look at the distribution of the hours throughout the day. She went on to say that it had been difficult in the past to recruit housekeeping hours for the afternoon and evenings. There were some hours for the evenings but this was to support the kitchen staff and preparation of supper. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 20 The requirement that the Commission must be informed of timescales for the completion of the refurbishment programme was in progress. Mrs Lavery said that she was meeting with the organisation’s property services the following week to establish outstanding items. The bathroom doors in need of replacement noted in November 2005 had not been replaced. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Care staff are well trained to provide a specialist dementia service. The majority of the care staff have a care qualification. A robust recruitment process is in place for the protection of residents. Staff have good access to relevant training. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The care staffing rota showed that there was a minimum of 5 staff and a care leader during the mornings, 3 care staff and a care leader during the afternoons and 4 care staff and a care leader during the evenings; this included the weekends. At night there were 3 waking night staff one with the responsibility of key holder. Care staff were supported by 4 housekeepers during the mornings together with cooks and kitchen staff, the administrator and the handyman. There was little use of agency staff. Mrs Lavery said that the staff worked well as a team, would offer to cover vacant shifts and that there was little staff sickness. Senior staff had delegated areas of responsibility, for example, fire prevention, medication, health and safety and infection control. The statement of purpose, dated 16.8.06 showed 58 care leader hours, 210 night care hours, 328 care hours and 132 housekeeping hours. One resident said that staff were very kind, always listened to them and were always bright and cheerful. They said they could have a laugh with staff. Another resident said that staff were lovely people and were anxious to help them. Another resident said that staff would explain things to them. A Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 22 relative telephoned to say that they found the staff to be caring and understanding. All staff, not only care staff, engaged with residents, chatting to them or explaining events. Staff were respectful and friendly with residents. Male staff were employed but there was no organisational policy on male staff working with female residents or indeed staff working with residents of a different gender. Care plans did not identify whether residents had been asked about their preferences. However, from discussions it was clear that some residents had indicated a preference and this was respected but not recorded anywhere. A policy must be in place for the protection of residents and indeed for the protection of male staff from allegations of abuse. There was evidence of a robust recruitment procedure with most of the documents and information required by regulation on file. The inspector advised of the need to have recent photographs of staff. Potential staff were required to fill out an application form. Interview notes were kept. All of the care staff recently appointed had had previous experience in care settings. No staff commenced duties without a negative Criminal Records Bureau certificate. All new staff were inducted. There was a training plan showing mandatory courses, for example, first aid, moving and handling, food hygiene, fire safety, infection control and health and safety. One staff was responsible for health and safety. Twelve staff, including night staff held NVQ Level 2. Two staff held NVQ Level 3. Mrs Lavery said that only 6 staff did not have a care qualification and it was intended that all would complete NVQs. All staff were expected to complete the organisation’s dementia training approved by the Alzheimers Society with many having achieved the certificate. Ancillary staff have access to the in house training, many of whom havi8ng done this training. Mrs Lavery also intended that staff should attend external dementia training courses. There was a list of training booked on the organisation’s training courses, including 2 staff for supervision training, 5 for dementia and 2 for induction. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 23 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): 31, 33, 34, 35 36 & 38 Mrs Lavery as a new manager continues to maintain good standards already achieved in the home. The home is run in the best interests of the residents. Robust systems were in place for safeguarding money held on residents’ behalf. Staff were appropriately supervised. Residents’ health and safety was considered a priority. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Mrs Lavery was being inducted into the role by the Lead Manager and had regular supervision from her line manager, the Care Development Manager. She was undertaking NVQ Level 4 with a view to completing the Registered Managers Award. In addition she had recently undertaken health and safety training and budget training with the administrator. Mrs Lavery has had over 22 years experience of working in care including senior management. She has recently had a 3 months secondment to another home in the organisation. It was the opinion of the inspector that Mrs Lavery had continued to maintain the Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 24 good standards in the home established by the previous manager. She had good relationships with staff and residents. Staff said they were regularly supervised and there was evidence of this on file. Regular staff meetings were held and minutes kept. Staff were trained in: fire safety, moving and handling, first aid, food hygiene and infection control. Two staff had the delegated responsibility for infection control and the names of first aiders were identified at different locations. The administrator explained the system for safeguarding residents’ cash held on their behalf. They said the money was held in a separate safe and only herself; the manager and care leaders had access. Residents could access their cash accounts at any time, and money could not be accessed by a third party unless the residents specifically requested. No valuables were held on residents’ behalf. Records and receipts were kept of all transactions with 2 signatures required for releasing funds. Regular audits of the accounts were carried out by the administrator and the manager as well as yearly organisational audits. Very few pensions were collected for residents and records were kept of these transactions. The administrator said that families would deal with residents’ finances or a representative of the local authority on a Court of Protection if residents had no family to support them. Fire extinguishers were covered with an easily removable cover to restrict accidental access to the mechanism. The fire log book was being generally well maintained with the exception of weekly alarm tests which had not been recorded since 17.7.06. The fire risk assessment had been reviewed on 12.8.06. Environmental risk assessments had been reviewed in March 2006 & August 2006. Risk assessments were in place for residents going out on trips. Accident records were removed from the log and stored in individual files. Mrs Lavery regularly reviewed any accident reports to establish whether any patterns emerge. Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 25 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 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 26 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 OP26 Regulation 23(2)(d) Requirement Timescale for action 15/08/06 2. OP19 23(2)(b)& (d) 3 OP7 15(2)(b) The person registered must provide sufficient resources to ensure that all areas of the home can be cleaned to a good standard at all times. (In progress, an additional housekeeper had been appointed and generally standards improved, but housekeepers only worked in the mornings with only one at the weekend). The person registered must 15/08/06 confirm with the Commission when the budget has been agreed for the final refurbishments of the building together with timescales for completion. (Most of the plan has been achieved except bathroom and toilet doors on one unit). The person registered must 15/08/06 ensure that details of residents specific care needs are recorded in their care plan, with details of how the need is to be met. This should include: certain medication, dealing with behaviours, monitoring of conditions and how others may DS0000028282.V291002.R01.S.doc Version 5.1 Anzac House Page 27 4 OP10 12(2),(3) &(4)(a) &(b) 5 OP7 13(4)(b)& (c) 6 OP8 12(1)(a) 7 OP9 13(2) 8 9 OP29 OP38 19, Schedule 2 para 1 23 (4)(c)(v) be involved in the care programme. The person registered must ensure that a policy is in place for the delivery of intimate personal care by staff of different gender. Residents or their representatives must be consulted about the delivery of intimate personal care, particularly by male staff. Preferences must be recorded in the care plan. The person registered must ensure that where risks are identified, management strategies and monitoring arrangements form part of the care plan. The person registered must ensure that residents who are unable to clean and cut their own fingernails are supported to maintain good grooming. The person registered must ensure that staff never administer medication until they have been deemed competent following induction through the home’s medication policy and procedure. The person registered must ensure that all staff files contain a recent photograph of them. The person registered must ensure that fire alarm tests are carried out in accordance with the timescales set by the Fire & Rescue Authority 15/08/06 15/08/06 15/08/06 15/08/06 15/08/06 15/08/06 Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 28 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 OP7 Good Practice Recommendations Consideration should be given to enlarging the photographs required to be kept of residents to ensure that residents are recognisable to others who do not know them. Body maps should include a full description of marks or wounds for monitoring purposes. Fluid charts should record a daily total for monitoring purposes. Measuring of cups, mugs or glasses should aid the process. Where medication is required to be cut to achieve the prescribed dose, this should be requested of the supplying pharmacist rather than staff; thereby reducing the risk of staff administering the wrong dose. 2 3 4 OP37 OP37 OP9 Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Anzac House DS0000028282.V291002.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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